breaking tissue and ROM

[ByteSize]

Wow, that was some interesting information.  It almost sounds like an attractive option to just have the MUA, and get it over with, especially if you are in such horrid pain.

I can't say that mine has been that bad, except for approximately once per session, I feel like I'm going to pass out.  But at least I'm not screaming -- just a lot of sharp intakes of breath, and the occasional moan.  It takes a lot to make me scream -- like breaking my patella!  

ByteSize, aka Kathy

[margarita]

hello everyone
kerrie, i so understand your pain and i am so sorry i literally cry.  I was at PT today and i was making such awful faces, a little girl asked her mommy if i was constipated.  Ohhhh How embarassing.   kerrie please keep us posted on the possible MUA.  as much as we want to avoid it, i think it might be the only way for us to gain ROM without this torture.  Its funny how no one else understands this except for us.  Only if you have been thru it, you can then  understand.  Its so sad that our quality of life had been so crippled by something i personally took advantage of ROM.  My own husband cant be near me anymore because all I do is cry all the time.  he thinks i pitty myself, but i dont i just cant bear this anymore.  
kerrie believe me i know, I am still stuck at 20 degrees and i feel like it will never get better.  
have faith and please be strong
margarita

[Janet]

I had a MUA with arthroscopy when I was stuck at 60-70 degrees. It had been very hard to get to that piont following a quad tendon repair, and nothing we did would push it further. After my MUA, I was able to get to 120 in about another three months. In other words, it still didn't happen overnight. My quad tendon especially (and everything else, too) needed to be stretched again. Talk about painful. I would break out in a cold sweat every PT session. But I was never pushed further than I could stand....never to the point of screaming or tears or extreme pain. Don't get me wrong, I always hurt and pain meds to help, but it wasn't what I would call excrutiating pain. Gaining ROM is difficult, painful and discouraging, but it is possible once the scar tissue is gone.

Janet

(p.s. Years ago I broke my wrist and had pins inserted. When I got the cast off, I had NO rom. None. I started PT, and he was able to break up the scar tissue. Painful! I wasn't sure I could go back the next day. But after each session, my wrist would bend further and we could work on the next step. I never needed further surgery on the wrist. Don't know if the same can work with knees....it didn't with mine.)

[Marie]

Hey all,

Just wanted to say that the natural approach can work for some people... I've been working at PT very diligently (on average: 2 hours a day) for 5 1/2 months and I finally reached 120 today.    Still got a ways to go before full ROM, but my everyday activities are no longer limited.

Marie

[bummmmknee]

Thanks everyone.. I found out today that indeed I am not as far in ROM as I thought.. When they measure me at the end they measure me on my back doing the wall slide... with a push. so my actually ROM is when sitting up .. wich i got to 86 today.  Basically whatever I can get on my own is my real ROM... the pushing they do just makes it easier next time to get a little further on my own.  I have alot of scar tissue in the front of my knee all on the lateral side which is where I had the LR as well.. there seems to be none on the inner side for some reason.  I can manage PT pain all except for the last excersise which is stretching when they bend while you are on your tummy.. that is the one that I cry and yell in.. they do it 5 times and hold for 5 seconds but it feels like eternity to me. that is the one that does most of the breaking and stretching.  Does scar tissue have to tear or is stretching it out enough?  I only heard 2 tears so far in working on ROM so I didn't know if it needed to tear or could just be stretched.  

Today I could only handle 3 bends on my tummy.. it gets worse every time I go.  but I was 71 on monday on my own with no push and 86 today so I gained and I would imagine as long as you gain that things may get better right?  I really want to make it to the 100 mark on my own so I can begin to do things like stairs and bike etc with ease.  now I know why I could not do the bike even though I was 90 on the wall pushed.. because there was no gravity on the bike to pull it to 90 .

I think I will stick to the natural PT approach unless my OS says I NEED the mua to avoid more problems.. If he thinks I have done enough by gaining 50 degrees in 3 weeks then I will just keep PT.. I just really don't want anymore procedures if I can help it. It is really scary to me.  Then again PT is becoming scary as well... thanks guys !  

