MUA So much contraction over my incision!

[Jockette]

I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

I need help from this community.

Are you willing to answer a Josephine’s questions so she can help you?

How long are you using the X10? How painful is it?

 

[katpkatp]

Today will be 6 days of using the x10. My case is very different from most users. I’m at 7 weeks and have very limited flexion 0-30.

Most sessions I start at 30 degrees and increase slowly over 45 minutes to to 45-50. 50 is my highest. At pt on Friday I got to 65 dangling off the table and was pushed to 70-asking pt to stop. I hate that feeling.

X10 hurts because I feel like piano wire surrounds my patella and down my calf front. If I hold my knee securely on both sides and press in, the pain is not as bad. This wire like feeling is what I want to know about. Have other people described this before?

 

[Jockette]

At pt on Friday I got to 65 dangling off the table and was pushed to 70-asking pt to stop. I hate that feeling.

Please stop allowing your “therapist” to hurt you like this. It isn’t helping. In fact, it making you swell more which in turn, reduces ROM.

You’ve had plenty of weeks of PT, and you’re not getting good PT. Take some time off and rest your leg, ice, elevate, and just do your daily activities. Give your leg time to settle down. I fear if you don’t, you will continue to have problems.

 

[Jockette]

Swelling is most likely responsible for causing that feeling that you describe as piano wires. That, and inflammation from soft tissues around your knee that were drastically upset during the surgery.

Here is how one of our advisors described it:

“Many members think PT is needed to alleviate tightness. Tightness is a normal occurrence after this kind of major surgery. Your surgeon did major carpentry work and disturbed every millimeter of soft tissue in this area. You aren't tight because your muscle is underused and needs to be stretched and rehabbed. You're tight because your tissue is healing...and full healing takes a full year or more.”

Rather than continuing to exercise it and force it to bend, rest it, treat it gently, so it can heal.

 

[Josephine]

@katpkatp legally I need your permission before I give you my questions.

 

[katpkatp]

I give you my permission.

 

[katpkatp]

Hi all, it is day 7 on my x10 home pt machine. I have the machine for 10 more days, the typical rental is about 17 days. I canceled my rehab pt session for tomorrow and for the next week, too. Not going back until fri, July 19 (advised by the rehab for Medicare continuing). I’m going to faithfully use the x10 and nurture myself. Mentally, I felt angry, tired, and unhappy, coming out of pt. My doc advised against it, but I did it anyway.

I remain stuck in my rom at about 50 degrees. As soon as I walk, this caged wire feeling around my knee increases to prevent flexion. Wires feel like they criss cross my kneecap. Today the PA suggested flexeril. I doubt it will help. Currently doing a month taper of prednisone just in case internal swelling might get released. Any similar experiences would be appreciated. Mentally, I’m in the dumps. Oh, doc on vacation this week. PA said she will get me into the office next week. They really are quite a good group. Thanks, k

 

[katpkatp]

Hello, has anyone had scar tissue take over after your tkr? I’m 8 weeks from surgery, my rom is never better than 60. My knee feels like it’s encased in a football helmet. I need to make it through7 days till I see the doctor. I can’t imagine that this feeling is anything other than scar tissue. Has anyone had the arthroscopic scar tissue removal? Is recovery tough? Does scar tissue grow back? I’m feeling panicky. This is tough. Thanks, k

 

[Jockette]

I give you my permission.

@Josephine katpkatp is ready to answer your questions.

 

[Josephine]

Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[katpkatp]

[QUOTE="Josephine,

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness). About a 6 most times. On the x10 I can stretch the “wires” to a 7 or 8. At night, trying to find a way to relax my leg, 7-8.

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often? Oxycodone, 5 mg. I take 5mg about 10-11pm to knock me out as my leg is the most constricted and angry at this time. I take 5mg before pt or going to church or out for light dinner. As of Wednesday I started taking flexeril 5mg, 3x a day . I notice I have better x10 sessions at about 3 hours after taking this.

3. how swollen is your leg compared to these? I am not very swollen, moderate, gets worse if I walk.

