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Author Topic: Need Help; How much pain should i feel when trying to regain range of motion?  (Read 2549 times)

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Offline jimmortal

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hey guys, my name is jimmy and im 22years old. im an active person who love sports but unfortunately for me i tore my ACL, MCL and meniscus from a bad fall while playing basketball on 17th dec 2010. my post op physio initially thought that someone sat on me after i fell to have had such a bad injury from a fall in basketball.

my MCL didnt heal properly by itself and so i had ACL, MCL reconstruction surgery done and part of my meniscus removed on 10th feb 2011. (hamstring autograft for my ACL and allograft for my MCL)

i am a little past 5 weeks post op and i am still having trouble regaining my range of motion. i can bend up to around 75 to 80 degrees.

the doctor that did my surgery left for canada to go on course and a new doctor took over.

on my first appointment with the new doctor, he told that my range of motion is bad and he is giving me until 28th march to bend at least 90-110degrees or else he will have to send me for another surgery in which he said he will remove all the scarring that has formed and that i will suffer if i have to go through that operation. im not sure if he said that to scare me but i really DO NOT want to go through another operation.

im trying all i can to bend my knee but at my max it just seems to get stuck and there will be pain from the inside of my knee in quite a few different parts.

from a scale of 1-10 i'd say the pain will go straight to around 4 or 5 when i am at my max range of motion and trying to push for more. the pain is sudden and sharp.

my question for you guys is how much pain should i be feeling and is it normal for me to only get 75-80degrees after 5weeks?

also, my physio therapist ordered me off crutches 3days ago. but after some walking i felt some discomfort and i cant seem to walk properly so at home i try to use 1 of my crutches for support. however my injured leg is able to bear my full weight comfortably and feels rather stable.

please give me some advice and share similar experiences. i really feel discouraged and down as i had hoped for a swift road to recovery but it now seems so daunting and im worried.

thanks, jimmy.
« Last Edit: March 19, 2011, 07:30:51 PM by jimmortal »

Offline smillie

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Gosh, it does sound like he was trying to scare you.  ::) No, you don't want more surgery if you can avoid it, but it's not the end of the world if you do have to do it.  Trying to get that bend back does hurt but shouldn't be unbearable. You want to push it as much as you safely can without irritating your knee so much that it swells up and makes your ROM worse. How is your swelling at this point? Swelling can make it harder to bend, so doing lots of ice and elevation to keep the swelling in check is helpful. When I was getting my ROM back, I found it helpful to put some heat on my knee--especially on the quads just above the knee--before working on bending, then afterward calming everything down with ice. Work on bending as often as possible throughout your day, not just at PT. I often made more progress at home than I did in PT because I could relax.

Good luck!
patella pain began early teens
'94 TTT/LR/VMO adv.
'94 MUA
'10 tried PT again
1/11 scope/hardware removal
4/11 (Finally!) dx medial instability due to LR
5/9/11 LPFL reconstruction scheduled

Offline jimmortal

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thanks for the reply! my knee is still quite swollen as i havent been icing it that often and i think its hindering my knee from bending.

just want to know, how long did you take to regain your ROM?? and 5weeks at 80degrees seems kinda slow right?

Offline Stasha83

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Hi Jimmy

I too had a major problem with scar tissue following my surgery last June and developed a condition called Arthofibrosis which is awful. At 8 months post op, my flexion was only 80 degrees. I had surgery 3 weeks ago to remove the scar tissue and adhesions and my flexion is now at 120 passive so for me, the operation has helped alot. I have a long way to go and will be seeing my physio for the next 12-18 months as I have alot of other complications but without the surgery I would have had no chance of recovery.

I'm not sure why your surgeon said you will suffer if you have the scar tissue removed  ??? Most the time they will preform an MUA alongside a arthroscopy unless major open surgery is required.

I agree with Smillie, you need to get the swelling down as much as possible as this will hinder you from recovering your ROM. Are you on decent pain meds? If the pain is under control that should help too.

At 5 weeks post op the scar tissue should still be flexible so as long as you have a good physio I am sure you should be able to make some improvements.

