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Author Topic: weak thighs causing pain in knees after 6 weeks of arthrofibrosis  (Read 25509 times)

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Offline mum2xl

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After a knock to my knee during a sporting activity 19 years ago, I have carried an intermittent pain in my left knee ever since. I had a consultation with a consultant and he said that I would need a week off work and would be back to exercising a month after the planned arthroscopy.  On 14 June 2012 in a private hospital, I had a simple debrasion to the rear of knee cap via arthroscopy to this knee.  The consultant also confirmed what I already really suspected - that I had quite a few areas of cartiledge wear and tear inside my knee and also that he found grade 2 arthritus.  I am confident that my right knee is of much the same condition as they always feel exactly the same after I exercise - burning pain and stiff under the knee cap.  I put alternate ice and heat on them and they were always back to normal within a day or so. without any remaining problems. 

I did the exercises I had been given every single day from the day of the operation.  After 2 weeks I was not progressing - my knee felt very swollen and stiff inside and I could hardly bend it.  I had not been able to lift it up to do the leg raise exercises with a straight leg at all.  It was like the message was not getting through from my brain to my leg.  I could do it bent with a towel underneath but it really hurt on the left hand side on the fat pad, where one of the incision points was.  Even though it hurt I continued to do the leg raises with a towel underneath.  I could not gain enough control over my leg to lift my leg on and off the clutch in my car until 2&1/2 weeks after the operation.  It just felt like a dead leg. I noticed that I could not flex my muscle in my thigh to lift my patella.  Nothing happened when I tried to do this.  I mentioned this to the Physiotherapist around the 2 week post op mark and he said he thought that this was maybe because I had not had my stitches out at this point and I still had a gauze across my knee.  I mentioned that I felt it was a bit weird why I didn't seem to have much control over my leg to him and he agreed - which concerned me slightly.  However he said that everyone heals at different rates and I was still within the 'normal' range.

I had my first back with the consultation shortly after this.  I voiced my concerns over the fact that my knee would not bend and the fact that it felt very stiff still and swollen inside.  He assured me that the stiffness would go in the next few days.   He said that although I had progressed a lot slower than was normally expected, he wasn't at all concerned as everyone heals differently.  I continued to make hardly any/if any progress whatsoever in the next week or so and this began to get very depressing.  I rang the physiotherapy department on several occasions at this time as I was starting to get worried sick about my knee.  It took them ages to get back to me even though it was clear that I was quite upset and worried.  When they finally rang me back after a couple of days the young physiotherapist I was seeing reassured me that again as he had previously mentioned, everyone heals at different rates - he gave the example of another patient who had only just got full range of movement back after 6 weeks.

Around week 3 I had a change in physio after the one I had been seeing left.  The senior physio took on my sessions after that and on the first one she told me that I was not progressing due to the fact that I had wear and tear areas inside my knee and it was just going to take time.  I asked her what the very rock hard swollen area was on the side of my knee and she explained it was my fat pad.  On the 2nd session with her, during a particular exercise done to try to strengthen my thigh (rubber band placed under my foot and holding each end of the band I was asked to straighten my leg).  She said that I should be able to feel my thigh muscle flexing as I straightened my leg.  I could straighten my leg but my thigh muscle was not flexing.  There was no movement in my thigh muscle whatsoever.  She put her hand on my thigh and agreed with me that nothing was happening when I straightened my leg.  She was surprised but not concerned and told me to pursue with the straight leg raises instead of this exercise with the rubber band.

I could still hardly bend my knee at this point - about 90 degrees and all during this time, my knee and thigh felt totally siezed up as soon a few minutes after putting my leg on the floor after getting up in the morning.  I felt like I was dragging a bit heavy useless leg around all day and I could hardly bear to walk on it because it felt so bad.  My 'good' knee, the right one was taking all my weight as far as going up and down the stairs etc and this began to take it's toll, it started to burn under the knee cap and felt stiff. It was a total nightmare.  I have 2 young children and it was terribly difficult looking after them.  I spent the days when they were at nursery and school with my leg up with an ice pack on it.  This was the only position I felt comfortable in.  I felt like I had a big lump inside my knee which was making me limp badly.

