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Offline rdstrasser

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Question About ROM
« on: May 05, 2005, 02:09:28 PM »
I had an ACL reconstruction using an allograft, a partial menisectomy of the lateral meniscus and a repair of the medial meniscus on March 16th, 2005. The first week and a half I was only allowed to move the knee to 40 degrees flexion. And after that only allowed to move up to 90 degrees of flexion. After my second post op appointment, I was allowed weight bearing as tolerated and the goal to achieve full ROM. I am now only at 120 degree flexion and even that hurts a bit. And I am walking pretty well with the ACL brace and without the brace I still use a crutch for support (just in case).  But I want to achieve full ROM just the same as the un-operated knee. My PT says that 120 all the ROM that we technically have to achieve. I am almost 8 weeks out of surgery. My full ROM in the other knee is only 137, I would think that it would be acceptable to get the other knee to that statis as well.

First of all, am I being unrealistic in wanting/getting my FULL ROM back? Will I develop scar tissue and never be able to achieve full ROM? Are there any exercises that I can do in order to help the knee out a bit, other than the typical knee slides that I am already doing?

I'm pretty worried about this and while I never expected my knee to be fully normal again, I certainly expected to regain full ROM. I know I should talk to my OS and PT about this and I will...but I wanted to see if anyone here had a similair situation and could offer some advice.

Thanks guys!

-Becca
Surgery 3-16-05 Two Meniscus Repairs/Removals and ACL Recon. on RK

Offline PattiAnn237

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Re: Question About ROM
« Reply #1 on: May 05, 2005, 02:25:32 PM »
Hi becca, I don't know much about you particular surgery, but i will say that I feel that 8 weeks out is still pretty early, I think you can gain some more ROM, are you still in PT?  They should be stretching you to get that full ROM back, if not, there is a really good stretch you can do where you lay on your stomach and attach a rope, or dog leash around your foot, bend the leg up as far as you can and pull on the rope till you feel a stretch, hold for 15 sec and repeat 4 times.  Your goal should be to get it a little futher each time.  Heres a pic of It I found:
http://www.simplefitnesssolutions.com/images/products/strap-quad105.jpg

ask your PT or doc first, but it rally helped me , good luck!!
~Patti
25 y/o
Left knee- lateral tilt, lateral tracking, arthritis
LR 8/5/04 (failed)
Diagnostic Scope- 5/2/05 (scar tissue removed)
Holding off on TTT till I can get through school!

Offline Nick_Knack

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Re: Question About ROM
« Reply #2 on: May 05, 2005, 02:30:10 PM »
Becca,

Hi.  Extension is the most important thing.  Flexion will come back on its own as your swelling continues to go down. 

To guarantee your extension comes back full, try standing on your operated leg exclusively locked in absolute extension.  So, whenever you find yourself standing, stand on your opeated leg locked in extension.  Screwed up bio mechanics result mainly from a loss of extension.  So make sure you are maintaining this.

I have had a lot of ROM issues so I speak from first had experience.

Good Luck
Age: 35
1989 rt ACL (+25 degrees ext loss)
1994 rt ACL resection (+ 10 deg)
2001 rt ACL revision (+ 10 deg)
2003 rt med meniscus repair (+10 deg)
2004 rt LOA and post capsulotmy (zero degrees)
2005 rt LOA and tib bone plug removal (even w/ other leg)
2006 rt Fulkerson TTT & ACI Carticel

Offline Patty0513

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Re: Question About ROM
« Reply #3 on: May 05, 2005, 02:56:22 PM »
Hi Becca,
   ROM can be difficult to regain, and PTs and OSs do consider 120 degrees of flexion to be funcional flexion, in other words, that is all you need to do normal every day activites (walking, getting in andout of the car, stairs, etc).  However, for a lot of activities, like yoga, you need full ROM.  I am still trying to get full TOM so I can get back to yoga! 