Good luck!
June 2010 - R knee TPF & Hoffa removal
Dec 2010 - R knee- Arthrofibrosis
Dec 2010 - L knee Myxoid degeneration of meniscus
Jan 2011 - R Knee 11 steroid injections & Synvisc1
Feb 11 - MUA & LOA
June 11- Steroid inj, EMG & nerve tests
Aug 11 - MUA & LOA
Feb 12 - R Knee denervation

Offline smillie

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I had different surgery than you and everyone is different. I can't remember exactly, but I know I didn't have more than 80 degrees at 5 weeks, probably much less.

If you are trying to get your knee to bend, it is critical that you are diligent about keeping swelling and pain under control. They will certainly work against you. If you are trying to resume normal activity and that is causing a lot more swelling, then you have to decide between getting back to that activity vs. getting your ROM back. Some people can come out of the surgery and get back to "normal" rather quickly, but then others have to fight the swelling and ROM battle a lot longer. It starts to feel like a full time job after a while, but it pays off in good knee function later.

Good luck and keep fighting!
patella pain began early teens
'94 TTT/LR/VMO adv.
'94 MUA
'10 tried PT again
1/11 scope/hardware removal
4/11 (Finally!) dx medial instability due to LR
5/9/11 LPFL reconstruction scheduled

Offline jimmortal

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im on 3 kinds of painkillers, the doctor told me to eat them everyday and bend as hard as i can. but i find that all these painkillers are messing with my head so on normal days i'd only take 1 or 2 of those meds... but its good to know that at 5weeks i still have a chance of breaking those scar tissues. im gonna start taking all the meds and push for more ROM everyday.

hey stasha, how was the surgery for the scar tissue like? how much pain was it? work hard i hope you recover soon! :)

yeah thanks smilie, im gonna really treat it as a full time job now, cant imagine life if my knee doesnt get better.

Offline Chris-tea

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I had a knee reconstruction when I was 14 years old. It was a different surgery. I had a smiliar problem with my flex. At about 5 weeks my doctor also told me that if I didn't have 90 degrees within 2 weeks he would have to put me under again and do some alterations and bend the knee for me.

My pain was really bad and it definetly is normal. I was walking in my immobiliser at 7-8 weeks still with both crutches and then I slowly went to one. After about 2 weeks with just one crutch it made me feel alot more confident so i started walking with no crutches but still my brace. it took me a further couple of weeks to walk without it. even then my knee would buckle underneith me becuase i lost alot of muscle.

The most succesful way i found getting to 90 was on an exercise bike (scary i know) but my doctor told me to go on the bike and keep trying to push urself. he said as soon as u can pedal once around you will be fine. so it took me the two weeks but i was motivated not to go back into surgery and i did it. Yes it is painful but it does get better.

Everyone is different. Only you know ur limit even though surgens and PT tell u, u have to do this.

2008 TTT and MPFL right knee (14 years old)
2011 MPFL graft fixed and Arthroscopic

Offline jimmortal

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omg chris that was what i needed to hear!!

my physio had put me on a exercise bike few days back and told me to try to pedal 1 round too. but of course i fell short by quite a bit, she told me to keep trying and as soon as i can pedal 1 round i'll be fine too! how many weeks post op did you take to pedal that 1 round? im just worried that if i dont get that 1 round soon my scar tissues will be harder to break down :(

Offline Stasha83

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The surgery wasn't too bad, it was easier than my first surgery anyway  :)

I had a femoral nerve block so for the first 24 hours I couldn't feel my leg so that helped with the pain. After that I was on a fentanyl drip for 48 hours and then moved to oral pain meds (paracetamol, tramadol, celebrex and gabapentin) which i'm still on now. I was put on a CPM about 5 hours after the surgery (it would have been sooner but I fainted and fell off the toilet and banged the knee!). The physio also came round at the same time and then every day whilst I was in hospital.