I rang and booked an extra appointment with the consultant because I was becoming increasingly worried.  When I went to see him I again voiced my concerns over the fact I could not bend it and told him that my knee felt warm and looked red.  He examined it and said he was not concerned as it did not look infected.  There was no pus coming out of the incision points.  He again assured me that everything would be fine eventually.

I brought my next appointment forward a week, with the consultant as I was even more worried at my lack of progress and I felt that I could not live like this any longer.  I could not look after my children properly, I could not do any housework,  I could not use the stairs, I could not stand on my leg very long and had not cooked a meal for my family in weeks.  It was putting immense pressure on my husband who was having to run the house and look after the children and me, as well as work full time.
This appointment with him was 5 weeks post op approximately and I was absolutely at the end of my tether by that point.  He could not offer any concrete explanation for what an earth was going on with my knee at first.  As the consulation neared the end it came to him that I might not be able to bend my knee due to excessive scar tissue that had formed around the incision point on the fat pad.  He said that he felt it might have been due to an allergic reaction to the instrument used or the dressing placed on my knee after the operation.  He said he had not come across it before himself but had heard of it.  He booked me in for another procedure under general anaesthetic a week later to have manipulation to straighten it.  He told me that he was 95% sure that before then however, I could straighten it myself.  I took strong painkillers and anti-inflammatories and began everyday to try to force it to bend it a bit further each time.  Within 3 days I had got almost a full bend on it.  I continued to work on it and by the time I saw him again a week later he was satisfied enough with my progress that he cancelled the manipulation procedure. 

At my next physio appointment I had to ask for ultrasound as I thought this might help.  It was not offered to me before this point.  The physio said I probably would not need it every week and indeed I did not have it on the next appointment, which I was a little disappointed at.

Very soon after I regained the bend in my knee,  I began to walk better on my legs and with a much more normal gait.  However both my knees very soon became constantly painful and I found it very hard to take each step.  They were both burning/extremely painful and very stiff.  It felt that I didn't have any cushioning in between bones in my knees and that everything was banging against each other inside when I walked.  I mentioned this to the consultant at this last appointment and he said that this would be temporary.  This pain did diminish over the next week and I found that I could stand up for longer periods without it happening.  Unfortunately, soon after this I began to feel very ill.  I felt exhausted, I was falling asleep all the time, I couldn't think straight, my legs were like jelly, I had a constant headache.  It really has been one thing after another.  After numerous blood tests, I found out after 2 weeks of feeling like this that I was low on iron.  I wasn't surprised because for the previous 8 weeks my family and I had eaten utter rubbish because I could not stand on my leg and cook.  I am now taking iron and am not suffering with these symptoms anymore.

I have been continually doing the exercises that the physio has given me and also using an exercise bike (which I got permission off the physio to do) since I forcibly bent my leg, to try and strengthen my thigh muscles because my legs are still very weak and as a result my legs feel very wobbly.  I find it I overdo things by only a very small amount, I am back to square one.  My knees become very sore - I get the burning, stiff pain back again and the fat pad becomes very painful and stiff once again.  It takes me about 4 or 5 days to recover from this everytime it happens.  When I mentioned this to the physio, she felt that I should infact have the ultrasound on the fat pad as it did seem to be helping.

My major concern is that I will never be able to get enough strength back in my thighs to keep the pressure off my knees.   I am still off work because my legs are so week and I can't stand up for long periods because I get the burning pain in my knees.  I can't sit with my knee bent for long because the fat pad aches.  The problems I am facing now are outweight the minor pain I had in my knee and I have wishes many times that I could turn the clock back and not have the operation.

