Should I have manipulation? Do I have to get to 120 degrees without help?

[sonshine01]

Hi all. Noob here.

I am 2 months post op and they tell me I'm not bending as far as I should be at this point, which is about 90 degrees with signifigant help from the PT or about 75 degrees without. They discussed manipulation with me around the first of this month, and said we'd see where I was on 12/1. I'm still going to PT 3 times a week. When everyone talks about 120 degrees rom, is that something I have to do by myself or with assistance? I have very little quad strength, ( I have a really tough time with straight leg lifts - I'm using a stimulator at home) which I think is part of the reason my rom is off. I did not have the continuous motion machine after surgery, but wish I had...the doctor said he didn't use them post op because they didn't see a benefit 4 months out. He did say if I get manipulated I would be on a machine afterwards in addition to 5 days straight pt.

Your help is greatly appreciated. Thanks in advance!

 

[Texas]

I was 4 weeks out from surg i was bending 68 so i did have a MUA it worked grat no matter how hard o tried i couldnt bend anymore........good luck to you.....but if you are gaining any rom maybe keep trying.......i was on the machine as well i was sore for a few days but that was all.......good luck to you.......please let us know...........) welcome

 

[sonshine01]

Thanks for the reply.

Does anyone know if they want me to be at 120 by myself, or with assistance?

 

[cindy88fan]

Ask the person that told you they wanted you at 120 if it's to be by yourself or with help. Jo will tell you that the ROM number is just a number. But you do need to work on your quad strength. Ask your PT if they have colored rubber bands. Have them show you how to use them and take it home and have somebody help you with this. The colored rubber bands really helped my quads get really really strong. I started out on orange then went to a green one...more resistant. If they don't have the rubber bands ask the PT what you exercises you can do that will help your quads. As far as CPM...I used one in the hospital but I didn't have one at home and I did just fine without it.

 

[HyperZen]

Sonshine, you are very young for this kind of procedure. I am guessing there was some trauma that lead to you needing to have a TKR done. Be mindful of that as you give yourself goals. Even with a new knee, you are not going to be leaping over tall buildings in a single bound if you weren't able to before.

Cindy is right that you need to work on your strength, as it doesn't do any good for someone else to push you to gain more ROM passively if you can't achieve it yourself or do anything once you have acheived it. Don't focus too much on the numbers but on the overall process. (Says the pot to the kettle....I have been obsessing about ROM since the beginning b/c it's what my PT clinic is fixated on. I had a manipulation last week, but mine was not typical as I started out with decent ROM, but my doctor wanted more for me since I am younger too.)

Only your doctor can tell you if you need an MUA, but it sounds like you might given that the range you are getting is limited and will keep you from doing what you want to do after recovery. What was your ROM before you had the TKR?

Good luck, and keep us posted!

 

[FrogFeathers]

I could only get to 70ish with assistance, so I ended up getting the MUA. That really is a question for the doctor and PT. My doctor took my PT's notes and how my leg was while in his office and that's how the choice was made for me. The MUA worked wonders for me.

I got to 110 on my own, 115 with assistance. And by assistance, I mean my PT pushed and I used my muscles. We also worked on strength and balance along with the ROM.

The MUA seems scary and overwhelming, but it really does help and if you need it, its best to get it.

(I hope this post made sense, I was interrupted four times by the three kids and husband kept talking to me while I was typing.)

 

[skigirl]

I recently read an article in an Ortho Journal and the docs who studied the issue all agree that the greatest predictor of ROM after surgery is ROM before surgery.

Mine was down to 122 before surgery and is not 135 after. It was fairly easy for me to get decent ROM, but Ihave worked hard at stretching for the last 10 degrees.

If you had an injury before surgery and were not able to exercise and keep your legs strong---then it is unrealistic to think that you will get maximum range of motion post surgery without a lot more work than some of the others.