And I have to disagree with Nick, flexion will not come back on its own!  I have altered my gait from lack of flexion and am now having problems with my hip, so I think that flexion is as important as extension!  But I agree with Patti Ann  that 8 weeks is not that long, keep working on it!!  The exercise that Patti Ann recommended is a good one.  There is a slight variation on this that is also helpful.  Pull the strap until it starts to get painful, then gently use the muscles to press against the strap.  Hold for 10-15 seconds and then relax.  Repeat and this time you should be able to bend the knee more before.  Do this about 5 times.  My massage therapist does this and it really helps stretch things.

Good luck and keep working on it!
Patty

Offline Janet

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Re: Question About ROM
« Reply #4 on: May 05, 2005, 03:07:13 PM »
I agree that you should continue to get your flexion back. I wouldn't stress out too much about it now. But....I have never been able to achieve more than 120 (and I worked really, really hard to get there) because of mechanical issues. I have plenty of flexion to do whatever I need to do. So even at 120, once your knee heals more and your pain is gone, you would probably be fine. I know that's not what you want, and I'm sure you'll gain more. I just wanted to tell you that 120 isn't the end of the world.

Janet
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

Offline sparkle999

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Re: Question About ROM
« Reply #5 on: May 05, 2005, 04:12:42 PM »
I hope you feel encouraged by all these posts.

Some PTs use 120 as 'full' ROM and others use 135. When I do have my ACL recon, I'll be wanting full ROM too, like you. I've already struggled with flexion post injury and find two exercises more helpful than others

1. tense your two lower legs together,good leg on top, while you sit on the edge of a chair. This is sort of like ankles crossed. Start at your comfortable flexion. Tense the legs together for a count of 5, then as you relax use your good leg to push the other one back a little.

2. Lie on the floor with your legs up against a slippy surface(fridge works well) Slide your leg down the fridge until its limit, then lean forward and pull a bit more, or use your good leg to nudge it down further. The gravity effect helps, but so does the fact that you can close your eyes, relax and allow the leg to relax and perhaps flex further. By altering how far your bum is from the fridge you can make this easier or harder.

Gosh it's hard to explain without pictures. Aside form using a pink fluffy scarf to assist with heel slides and lying on your tummy and using the same pink fluffy scarf to help the knee flex further, I don't have any more suggestions.

Oh! Except doing lunges with your bad leg on a step(or 2 steps up). You have the back,good leg straight on the floor and put your weight through the bad leg either one or two steps up as you lunge forward. This one also helps with proprioception(so my PT says) and was largely responsible for getting me off full dependency on crutches after the injury.

Good luck, but it sounds to me like you're doing pretty well. Hang in there. It's a long haul.

xx
35 y/o
ACL rupture
loose body under kneecap
impaction fractures
injury 19th march 2005
scope 9th may
recon 24th october 05

Offline pxs

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Re: Question About ROM
« Reply #6 on: May 05, 2005, 04:20:31 PM »
if you are at 120 at 8 weeks it seems likely that the rest will come.  keep working at it even if the p/t wants to focus on other things.  I had a rubber band/rope that had a loop at one end.  i placed it around my foot, and then when laying on my belly pulled the leg into flexion, kind of like what the p/t does when he works flexion but you do it yourself.  pulling it to a stretch and holding it for 5 minutes every night is how i got the last 5 to 10 degrees to the point flexion was equal to the other leg.

Offline ski bum

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Re: Question About ROM
« Reply #7 on: May 05, 2005, 07:20:08 PM »
Yoga has actually helped me regain ROM.  Background:  I'm about 13 weeks or so post surgery but got reset exercise-wise about a month or so ago due to fat pad irritation (that is, I was put back into a brace & only allowed to do week 1 exercises, along with elec stim for the lagging quad).  After nearly a month of this, the quad is coming along and I've been allowed to progress some in PT--still no WB single leg  or lateral exercises.  I've now been to two yoga classes, taking care t not to push the surgical knee too far.  The classes are reasonably difficult--but slow paced, allowing for individual variation if needed.  I also talked to the instructor to alert her about my knee. 