I now feel that both the consultant and the both physiotherapists have let me down in their care for me.  I feel like this whole process has not been managed very well at all.  I have researched the problem I had with the fat pad scarring on this website and believe the terminology for it is arthrofibrosis?  I have read on here all about the that the trigger points for alerts for arthrofibrosis and believe they should have been picked up a lot earlier than they were in my case.  If they had have been, my thigh muscles would not have become as weak as they are now and I would not have suffered/still be suffering all these complications.  I had shown classic signs for arthrofibrosis e.g. I did not progress in the first 2 weeks, I could not bend my leg, I could not flex my thigh muscles and lift up my patella, I had a very warm red knee across the patella leading from the sore fat pad.  I am now at the point where my insurance company are quibbling over the fact that I need more physio sessions and are asking for a report from the physiotherapist.  I feel I have paid for wasted consultations and physio sessions that were not of any benefit to me before I had the ultrasound.  I have my next consultation with the consultant next week and am getting quite despondent.  I feel like I am going to be in this state forever.

Can anyone offer me any advice as to a way forward with anything.  Thanks.



Offline The KNEEguru

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Re: weak thighs causing pain in knees after 6 weeks of arthrofibrosis
« Reply #1 on: August 16, 2012, 09:37:22 AM »
Hi mum2xl
You dropped me a line to mention that you had no replies to your first post. I am sorry about that, but replies will come. It may be that your first message, although excellently written and very comprehensive, was a bit long, and readers tend in general to steer away from long posts.

So I will start off the dialogue.

By my counting it is now nine weeks since you had your arthroscopy, which seems to have been an investigative arthroscopy to try and resolve intermettent pain you have had for a long time following an old injury. You say that the surgeon found grade II cartilage changes in your knee, and abraded the back of the patella.

No patellar abrasion is 'simple'. It might look 'simple' if one is looking a video of the procedure, but rehab as you have discovered can be painful and challenging. Also, it is not unusual for patients to have inhibition in their quads after such painful surgery, and difficulty getting the quads to 'fire'. And a weak quads can lead to tracking problems of the patella, further pain, further quads inhibition - not pleasant at all. And, as you pointed out, the other knee picks up a lot of the gait problems and pain can start there also.

Tell me, did you have any nerve blocks before or during your surgery? Arthrofibrosis is a possibility, but your issue seems to be more related to quads weakness - what do you other 'Arthrofibrosis' people think?

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Offline nwc07

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Re: weak thighs causing pain in knees after 6 weeks of arthrofibrosis
« Reply #2 on: August 16, 2012, 02:00:53 PM »
Mum2xl
I have had a similar problem which occurred after one knee scope.  Is this your lateral fat pad near the lateral incision?  Does massage help or does that just cause it to swell?  Once it has scarred sometimes the only thing the helps is removal of the scarred areas.  Have you had an MRI since your surgery?
09/10- left knee subluxation..

Offline mum2xl

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Re: weak thighs causing pain in knees after 6 weeks of arthrofibrosis
« Reply #3 on: August 16, 2012, 02:22:49 PM »
Hi, sorry but not sure what lateral fat pad is? As I'm looking down at my left knee, it's the left fat pad that I was told by the consultant had developed all the scarr tisuue and that's why it wouldn't bend. I got it to bend over a few days by forcing it a bit further each day. It was painful to do but painkillers took the edge off it. The problem I have now is that I have had 8 weeks of relative inactivity, apart from recuperation exercises which did not help with flexation. (6 weeks with stiff leg and 2 weeks after that with anaemia because I couldn't stand up very long and cook my usual healthy meals). I'm now in my 9th week and both knees are burning and stiff due to the arthritus and my weak thigh muscles not supporting my legs. I'm having trouble building up the muscles at any speed and if I do too much the pain under knee caps really hurts. Every step becomes difficult.

Offline mum2xl

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Re: weak thighs causing pain in knees after 6 weeks of arthrofibrosis
« Reply #4 on: August 16, 2012, 02:26:47 PM »
Massage has helped the fat pad go soft again yes and ultra sound. Haven't had MRI since op no.