Kerrie

[ByteSize]

I have only felt the ripping/popping sensation a couple of times.  Today, I got to 85, without those sensations, although it was pretty darn painful.

ByteSize, aka Kathy

[kateb102]

I had my lateral release surgery a little over two months ago.  I am finally off of my crutches for only a little over a week.  I have been going to physical therapy for three days a week for about three hours each day since a week after surgery.  I started to do well on some of the exercises but have recently reached a plateau.  I was told that I have excess scar tissue and plica (?) around my knee.  I understand what everyone says about how it sounds like your knee muscles are ripping while you are laying on your stomach and trying to bend your knee.  I can only get to 90 degrees and would love to do more.  I also can not fully straighten my knee either so I end up walking with a limp.  Of course this doesn't make me too eager to want to go out and walk around.  Any ideas on what might help me break all of this darn tissue that is holding me back?  I would love any suggestions as I am starting to think that the surgery wasn't worth it and I no longer have the desire to have my other knee worked on as well.  Not only was my knee cap off track but I also had bursitis in the joint which caused pain all down my leg and fluid all around my knee with a cyst in the front.  

Thanks up front for any advice you send my way!!  

[bummmmknee]

Kateb... all I can tell you is to do alot of scar message and patellar immobilizations... message helps loosen up some of the small new areas of tissue.. but so far braking it free is all that works and it is VERY VERY painfull bk it only happens to me when they force the ROM and I yell and cry... I no longer want to do that and refuse to do that it is inhumane.. so I go tomorrow to the OS to discuss maybe a MUA or scope or both...the breaking of the scar tissue is a slow painful process but it can be done.. I am sorry about your loss of extension as well.. theres lots of good info on here to help regain that if you put it in search about extension... good luck!

Kerrie

[Heather M.]

Kateb (and all the others with scar tissue, too),

Your story sounds remarkably familiar...down the lateral release and cyst!  I would strongly, STRONGLY urge you to get a second opinion from a doctor who specializes in patellofemoral issues and most especially scar tissue.  Read down below in the soft tissue healing section about scar tissue/adhesions/arthrofibrosis.  It's a very serious complication after lateral release, and I'm sorry to say the scarring is not the worst of it.  You need to be evaluated for complications of the scar tissue, which I also developed, and which can be permanent if you don't deal with them quickly.  Ideally, you'll want to get that scar tissue out and do a specialized arthrofibrosis rehab within 6 months of the original surgery.  If that happens, you have an excellent chance of full recovery--how does that sound?  Please don't do what I did:  wait too long (five months post op) then go back to the same surgeon for three more procedures over the next year.  The scar tissue grew back each time, and it has caused permanent changes.

I don't want to alarm you, but it is not normal to be lacking flexion and extension two months after arthroscopic surgery.  It means that your knee's soft tissue was supremely outraged by all the work that was done, or it could be that you have a genetic propensity to form scar tissue. It sounds like you were just immobilized and laid up for a while, so there is definitely cause to have hope.

Following is a link to potential complications from lateral release surgery.  http://www.kneeguru.co.uk/html/steps/step_05_patella/lat_release.html
 I developed all the big ones:  hemarthrosis and scar tissue.  I initially did okay, then went downhill fast.  I had five surgeries in a 15 month period of time because I didn't know any better.  It was only when I saw a PFS and scar tissue specialist that I got on the right track, but by then I'd developed some serious long term complications.

Kateb, your story sounds so familiar!  I hope you get help and don't suffer for as long as I did.  If I'd known then what I know now, I'd be back hiking....!

For everyone else, reading about your PT sessions is giving me a queasy, remembering kind of feeling.  There is nothing worse than aggressive PT when your knee is frozen.  In my humble opinion, suffering is overrated!  I would go in for the MUA and/or scope for lysis of adhesions before I'd go through the 5 weeks of frozen knee hell that I once endured.  Never again.

Take care and keep posting to let us know how you are doing.

