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Author Topic: MPFL & Physiotherapy  (Read 3830 times)

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Offline natasha1905

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Re: MPFL & Physiotherapy
« Reply #15 on: August 13, 2012, 07:39:08 PM »
Hi folks

I just wanted to check in with you all. I had my follow up consultation after my op today and the doctor was pleased with my progress. I am apparently a week ahead of schedule in my recovery and have been given the ok to start physio!!! EEEKKK!!!!

He also said I should be starting to try to walk on my leg, starting with crutches but also without. Only 3 weeks post op I personally think this is a bit soon but i guess he knows best!!!

Only area of concern is that I cannot really lift my leg while straight and hold it in the air, he said this is something i need to work on but at the moment I just dont have the strength to keep it straight and hold it in the air :(

Offline natasha1905

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Re: MPFL & Physiotherapy
« Reply #16 on: August 13, 2012, 07:47:19 PM »
Hi Claire,

I agree with all comments, everything should go ok in the surgery and will hopefully be worth it all in the end when your knee is fixed :)

Similar to the others I was on a lot of morphine and tramadol (which i am still taking now) although these made me very sick during the day so I am only taking these at night now. The pain is never taken away with the pills but at least the edge is taken off it!

Not sure about you being kept in hospital until you can bend your leg and weight bare. I was allowed home the next day after my surgery and couldnt bend my knee at all and wasnt allowed to weight bare with the crutches for a couple of weeks. As I havent been to physio yet myself I have just been trying to bend it as I am sitting on the sofa/chair at home - sliding my heel backwards. I got a really good tip to put a plastic bag under my foot to help it slide and it worked great :)

Good luck for your op and keep us posted! If you have any questions I will try my best to answer although everyone has had a different experience
Take care
Natasha x

Offline Xeplasma

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Re: MPFL & Physiotherapy
« Reply #17 on: August 13, 2012, 08:30:15 PM »
That's great news Natasha! OS wants the crutches out between 4 weeks and 6 weeks, that's the goal, not sure it is a realistic one for me.
Hi Claire!
It hurt quite a bit for the first 3 days and I was given some hydrocone(7mg) with acetaminophen(500mg) in one pill to take every 4 to 6 hours. I stopped taking it at day 5 because by then the pain was of the same intensity as post twisting my knee. I took a pill of acetaminophen for two days but then have been off meds.
I am 13 days post op and partially weight bearing. It is becoming easier every day to hop around so I am hopeful.
There are a couple of MPFL recovery diaries on the forum in case you're interested in reading or starting your own.

Offline Ouchy

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Re: MPFL & Physiotherapy
« Reply #18 on: August 15, 2012, 08:41:54 PM »

Hi Everyone,

Thank you so much for all your comments and advice! I had a lateral release and for some reason had just let myself think that the pain/pain relief was likely to be similar. At least now I'm mentally preparing myself for it being quite a bit worse.

I think the ice is a really good idea. Do you all just use normal icepacks or did you go for cryocuff type things?

I'm going to try and use some of my savings for private physio as well as NHS I think. After my lateral release I was only seen 1:1 once and then put in an ACL class which wasn't really massively useful and I'm quite worried that if the same happens this time the operation will just have been a bit of a waste of time! I know of a good private post op physio so fingers crossed if I go for some intensively for a few months it'll get me back on the right road!

Good luck with all of your recoveries  :) I will definitely check out some of the MPFL diaries as well.

Claire xxx
2001-2010 - Multiple dislocations of both patellas
October 2010 - R patella dislocation during first aid training!
June 2011 - R arthroscopy with lateral release & debridement
August 2012 - R MPFLr

Offline Teacher2Many

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Re: MPFL & Physiotherapy
« Reply #19 on: August 15, 2012, 09:54:17 PM »
Natasha...I too am 3 weeks post MPFLr but mine was done bilaterally.  I was off crutches at 2 days post-op so although it may sound like 3 weeks is early, it is doable.  I was using them when I'd go out (only 1 for balance) but don't even do that anymore.  For me, I always found the longer I was on crutches, the more I became dependent on them and lost a normal gait pattern so the sooner I was able to ditch them the better.  I used them for the first two days as they had to do a femoral nerve block on my left leg and couldn't feel if I was putting weight through it at all so I used them for balance, not actually 'hopping' with them.  Plus with my shoulder issues, I didn't want to aggravate it at all.  Start small when ditching them-little things like walking around your house but always where there's something you can hold on to (counters, walls, etc) until you are comfortable.  I found that walking barefoot is best-socks make it too slippery and shoes make it too hard for you to feel where your foot is landing.  But that's just me!