4. what is your ROM - that's flexion (bend) and extension (straightness) flexion is 50-60 on my best days. Extension is 0

5. are you icing your knee at all? If so, how often and for how long? I ice after every x10 session or activity, and bedtime. So at least 6 times a day.

6. are you elevating your leg. If so how often and for how long? Legs are slightly elevated above my head. My recliner allows my butt to sink down

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and. I live alone so I do everything. But everything is done slowly and for very short intervals

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day: 3, 45 minute rom on x10, 2, 10 minute sessions of concentric program for quads and hamstrings, right now not going to pt (only 6 days)
- enter exercise by name then number of repetitions of each
etc., etc.
When at pt only I do the same exercises they have me do except bicycle, dangles, etc.
Anything done at PT
- how many times a week:was and will return to 3x/week
- enter exercise by name then number of repetitions of each
etc., etc.[/QUOTE]
Swing to side, swing to front and back 40
Twist upper body, heel lifts, heel stretch, 40
Ham stretch, quad stretch,5
Stretch leg over bolster, dangle off table-hate both of these, hurt the most-5min
Step stretch, standing squats, toe taps on step 40

Last Monday was my last pt as I have the x10 machine in my home. I made a decision to use 5he machine 3 times each day. Pt would push me to 60-70 flexion, but I’d come home feeling beat up. I can feel the ‘wires’ or banding getting worse and larger, seems like each day. The good news is, I see my doctor on MONDAY. I kept emailing my OS office trying to explain and they got me in on Monday. If the is adhesion, scar tissue, I’ve got it bad. Remember that I am 8 weeks post op and 2 weeks post mua. I can’t drive because I can’t reach the gas pedal with the seat that far back. Hope all this helps.

 

[floridoris]

This seems like way, way too much PT/exercise, just punishing to your poor knee.

I don't think I understand the flexion/extension measurements well, but isn't 60 rather good?

 

[Celle]

If the is adhesion, scar tissue, I’ve got it bad. Remember that I am 8 weeks post op and 2 weeks post mua. I can’t drive because I can’t reach the gas pedal with the seat that far back. Hope all this helps.

I'd bet anything that you don't have scar tissue (adhesions) - just swelling and angry, inflamed soft tissues, from too much aggressive PT and the added trauma of an MUA.

 

[katpkatp]

I'd bet anything that you don't have scar tissue (adhesions) - just swelling and angry, inflamed soft tissues, from too much aggressive PT and the added trauma of an MUA.

Can a doctor tell if this is NOT scar tissue? Is it too early for scar tissue to be so developed? It actually feels like wires surround my kneecap. How could I have such horrid flexion? On rising this AM I bet I don’t have 40. And I have pain, too. I’m a mess. Everyone els3 at pt can move their knee. Feeling lost and sad. I don’t know what to choose. I see the os Monday @5:10. Guess you all get tired of hearing people like me. With 2 options, doctor and aggressive treatment or bonesmart wait and see. Scared, k

 

[tabbykit]

@katpkatp You have my sympathy, as I had this problem with my TKR four years ago. I'm now 4 weeks postop on the same knee revision, and trying the BS regime. Remember though that you have just had two traumatic procedures within a very short time, so of course your knee is angry at present. Try to stay positive, rest, ice and elevate, and take PT slowly. I hope you will find your OS visit helpful and positive.

 

[Jockette]

Guess you all get tired of hearing people like me. With 2 options, doctor and aggressive treatment or bonesmart wait and see. Scared, k

We never get tired of hearing from “people like you.” We care about each and every member and want to help you not only have a good outcome, but help you be as comfortable as possible with all that this recovery entails.

What I do get tired of is PTs and surgeons who don’t see the common sense of how swelling and and upset tissues reduce bend, and the common sense that says the knee must be allowed to heal, rather than to try to beat it into submission with force and too many exercises.

You have tried it their way for the past 2 months. Some people can handle that type of rehab and some people can’t. I was one who couldn’t.