Interestingly, after the first class, my flexion went from around 130/135 to 145.  My guess is that the next time it's measured, after the second (and likely 3rd) class, it will have increased again.  I had originally thought I needed to wait before returning to yoga but rather having gone, I'd recommend just doing it...carefully.  Yoga itself may help your flexion ROM.

Andy
12/23/04:  complete ACL tear, partial LCL, tibia bruise
1/19/05:  allograph ACL
7/8/05:  AIR-scar tissue & ACL graft girth reduction
8/4/05 nearly full ROM-released to ski
8/11/06: AIR-scar tissue, grade 3 cartilage potholes on femur
10/13/10:  Mfx, L knee to fix 3cm pothole

Offline rdstrasser

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Re: Question About ROM
« Reply #8 on: May 05, 2005, 08:36:20 PM »
Thanks for the information everyone. I'd thought before about using a band on my ankle and pulling the knee towards me and I figured that would help. I'll ask the PT about that one tomorrow and see what he thinks. He knows I want to get as close to my full ROM as possible so I am sure he will be glad to let me know if he thinks that is safe for me to do at this stage. I am just worried. And I know 120 is not the end of the world, I just want more. It seems like it's just not enough sometimes. But I am afraid to push it at this point because the knee is still really sore and I don't want to screw anything up in there. I am sure you all know where I am coming from. But I think attaching a band to my ankle and pulling until I reach a certain pain level would be okay. I am not sure wall slides would be ideal for me at this point. I am afraid that I would actually end up hurting something.

But anyhow, I guess I am just trying to achieve more than what the knee is ready for at this point. I know most times when I really get a stretch in the knee, sometimes I get a burning sensation in the area where he repaired the medial meniscus. That scares the crap out of me. I always think that I have pulled something loose in there or damaged the meniscus.

Again thanks for the encouragement. It is helpful to know there are people out there in the same situation as I am.

-Becca
Surgery 3-16-05 Two Meniscus Repairs/Removals and ACL Recon. on RK

Offline Jaci

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Re: Question About ROM
« Reply #9 on: May 05, 2005, 10:31:39 PM »
Hello, Becca.

I've been battling severe arthrofibrosis for about 18 months and have learned a few things about working on ROM while causing minimal irritation to the knee joint. Here are a few suggestions:

Pulling on your ankle to increase the bend while doing heel slides can irritate your knee. Try wrapping a strap around your thigh and pulling your thigh back; your knee naturally bends and just follows along. I've done these both lying on my back and sitting, but find that doing it in a sitting position, with my other leg stretched out straight in front of me, works best. In a sitting position, you can pull your thigh back with your hands. Pull back until you feel a little resistance in your knee, hold for 10 seconds, then relax and repeat.

You mentioned that you were concerned about doing wallsides. They're actually one of the best exercises you can do for flexion, if you let gravity do the work for you. To do that, lie on your back with your bottom about 6-12 inches from a wall ( I do these on a door with a smooth finish), put both legs straight up and rest them against the wall, bend your 'good' leg and hook your foot behind the ankle of affected leg. Then relax the quad muscle of your affected leg, bend your knee and allow your foot to slide down the wall. Use the opposite leg to keep it from going too fast or bending too far. Bend until you feel a little resistance, hold for 10 seconds, then push your leg back up straight with your opposite leg. The key here is to relax the quad of your affected leg. (The OS and PT that I'm seeing work with many top athletes. Knee patients begin wallslides the day after surgery.)

Last one, check with your PT before trying this, lie on your back on the floor, bend both knees as far as you can, wrap both arms behind your thighs and pull them toward your chest. Again, use the foot of your good leg to support your affected leg and control the amount of bend. Relax your quad and let your knee bend until you feel a little resistance, hold 5 to 10 seconds. Then use your hand or good leg to relieve to pull on your knee, rest, and repeat. I find that using a folded wash cloth behind my knee joint, opens it up a bit, and reduces internal irritation. Check with your PT on that aspect in particular.

I hope all that makes sense. Best wishes to you. Fingers crossed that you gain full flexion.

