TKR ROM-chatter

[Ollie]

I can't tell you about MUA - my OS never has brought it up, and my PT got a horrified look when I asked him if it is something he sees from the local surgeons. He told me that none of them even think of it until much later, especially the surgeons who emphasize aqua therapy because of the high success it has.

My ROM has come along slowly - I was no where near 85 at three weeks, but now at 8 weeks, I am happily at 116/0. I started aqua therapy @ three weeks and have been progressing well ever since. I am just ready and able to push more/harder as my pain and swelling are both fading away - although I do still ice after every PT session and any other activity that works my knee.

You are simply too early in your journey to have anyone holding an MUA over your head. And to have a medical professional call advice that comes from both research and the practices of other highly respected and qualified medical professionals 'malpractice' . . . I believe that patients MUST be informed and proactive in their care. Some good doctors aren't good at listening. They need to do better.


Ollie. LTKR June 10, 2014

 

[bumknees09]

@Ollie - thank you for the comment and advise. I will definitely look into aqua therapy, for starters. I have a lot to look into and a lot to think about. My PT doesn't think I need it (right now anyway) but, she wasn't negative about it either. She said she mostly has seen good results with it. Again, scares the daylights out of me so.....

 

[Ollie]

@bumknees09 I hope you get to have a good talk with your PT and maybe your OS about using pool therapy. I has been so good for me - and others, too. My surgeon actually specifically requests his patients use the pool - even for general rehab, not just surgical.

Please also know that right now you are still recovering - your body & emotions are all on edge. I was there, too. Read through the boards here and you'll see that the vulnerability you feel is real and common. We have all felt it; that you are in such an emotional situation, that you are afraid is where I was, too. It is hard to be strong and know what to do. I firmly believe that this forum gives good information - even my PT thinks so!! You can be strong in that!!

Right now, heal. Ice, elevate, take your meds, do your gentle stretches. Advocate for aqua therapy if you can. It would mean PERHAPS getting a new PT ... At the very least don't be bullied into an MUA if you don't feel comfortable with it. Maybe you can bargain with your OS : he gets you into a pool for a month or so THEN you reevaluate . . . Maybe?

 

[bumknees09]

@Ollie - thank you again for sound advice. Will talk to my PT today about the aqua therapy etc.

 

[kneeper]

Finding the balance between challenging yourself a little to go past your comfort zone but not overdoing is hard for most of us. Also time for the swelling to come down seems to be the thing for most people. It sounds like you're doing just fine at 3 weeks.

 

[bumknees09]

@kneeper - i'm definitely pushing myself but yes I think I'm doing fine. Regarding Aqua therapy, my PT said to check with my OS but she doesn't think it's going to fly. She said they don't want you in a pool or any body of water until your incision is hundred percent closed and there's no chance of infection! Of course I asked about putting some kind of waterproof dressing on the incision in order to do that. Her reply was it doesn't matter what they put on they don't want your leg submerged in water even with waterproof dressing on it. That's why they tell you not to take a bath, to shower instead. Onward. Oh, and I got 87° angle today! Yippee!!

 

[Ollie]

@bumknees09 - Good for you!! Keep up the great work and it will all work out!

And it is so interesting the differences in treatment theories around the US.
I was in the pool at @ the 14 days mark; had my 10 day checkup with my OS and he said to get right on the aqua therapy. My PT told me that in Spokane, WA, they get patients in the pool even faster, like after three days. They do use the waterproof dressings and carefully keep the incisions dry, but they have tremendous success there. If you read through the forum, you'll really see how different things are all over!!

 

[Josephine]

Well, I'm going to speak to some people who have had it!

Well so long as you remember that he definitely won't send you to any patients who were DISsatisfied, will he?

My OS said he said he has had nothing but great success with it, across-the-board

Honestly, I don't believe him. Fact is that at this stage, 3 weeks out, the reason for your seeming lack of progress in the ROM department is NOT due to adhesions. It's just due to swelling and pain.

I will definitely look into aqua therapy, for starters.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Exercise as in strength training is counter-productive and does more harm than good. Normal mobility and stretches are the key to success.

Oh, and I got 87° angle today! Yippee!!

There, y'see? Things are improving already! Just take it gently and you'll get there.

 

[kneeper]

I actually found when I got kind of lazy I actually improved as much as when I was working "hard." i think it was time and decreased swelling that helped as much as anything.
Waiting to get into the water doesn't mean you still won't get benefits once you're able to.

