LOA & MUA round 2

[Juneau]

Hi Stasha,
I am so sorry to hear that you are struggling with your rehab.  Having to deal with AF setback is such a strain on our emotions.

Maybe your patella getting tight is your knee's reaction to doing too aggressive rehab that it can't handle. Having increased pain after physio may be a sign that your PT is trying to work you too hard. You went through quite a bit of surgery pretty recently and your knee is trying to heal from that and then just can't handle the added activities.

I was doing fine with rehab until 3 weeks ago (which was 6 weeks post surgery) when I did a leg press like device in one PT session and then a bit too much wall slides a couple of days later and I started to get into swelling cycles - knee got much more swollen, hot and had more weightbearing issues again.

I cut way back in my rehab and have been doing only the bare minimum to keep the current mobility.
Careful stationary bike a few times a day (I am not on a CPM anymore, so bike for flexion),
hamstring stretch in sitting position, quad set, and patella mobes every 1 - 2 hours during the day

The first two weeks, I basically stayed all day on top of the bed so I could elevate my legs really high all day. Only got up to do my exercises and when necessity called. Used two crutches if I had any pain while walking. My knee would just balloon up and get hot whenever I got up even to go to the next room - but I still did those very limited exercises without pushing too hard. It was also hard for me to have to ask my husband to cook all of my meals again and serve me since he is so busy with his work, but I just had to really cut back in my activities of daily life as well.

My patella mobes felt squishy and a little tight at times, so I had to start carefully and do them a bit longer.

My knee was heating up uneven, my portals were often way more hot. It helped to use an ice cube on them and do a little ice massage before I did my regular icing. Otherwise I would have a very icy knee on one side and still warm knee in those sensitive areas.

It really helped me to try to relax as much as I could. The three day weekend last week really helped. I did not turn the computer on. Got a massage, read a gripping book, watched some fun movies - tried to get away from it all.

This week I started to do much better and felt that I could add more activities again. I could go to the office again to work instead of having to work on top of the bed lying down. I still swell up after exercise and if I do too much but it goes down again and my knee is looking normal again and I don't have to ice it anymore at night, only during the day. I also felt that I could add again straight leg raises and straightening and locking my knees standing up.

I think that we have to listen really hard to our knees and adjust all our activities as needed. Our PT's think that we need to follow a schedule to see this and that improvement per week and our AF knees just can't handle it. A normal knee may take a couple of days to deal with a setback but an AF knee may take a few weeks.

Hope you can relax this weekend and take it really easy! I wish you all the best to get back into your groove 

[Decruz]

This suction cup device is what I have my PT use to keep my patella moving. He can then lift it slighly up and then mobilize it. I got the set, I think throuigh Amazon.com, because I wasn't sure of the size cup I needed, but I only use the yellow cup.

http://www.bannertherapy.com/ProductInfo.aspx?patella-mobilizer-set&number=95-550

Kristin

Hi Kristin,
when you buy this patella mobilizer set (http://www.bannertherapy.com/ProductInfo.aspx?patella-mobilizer-set&number=95-550) it includes 1 bulb and all the suction cups available? If I got it right the suction cups are different in size so once you get the set you pick the one that better fit to your knee, right?
Thank you

[kcknee]

You get the set of one bulb and the three cups. They used to sell the cups separately, but it looks like they must have sold out of the individual cups. My PT tried working with each of  them and the yellow works best for me. He wets the cup first so the suction is better. The scar tissue coming back over my knee had stopped me from doing stairs normally for months before my PT tried this and now as long as I get him to do it a few times a week I can do stairs normally most of the time. My PT can get a better angle on this than I can and uses more strength, but it does work when I do it too.  My insurance lets me see him 2-3 times a week so I usually let him handle the major stretching out of my knee.

If you live in the States, compare the price + shipping with what it is on Amazon; at the time I got it Amazon was slightly cheaper. Search for "patella mobilizer".

Kristin

[Lottiefox]

Hey Stasha

How has the weekend been? Have you had gales?! It has been pretty windy up here - cats blowing sideways....

I hope that your pain and patella have settled down. You've got some really good advice from folks here. I know I don't have AF but RSD seems to have the same "mind of its own" mentality with the key to being pain free (relatively) and having good function being able to identify what is enough but not too much activity. I am nowhere near that. It is hard work, draining on the soul and the emotions as well as the physical side.

We do get it on here so feel free to vent and also to let us know you're OK,

Hugs xxxx

[Decruz]

Yes, it costs less on Amazon: http://www.amazon.com/Therapy-Best-Buys-Patella-Mobilizer/dp/B0008EJFWW/ref=sr_1_1?ie=UTF8&qid=1315794174&sr=8-1

Thanks

[Stasha83]

Hi everyone

Thank you for all the replies, I really do appreciate all the help and advice. I am trying to keep my weekends 'knee free' for the sanity of my family and friends (I fail miserably though!) so haven't been on here over the weekend.

