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TKR TRKR 10/13/23 - Moving Forward with Many Detours

The thing with releases and the accompanying trigger point therapy is that they can work right away for a while, but it’s possible for things to go back fairly quickly. The pain is originating from “knots” in the muscles that the therapist can actually feel. These are called trigger points. Pressure and/or massage is done on the trigger point and the process is complete when the therapist feels the tight area relax. It is common for you to feel much better when this is done, but over time the area can tighten up again. Usually the releases will be done fairly frequently and eventually your body “learns” to stay in the released mode. So, don’t be disappointed if this type of therapy takes a while to completely resolve the problem.

In my case, my therapist was always able to find those tight bumps, push and hold pressure for a bit, and they would release. At the beginning the release might only last a few hours to a day. But gradually over several months, the release time increased until magically one day, it just stayed. But for me, it took two days a week of therapy for about 6 months. Our sessions actually took only about 15-20 minutes. And after the releases, she would massage the area with a Theragun.

Your therapist should be able to tell you where the pain is originating. I’m betting it’s muscles, not a tendon. I would completely stay away from the leg press right now. Any time you’re getting pain when you do a particular activity, it means your body is not ready for that quite yet. It’s never good to try and “work through it” when you’re healing from joint replacement surgery.

For me, it was a full 9 months before I was able to walk down steps without some discomfort and weakness.
 
I still get occasional discomfort on stairs after a long day at two years plus after my PKR. In my case it is due to having 3 flights of stairs in my house/ a chronically overstretched MCL/ and a bit of arthritis in my unoperated femoropatellar joint.
Stairs are tough. I would agree with @Jamie about staying away from the leg press if you are experiencing pain.
Have a look at my excellent pilates teacher's free videos on YouTube ( Google Katja pilates). She has a side lying glute and leg strengthening one with no squats, which is good for post injury knees. This is my regular exercise now.
 
Jamie said:
The thing with releases and the accompanying trigger point therapy is that they can work right away for a while, but it’s possible for things to go back fairly quickly. The pain is originating from “knots” in the muscles that the therapist can actually feel. These are called trigger points. Pressure and/or massage is done on the trigger point and the process is complete when the therapist feels the tight area relax. It is common for you to feel much better when this is done, but over time the area can tighten up again. Usually the releases will be done fairly frequently and eventually your body “learns” to stay in the released mode. So, don’t be disappointed if this type of therapy takes a while to completely resolve the problem.

In my case, my therapist was always able to find those tight bumps, push and hold pressure for a bit, and they would release. At the beginning the release might only last a few hours to a day. But gradually over several months, the release time increased until magically one day, it just stayed. But for me, it took two days a week of therapy for about 6 months. Our sessions actually took only about 15-20 minutes. And after the releases, she would massage the area with a Theragun.

Your therapist should be able to tell you where the pain is originating. I’m betting it’s muscles, not a tendon. I would completely stay away from the leg press right now. Any time you’re getting pain when you do a particular activity, it means your body is not ready for that quite yet. It’s never good to try and “work through it” when you’re healing from joint replacement surgery.

For me, it was a full 9 months before I was able to walk down steps without some discomfort and weakness.
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Your entire message helped me so I'm replying to it. Thank you for explaining the trigger point release in detail and how it works, and your experiences with having it done. Seems it must be done often. Though I've been working with this therapist for nearly two weeks, Friday was the first time he introduced trigger point massage. I've one more week here and shall ask to continue as Medicare allows if it the therapist says it's necessary. I'm also going to watch what he does to see if I can do it myself at home. This is a different kind of tightness near the bottom of and across my kneecap, unlike the surgical tightness. The top is fine, no pain, doesn't crackle. I think you're right about muscle pain; maybe it was hamstrings. Most of the PT is gentle: holding a small pliable ball between my knees, no bridge (hurts my back), and rolling a very large ball from my ankles to the back of my knees, and bicycling. I don't know what healing from scar tissue removal entails and am afraid of forming more of what was removed. Since the summer, walking down steps has been painful so I did them one foot, one step.
 
