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[MUA] Wenfaith's RTKR/MUA Recovery Thread^

Discussion in 'Knee Replacement Recovery Area' started by Wenfaith, Nov 26, 2017.

  1. Wenfaith

    Wenfaith new member
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    Hello everyone,

    I am very grateful to have found this forum and have spent time reading articles and a lot of wonderful advice. Thank you all for sharing.

    My RTKR was on October 5, 2017. I began outpatient PT on day 5, which felt too aggressive to me from the start but I didn’t have anything to compare to other than my own intuition. As PT increased it became all about aggressively increasing flexion and although I tolerate pain very well, I was in so much pain and tears at most sessions as the therapist pushed on my knee to try to gain more flexion. I was stuck at 45 degrees flexion/about 0 degrees extension for quite some time and left each PT session in defeat, feeling as though I was at fault. Although my therapist speaks kindly, she is also did a lot of frowning and expressed concern at how much further along I should have been at each session.

    At my 4 week post op appointment with my surgeon, she suggested I take 1 week off from PT and work on trying to gain more flexion on my own in a more relaxed and gentle way and she scheduled an MUA for the 6 week anniversary date of my surgery if I wasn’t able to achieve 90 degrees. I increased my flexion only a little, so I had an MUA on November 16, 2017. It has been 10 days since my MUA and although my flexion increased from 45 to 87 degrees the day after the MUA, and my knee is no longer sore, I still have enormous soreness in my thighs (front and sides, inner and outer) from the MUA. I hadn’t expected that but it makes sense that when my surgeon bent my knee so deeply, the muscles in my thigh hadn’t been stretched that intensely for over 10 years since I have had knee pain for so long and I fractured my pelvis in a car accident in 2006.

    Since the MUA, my flexion has only gotten to 89 degrees simply due to the soreness and swelling in my thighs, and PT has been required daily for 10 days following the MUA so there is no recovery time for the thigh muscles. My knee doesn’t hurt at all and moves very freely but it is the thigh pain from the recovering muscles that is the hold up. This past Friday, I asked my PT to give me a little time for my thigh muscles to recover without trying to increase my flexion. Yesterday I saw my massage therapist who gently made great progress on my thigh muscles and I have been resting, elevating, icing (knee) and heating my thigh muscles and lightly stretching when I get up and walk, as well as dangling my legs off the side of my bed with some light stretches.

    Tomorrow I am scheduled to go back to PT, but instead I have scheduled another massage at my massage therapist’s recommendation. She made tremendous progress yesterday and my thigh soreness has decreased by at least half. I am also considering switching physical therapists. The day following my MUA I was seen by someone else at the facility who had a much gentler approach. I responded very well to his style and although I currently see the owner of the facility, I would like to switch to the gentler therapist. I am going to inquire about this tomorrow.

    Thank you for reading my post and I hope I have followed the forum guidelines correctly. I look forward to any feedback and ideas. I am 7.5 weeks post op and although trying very hard to remain positive, I have felt defeated about my recovery for weeks. I had hoped post MUA to be “over the hump”, but did not anticipate the thigh muscle soreness and swelling. I think I will easily be able to reach 90 degrees flexion, maybe more, once my thigh muscles recover. I will be so grateful when I am able to be independent and especially drive again, and hope that time comes soon.

    Thank you,
    Wendy
     
  2. Jockette

    Jockette Senior BoneSmartie Forum Advisor

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    Hi, Wendy, I’m sorry you have suffered so much abuse in your recovery at the hands of people you trusted to give you the appropriate care. This is exactly why if I have to ever have another replacement I will not go to PT. Not after all I have learned here on Bonesmart that it is not even necessary as we have been led to believe.

    A staff member will be along with helpful advice and some wonderful reading that will be quite the eye opener for you.

    Welcome to Bonesmart, home of a much more gentle approach to recovery from knee replacement. We care, and look forward to journeying with you through recovery. :console2:
     
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  3. Pumpkln

    Pumpkln FORUM ADVISOR Forum Advisor

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    Wenfaith,
    Welcome to BoneSmart, glad you joined us!

    Sorry you have had to go through such an aggressive rehabilitation program in the early days of recovery.
    Your ROM is there and has been all along, all your knee needs is half a chance to heal. As the swelling and inflammation go down, your ROM will emerge. All that pushing and shoving for ROM has set back your recovery, blocking your ROM with swelling and inflammation.