Offline missmyknee

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Re: weak thighs causing pain in knees after 6 weeks of arthrofibrosis
« Reply #5 on: August 16, 2012, 06:47:07 PM »
Hi Mum

How well does your patella move ?  Can you move it freely in every direction , just like the other knee? If not then you probably have scar tissue around the patellar area causing you not to be able to flex. How is your extension? For quad inhibition, you can get an electrical stimulator machine like PTs use. You place two electrode pads to the VMO and quad. A small adjustable current will help you fire up those muscles to retrain them since they shut down from your surgery. Forcing flexion can make the problem worse as it causes micro tears to tissues which inflames them and causes a process for more scar tissue formation. You might try finding someone who does some form of active tissue release such as ASTYM or GRASTON techniques. ASTYM depends on what country you live in. There are some on this board who are using ASTYM. A poster named starpolisher has had good results. A poster named kcknee has been doing GRASTON. If you google those two techniques, you will find their websites and locate a place near you.

Your doctor did a manipulation but did not do a scope with it. A manipulation only will just break scar tissue so unless you have a scope, it is still in there. You might need a scope to remove scar tissue around the patella and fatpad.

If your consultant does not know what to do, then you need to see a doctor who knows how to handle arthrofibrosis. What country are you in? If you tell us , we might have a name of a doctor for you to go to.

Pam
« Last Edit: August 17, 2012, 09:34:13 AM by The KNEEguru »
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
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PLC recon,revison,LOA,synovec
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Offline mum2xl

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Re: weak thighs causing pain in knees after 6 weeks of arthrofibrosis
« Reply #6 on: August 17, 2012, 08:40:50 PM »
Im not sure about patella, it actually makes me a bit nausious at the thought of moving it myself.  I know for sure it would not move at alll until I was told to force the knee myself.  That was one of the big things I noticed and thought how strange it was.  I can flex well now, since I forced it to bend over the few days.  However, it does feel like the scar tissue keeps building up and I have to keep breaking it down again. (very sharp pains over my fat pad - it does indeed feel like tiny tearing every so often when I bend it hard).   No the doctor did not do manipulation in the end - he told me to force it to bend over a few days. I am in the UK.  It would be fantastic if you could let me know of any arthrofibrosis specialists in UK.  Thank you.  I really do not think that my PT and consultant know much about this.  My PT has currently got me going on a trampoline and my knee caps are hurthing terribly and are very stiff.  I have arthritus in my knees and my knees are taking the full impact of everything due to 8 weeks of muscle deterioration in my legs.

Offline mum2xl

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Re: weak thighs causing pain in knees after 6 weeks of arthrofibrosis
« Reply #7 on: August 19, 2012, 03:41:08 PM »
Hi, re my last post about my pt telling me to use the trampoline everyday for last 2 weeks, I'm sure this is making my scar tissue worse. I'm not jumping or anything like that, just paddling motion with both feet. However, my knee feels like its starting to sieze up again and its started to give way again. The redness and warmth across the knee cap has come back too. The area across over underneath of patella feels also very much like pins and needles.

Does anyone else think my pt might be wrong telling me to use a trampoline.

I'm getting quite despondent with the way my knee seems to be getting worse.


Offline missmyknee

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Re: weak thighs causing pain in knees after 6 weeks of arthrofibrosis
« Reply #8 on: August 19, 2012, 06:57:07 PM »
Hi Mum

I'm going to give you a couple links to read. I don't know if you saw all the info in the Information Hub regarding arthrofibrosis, or AF for short. Read thru all of them thoroughly. It will help you understand what you are dealing with and help you form questions to ask your doctor and PT and become a very well informed patient . What we all have come across is doctors who have not seen or treated any cases of AF and PTs who are not knowledgeable esp where it concerns the special rehab for it so as not to set of the scar tissue cycle, which begins with inflammation. This cycle begins with the knee feeling hot, increased swelling and pain. Scar tissue is manufactured during this time. Taking NSAIDS or prescription NSAIDS , cortisone shots, or medrol dose paks can help with inflammation. Make sure you are keeping it elevated and iced as much as possible, which greatly helps too.