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EalingGran said:
I still get occasional discomfort on stairs after a long day at two years plus after my PKR. In my case it is due to having 3 flights of stairs in my house/ a chronically overstretched MCL/ and a bit of arthritis in my unoperated femoropatellar joint.
Stairs are tough. I would agree with @Jamie about staying away from the leg press if you are experiencing pain.
Have a look at my excellent pilates teacher's free videos on YouTube ( Google Katja pilates). She has a side lying glute and leg strengthening one with no squats, which is good for post injury knees. This is my regular exercise now.
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Thank you for sharing and about the pilates videos. This is very helpful information, and I appreciate you telling me. I saw a few that would help my leg and my lower back. Walking stairs in the hospital, when the leg may be numb from either a nerve block or from the surgery, is different from walking stairs many months or years later.
 
Good morning. :wave: I'm trying to find other members who are more than 12 months post op to read about their experiences, and I also have good news to share. It's a bit of positive in this nonlinear healing journey. Yesterday I went to a friend's house; he has carpeted stairs, which were OK going up (he has a banister). It was rainy and cold, and my knee wasn't happy. Without much thought I later walked downstairs foot over foot and felt a twinge, again not enough to stop me. Sunday evening I stood for about 40 minutes at a meeting of our building's residents - all chairs were taken - and my knee began to ache. I'm slight and was balancing my weight on both legs. Maybe it's because it was the end of the day. No ache when food shopping and standing in aisles to check labels. This second procedure comes with another set of knee learning.
 
I think your report is excellent! You’re right that each joint brings its own experiences.

You can use the forum’s search feature to find other members’ recovery threads to read. There are many search options to enter so scroll down through them and you can use these options to get the search result you’re looking for. There is a tutorial for searching that may help located under the How To Use This Forum link under HELP/INFO link in the blue toolbar at the top of the page.
 
Thank you @Jamie. I'm looking for others who also had scar tissue removal after one year post op and shall check the link you suggested.
 
You might do a couple of searches. Maybe one with the keywords lysis of adhestions, which is the medical term for removal of scar tissue in a joint following surgery.
 
Thank you again @Jamie. It's stiff in different places. Another set of stairs, these in the medical building I went to today, done with some wincing. This thread is the only one that comes up with the phrase so I'll try them separately.
 
Happy Friday! We got a little snow this afternoon to add to the holiday cheer. My knee wasn't as happy today as it was yesterday, when the weather was warmer. Nevertheless, I had a chance today to apply BoneSmart advice, which the PT did not like at all (kept the source to myself).

My excitement at walking downstairs foot over foot was overshadowed by him telling me I need to strengthen my quads and my core, both of which, he said, are weak. I told him my quads fired very nicely after my knee was replaced last year and again after the more recent scar tissue removal. He told me I'm afraid to be hurt, and then I let him have it - nicely. I told him there's no reason to be hurt, and there's no warm, moist heat for my knee and quad prior to exercising or ice after each session. How does he expect me to strengthen my knee and quad by coming only twice a week for three or four weeks? I told him I have bursitis on the upper part of one hip, a painful lower back, and it's difficult for me to lay on one side on the hard mat because I'm thin, and my hip hurts when I lay on it. I told him I've come very far from walking downstairs one foot, one step to walking the way I did prior to arthritis flaring in my knee, and I can get up from chairs and out of my car. I'm not a weakling; however, I'm 67 and a few months with fibromyalgia and do not expect to sprint when I come to PT. Maybe other people can get strong after only four weeks of PT; not me. I said it with a smile, and I said it with inner strength. Telling me I'm not progressing? Sure as heck I have progressed, and maybe it was because the scar tissue was removed, not because of doing PT. Odd that he said Medicare would not allow me to continue because I've not progressed. After January 1 I'm going to a different facility as Medicare starts fresh.
 
Medicare approval is only part of the story with coverage. The first step is for a "good" therapist to make an individual patient diagnosis that may not follow the "norms" and then set appropriate goals for improvement during the therapy process. That information is conveyed to Medicare and in most cases should be approved. If you enter the phase known as a "plateau," and you're not refusing therapy and still wanting to improve, the therapist should be able to continue new, appropriate goals for you almost indefinitely.

You need a better therapist who understands how this works and can treat you as an individual with unique needs.

But I'm glad to hear you stood firm. Bravo!!!!
 