    You will find as you read that many of our members have skipped PT and have done very well with their TKR's, regaining function and ROM without all the stress.

    Your knee has gone through a major surgery and needs time to heal. Here are some photos so you can see what your poor knee endured during surgery. TKR surgery - WARNING: real life photos

    I agree with your decision to see the massage therapist who helped your quads, and skipping the aggressive PT that only irritates and aggravates your knee. Suggest you skip the PT and let your knee heal, the recovery guidelines are below for you to read.

    Here is your copy of the recovery guidelines, the articles are short and will not take long to read.

    Knee Recovery: The Guidelines
    1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
    2. Control discomfort:
    rest
    elevate
    ice
    take your pain meds by prescription schedule (not when pain starts!)
    don't overwork.
    3. Do what you want to do BUT
    a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
    b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.
    4. PT or exercise can be useful BUT take note of these
    5. At week 4 and after you should follow this

    The Recovery articles:
    The importance of managing pain after a TKR and the pain chart
    Swollen and stiff knee: what causes it?
    Energy drain for TKRs

    Elevation is the key
    Ice to control pain and swelling
    Heel slides and how to do them properly

    Chart representation of TKR recovery
    Healing: how long does it take?
    Post op blues is a reality - be prepared for it
    Sleep deprivation is pretty much inevitable - but what causes it?

    There are also some cautionary articles here
    Myth busting: no pain, no gain
    Myth busting: the "window of opportunity" in TKR
    Myth busting: on getting addicted to pain meds


    We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
     
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  4. Spex10

    Spex10 graduate

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    I had the same problem and was stuck at first of all 60 then reduced down to about 45 flexion. I had a MUA at 12 weeks which meant I'd healed more than you. I was very pleased to attain about 85 after that. Yes I was very swollen before and after the MUA but I didn't experience the thigh pain you mention. My thigh muscles were in good nick before the op though.
    I had a VG PT after a few sessions with one who must not have been very experienced. The good PT did no forcing, used massage and was practical and encouraging. We worked on gait and stairs - every day life stuff.
    Time has gone on. My knee bends perfectly and doesn't hurt. I sleep well and have taken no paracetamol for months.
    You'll get there. It takes time and patience. Good luck.
     
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  5. Wenfaith

    Wenfaith new member
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    Jockette, Pumpkin (Chris) and Spex10, thank you so much for your replies and encouragement.

    Chris, I am so grateful for all of the outstanding information. I have read some of these articles previously but thank you for sharing everything that you posted. This is the first time that I realize that my physical therapy actually set back my recovery when all along I had been blaming myself. The article that you sent about Losing the Work Ethic really hit home. I have been treating this as my therapist has been suggesting, which is if it's not bending, I must need to work harder. What an eye opening realizing this is.

    Spex10, thank you for sharing your experience. I appreciate you mentioning that your VG PT focused on gait, stairs and the everyday life stuff. I finally feel encouraged and supported that my intuition has been correct all along.

    Wendy
     
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  6. funkymuse

    funkymuse senior

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    Hello @Wenfaith: I've been following along and had you known what you know now on the Bone Smart way, would you still have gone ahead with the MUA? I'm anxious to see my Surgeon this next Wed and see what his viewpoint is on my low ROM and where he thinks I really am in my recovery due to my 2nd small surgery. I'll find out if he wants me to go gently or if he is of the old school thought process. I hope he's of the gentle type.
     
  7. Pumpkln

    Pumpkln FORUM ADVISOR Forum Advisor

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    One of our forum advisors RoyGardner posted this recently.

    When you are icing and elevating and watching telly you are not 'dossing around' you are 'engaging a carefully considered proactively designed heuristically programmed dynamically structured recovery programme'.



     
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  8. Wenfaith

    Wenfaith new member
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    Hi @funkymuse, thank you for following along my post.

    If I had been rehabbing the BoneSmart way I may have waited for the MUA, however, there is so much relief in my knee, I am very grateful that I did have the MUA. Prior to the MUA, there was a lot of pain, tightness, stiffness, and what seemed like a lot of fluid around the knee joint, and there was so much frustration and defeat in my mind. Much of which was due to my therapist, I now understand, yet I had spoken to a few other people who had MUAs prior to mine and they all said that although they were uncertain and we were all duly afraid of the idea of the surgeon leaning hard on the knee to make it bend, each person said they were very relieved after the initial swelling went down.

