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Discussion in 'Knee Replacement Recovery Area' started by Steelergal, Jul 22, 2019.
Has anyone had experience or success with cold laser therapy?
I'm not sure that cold laser therapy will help at this stage.
Essence of Time is your best bet. That, and concentrating on reducing swelling, with lots of rest, ice and elevation - and only a small amount of gentle exercise.
There's no need to rush to get ROM because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR
@Celle Even if it wouldn’t work at this stage, I’m just trying to learn about anything that might help at some point if necessary. I know it’s a different surgery, but i have a couple of friends who benefitted from cold laser therapy after their ACL repairs. So this is more research-mode at this point.
Hi how are you? I read on fitgals thread that you have to travel this week...yikes!! I hope it goes well for you. As I told her, I wish you lots of legroom, pillows & ice!!
Hi @Ladyala thanks for checking in! I’m pretty much the same. My knee is stronger and i can bear weight well but my ROM is still pretty lame, hovering around 80/6. I see my OS on Tuesday for my 8 week check so we’ll see what he says. My PT has suggested i think about dry needling once i hit 12 weeks to maybe help loosen up my tight muscles.
Yes I’m flying to Europe on Thursday for a good friend’s wedding. I’m quite nervous about the flight but i have my compression socks, ziplocks for ice, and an aisle seat. I’ll get up a lot and hope for the best! I ordered a wheel chair at the airport and am traveling with another good friend who will be very helpful. All good vibes are welcomed!
Good luck with your travels! Where will the wedding be?
Do you have a cane? If you do, take it with you even if you dont think you need it. I've found that more able bodied people wont crowd you if you have a cane, and if you need a seat or assistance, you are someone who automatically looks like you might need some. People are happy to help, dont be afraid to let them.
It sounds like a lot of fun!
@luvcats The wedding is in Venice (one of my favorite cities) and then we have a cruise booked through the Mediterranean. It's been planned for almost a year and while I'm worried and kind of regretting this (I thought I'd be farther along in recovery by now...that was so dumb), I'm not cancelling. I do have a cane and will definitely use it. Luckily the cruise is pretty easy. We booked a couple of excursions, but they're mostly taking a motor coach and then wandering around so I'll have flexibility to rest if necessary. I figure, even if I'm just sitting in an outdoor cafe doing some people watching, I'll be doing it in Italy, Greece, and Croatia! My biggest concern is the flight, once I get past that, I think I'll be fine. I know my limits, I have pain meds and a plan for ice. I feel as prepared as possible. I've had to adjust my expectations big time, but now I'm ready to go and enjoy as much as I can, even if I don't get to see everything I thought I would. It's good to have a reason to go back!
Oh I envy you!! I adore Venice. It is my favorite city. The history everywhere you look!
I've cruised several times almost completely disabled pre surgery, so I'm certain you'll be able to have a lovely time during your recovery. In fact, I think cruising is about the most perfect vacation there is.
Airlines are set up to help those with limited ability. Let them, and if they try to slack, MAKE them do it! Be pleasant, but insist. Save your energy and maximum mobility for Venice!
That sounds amazing!!
Well I had my 8-week appointment today. Mostly it went well. He’s happy with the scar and the strength of my knee (I’m full weight bearing). However, he’s not happy with my ROM. He wants to see me in a month and then we’ll discuss MUA. He said it’s rare to have to do it but he’s found it to be mostly successful. The thought of it terrifies me. My PT suggested dry needling last week to help with the scar tissue and adhesions. Has anyone had success with that? I want to try anything that might work to avoid the MUA. I’m pretty discouraged right now and wish i could wave that magic wand to have a better ROM. I know it takes time and patience, etc., but i could really use a win right now. Getting to that 90 degree milestone would be so fantastic!
The good news though, I can start Pilates any time!
A couple of things I learned from reading posts here, is that often ROM keeps increasing slowly with time for months or even years, and also that you don't have to have an MUA done unless you yourself want one because you are dissatisfied with your present ROM. Is your ROM causing you problems in daily life? That's what I'd be thinking about.
You said your ROM is around 80/6. Mine went up to 101 once, but with swelling it has gone back down to 85/17. I don't think my surgeon is even thinking of an MUA but if he suggests it he is going to get a polite but firm "NO!" from me. I know that 17 is not ideal but my thoughts are basically so what. I don't need a great ROM to live my daily life.
I don't know anything about it but just wanted to say that whether or not to have an MUA is your decision. It's your knee, and you don't have to have one unless you want it done.
Dry needling is primarily a treatment for pain. I know of no clinical evidence that it could make a difference with any existing scar tissue, if that is your problem.
If an MUA is truly needed, please don't be afraid of it. It is not an invasive procedure and, if there is actual scar tissue that is inhibiting your movement, it can make a difference. It will reset your recovery clock to some degree, but that is a small price to pay if it helps you.
I agree @Jamie. I need MUA on my first knee after 13 weeks when I still was around 70... it worked wonders.
