Forcing extension - how to ease the pain

[Katwoman]

Went back to the OS yesterday (3 weeks post op), he is not happy with either my extension of my flex.  I had been happy as they were improving every couple of days.  He said I have 3 weeks to sort out the extension otherwise he will do it under anaesthetic.  He said I wasn't doing enough to sort out my leg (have physio three days a week which is getting really expensive, do the physio exercises for 45 mins every 2 hours as per instructions and do hangs in between).

He said that I need to get someone to forcably push down on my knee for twenty minutes three times a day, then demonstrated.  Well to say I wasn't expecting him to just walk up to me and push on the knee is an understatement.  When I peeled myself off the ceiling he asked what was wrong...I told him the pain was excrutiating...response from him...get used to it, it has to be done.  I have tried panadol and nurofen plus to help with the pain...but they don't seem to do anything.  Does anyone have any advice?

[Rknees4]

Katwoman,
Sorry your OS was so terribly unprofessional. Firstly I would be giving him a boot in the shins and telling him to smarten up.(just A thought)
Wish I could be more helpful but try some heat or ice to see if it helps loosen things before you start.
Take Care and goodluck on the extension and flex,
Rknees4

[smillie]

Ouch!  That seems a bit extreme. Extension is important, but good grief!

Have you tried elevating by just putting your foot/ankle up on something with nothing under your knee but air?

When I was trying to get mine to bend again, applying some heat beforehand helped a lot and then icing it well afterwards.

Keeping the swelling under control is helpful as well.

[Katwoman]

Thanks for the heating tip (and the tip on kicking him in the shins).  The heating has helped a bit.  My only problem now is after doing the forced extension i find my flex is not as good....ah well.  Time to stop feeling sorry for myself and feeling good about each victory (no matter how small) like I did before the visit.

I have to say though, after two months of it being stuck in the one position prior to the op I have a lot more ROM now than I did before...so I am happy.

[Rennschnecke]

Hi Katwoman

I'm sorry your OS caused you so much pain, but it is critical you get your extension back early.  It is far more difficult to sort out than flexion and lack of extension will lead to further problems not only in your knee but also your hip and back.  The ripple effect can be debilitating.

Things to help extension:

Prone hangs +/– ankle weights with warm packs on hams & calf for 10 – 30 minutes
Heel props (i.e. heel/ankle propped on a cushion/firm roll) +/– ankle weights placed above the knee for 10 – 30 minutes
Extension stretches where the ankle is propped on a cushion and you press down on the thigh and release repeatedly 30 – 60 times, every two hours if you can
Quad sets starting with simple ones then increase hold to 2s, 5s, 7s, 10s as tolerated – 3 sets of 10 3 – 4 times a day

The extension will affect flexion to begin with so it's best to alternate your extension exercises with flexion and end with extension.  If you have significant swelling try to adapt what you can so that you can have your leg elevated with the knee above heart level.

Your should also be doing patella mobilizations.

TBH your physio should have been doing these things with you and showing you what you need to do between sessions.

Have you looked up Dirk Kokmeyer's piece of rehab for arthrofibrosis.  You can find this by putting his name in the Search box at the top right or going to the Information Hub.

HTH

[Katwoman]

Thanks for the advice.  It feels as though the extension is getting better.  I find after the extension exercises I get a few clunks from my knee...there is a little pain when the clunking first happens, but nothing afterwards.  I am hoping this is either the patella getting back into place, or scar tissue breaking up.  I don't think it is anything major as the pain is minimal..and it only sticks for about 2 seconds.

[Katwoman]

Thanks Rennschnecke,  I have been doing your suggested exercises and combined with some pool work.   I have gone from a maximum 60 degree flex on Thursday to 100 degree today (Wednesday).  While my extension isn't always 100%, after doing extension hangs for about 30 mins it is perfect.

[Rennschnecke]

Hi Katwoman

So pleased to hear that you've improved your ROM.  That's a phenomenal increase!  I hope you're pleased.

Getting to 100 degrees is good and OSs don't normally go in again with this flexion as the theory is that you will continue to improve once you are past 90 degrees to be at least functional even if not full ROM (i.e. equivalent with the other normal knee).

The important thing is that you can get back your extension.  When you see your OS be sure to let him know that you do get it back (shows that nothing is blocking it).  Take a photo even for proof (assuming he accepts it and doesn't think you've Photoshopped it  ).

Hope you continue to recover well!