The day I was discharged I had to go straight to my own phsyio and have been having physio every day since along with home rehab so it's hard work, it is my full time job at the moment! I also had to hire a CPM for home for 6 weeks so all my time is either spent on the CPM or doing physio. I've got 3 weeks left with the CPM so that's not too bad  :)

The exercise bike is a great idea, I had to have the seat really high to start with and then gradually lower it to a normal height. Ask your physio if you an put the seat high and see if that helps. And it is true that once you manage to pedal round once you will be able to keep going and it will be so much easier.
June 2010 - R knee TPF & Hoffa removal
Dec 2010 - R knee- Arthrofibrosis
Dec 2010 - L knee Myxoid degeneration of meniscus
Jan 2011 - R Knee 11 steroid injections & Synvisc1
Feb 11 - MUA & LOA
June 11- Steroid inj, EMG & nerve tests
Aug 11 - MUA & LOA
Feb 12 - R Knee denervation

Offline Snowy

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I can vouch for the exercise bike as a great way of working on ROM. I really struggled with flex after my ACL reconstruction, and was hugely frustrated because I couldn't bend my leg enough to turn the pedals on the bike a full rotation. So I ended up sitting on the bike, using the pedals as a lever to force my leg to bend a tiny bit further. I'd turn them as far as I could, and then at the point when the knee stopped I would rock the pedals gently at the end point, pushing just a little with the good leg so that the pedal forced the bad leg to bend a degree or two more. Doing this in front of a mirror was super helpful - I could see exactly how far I was pushing the leg by the position of the pedal shaft. This was such a help in increasing flex slowly but steadily. Eventually I was able to get the pedals around, and after that things came on much more quickly.

Hope this helps - good luck!
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA

Offline smillie

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I don't know if anyone else suggested it or not, but pedaling the bike backwards at first is easier. Then when you can get all the way around, go frontwards. But pedaling backwards is easier to get a good stretch on that bend and is a less awkward angle.
patella pain began early teens
'94 TTT/LR/VMO adv.
'94 MUA
'10 tried PT again
1/11 scope/hardware removal
4/11 (Finally!) dx medial instability due to LR
5/9/11 LPFL reconstruction scheduled

Offline Chris-tea

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Yes, pedaling backwards is easier.

The first time I went round it was backwards.
I think i was about 6-7 weeks maybe when i got my first pedal once around.

I only ended up doing Physio 3 weeks before i had to stop because they were a really s**t place, and couldn't go anywhere else. So I ended up having to do it all by myself which is very hard.

I have to get my TTT re-done in about 3 weeks which i am not looking forward to. Atleast the excersise bike will get some use  ;)

2008 TTT and MPFL right knee (14 years old)
2011 MPFL graft fixed and Arthroscopic

Offline Ironjill

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Wow I'm really surprised you are allowed so much ROM given the MCL reconstruction. Very different beast from just an ACLr. Good luck :)
April 4 2010 skiing accident :
R. Knee ACL rupture, grade 3 MCL tear, tibial plateau fracture, separated meniscus, meniscus tear.
L. Knee PCL rupture, grade 3 MCL tear, meniscus tear
Aug 18 2010 R. Knee ACL reconstruction with allograft.
Oct 15 2010 L. Knee PCL & MCL reconstruction with allograft.

Offline jimmortal

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i had physio today but still i couldnt get that 1 round :P another session on friday, i will try out pedaling backwards then! lol my scars are still red and they heal so slowly.. and maybe it's due to the fact that i dont eat my greens so i might have less vitamic C. c

ome this friday and it will be 6weeks, how long does it take for the scar tissues to harden that they cant be able to be broken down without surgery??

ironjill, i have no idea about that, what im told is to regain as much ROM as possible but yes there is some soreness near the MCL area that is also preventing me from bending more.


Offline smillie

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I'm surprised they didn't tell you to go backwards first. Definitely try that. It's a different motion and I think a lot easier. Also have your seat up nice and high. After you get good at backwards, then try forwards. Then when that is easier, start lowering the seat. Then when you have your ROM, add the resistance. At least that was the plan used at my PT place. Consult your own PT, of course, to be sure it works with your protocol.
patella pain began early teens
'94 TTT/LR/VMO adv.
'94 MUA
'10 tried PT again
1/11 scope/hardware removal
4/11 (Finally!) dx medial instability due to LR
5/9/11 LPFL reconstruction scheduled















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