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I agree with the perspective expressed by @Carole4815. We all have to set our own goals. Personally, given my experiences, I'd be happy to be able to walk upright with a pain level of 3 or less, and to be able to climb one flight of stairs, even if I need to do it one step at a time. Recovery by the numbers tends to overlook the fact that everyone's goals are not the same, and that sometimes the perfect is the enemy of the good.
Please let us know how your return to Pilates (mat?) goes.
Hope you continue to improve.
Thanks for the comments everyone! I'm just trying to get my head around this and figure out what I should do. It's so hard to know if this stiffness and poor ROM is just normal and will get better, or if it's truly serious scar tissue.
@Carole4815 I do feel like the lack of ROM is affecting my daily life. I can't do stairs well, it's affecting my gait, and it's very stiff. I think if I even had a few more degrees of flexion I'd be able to walk better. I know I don't have to go through with the MUA (and it terrifies me to think about it), but I'm anxious to find some sort of solution.
@Jamie Thanks for that info. It's good to know that the MUA is not that invasive. Everything I've read on here seems to lean towards "don't do it!", which is scary. How do I know if it's really needed?
@Didot I'd love to hear more about your MUA experience!
@marieltha I'll likely start Pilates in a couple of weeks (reformer). I have a wonderful instructor and I trust her completely. It'll be nice to have some activity that can possibly help stretch these tight muscles, but isn't PT!
We tend to caution people on the forum to think twice before getting an MUA because some surgeons are a little bit too quick to blame "scar tissue" when the problem with ROM is really swelling. In those cases doing an MUA just irritates tissue in the knee that is already inflamed and sets recovery back even further. We've seen cases where MUAs are being recommended in the first month or two of recovery when you're still in a healing stage.
But there are some cases where, for whatever reason, some adhesions develop and restrict movement. Sometimes this happens when people engage in too much exercise or activity immediately after surgery, when they should be resting and allowing their knee to heal properly. In those early days, only gentle bends and stretches and some walking about the house are all that is needed to keep the joint mobile while healing takes place.
Usually in cases where there are adhesions restricting movement, you will feel what we term a "hard stop" when you try to bend the knee. It's not pain or discomfort, but a very significant feeling that the knee just won't go any further. Some people even feel or hear some tearing (like pulling velcro apart) if they try to bend.
An MUA (manipulation under anesthetic) is just that - a manual movement of your knee that will break apart any scar tissue that is in the joint and free it up for better movement. There is no cutting. You are asleep and don't feel anything. When you wake up, you likely will have some pain and soreness IF there was scar tissue that was broken up. You could even have some swelling for a period of time as a result. But if adhesions were the problem the procedure should improve your movement.
As you can imagine from this description of the procedure, the process will set your recovery clock back a ways and you'll need to keep that in mind. But, when it's successful, most people are pleased that they can finally start making some progress in their ROM, they don't mind a little additional discomfort for a week or two until things settle down again.
Because you haven't made any forward progress in 8 weeks (and I'm assuming that you have not been overdoing the exercise and activity), it may be that an MUA would help you if you are still at this same place at the 12-week mark when you see your surgeon again. It won't harm you other than causing some backwards steps in the recovery process for a bit. Sometimes it's worth a try to get things moving. We just don't like to see patients get them because they haven't reached some arbitrary number set by a doctor or therapist by a certain time. As long as progress (no matter how slow) is being made, it's usually better to let the knee heal and improve on its own. It sounds as though your surgeon supports this same idea. Twelve weeks with no progress could mean you need the MUA. And it sounds like, if you've started to make some progress in these next couple of weeks, he wouldn't do it. That is the right approach. If you find yourself starting to gain ROM in the coming weeks, you might want to hold off on an MUA for a while to see if the progress will continue.
Thank you @Jamie! This is exactly what I needed to know. Luckily my OS is great and doesn't seem to want to jump into anything. I appreciate that he's giving me the option, but waiting to see what happens and letting this be my decision. I definitely didn't do much the first few weeks, mostly ice and elevate and a bit of walking around the house. Even now, I'm not pushing myself too much in PT. I'm doing what I feel I can, pushing slightly to strengthen, but never to the point of pain or swelling. My knee doesn't look swollen on the outside, but I know that it could be swollen on the inside. I definitely have pain when I try to bend my knee past 80-83 and it also feels like it just will not go any further, even with pain. I keep describing it as feeling like someone poured cement into my knee and it's not budging. I'm hoping that's not the case and that I can gain ROM, even a few degrees. If I can get myself to 90 degrees, I'll consider it a huge accomplishment and feel that it would help my gait quite a bit!
I think by the end of the 12 weeks you'll know whether or not you want to try the MUA. I just wanted to be sure you weren't afraid of the procedure. Yes, it can hurt a bit afterwards. Some pain meds and ice will help with that. But it's nothing at all like your knee replacement surgery.
I look forward to seeing where you are in a few weeks. Be sure and tag me when you do an update.