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Author Topic: going backwards in therapy - suggestions?  (Read 1778 times)

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Offline 2badknees2

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going backwards in therapy - suggestions?
« on: February 08, 2011, 03:57:56 PM »
This has been a long, long haul!  I'm a very active 43 year old and have had knee issues since I was 12 years old.  I've had 9 scopes, combined, on both knees.
In the last 2 years, I have had 4 scopes to clean out floating meniscus and repair a fractured knee cap.  In June my O/S and I began discussing ACI.  We had many consulting appointments.  He wanted to make sure that I was willing and motivated to adhere to the recovery process.  I spoke with many of his past ACI patients and they all had very positive results and expressed to me that I should do it if I wanted to be my active self again. 
So, I did it.
I had ACI & HTO on December 2.  My O/S removed staples on December 10, as some were beginning to dislodge.  On December 16, I was back in the OR for a staph infection that developed.  I was in the hospital for 5 days.  I began physical therapy 3 weeks ago.  On my first day of pt, my flexion was 65 degrees, and that was a struggle.  I have been on the CPM since December 3 for 6-8 hours a day.  Since physical therapy began, I have added the e-stim, for quad strengthening and other exercises given to me by my therapist. 

Yesterday, my flexion was 60 degrees, a very painful 60 degrees.  I'm very frustrated as is my therapist.  He is the only therapist my surgeon uses for ACI, so he knows the rehab protocol.

I'm still on crutches, still use the CPM and I use the dyna splint whenever I am not CPM-ing.

HELP!!!!  Does anyone have suggestions as to what more I can do to get my knee to bend.  Extension is bad too, but, right now, I'm focused on flexion.

Any suggestions are greatly appreciated. 





Offline Lottiefox

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Re: going backwards in therapy - suggestions?
« Reply #1 on: February 08, 2011, 10:10:01 PM »
Hi there

Can I suggest you post this down in the ACI section as there will be more people around who might have ideas? (apologies if you've done this, I don't check out all areas of the Board!). Where was your ACI done in your knee? Do you have a lot of swelling still? Have you ever had an issues with scar tissue inside the joint at all on previous surgeries? Does anyone think the infection may have linked to this lack of ROM? Have you always got full ROM back after previous scopes? ACI recovery is a LONG process, I know when it was mooted for my patella lesions my doc said 2 years rehab. Then further gains after that. But clearly you need to be making some gains now in terms of flexion and also, vitally, extension. Are you UK based?

Good luck and I hope things improve

Lottie  :)
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline Countess

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Re: going backwards in therapy - suggestions?
« Reply #2 on: February 08, 2011, 11:29:22 PM »
Hi There,

Sorry to hear about what you have gone through!! I have had problems with my left kneecap since I was 15 so I can understand the long struggle with a bad knee. Although I had a cartilage implant as well, my OS used a synthetic plug rather than growing it in the lab. I slipped and fell so there was no time and I did A LOT of damage in the left knee. Otherwise, I would never have had surgery to begin with and lived with the dislocations.  

I thought my recovery time would be faster than what it has been. When I first started therapy it was 5 months after my surgery. I was in a straight leg brace to protect the graft and implant. I gained...but then I lost. My therapist and I were frustrated like you are now. She custom tailored a program for me. Every patient is different and everyone heals differently. You cannot perscribe the same protocol for everyone. My therapist took the time to figure out what was working...and what wasn't working for me. After that, progress has been slow and painful. I gain 5 or 6 degrees here and there on flexion  but...progress is progress no matter how small. I did have 0 degrees extension before I started working flexion and am now at 3 extension. I am now at 82 degrees flexion.

I would have a chat with my therapist. What exercises are you doing right now for flexion? Are you scarring down at all?? That's another problem that could be going on...as it is with me. If I don't gain significantly by March 2nd when I see my OS again, I am facing an LOA and MUA as I probably have developed secondary arthrofibrosis.

Don't feel bad about the crutches. I gradually stepped down to one crutch and then just last Friday to a cane so it can be done.  ;D

Let us know how everything is going. I know it is frustrating but there are folks here who are going through the same thing. I might also suggest the same as Lottie and try posting this on the ACI section of the board if you haven't already.

Good luck!!

Nov 4, 2010 - patellar realignment, lateral release, open debridement, cartilage implant, medial reefing and chondroplasty - left knee.

April 18, 2011 - MUA

Link to Diary: http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=55169.0

Offline 2badknees2

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Re: going backwards in therapy - suggestions?
« Reply #3 on: February 09, 2011, 04:33:27 PM »
Thank you for the suggestion of posting in the ACI area.  I don't know why I didn't think of that in the first place.

I've not had scar tissue before.  So this is all new to me.  Swelling is still significant in my knee.  At p/t on Monday, my  left knee was 9 cm bigger than my right knee.  It was 9.5 3 weeks ago, so I guess that is a little gain.  It has always taken me a while to get full ROM back after my scopes.  I also had a tibial osteotomy  with this, so they believe the infection was from the hardware. 

Besides CPM and e stim, I am also doing foot slides, hanging my leg on the side of my bed (thank goodness we have a tall bed), massage and I also attempt to do SLR, although mine are not straight, since I am unable to straighten all the way.  I also wear the dyna splint whenever I'm not doing the previous exercises. 

I know it is a long recovery process, but I just don't even feel like I've started.  I go to the dr. tomorrow, so hopefully he can shed some light on this.

Thanks for your advice :)

Offline stacey123

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Re: going backwards in therapy - suggestions?
« Reply #4 on: February 10, 2011, 01:27:54 AM »
I was stuck at 90 degrees ROM for a long time and then I used a machine called ERMI and a lot of massage therapy for scar tissue and "lengthening" of my ligaments. I quit pt because I had no progression, only pain. I am now at 130 ROM and that was after using the ERMI machine for 2 months. It was expensive and was not covered by insurance but you might want to look into it or some variation of the machine. You control the flexion and the theory is to "pump" the machine until you are flexed at a point where it is uncomfortable, but not intolerable, hold it there for 10 minutes, rest 10 min., then repeat. I did this about six times a day.
12/29/09: Complete tears ACL, PCL, LCL, bucket handle tear of meniscus, post lateral corner damage
1/26/10: Menisectomy, 95% removed