Regards,

Jaci
« Last Edit: May 05, 2005, 10:38:10 PM by Jaci »
10/03 Twist injury
12/03 Menisectomy- tears ACL, MCL, & LCL missed by OS
Arthrofibrosis ROM 38-68
3/04- 4/08 Multiple scar tissue procedures:
6 scopes w/LOA, AIR, LR, chondroplasty, synovectomy, bone spur & plica removal
3 insufflations, many injections
Chronic AF, patella infera, IPCS

Offline Ferris

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Re: Question About ROM
« Reply #10 on: May 06, 2005, 08:32:46 AM »
Have you tried using a rowing machine - the type with a single handle attached on a chain that moves around a wheel (Concept II ergometer) is the one that my physio, gym and rowing club all use.  They helped my ROM along great.

Rachel

Offline rdstrasser

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Re: Question About ROM
« Reply #11 on: May 06, 2005, 07:05:45 PM »
I talked with my PT today. He's not concerned about me getting my ROM back and feels that it will just naturally come once more of the swelling is down. He doesn't want me to push too hard in getting the ROM back. He said he would rather I just concentrate on Extention for now. Even though I am at 0 extention, standing up it seems to be bent slightly, so he's more concerned about getting that under control. Apparently they (both PT and OS) are really concerned about the meniscal damage on the medial and would rather I take it extremely slow in getting more ROM back. He measured me today when I first started my heel slides and I was at 120 but towards the end it always loosens up a bit and I forgot to ask him to measure me there. So I am sure that I am up to at least 125. I see him again on Monday so I will just keep doing the heel slides for this weekend and see what my ROM is like on Monday. If it's increased even a little then I will just follow along with what they are telling me to do. If not then, we shall see what the OS says on Friday when I see him.

I'm just so scared to do further damage to it and have to end up having another unwanted surgery. Had I kept exercising over the years and keeping those muscles strong that supported the knee, I may have last even longer with a torn ACL. Who knows. Glad I had the surgery, just want a 100% recovery. Maybe I am just asking for too much. LOL

Thanks for all the advice. I am going to ask the doc about wrapping a strap around my thigh and doing it that way. That might be less cumbersome than anything else. The PT said we will work on more flexion later, right now at 120 he feels that I am able to function well in day to day activites and should not worry about the rest at this time. He is in agreement with Nick that the ROM will come back on it's own eventually. As long as I am still doing heel slides and laying on my tummy pulling my knee towards my bum as far as I can.  So who knows, I will talk more with the doctor next Friday and see what he thinks and if he has any suggestions. After all he is the only one that knows how bad the meniscus damage was and he should be able to tell me what I can safely accomplish without hurting myself.

Thanks again everyone!

-Becca

Surgery 3-16-05 Two Meniscus Repairs/Removals and ACL Recon. on RK

Offline rdstrasser

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Re: Question About ROM
« Reply #12 on: May 24, 2005, 12:39:21 AM »
On Friday, May 13th,  I went to see my OS and apparently he thinks things are going really well. I won't see him again until the middle of July. He also told me that I could take the brace off and not use it unless I felt that I had to have it. I seem to only need it when I do a good amount of walking. But other than that...I'M BRACE FREE. Today I went into my PT and he measured my flexion for the first time in a while. I was concerned that maybe I wasn't progressing well at all. But I was at 132!!! And my normal ROM is only 140. So really I am almost there. Though it still hurts like *&%[email protected] to try and sit on my knees. But I suppose it will all get better eventually. Apparently my PT also thinks that I will not need much PT after this round. Next month after the 16th I will be released for jogging. And he believes that I might need one more month after this to make sure I am doing things correctly and then I will be completely released from PT and continue to do my exercises at home and such. I just wish there was a way to quickly build muscle tone. At least build it up as quickly as it suddenly disappeared. *wishful thinking on my part*

I do hope that everyone is doing well out there in "Knee Land".

-Becca
Surgery 3-16-05 Two Meniscus Repairs/Removals and ACL Recon. on RK