Now it’s time to try a different approach. Try the Bonesmart approach, just do your daily activities as you are able, do some very gentle bends to keep your knee mobile. Spend time resting with your feet up, ice as tolerated. At this point, this is the only way your poor overworked knee will settle down.

It breaks my heart that “people like you” are abused like this in a recovery that is difficult in the best of circumstances.

 

[katpkatp]

@katpkatp You have my sympathy, as I had this problem with my TKR four years ago. I'm now 4 weeks postop on the same knee revision, and trying the BS regime. Remember though that you have just had two traumatic procedures within a very short time, so of course your knee is angry at present. Try to stay positive, rest, ice and elevate, and take PT slowly. I hope you will find your OS visit helpful and positive.

How did you go 4 years with a bad knee? Did you go to a new doctor for your revision? I’m concerned that any choice I make will be the wrong one. Thanks

 

[lisabl]

@katpkatp Last year I had a partial knee replacement. Recovery seemed good in so far as ROM but I was in constant pain. PT just kept on with balance, strengthening quads and even a trampoline!!! saying things would get better.... I trusted them but gave up physio after 7 months, still icing and resting. I decided I had given it enough time when knee started to rapidly deteriorate at 9 months and got a second opinion. This time round following bonesmart philosophy and only seeing pt once every 2 weeks mainly for ultrasound massage and measuring progress, and outcome so much different. I learnt they do not always know best for every person and every unique knee scenario.

 

[Rockgirl4]

I know for a fact that PTs can tell the difference between adhesions,swelling, and muscle guarding in the knee. The problem is finding PTs who are experienced enough in this and willing to spend the time to do so. Many here have had horrid PT experiences (me included), and I count my blessings I found a true gem this time around. I did LOTS of homework before my TKR to find her though.

I've had 2 very good PTs over the last 2 yrs---one after a Microfracture on the left knee and my current one who is helping me rehab the TKR. I've also had a very good lower back PT who told me what to look for when it came to my TKR, as she would be too far for me to go all the time. She was just like the other 2 good ones and reminded me a good one will know when adhesions are a problem or if it's swelling/muscle guarding----and if they're too quick to jump on the scar tissue bandwagon, run the other way---her words exactly!!!!.

As for the knees, they spent a lot of time massaging the back/side of my knee and messing with the soft tissues around it. They both reassured me we were dealing with massive swelling and muscle guarding---not forming new adhesions. We were "on the lookout" after a horrid scarring/adhesion experience in 2015-16---some of which truly was adhesions---but they formed from over-aggressive PT, and no other reason. Neither of these people worked together, and I knew both well. They said scar tissue does not feel pliable and has no give to it---where swelling and muscle guarding behaves very differently. I've had them mobilize my patella (kneecap) and know when it was scarred down vs when it wasn't, and whether the muscle tightness around the knee was preventing the movement or not. I've had 11 knee surgeries to pull from, so I've accumulated a lot of good and bad experiences over the last 20 yrs.

I'm not sure if you have any such experienced PTs available to you. What's sad is it seems like too many PTs just want quick/easy patient recoveries. I've had both kinds, and if they don't spend a good 15-20 minutes massaging and doing gentle hand's-on stretching with YOUR knee alone, they're not helping any.

 

[katpkatp]

Thanks everyone. I just got back from os appointment. Not good news. I do have scar tissue and a swollen knee (remember I’m at 9 weeks). Here’s the bottom line. I need to be very gentle and rest my knee. So you bonesmart folks got it right! I am to take medication and keep pain managed (don’t know exactly what this will look like). I am to get a dynamic brace. PT only once a week and they may only instruct and supervise exercises. No more forcing flexion. At home, exercises (don’t know exactly what they will be) 3 times a day for 15 minutes-if it hurts, stop. The x10 machine should be stopped. (I still think the x10 is a great product for normal knees). My knee is too swollen to remove scar tissue now. In 6 months probably arthroscopy to remove adhesions, etc. I may never have a leg that bends well, but I’ll have a leg. So, I gotta suck this up and accept what I got. I grow scar tissue like crazy. Most people don’t. Accept and adjust.