Thank you @Jamie for this information and encouragement. He amused me when he said he was "running out of options" for exercises. I've an evaluation at the new facility January 2.
 
Good morning. :wave: I hope everyone who observes had a joyous Christmas with friends and/or loved ones. Happy Hanukkah, which began last night, to those who observe (me). I haven't posted in a while and am sorry as I missed coming here. Lots going on, including what I felt was a bait and switch. The therapist two weeks ago who did myofascial release and told me to make note of how I feel tomorrow never did it again. I reviewed it on Google and gave three stars. If I erred by mentioning names, then I'll remove them.

"The front desk staff is friendly, and the atmosphere is comfortable. Stephany was very good helping me with ankle exercises, and while there is no moist heat prior to sessions or ice afterward she gave me ice for my knee after several sessions. The next time, she had me do leg presses, which my surgeon told me not to do, so I asked for another therapist. I went to Burke at Ridge Hill because two friends recommended Burke at White Plains; I’d had scar tissue removal from my 14-month-old knee replacement, and my range of motion (ROM) was 130-135.

I was reassigned Pablo, and after a helpful session asked to be put on his schedule. Big mistake. He also mentioned the leg press, and after that one helpful session he became sarcastic, telling me "you won't be able to do certain things if you can't do these exercises." I have a bad back and was unable to lie on my side to do as he asked, which seemed to frustrate him as he frowned several times. He was intent on telling me to do what I was unable to do, and when I stopped he kept counting. I had more pain in my op leg after my last session with Pablo than before I began weeks ago. Ask for another therapist if you are assigned Pablo.

Victor guided me through exercises and then evaluated me at my last session. I was wearing Merrell slides, which make balancing on one foot a bit trickier than if I was wearing sneakers. He also asked me to stand with one foot directly in front of the other as if I was on a balance beam and measured my ROM. It was good prior to working with him yet he asked if he could push my leg so it was higher. That was not Burke's doing as it was high prior to scar tissue removal and returned as the swelling in my knee subsided."

Therapists are hung up on numbers. My surgeon never measured my ROM and eyeballed it, pleased I could bend my knee nearly to my chin when laying down. He said sit-to-stand position will come in time and not to agitate my quad. Pablo kept telling me I need to squat to use the bathroom, get into and out of my car, etc. I have fibromyalgia and a cyst on my spine, which makes certain exercises painful. I'm also thin so laying on a hard mat on either side is painful. I don't get why I was asked to balance on one foot - did it at home with no problem - or put one foot in front of the other as if I was walking on a balance beam. Lesson learned: just because a big-name facility hires therapists does not mean they help every person assigned to them.

I keep remembering less is more, and that agitating a joint to "make it stronger" is counterproductive. As I sit here typing, my op leg is bent under my chair, and I'm happy with my progress. Here's to a positive day.
 
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dubloosh said:
I keep remembering less is more, and that agitating a joint to "make it stronger" is counterproductive.
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YES!
dubloosh said:
As I sit here typing, my op leg is bent under my chair, and I'm happy with my progress. Here's to a positive day
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The is wonderful news. Thanks for the update. Wishing you the best in the coming year!
Happy Hanukkah!
 
Thank you @Layla, and the same to you. Is it routine to ask clients to contort at their final evaluation? I didn't understand why he asked me to do both, and he had no answer.
 
dubloosh said:
Is it routine to ask clients to contort at their final evaluation?
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Absolutely not! My physical therapist never pushed me into pain. His approach was to figure out which movements and therapist would help relieve my pain.

Sounds like your PT is more interested in "proving" his value than in helping you recover. I'm sorry you had such a bad experience and glad that you are taking back control of your recovery.
 
I think its normal to do an assessment of your progress at your last visit to evaluate your strength and flexibility compared to where you were when you started with them. However, you still shouldn't be pushed to pain, but only mild discomfort at most. Thankfully it is now behind you. You seem to be on track for a full recovery.
Good things to come in 2025!
@dubloosh
 
Yes, and thank you again @Layla. I contacted Burke's main office, and the director of that location will call me next week. Moving forward with a few more detours.. :walking: I'll search again for others' threads who may have had scar tissue removal. This year flew by!
 
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