 

[bumknees09]

Thank you one and all once again for replying. for your comments and your advice.
I am going to continue to pursue looking into the aqua therapy. That sounds like a wonderful way to recover from this. Regarding my OS? He's a straightforward super easy-going nice guy that I do trust. I think part of the problem is that a lot of these OS or PT's have never had this done. So while they may be very sincere and honest in there thought about something, it doesnt mean that they're trying to talk me into doing something or give me bad advice. This may be medically what they may have actually seen take place with patients or the majority of patients.. You understand what I'm trying to say? My point is my particular OS and PT over professional very upfront and seem very sincere of course. I don't think they're trying to talk me into doing anything that they don't genuinely think would be my best interest. Is what they're telling me possibly in my best interest ? maybe not. but I don't think it's anything malicious of course. I just really need to try to keep working and figure out what to do if the time comes. which I hope it doesn't! (meaning the MUA)

 

[Josephine]

I'm not suggesting they're being malicious either. I can guarantee that your surgeon has more than enough cases on his list without inventing new ones just for the fun of it! What I am saying is that he seems to be in a bit of a rush to get you where he thinks you ought to be which is, according to all the evidence, unnecessary. You will get there ultimately and it could take some months. That doesn't matter. Right now you are only 3 weeks out which is far too early to be taking such a step. If you get to 12 weeks and find you're still lacking in numbers - such as only 90 degrees of flexion - then will be a more appropriate time. But you're nearly 90 now so I think that, given another 8 or 9 weeks, you will find things are very different.

 

[bumknees09]

@Josephine - I somewhat agree with you but you've got to grant me this...... There are several schools of thought on the best way to proceed after TKR. Whether it be MUA if need be, Aqua therapy. going slowly, pushing yourself, not pushing yourself. I think @Ollie hit the nail on the head by saying that it was interesting how different areas of the country and the world go about the recovery of this differently. There doesn't seem to be any set way to do this. I guess you could say that's the case for everything but you know what I mean. It's hard to know which would be the best route for everybody as an individual. I certainly have no idea what the best route for me is that's and I'm trying to figure out. And there are people say adhesions can form very quickly and people can scar quickly and have to make sure you get the knee moving by a certain point . so on so forth. it's very unnerving to put it mildly!

 

[kneeper]

It is very confusing to have different schools of thought from health care providers. Based on my years of reading this site, it does seem like MUA is a good option for people who truly get "stuck" but that there are lots of people who are a bit slow in the first weeks due to swelling, but then they pick up speed. Anecdotal yes, but then I think some of the docs are going on anecdotal evidence too. @maryo52 is kind of our first person expert on adhesions & mua.

 

[Josephine]

There doesn't seem to be any set way to do this. I guess you could say that's the case for everything but you know what I mean.

Yes I do but you're mistaken. ALL the medical research is of the same mind - early MUA is ineffective. I left you the link to that article earlier. If I were forced to put a number to it, I'd say that around 90% of knee surgeons don't subscribed to the early MUA thinking.

And there are people say adhesions can form very quickly and people can scar quickly and have to make sure you get the knee moving by a certain point

Well, that's a myth! Myth busting: the "window of opportunity" in TKR and Myth busting: the "window of opportunity" JBJS. It came about by PTs and some surgeons using scare tactics to make their patients comply with their routines of aggressive exercising.

 

[bumknees09]

@Josephine- not all medical researchers of that mindset. There are any number of studies you can find like the one I just found from the Journal of orthopedics, regarding MUA saying that the majority of the people in the study had significantly higher ROM (22% higher) afterword and less pain. Just saying if you Google or Bing or research anything you're going to find studies at both ends of the spectrum. It really is very difficult to figure out which is the best route. That's why I was seeking out people who've actually had it done. Although, even that seems to be about 50-50 on the pros versus cons scale. It's a tough one. I will say this though, I hundred percent agree with the statement about the knee not being able to bend more because it's swollen. That makes sense to me. I mean really, how could it possibly bend more if it's swollen? That doesn't even make sense!

 

[jerseygirl-in-ca]

@Vintage barbie . I saw your saran wrap section. What kind of tape did you use? My husband suggested that we use duct tape and that was a nightmare getting it off. LOL Why didn't I think of saran wrap? LOL

 

[jerseygirl-in-ca]

@bumknees09 I was unable to have a block and woke up with saying shoot me. It hurt like mad. Take plenty of pain meds and I added an anti-inflammatory. The tylenol does nothing for me so I added ibuprofen. I found the ice was my best friend. It kept more in check when elevated for me. he mantra's here rest, ice, elevate are true and take your meds. I slowed down trying to not take much and I was back at square one. The worst is shorter that it feels it will be at first. The members here will be your "map of recovery"

 

[Josephine]

I just found from the Journal of orthopedics, regarding MUA saying that the majority of the people in the study had significantly higher ROM (22% higher) afterword and less pain.

Yes, but at what stage were the MUAs performed and what ROM? I think it likely the cohort probably represented an average of 10-14 weeks, not 4.

You know I do read a lot of different articles. I subscribe to several orthopaedic and joint replacement journals. The articles to which I referred in previous post were about early MUA, not MUAs in general. There is a big difference.

 

[bumknees09]

@Josephine - I am not sure what stage the MUA was. I suppose it would make a difference. Well, onto another issue… I don't think I overdid it today I certainly didn't mean to and now my leg is so stiff I can't bend it at all!! I'm icing it again and I'm ready to burst out crying.

 

[Josephine]

Aawww, don't be down about it. That's the roller coaster of knee recovery. Just remember the old saying "tomorrow is another day"! You're just getting a touch of Post op blues