    In my case, I had no soreness or swelling in my knee, and all of my pain, soreness and swelling has been in the quads, adductors and IT Band. Following an MUA protocol is PT daily for 10 days, which is why I believe my swelling and muscle soreness is still with me, and by an aggressive PT who wants to bend and measure at each session. Yet, the knee feels great and is ready to progress once the muscle soreness and swelling is relieved.

    I don't know your whole story but I see you had a hematoma removed along with an MUA. I will look for your thread and am also interested in seeing how your progress goes as well. Wishing you good luck at your appointment and hope your OS recommends gentle therapy.

    Wendy
     
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  9. Josephine

    Josephine FORUM ADMIN, DIRECTOR Administrator

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    Yet it was her fault that you had a slow progress!
    I'd strongly suggest you quit PT altogether.


    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?
     
  10. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    Many of us never took formal PT or did exercises. I am one of them. I had 11 knee surgeries, 2 of them kneecap removals and 1 tkr. Even after those I never took PT. But, I didn't just sit around and do nothing. I took care of myself, my house and yard as my knee allowed me to do. As I healed, I did more. But, my knee was always in control! This was enough therapy for me and would be for any tkr patient. All the awful pain of PT is so unnecessary.

    All you have to do is use it in your daily living! Your knee knows how to rehab itself and doesn't need anyone telling it how. Just use it and it will come back like new! You have to be patient, though, ut doesn't happen quickly! ADL,(activities of daily living), will be all the exercise your knee needs. If you just use it daily in your living, you will have a quicker and less painful recovery. We know what works, we've been there!

    Be careful to not overdo. Sometimes PT can get carried away and end up causing a set back. You stay in control and not let them push or pull your knee. My PT at the hospital was sneaky and tried to push my foot with her foot and I strongly told her, "No!", and she stopped. You have that right, too. You can't force your knee to heal any faster by exercising, but you can sure set it back. If you follow the BoneSmart guidelines you'll have a quicker and a much less painful recovery! Trust all of us who have been through what you are going through! Experience knows!

    Your knee is damaged requiring healing, not unfit needing training. Bending past the point of pain is not helping your recovery but compounding the damage done by the surgery. Your knee needs GENTLE stretches only, without pain.
     
  11. Wenfaith

    Wenfaith new member
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    @Josephine, I am so sorry that I never saw your note about offering structured advice. I would be very grateful. Please ask any questions.

    As an update, I am currently at 115 degrees ROM with a PT pushing on the knee. I am not in pain but still have some ache and swelling, and down stairs are most difficult. Also, I would be grateful for your thoughts on what the feeling is like with the knee joint. Some days I feel it with every step — no pain but it feels so unnatural and almost a little clunky. Does it ever become smooth and more natural?

    Thank you so much!

    Wendy
     
  12. Jockette

    Jockette Senior BoneSmartie Forum Advisor

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    I am one year out and mine feels about the same as yours. I’m looking forward, too, for that day when I can forget about it!
     
  13. Celle

    Celle FORUM ADVISOR Forum Advisor

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    Please don't let the PT push on your knee. It's bad for it.
    PT shouldn't need to touch your knee, except to massage gently.

    In any case, the bend you get when he/she is pushing doesn't really count, because it's passive movement.
    What matters is how far you can bend, using your own muscles.

    Yes, one wonderful day you will realise that you haven't even thought about your knee. It takes time, but it will happen.
     
  14. SusieShoes

    SusieShoes FORUM ADVISOR Forum Advisor

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    In my case, I have become much less aware of my knees being artificial. It goes hand in hand with the healing. My right knee healed faster and I have seldom thought about it at all for months. My left knee remained painful for longer and only recently do I mostly not think of it. Yes, the knee eventually does move smoothly and reach the point of feeling natural. :friends:
     
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  15. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    My knee is now my knee and not a piece of equipment! The best thing is walking and going up and down stairs doesn't hurt anymore!
     
  16. Josephine

    Josephine FORUM ADMIN, DIRECTOR Administrator

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    Do not EVER allow that! It's a very good way to get problems.
    I would dispute that you have no pain. You have swelling for a start which is, in itself, a form of pain.

    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?
    ai63.tinypic.com_eta39s.jpg

    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.
     

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