There hasn't been any improvement with my pain levels and if anything, my knee is feeling stiffer. I agree that perhaps we are doing too much in physio. My OS said he wanted me to just do basic ROM work and quad activation exercises for the first 6 weeks but my physio is really keen to push forward. I can understand this, but like Juneau said, AF knees can't handle it. I am seeing a different physio today as my usual one is off. I think it will be good to get a fresh opinion on things.

This time round is so much harder than the LOA in February. I guess it is because I had more done? Everything hurts more and my recovery is much much slower. I read my surgery notes recently and I found out that my patella tendon also had to have scar tissue 'dissected' (my OS used this word). If my patella and patella tendon were both effected does this put me at a higher risk of patella baja?

This morning I found a small lump in my calf which is also bruised. It is painful to touch and painful when I lift my toes towards my knee. I am slightly paranoid that this could be a blood clot. I am probably worrying over nothing but will check with my physio when I go this afternoon.

Kristin, thank you for the link to the patella mobilizer, I have never heard of this before and will speak to my physio about this. Anything is worth a try!

Lottie, it is very windy here today! I'm not sure how me and my crutches will manage going to physio! Your numbness sounds worrying, could it be something to do with a nerve? I hope you get an appointment with your pain doc soon. Did you find out about the Lidoderm patches? I am going to ask my GP for a referral to the NHS pain clinic, I'm not sure that there would be much they could do for me but I think it's worth a try.

Juneau, thank you for the advice. I try to not think about my knee at weekends, but it's a little tricky when I'm in pain and on a CPM! Managed to go to the pub for a few hours this weekend which was a great distraction. When you had your CPM did you still use the bike? I have a CPM at home, but when I go to physio (3 times a week) I also go on the bike for 10mins with no resistance. Last week we also did the leg press machine with very little weight (2kg) to work on my lack of terminal extension. I'm wondering if this is too much at this stage?

Stasha

[Stasha83]

So it turns out that I was right to be paranoid about a blood clot as I do have one! I have what the Doctor called thrombophlebitis which is basically a small clot and an inflammed vein. I just need to keep an eye on it as there is a small risk that the vein could get worse but hopefully not a DVT! Stupid leg! 

[Lottiefox]

Boo! Stupid leg! Why are our lower limbs so determined to misbehave??? Good work on getting checked out. Do you have to try and do more ankle punp type actions and stuff? Can you massage it or does that raise the risk of it getting more upset? Boo. Not what you needed!

How is the knee feeling today? I think Physio perhaps needs to back off a little, although I am no expert in AF. Balancing acts are very hard to achieve....

Hugs,

Lottie xxx

[Juneau]

Hi Stasha,
It's very healthy to get a way from the computer over the weekends and to try to relax. It was also very good for me, when I took it completely easy with no computer over the long labor day weekend.

Doing the leg press at Physio 3 weeks ago (which was 6 weeks after surgery) is what caused my setback that I now have to deal with. I talked to my OS after it started and he said - absolutely no leg press!  My knee can't handle the extra pressure at this point in the rehab. I am only to do exercises for ROM and isokinetic squad. That's pretty similar to what your doctor said. I have read in many places that for AF knees, you have to first work on ROM and that the knees can't handle being loaded early. I also have terminal extension lag and I need to get stronger to get over this - but I can't get it through machines or aggressive rehab. I am planning to start going to the pool later this week or next and start walking there to strengthen in a safe manner for me. That's what helped getting my strength after my last surgery.

I either used the CPM or the bike, because as long as I used the CPM, I could not go around on a bike (except at the Physio in Palo Alto where they had a special bike that allowed my full rotations even I had not achieved enough flexion yet). If you do the bike at the Physio, don't force the rotations either - if you use it to warm up and you can't go around at first, then just do some half circles until you can go around easily.

You might have to reduce even further what you are doing since you have a flare up. I even eliminated my straight leg raises and I can just now start doing them again 3 weeks after my flare up started. Don't let the PT bully you into doing more because it's what they expect you can do. I have discussed with them that I need to follow a schedule that my knee can handle. Maybe your PT can just work on hands on massaging and stretching you to help with your extension for the time being. I had to reduce dramatically the exercises that I am currently doing at Physio and even reduced the visits for now - my knee needs to get over the setback and then I can be more aggressive again.

Sorry to hear about your blood clot. I guess your knee just wants to be treated very carefully now.
Take good care of it.

[Stasha83]

I'm certainly not willing to be friends with this leg now!

The Dr just said to elevate it as much as I can (difficult on a CPM and AF rehab plan!) and keep an eye on it. Its  really sore so I'm not very keen on touching it. Sure it will be fine. Hoping it won't leave an ugly lump in my leg though, the multiple scars are enough!

The pain in the knee is still high, I'm seeing the physio tomorrow but I agree that we need to back off a bit. I'm sure this amount of pain is not right. I haven't had much heat or swelling so that's something to be pleased about.

[Stasha83]

Sorry Juneau, I posted my reply before seeing yours.