PT is always done in a pain free zone. You can go to some discomfort or stretch , but not pain. Adjust the exercise or reps to where it does not cause pain. The knee must not be forced, while doing an exercise, esp forcing flexion. Flexion and extension are done passively and held in a good stretch for about 2-5 min, then released to rest, then stretched again.  Frequent passive stretching provides a gradual continuous stretch to tight tissues.The patella needs to be moved back and forth and side to side. A freely moving patella is key to the knees movement. This is done several times a day. The tissues around the patella need to have deep tissue massage done several times a day. This prevents adhesions from forming. Sometimes training someone who lives with you to do it, helps when it is hard for you to do it yourself. The quad and VMO muscle need to fire and gain strength so it can help keep the patella up in the correct position and keep your knee from giving way. You need to ask your doc or PT, if you can get an electrical muscle stimulation unit that will help retrain your muscles to contract. Extension needs to be 0 and preferably equal to other leg.

The only time I used a trampoline ( a mini trampoline) was to work on balance by standing on bad leg for 10 secs working up to 1 min and repeating it.  Also standing on bad leg and throwing a weighted ball into another tramp and catching it, repeatedly.  If it is causing too much pain, you should not do it or adjust your exercises so it does not cause too much pain.

The extensive work done behind the patella can be very painful. My Knee doc told me the patella is highly innervated which is probably hampering your rehab.

Here is a link to all the AF info on the HUB. Read all of it esp Dr Noyes 12 part tutorial on AF. It will give you an understanding of AF. Some of us have had to print it off to show the Dr and/or PT. There is also 3 links in that section on rehab exercises from Dirk Kokemyer , a PT with Dr Steadman, another excellent AF Dr in the U.S.

http://www.kneeguru.co.uk/KNEEnotes/taxonomy/term/71

Here is the link to the AF doctors list. A doc named Glynn Evans from the U.K is listed and was used by a former poster with very good results. He trained with Dr Angus Strover who also treated AF, but unfortunately, Dr Strover has since retired. Click on his name for his info. As you page down the list, you will see a link to a thread discussing other docs in the U.K and Europe, including links to their written papers on AF, but we have not had any patient feed back about these docs, on this forum.

http://www.kneeguru.co.uk/KNEEnotes/node/427

Pam
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline mum2xl

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Re: weak thighs causing pain in knees after 6 weeks of arthrofibrosis
« Reply #9 on: August 19, 2012, 10:43:44 PM »
Thank you so much Pam. I have read quite a bit but am really grateful for the link to take me to all the information. I am going to see both the consultant and pt on Thursday armed with a list of questions. I will also print some of the info off from the link and take it too. I appreciated the explanation of how the cycle begins again. It has started since I started using the trampoline and I have especially felt it in the last few days. My knee is hot and I have what feels like the thickness of a hair in multiple places over the fat pad being pulled very tightly causing pain. I am so grateful for the name of the AF doctor. Thank you.  My pt and consultant are definitely not trained in this area.

Offline mum2xl

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Re: weak thighs causing pain in knees after 6 weeks of arthrofibrosis
« Reply #10 on: August 19, 2012, 10:48:38 PM »
Pam sorry I forgot to ask, is surgery to remove the scar tissue not always necessary? Can scar tissue be prevented reforming using the techniques you have mentioned?


Offline missmyknee

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Re: weak thighs causing pain in knees after 6 weeks of arthrofibrosis
« Reply #11 on: August 20, 2012, 07:16:54 AM »
Hi Mum

The key to keeping scar tissue from forming is early recognition and treatment and keeping inflammation from happening. The doctor and PTs need to recognize the symptoms reported by the patient and act on them. This means close monitoring and implementing by the doctor , treatment methods of adding NSAIDS, prescription NSAIDs, cortisone shots and medrol dose paks. Within the first few weeks after surgery a gentle MUA can be safely done  because scar tissue is still in the wispy stage and pliable, so the chances of causing damage and micro tears to surrounding tissues , muscles, ligaments, tendons and bones is extremely low. After that time an MUA should have a scope done first, to remove scar tissue , then a gentle MUA performed.