Claire...I think everyone who's had this done can agree that pain for those first few days is the worst.  Stay on top of your pain meds, especially in the beginning, even if it feels like you don't need them.  It's always harder to get ahead of it once it rears its ugly head.  My bilateral MPFLr was outpatient so I was sent home on hydrocodone 10/325 and that's it (other than the lovenox injections).  But I had some toradol from previous surgeries that I used twice, as it works far better than any other pain med and is not a narcotic but you can only take it for 5 days if you take it regularly as prescribed but I only use it at bedtime when it's absolutely necessary so it's not constantly in my system.  I did get the cryocuff and love it; I usually ice for about 1-1.5 hrs. at a time/leg and in the beginning was doing it religiously-as soon as one leg was done, I'd switch to the other.  I would go to bed with it on and even use it in the middle of the night when the pain got really bad-for me, it worked better and faster than pain meds so I always start with that and if it doesn't work, then I would consider a pain pill.  I think my surgeon typically prescribes the ice machines but I think this time around, I got the cooling/compression one because I developed 2 blood clots after major surgery last summer and once you get them once, you are more prone to it so the cryocuff not only helped with the pain and swelling but also provided that compression to keep the blood flowing.  I had my first post-op appt. at 8 days and started PT at 9 days and currently going 3x/week but think when I see my surgeon next week, if he can rewrite the script for 5 days/week until flexion improves.  Going privately is a good idea-it's always hard to inflict pain upon yourself and sometimes you need that person bending your knee a little farther to get flexion back when you probably would stop due to pain.

Best wishes to all!
6/07-L TTT & LR
6/08-R TTT & LR
6/09-Bilateral ACI
7/10-R derotational femoral & tibial osteotomies, LPFL reconstruction
6/11-L derotational femoral & tibial osteotomies, R hardware removal
1/12-L tibial hardware removed, R scapulectomy
4/12-L femoral hardware removed
7/12-L & R MPFL reconstruction

Offline franny

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Re: MPFL & Physiotherapy
« Reply #20 on: August 16, 2012, 10:23:58 AM »
There are some fantastic super recovery stories here but also don't be too disheartened if you don't get on as quickly.
My progress hasn't been anywhere near as good as Teacher2Many unfortunately and it is really easy to get disheartened when reading how well everyone else seems to be doing.

I am also an NHS patient and for some reason my OS kept me in a straight leg immobiliser for 3 weeks so my ROM is not as high as some others who started PT earlier. I personally will push to get mobilised earlier than this when I have it done on my other leg and I think going private, if you can afford it, for PT is a great idea. My referral to PT was  a nightmare and I subsequently started over a week later than was recommended and only got an appointment because I kicked up a fuss! Finally got the referral call at nearly 6 weeks post op! So glad I can be quite forceful when it comes to my health!
I do think you'll get seen 1:1 with this one though as it is quite a personal recovery and you will have a lot of manipulation by the physio.

Phew, got on a bit of a rant there!

What im really trying to say is that each different OS has a different protocol and there own reasons for it. Some people heal really quick others not so quickly. I'm really trying to stop comparing myself to others so much, it is great to get encouragement from others on this board but in the only person you can measure yourself against with is you. If you know your doing all you can to get better then that is all you can do.

Good Luck!

F
x
Bendy Childhood
1999 - Dislocation R Knee-cap
2002- dislocation L knee-cap & arthroscopy
Many subluxations & instability in both knees
2008- gave birth to daughter, PGP, subluxation and instability following birth
2010- dislocation L knee-cap
2011- EDS III diagnosis 
02/07/12- MPFL Reconstruction

Offline emm10161301

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Re: MPFL & Physiotherapy
« Reply #21 on: August 16, 2012, 12:52:05 PM »
Hi franny, I totally agree with you, every os does and has their own way. I was over a month post surgery before I got a referal and even now being 2 months post op on mon, I am only going for my 4th physio session today. They last 20 mins, (if that) and I feel the time goes too quickly. I was told I'd have physio for 8 months aprox. After surgery. So that's a long time, I think?. But I'm appareantly wizzing through, although compared to others I feel I'm miles behind, with still being on crutches. But everyone is different and heals at different rates, some peoples knees may have been slightly worse that others, some have higher pain threshholds and some don't. So my moto is do your best, and a little bit more :)
2002-2012 regular dislocations of both knees, tried everything from braces and casts to physio.
June 2012 MPFL surgery on both knees

Offline Teacher2Many

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Re: MPFL & Physiotherapy
« Reply #22 on: August 16, 2012, 03:47:25 PM »
Hi all,

I totally agree with everybody in that each surgery, each protocol, each OS opinion is different.  This board is great in getting rough ideas pertaining to pain, recovery, etc. but more importantly, to know you're not alone and that others have been through the same thing and know the frustration, pain, and simple joys that other non-knee people don't quite understand, despite how hard they try.