Heather

[SusanMarie]

Hi Kerry,
    I was wondering if they do ultrasound on you before they bend the knee...I found that really helped me.  It warms the tissue and helps it bend easier...sorta like when your in a hot bath and are much more flexible.  I had very similar problems.  I am 19 weeks post op on Monday and I really think some of it just takes time.  I realize the importance of bending the knee but I also feel I did better as I healed.  I had the same surgery on both knees.  I am between 120 and 130  depending on the time of day and swelling but the doc said I could have that for 6 months or so.  Ask about the ultrasound if you don't have a metal screw.  I have a disolvable one.I guess with a metal screw the ultrasound can heat it up and it can burn you.....Take Care        Sue

[bummmmknee]

HI susan. well I don't go back to PT... atleast not until my OS tells me to and then I am going someplace else.. I will ask about the ultrasound too.. I have bone staples so I think it might be safe.. I don't know why he did not use the screw on me.. Thanks so much for your reply. I have 4 weeks to work at home on ROM and strength.. I hope I can get some progress so I don't have to do that forced stuff again.. I really can't do it again.  

Kerrie

[Marie]

Hello!

Just wanted to say I've been getting ultrasound for bursitis just under & lateral to my patella for about 2 weeks.  I have 2 screws in my medial tibia, and they're not aggrevated by the ultrasound since the physio asst never goes near them when treating the bursa area.  Not sure if the ultrasound is helping with the bursitis, but ROM is still progressing (and we do it right after the ultrasound) so that seems to be a good sign.

Kerrie - don't let them force ya anymore in PT!  If it's against OS orders it's a BIG no-no.  

Sue - nice to see you still around.  Good work with the ROM... hope it continues to progress to "all the way" for you.  

Hugs-
Marie

[SusanMarie]

Kerrie,
    Just try to be patient.  This past surgery has been by far the most difficult ordeal I have been through in my life as far as frustration.  I had a little set back the week before last.  (I basically overdid the therapy) when I called my os he said to really not expect to be back to normal for a year. I swore I was the only one in the world that had rom problems (then I met Marie on this web-site)  ha,ha......Seriously this web site kept me going when no one else could understand me....you really don't know unless you've been there..........With my particular surgery progress is really slow...I would say I noticed progress every week and half to two weeks........God really was trying to teach me patience.  Work on what you need to do but don't be hard on your self and when you go back to therapy expect to be uncomfortable but there is no need to be in extreme pain.  One session my pt pushed my leg so hard that I broke out in a cold sweat and threw-up........well let me tell you, that was the last time she did that.  We actually discussed mua at one point but luckily things progressed with me.  I work at a beauty salon and we just hired an excellent massage therapist.  She was telling me how important it is to massage the knee and keep all the fluid moving.  My leg was really stiff after a four hour shift yesterday and she loosened it up in 15 min.  You might look into that.      
 
Hey Marie,  Hope things are going well for you.  I am working a bit now so I don't get on the computer as often.  How is the rom for you?.  I can;t wait until the day I I hit 150 and am able to jog a couple miles.  That is my goal I am working towards, and lose this limp.......Do you still limp?  I tend to hyperextend my leg when I walk.  I am on the treadmill for 30 min walking at a faster speed so hopefully one day I will get there.........Take Care.....Sue

[brianajade]

I too am having problems with ROM and "tearing scar tissue".  The pain is awful.  I take two ultracet an hour before PT and six weeks post-op can only get 120 after the torture stretches and total body gym.  My doctor recommended putting me under anesthesia and "breaking the scar tissue".  I'm trying to get full ROM because I'm a dancer and need it.  Has anyone talked to you about that?

[Sarahreindeer12]

Ih ad 2 MUA's and an arthroscopic procedure.  I also had radiation.  So far, so good for a TKR.  However, before we got a clue that it was a scar tissue issue, I would literally vomit over the side of the PT bed as he forcibly tried to bend my leg.  Absolutely follow the scar tissue protocol and go slow in PT.  Good luck!  Sarah