PTs must recognize those symptoms reported and notify doctor and make the necessary adjustments to the patients rehab program to keep the knee from becoming inflamed. PTs use e-stim to stimulate muscle contraction, ultra sound to gently heat and soften any tightened trouble points, perform deep tissue massage to break up scar tissue and make pliable and apply ice.

Patients need to be diligent in their home rehab program , elevating and icing as much as possible. If weight bearing causes knee to become inflamed, then crutches are used til knee can bear weight without becoming inflamed. Rehabbing from AF requires a lot of patience. Many times people have made 1 or 2 steps forward, only to have to go back to square 1, because the knee became inflamed.

Once scar tissue gets beyond the 4 month post-op mark, it is no longer easily pliable and the above methods lose their effectiveness. Surgery is then usually needed to remove the scar tissue. Some cases require scar tissue surgery earlier.

Despite all this, sometimes you can do everything right and scar tissue still forms. This has happened to me several times.

Pam
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline mum2xl

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Re: weak thighs causing pain in knees after 6 weeks of arthrofibrosis
« Reply #12 on: August 20, 2012, 11:33:18 AM »
Thanks for the information Pam. My fear is I'm now nearly 10 weeks down the line. 2 Pts have missed it - even the senior one I'm seeing currently, plus my surgeon. He mentioned he thougt it was scar tissue at the 6 week stage when it still wouldn't bend and made me take painkillers while I forcibly bent it over a few days. He said everything would get better on its own after that! Which of course it's not doing. I don't have any confidence in either him or the senior pt anymore. I think he needs to refer me to someone who know what they are doing quickly. He told me at the 6 week mark that in another 6 weeks I should be able to get back to exercising like aerobics.  There's absolutely no way.  Can you tell me if any one does return to exercising again after this?
At the moment I feel I'll never be like I was again.
Thanks again.

Jennifer

Offline mum2xl

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Re: weak thighs causing pain in knees after 6 weeks of arthrofibrosis
« Reply #13 on: August 20, 2012, 11:47:35 AM »
Just to add to above, sorry what is an MUA and NSAIDS please? Thanks Pam.

Offline missmyknee

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Re: weak thighs causing pain in knees after 6 weeks of arthrofibrosis
« Reply #14 on: August 20, 2012, 10:13:21 PM »
Hi Mum

It is possible to get back, but the best way is to be treated early and by a doctor who has knowledge and has successfully treated arthrofibrosis and to have PTs who have knowledge of AF and the specialized rehab it involves. My AF doc is located 700miles from me and he has his own PT dept, where they are trained to rehab AF patients. When I returned home, I had to copy and tell them how my rehab was to be done. It is not the generic rehab other patients get. It takes a longer time to rehab compared to someone without AF. It all depends on how bad the AF was and how long the patient has it before the correct treatment is implemented. Only 1% of people develope it, so most doctors and PTs have never come across it. The link I gave you provided names in the UK for treatment. You might use the search box on this website and search for post from Stasha and one from Rennschneckie. They are from the UK and are the most recent posters with AF and their treatment. A poster named, dynamite, posted several yrs ago and had successful treatment with Dr Glynn Evans.

MUA stands for manipulation under anesthesia

NSAIDs stands for nonsteriodal anti-inflammatory drug like Ibuprophen, Aleve ( U.S drugs) or prescription ones such as Celebrex.

Medrol dose pak is a steroid called prednisone. It comes in a pak that has all med doses measured out. The dose starts out high, then tapers down thru a period of 5 days. Sometimes it can be repeated or for longer period of time.

Pam

« Last Edit: August 21, 2012, 08:53:02 PM by missmyknee »
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions















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