My previous post was definitely not one to 'brag', for lack of a better word, and hope it was not taken as such.  I have had major knee surgery every summer since 2007, with smaller ones over spring and winter break.  This past surgery, the bilateral MPFLr, was surgical incision number 24& 25 (I say incisions vs. procedures as sometimes one incision leads to 2-3 different things being done and of those 25, 19 have been on the knees and/or hips.)  I definitely was more cautious with the first 2 major surgeries in regards to fear of getting off crutches, worried about every little slip of the leg when walking, etc.  but I've been down this road so many times already, that some of those things don't worry me anymore.  I hate crutches so as soon as I got the ok to ditch them from my OS, trust me when I say they were gone as soon as those words left his mouth and I just learned to do without and manage the pain-the saying of "slow and steady wins the race" certainly applies as what would be a 10 minute trip to Target turns into a 30-45 minute trip!   Certainly wasn't easy but for me, the longer I was on when the more dependent I got and the more the muscles atrophied from not being used as much which ended up making rehab even harder.  But that's just me and everyone heals differently and knows what they can/cannot do at given times of rehab.  :-).

I did question my surgeon when he removed the full leg braces at one week post-op (originally they told me id be in them for 6 weeks) and he said that research is showing and they're finding that MPFLr is actually a very stable surgery and the graft is very strong so there is no need to be as cautious as previously thought, although not sure if it depends on the type of graft used or not.  Here's a link I found when first doing research on this surgery and thought I'd share it with you (Dr. Teitge is one of my OS who did the derotational osteotomies on both legs but all others were done locally).  http://www.healio.com/orthopedics/knee/news/print/orthopedics-today/%7BF3A20A13-96EC-433C-89DD-11CFAC6E946E%7D/MPFL-reconstruction-for-patellar-instability-in-younger-patients-Saveit-for-the-recurrent-dislocators.            it just shows the differences in protocols and thoughts behind this surgery, reiterating how everyone has different views.

Hope all have a great day-wet and rainy here so I'm definitely avoiding any outdoor activities; rain and flip flops don't mix well without it causing some slip and slide fun! 
6/07-L TTT & LR
6/08-R TTT & LR
6/09-Bilateral ACI
7/10-R derotational femoral & tibial osteotomies, LPFL reconstruction
6/11-L derotational femoral & tibial osteotomies, R hardware removal
1/12-L tibial hardware removed, R scapulectomy
4/12-L femoral hardware removed
7/12-L & R MPFL reconstruction

Offline franny

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Re: MPFL & Physiotherapy
« Reply #23 on: August 16, 2012, 04:23:38 PM »
Teach2Many, I haven't taken your posts as bragging at all - i didnt intend for it to come accross that way. I think its great you are doing so well and it makes me feel good reading positive stories and outcomes, I think it gives you positive things to aim for reading of others success  :)

I just wanted to give some assurance that we all progress at different rates and it so easy to beat yourself up if you are trying really are and don't feel like you are getting as far as others, which is how I have felt at times.

Thanks for the info about mobilising, I think I'll whip that out when I'm having the inevitable argument with the OS about the rehab after the right knee is done!
I agree with the crutches - don't use them at home at all, other the stairs but due to really bad muscle atrophy I've been told ie got to se them out and about, only use the for balance though - am able to weight bare great just really struggling with the bend. I've also got some tethering under the scar on the patella.
Any tips on how to deal with bending and tethering would be much apreciated. Doing the usual massage over the scar but other ideas would be fab.

F
x

Bendy Childhood
1999 - Dislocation R Knee-cap
2002- dislocation L knee-cap & arthroscopy
Many subluxations & instability in both knees
2008- gave birth to daughter, PGP, subluxation and instability following birth
2010- dislocation L knee-cap
2011- EDS III diagnosis 
02/07/12- MPFL Reconstruction

Offline Teacher2Many

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Re: MPFL & Physiotherapy
« Reply #24 on: August 16, 2012, 04:39:15 PM »
I agree with the ease of beating yourself up-there is a 20 degree difference between flexion in the two knees and It drives me crazy, especially as I am returning to work next week!  Oye vie!  :-)

I had gotten really frustrated last week as the left knee did not gain flexion at all in th course of over a week nf when I looked up protocols online (my OS doesn't have one), some were stating flexion at 90 at 2 weeks post-op!  I was in tears as I wasn't there yet and it's so easy to assume you should be farther along than you are.

