How can I continue to break up scar tissue once PT ends?

[cc44]

I had chrondoplasty on Jan 4 and have been going to PT 3x week since 1 wk post-op.  However, I am reaching the limit of visits that my insurance will cover, and have not regained full ROM, and one of the portal scars, the one that's uppermost, is still pretty swollen and hard, although it was harder and the massages have helped.  I try to massage it myself, but it is hard to get the right angle.  I've already had more PT than usual because according to the OS it is my quadriceps that are misfiring and tense and preventing full flexion.  I am worried that if I cannot go to more PT I will not get past this point.  I can get to 128 degrees very painfully when the therapist forces it, but my good knee is 145 degrees.  What other things can I do to break up this scar tissue?

[Nettan]

HAve you treid to see if the insurance somehow can help you anyway ? Maybe a person near you can visit together next time at a PT session and learn to give you the massage ?

NETTAN 

[jim mac]

If you can get your insurance to pay for a cpm for a period of time it would help to break up at least the small soft tissue adhesions.  I can only get them to pay for 21 days at a time following surgery.  It seems that if you have arthrofibrosis you should be able to get better coverage for a cpm than say a routine acl surgery but that isn't the case.  Good luck!

Jim

[cc44]

Since I wrote this post I went back to the OS and he said that while it is natural for the PT to assume it is scar tissue that is causing the problem, that isn't it because there isn't that much.  He said it is due to the fact that my quadriceps are so tense they are pulling on the tendon covering the patella and it is preventing full ROM and causing more pain than most people have by this point.  He prescribed a third round of PT and said I must do as much stretching as possible when not in PT.  What I really need is advice as to how I can get my muscles to stop tensing in anticipation of the pain.  My PT suggested meditation, but I have never been able to meditate.

[dirk_PT]

Hi cc44,

I work with these condtions quite a bit.  How long out of surgery are you?

If you are running out of insurance and need a good home program, I think I can help.  Please email me and let me know the details or you surgery, date of surgery, ROM, if you still swell and what you are currently doing for rehab.

Dirk_pt

[shazbrown]

Hi

A bit simple I know, but I was advised to massage, massage, massage - my scar, and all around the site where I felt hard tissue underneath.    It has worked well for me although i still have a swollen knee which I think is just me, the hard tissues under the surface have almost gone.   I would lie on the bed with my leg in the air and start massaging in small circular motions from my ankle to way past my knee.  I just used Johnson's Baby oil.   It's worth a try!

Good luck.

Sharon

[cc44]

I looked up CPMs in response to jim mac's reply, but I am already past the point of how far those machines bend the knee.  I never had CPM, even right out of surgery; both surgeons in the practice were against using it.

Further complicating things is my OS is moving from NJ to CA shortly, and has discontinued my insurance.  I have two more visits to the PT left.  She has been putting the e-stim on the quadiceps in a pulsing motion while I contract my leg in a straight position.  It used to be she would put the e-stim on the sides of the knee, near the portal scars, in a steady motion.  I can get the knee while she pushes it to a painful 132 degrees, and on my stomach almost as much as the good knee, but it feels like the whole inside of my knee is going to rip apart while this happens.  I guess this is what everyone feels?  Before the surgery I could bend my knee all the way, I could even crouch while wearing jeans, even with the injury. 

With regard to dirk_PT's response, I am in NJ and unfortunately cannot go to your practice in CO.

[Jennifer_G]

You should try the ERMI Flexinator.  It is amazing and several of us have used it on this board and love it.  Go to GetMotion.com and look it up.  MelP has also written about it in the section about products you can't live without! 

Jennifer G

[cc44]

I think I saw a reference to this ERMI Flexinator in another post and looked it up, and it does sound exactly like what I need.  But it looks like it takes up a lot of room, I have limited space.  Is it something you have to buy, or can you just rent it?  Would insurance cover this?  I have a feeling mine won't, as with every PT Rx they like to play this game of, "If the OS wants nine sessions, we're only approving five, if he wants six, we're only approving four", and then they send me letters saying there is no medical justification for more.

I looked at the physician section and it says you can't just get this device on your own.  I am going to bring this to my OS when I have a follow-up visit on Thursday, but for all I know he will not be familiar with this device and not prescibe it.  He has been saying that if he had me under anesthesia that he guarantees my knee would completely bend, that is is me who is not doing enough forcing of the stretch and putting up with the pain--basically I am feeling that it is all my fault that I can't get it to bend all the way.

[Jennifer_G]

The machine is something you have to rent, not buy.  I had it for so long that I asked if I owned it yet and was told that it was majorly expensive ($27,000 I think) so renting it is much cheaper!!!

This device is considered Durable Medical Equiment (DME) and you do have to have a doctor prescribe it.  Now typically there is a DME network that you insurance company offers.  If you are not in Georgia (Where is company is located) it most likely will not be in your network so your insurance company will try to deny it or make you use out of network benefits.  ERMI challenged my insurance company (BCBS in Ohio) and said that no one in the network offers something like this so BCBS had to pay it as if it was in network. 

Each month my doc had to write a letter stating that I still needed it and the insurance company paid for it another month. 

It doesn't take up much room other than it is long but only the width of a chair.  I HIGHLY suggest you pressure your doc to prescribe it.  Dr. Noyes is the one who perscribed it for me and he is one of the best in dealing with scar tissue and loss of range of motion. 

I would call ERMI and see if you can gather some of the statistics on the device so you can show them to your doc as he might not have the time or want to research it himself. 

Sounds to me like your doc might not be well educated when it comes to scar tissue.  Anyone who knows anything about scar tissue knows that it is not all in your head and that when there is a physical blockage of the joint it will not move no matter what.  Have you seen someone who is reccomended for dealing with scar tissue? 

It is not all in your head.........trust me it is you that wants it to bend more than anyone else!  Do your research on the ERMI machine and possible seek out a doc who is a specialist in scar tissue. 

Jennifer G

[cc44]

Thanks for the thorough explanation, Jennifer.  As of now I have a plan that does not include either out-of-network or durable medical goods coverage, so even if I can get a prescription for this, I won't be able to get it.  But that may change.  I finally got a new job and start next week.  I don't know how long it will take to get on their plan, or what their plan is, but I do know it is with the same insurance company, which means that my about-to-move OS won't be on it, nor will his partner, and I hope if I can find another OS who is familiar with this device and will prescribe it I can try it in the future if I still haven't regained full ROM.  In the meantime, if the problem is completely the tensing of the quadriceps, is there anything else that might relax them?  What about complementary medicine, like accupuncture?

[Jennifer_G]

Don't know anything about accupuncture but I have had deep tissue massage and let me tell you that works!  Because I couldn't bend my knee my quad was shortening and my hip, back and leg muscles were not firing anymore.  She would do deep tissue massage and work out knots and help lengthen my muscles.  I could bend my knee as far as I could after two hours of PT after 45 mintues with her.  Insurance will not cover this typically and it can be costly but it is definetly worth trying. 

Jennifer G