I was worried about the leg press machine, but with very little weight I hoped it couldn't do any harm. This was last week, so 3 weeks post op for me. Way too soon. I won't be going near that machine again for a while!

I am going to firmly stick with just ROM and quad activating exercises, no loading and no irritation (I hope!). I just hope my physio doesn't take offense when I see him tomorrow. My OS did speak to him about this and so have I, but for some reason he is just so keen to push forward. I guess this is what you would do for a normal knee but it just doesn't work for an AF knee.

I have got my CPM for another 3 weeks. It does take me a while to be able to manage a full rotation on the bike and I have to have the seat pretty high but I get there eventually!

I'm impressed that you can do a straight leg raise! I haven't managed this for over a year now and still can't even get close. I can lift my leg but the knee has to bend before it will lift. I guess I'm just not strong enough.

It's interesting that you mention going to the pool, I was thinking about that this morning. I think walking in the pool would be great, I don't think I'm quite at this stage yet though.

Thanks again for your advice, I'm off back to bed for my next stint on the CPM - lucky me!

[Juneau]

Stasha,
Don't worry about your physio taking offense. It's your knee that has AF and you have to live with it. Some physio's and OS that are not experienced with AF think that the patient is not working hard enough but we can only do as much as our knee allows. A normal knee might take a couple of days to recuperate from a setback but an AF knee may take a few weeks.

If you have not done so yet, print out the Rehab protocol that Mr Dirk Kokmeyer, physiotherapist at the Steadman Hawkins Clinic posted on this site. I have given this to my physio therapists.
http://www.kneeguru.co.uk/KNEEnotes/node/263

Under the principles he explains clearly:
"Decreasing swelling and preventing inflammation is essential to maintaining and increasing motion. Weight bearing is also another important variable. When the knee is loaded by early weight bearing activities or aggressive strengthening, recovery from an inflammatory process will only be delayed or exacerbated."

Another good article that I have found that was written by Dr. Millet a few years ago that also explains the rehabilitation process is:
http://drmillett.com/attachments/article/87/Rehabilitation%20of%20the%20arthrofibrotic%20knee.pdf

I can do up to 15 straight leg raise on the bed (not on the floor) if my knee is not irritated. If it is irritated, I can't do it either. On the things that has helped me tremendously with getting strength is Kinesio taping. I am planning to post some of that but have not had time to do it yet. I have been so busy with work the past week.

It's probably a little too early for you to go to the pool. Your incisions have to be all healed up again. I want to go this week but one of the things I have not done it at our public pool yet is that I am a bit concerned about mastering the wet floor in the locker room and pool area. I wished there was a person I could go with the first  time.

Good luck with your appointment tomorrow!!!

[Lottiefox]

Hey Stasha,

How are things going? Has the leg settled down now? I hope the Physio took on board your concerns...after all this is YOUR leg and knee and you know it well! Hope you had a weekend where the knee didn't dominate things too much....let us know how you're getting on...

Sending positive thoughts!

Lottie xx

[Stasha83]

Hi Lottie

Thank you for asking after me, not much has changed really. I had a really positive discussion with my Physio and feel that we are now thinking along the same lines. We have backed off a bit and spent the past few sessions just working on the patella and surrounding tissues to try and keep everything free. I think my knee has dropped a level in pain but I am still in pain all the time so it's hard to tell.

Im seeing my OS next Monday so I'm hoping he'll be pleased with my progress. Im planning on going back to work in 3 or 4 weeks so fingers crossed!

How are you getting on? Any improvement? I hope things are getting better for you.

Stasha

P.S Apologies for any typos, I'm typing this on my iPhone and can't fully see what I'm writing!

[jigs]

Hey Hey Hey Stashaaaa...........

Calling out to u. Quickly read thru all u have gone thru and feel for u. Hope u remember me. I sued to post in ur earlier post and last couple of months I got really tied up so couldn't  post and also couldn't do much with the knee either. All i am gonna tell u is that just HANG IN THERE.....

Well today is my knee anniversary and exactly a year ago on 25th sept i busted my knee and my ACL.... though i had my surgery in oct and then an MUA in feb......

I have been doing quite well..... though my extension still lags by a 2 to 3 degrees and my bending lacks by a couple of inches and when forced my ankle touches my butt...... the pain comes and goes but it is nothing severe........ i can run or jog for 3 to 5 mins and then the knee acts up..... i have not been doing physio for the last two months or so and also no workout for the last month...... and as i see it my knee has been doing reasonably well........ though i dont wanna jinx it by saying so...... i do get worried suddenly coz i have not been doing much for it in the last cpl of months due to my crazy busy schedule........

One thing i have discovered and studied over a period of time is that the lesser scopes and surgeries u do the better it is....... i am glad that i just did an MUA in feb and it seems it have almost sorted my knee..... All i can tell u is just hang in there and give it ur best shot this time round and trust me u will be sorted.....

Was thinking about u so specially came to check on u and discovered that u have got another scope done.

Will keep checking on u for sure

KEEP SMILING.....

Cheers.....

JIGS....