If you were severly limitied in your ROM, than perhaps you mght have to adjust your expectations to what is possible for your body. (I know everyone is laughing now---I am a push, push, push person!!!!)

The cpm machine is the center of controversy. My doc, who is a knee specialist, says that after you get 90 rom the machine is practically worthless. I got 90 the first day after surgery, so i never used the machine at all. If you are having trouble bending, then perhaps they might consider using one for a week or two.

So, Jill---It IS just a number. for me, I was not as fixated on a number as that I wanted to kneel and to do "child's pose" in yoga---to sit back on my heels. I have worked very hard and I can do that know. I can even kneel and then sit back on my heeels--but it has involved lots of work getting here---and help from my pt.

the old knees used to have 120 as the MAXIMUM that you could reach--and if people got to 100, they were lucky. Now, we have greater expectations---we want to go to yoga and bend ourselves---we want to ski and hike---so we push ourselves more and happily, the knees have a higher ability to bend now. Mine will go to 145.

I am six months out now, but I remember my own fixation on ROM---I wanted to be the best and was not happy if my rom fell to 124----which it did ---it varied from one day to the next---swelling was a factor, my own fatigue was a factor and the knee itself was a factor. So, relax, allow yourselves to work out in pt to the best of your ability!!

I do, however, think that quad and hamstring strength is critical to the performance of the knee. I run upand down stairs without even thinkiing of holding on to the bannister. That is about quad strength---so think about some of that instead of only focusing on rom. good luck you two.l kelly

 

[FrogFeathers]

The cpm machine is the center of controversy. My doc, who is a knee specialist, says that after you get 90 rom the machine is practically worthless. I got 90 the first day after surgery, so i never used the machine at all. If you are having trouble bending, then perhaps they might consider using one for a week or two.

My doctor doesn't use the CPM for his TKR patients. After my MUA, he had me use one, but it was to try and control the build up of scar tissue (because I build that stuff up like nobody's business!).

I hated that machine- again, not because it hurt me or anything serious. I hated it because the regime I was on kept me stuck in my bedroom with nothing to do and not being able to even read! (I can't read laying down).

 

[Jamie]

Hi, Sonshine....welcome to the BoneSmart family. We'll be here for whatever support you need during your recovery.

Your surgeon is the best person to decide whether an MUA is the way you need to go or not. But....don't be afraid of it. You're asleep when it happens and the results can be quite dramatic. It's just one of the tools available to help you get back to your normal life. Others are....as people have said....conscious effort at working to improve the range of motion. Numbers are important, but only in how they relate to what activity you expect from your new knee.

 

[Josephine]

75 at 2 months? I'd say an MUA was on that cards. But the others are right - the key to ROM is muscle strength which is why the CPMs are dubious at best. They are passive which means your muscles do no work at all and therefore do not grow in strength. You need exercises that will help build your muscle strength then you'll be better able to achieve good flexion on you own.

 

[Simon]

I also had trouble with ROM and because of some other problem decided to keep going with PT instead. At 7 months I did get it to 120 and kept working at it but have since lost about 15 degrees of ROM which my former PT can't figure out. The OS did not seemed concerned with the loss as I am bending it about 10 degrees more than before surgery. He also said ROM before surgery is usually pretty close to the after surgery ROM.

I have had trouble with scar tissue in previous surgeries and do wonder if I would have been better over with a MUA. I am trying some different exercises, especially to stretch the hamstrings to see if that works.

Simon

 

[sonshine01]

I'm going in for manipulation tomorrow. The person the brought out the cpm today told me to start at 50 degrees and add 10 every day. But that doesn't make any sense. Wouldn't I want to start as high as possible (like 120?)

 

[Linda2]

Nope--that would really hurt! :shk: You work your way up--rather as you would lifting weights or running marathons.

 

[Josephine]

I'm going in for manipulation tomorrow. The person the brought out the cpm today told me to start at 50 degrees and add 10 every day. But that doesn't make any sense. Wouldn't I want to start as high as possible (like 120?)