Unfortunately, don't have much to offer with flexion tips, other than heel slides both active and active assisted and doing them both when laying on your back and with your foot against the wall, as I'm stuck at the same measurements, other than a few degrees of improvement.  I am wondering if using a CPM initially would help, even if it's only set to 15-30 degrees, just to keep things moving.  Some OS recommend it, others don't.  If my OS has any advice to shed at my appt. next week I'll be sure to pass it along.
6/07-L TTT & LR
6/08-R TTT & LR
6/09-Bilateral ACI
7/10-R derotational femoral & tibial osteotomies, LPFL reconstruction
6/11-L derotational femoral & tibial osteotomies, R hardware removal
1/12-L tibial hardware removed, R scapulectomy
4/12-L femoral hardware removed
7/12-L & R MPFL reconstruction

Offline natasha1905

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Re: MPFL & Physiotherapy
« Reply #25 on: August 16, 2012, 09:31:11 PM »
Wow everyone seems to be doing so well!!! Similar to what everyone else is saying everyone heals at different rates but I totally understand its hard not to compare your own recovery to that of someone else, especially if they are progressing quicker than you!!! Then it's complete jealously!!!

I have booked my first physio session for next Tuesday and am really nervous as to what to expect, it's just a 30min session so hopefully it won't be too painful!

I am trying to get around the house now without the crutches but my leg feels so weird walking when I can't bend it properly! When you say about pushing your foot up the wall is that just to have something to kinda force the bend? Sorry if that seems like a stupid question :) x

Offline emm10161301

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Re: MPFL & Physiotherapy
« Reply #26 on: August 16, 2012, 11:40:47 PM »
Hi natasha1905 the foot slides up the wall are like the ones you do lying in bed where u slide your leg up to the bend and back out straight. Some people find that if you do them against the wall and have your leg flat against the wall. And let gravity slide it back down it helps with the bending. My explaining maybe isn't great but I hope this helped??

I had physio today and I had both knees MPFLr also. And well I am quite dependant on my crutches, being 2 months post op on monday I'm jealous of those of crutches! Don't get me wrong, I'm pleased that you's have progressed soo well. But my two knees are proof everyone heals differently. My right knee was measured and ROM is back to 100% and my left knee is reaching 103o. My 100% is 135o. It has taken me weeks to get the left leg back to bending even this much. But my physio taught me to put one finger and thumb slightly above on either side of the knee (my poor diagram shows - the line is the thigh, circle the knee and the dots either side of the thigh is rooughly where u place a finger and thumb)
   . |.
     
     |

But when you tighten your mucles holding your finger and thumb there you should feel, so as you progress on you will feel them building. It helps if u have a good leg to compare to.

But that's my useless info for today :) night everyone
2002-2012 regular dislocations of both knees, tried everything from braces and casts to physio.
June 2012 MPFL surgery on both knees

Offline Xeplasma

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Re: MPFL & Physiotherapy
« Reply #27 on: August 17, 2012, 03:12:03 AM »
Nice link teacher2many. I actually read this article week 1 of recovery and it is interesting o see different approaches. There is no one size fits all.
I'll just add to all he great posts above that keeping a positive attitude is key. It is motivating to me to read other people stories although at times I wish I could go as fast as some too. I think we need to boost each other up. I like Emm's motto and might steal it, heck I think it should our 'group' motto: do your best and a little more. We can do this thing!

Offline YogaGirl

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Re: MPFL & Physiotherapy
« Reply #28 on: August 17, 2012, 01:43:49 PM »
It really is motivating to read everyone's stories. I feel like I'm so ahead of the curve now hearing tips on how to get around and work on flexion...  ;D

When my surgery comes around I'll be posting a post-op diary, but I also am going to start a blog (www.peaceloveknees.blogspot.com) to tie in the surgery recovery to yoga (I'm a yoga teacher)... I feel like it would be helpful for people in our situation to have some other stretches/shapes/exercises besides just the typical PT to do at every step of the recovery. What do you think? Looking forward to getting ideas, tips, suggestions from everyone here too  :)
www.peaceloveknees.com <---- check out my MPFLr blog
www.brightskyyoga.com

Offline natasha1905

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Re: MPFL & Physiotherapy
« Reply #29 on: August 18, 2012, 12:32:52 PM »
Hi Yogagirl

I think that would be a great idea!! Something I would def look into. Before I had my operation I had to try physio first and they kept coming back to yoga or pilates for core strength which in turn would strengthen everything else. Although doing something like that now would have to wait for a while as I dont think i could get into those shapes with my knee not bending very much!!! Keep us posted on that and how you get on :)

emm10161301, i wouldnt be put off that you still are on crutches, you have came so far having one knee back to 100%!! I have my first physio session next week so ill be able to let you all know how i get on. I am trying to tighten my muscles as you have described in your post but so far my brain and knee dont want to listen to each other :( But hopefully physio will be the kick up the backside i need to get my knee bending and get these muscles working.... i doubt ill be saying that next week, ill be crying like a wee girl :)

xx