MUA Recovery After TKR & MUA

Welcome to Bonesmart, sorry to hear of your troubles with ROM and about your upcoming MUA. There are helpful articles in the Library that you will find useful.
A moderator will be along soon with some answers to your questions.
Good luck and all the best in your recovery.

Welcome to BoneSmart!!! I'm going to tag our forum nurse, @Josephine, so that she can come and respond to your question. I do think your exercise routine was way too aggressive.....an hour of exercises THREE times a day, every single day is a lot!! Your poor knee and muscles.

This is not a situation where you are in need of training and rebuilding muscles. Your knee is injured from the surgery and needs to heal. After the MUA, I suggest that you tone that exercise way, way down and do more resting, icing, elevating and taking pain meds if you need them. The only exercises that is really needed are gentle bends and stretches until your knee is healed and ready to move on to more.

While waiting for Jo to come along, here are some basic recovery articles from our BoneSmart Library. Please read them....they should help you better understand the recovery process. Ask any questions that you may have as you go through them.

First are the mantras ....

- Rest, elevate, ice and take your pain meds by the clock
- If it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- If you won't die if it's not done, don't do it
- Never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!

Next is a FAQ (Frequently Asked Questions) thread.

And then the articles in order of importance.

Group A
The importance of managing pain after a TKR and the pain chart
Myth busting: no pain, no gain
Swollen and stiff knee: what causes it?
Progression of activity for TKRs

Group B
How Long Does Healing Take ......
Chart representation of TKR recovery
Energy drain for TKRs
Elevating your leg to control swelling and pain
Using ice

Group C
Knee Replacement - Where Am I in Recovery?
So What Is It Going to Take? The Five “P’s” of Knee Recovery
Work “Smarter” and not “Harder”
About recovering a knee - from one who knows!
Some suggestions for home physio (PT) and activity progress
Myth busting: The "window of opportunity"

Group D
MUA (manipulation under anaesthetic) and adhesions
It's never too late to get more ROM!
It's Worth the Wait for ROM
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

scooterdiva said:

the surgeon on my first follow up appointment and he said that sometimes a muscle can get cut during surgery

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Umm ... that's not a 'can be' that's an 'on purpose'! Generally referred to as a quads snip.

scooterdiva said:

I got the impression that they thought that it was because I may not be doing any exercises and that is why my ROM is so low.

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It's been my experience that these problems are invariably caused by too much exercising and that the typical A types who go in for lots and lots are often mistaken in what they perceive to be gentle or less!

For instance you said you do
- 10 minutes on the exercise bike just going back and forth
- 10 minutes doing a stretches that would encourage the bend
- 10 minutes total a day doing a lunge on the stair
----- but that's only 30 mins. In post #1 you said you do them "3 times a day for at least an hour with out fail".
Therein lies your problem.

I have an article Activity progression for TKRs in which I recommend a programme of activities which were prescribed me by my surgeon. He started off with
weeks 1-3: dedicated to rest, elevation, ice and pain management. Walks around the house as needed to bathroom and kitchen. Exercises: none except ankle pumps and foot rotations for ant-thrombosis and gentle heel slides at the rate of 5 every couple of hours only to the point of discomfort.

I see many members from across the pond who have been led to believe that PT should be 'high, hot and a helluva lot'! All this gets you is hot inflamed muscles which are twice or three times as likely to develop adhesions that no PT at all! However, this is not posted to make you feel guilty or that it's 'all your fault' because it's not. You were ill-advised by your carers who should have known better.

So the upshot is that you probably do need an MUA and will be much better for it.

scooterdiva said:

I have had pain just about the knee in about an area of about the size of a baseball that is so tender to the touch.

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Can you tell me the exact site of your pain using this chart?

We are all tempted to work hard in order to get our life back together.

Please understand that is is not about how hard you work; it is, rather, how smart you work. Instead of the "no pain, no gain" attitude, try the "no pain, more gain" attitude and see if your surgical knee gains more ROM.

Trying to outwork your kee simply overworks it, and the "kinder, gentler" approach actually gets much better results.

scooterdiva said:

I guess that although the PT didn't come right out and say it out loud, I got the impression that they thought that it was because I may not be doing any exercises and that is why my ROM is so low

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Many PT's take the "Athletic recovery" approach to TKR rehab/recovery. The best ones, though, do not push their patients to do too much, understanding that "less is more."

Please understand that the amount of exercise that may to our way of thinking seem minor, to a post-surgical knee is a triathalon. And these soft tissues, after surgery, are very cranky. So they get inflamed, and guess what that leads to? Adhesions or its more serious version, scar tissue. Most people can get away with inflamed tissues and still achieve their ROM. A few of us get tripped up by that inflammation, and will dial up the efforts only to discover that things get no better and even worse.

Post-MUA, you will need to be very careful. You have to keep the knee from getting inflamed. Therefore a wee bit of effort at a time spread over the day is plenty. You will not need to do strengthening exercises. That can come later, and they will only contribute to the inflammation. Whatever way you encourage bend, continue to not bend to the point of pain, only to the point of discomfort. Again, pain = inflammation = adhesions. Someone on this forum was coached to bend 3 times an hour, and those bends were done very slowly and held for a minute. This followed by icing and elevation will allow you to vigilantly encourage bend without inflammation.

Also, be warned that if "they" thought your low ROM was due to inadequate effort (!!!!!), they will likely push you afterward ("they" meaning the surgeon and/or the PT). I'm sure as a massage therapist you are good at setting boundaries and you'll need those skills to protect your knee. Our coaching may very well go against what they're saying. I've had the same kind of knee you have and I know from experience that the knee is boss and the "experts" can be wrong.

Also, there usually is an initial backslide after MUA that can destroy your morale. Expect it, and then be prepared to summon all your patience for the next week or two. Some people have good immediate gains, and others only creep along. Only time will tell in your case.

You are describing a "hard stop" in ROM which is an absolute indication that MUA is needed. A hated having to go in and go through all the same rigamaroll (intake, IV, drugs, recovery, etc). But it is necessary.

There's a forum member on here, @RestAssured, who we all love because of her faith and warmth, which didn't stop her from lashing out at a PT that hurt her. Sometimes I wish I had given my PT a good dope slap when he hurt me. But they did me a favor because when I ditched the PT "experts" and designed my own routine, my ROM finally improved.

I did try the water therapy, but not after my last intervention. I tried EVERYTHING searching for anything that would make my knee happy or help it bend. Eventually what worked best was sitting on an exercise ball and slowly rolling forward, which bends the knee in a very controlled way. My knee felt so vulnerable but that routine seemed ok. What's best is what works best for you!

Not sure your surgeon's views of PT, but mine only prescribed PT if there seemed to be a problem. He was totally fine with my giving it up. If he had objected, I still would've ditched PT, because ultimately it was my decision. But I'm glad he supported me. Anyone who has an unbending post-surg TKR needs all the support they can get.

Hello @scooterdiva!

Aqua therapy is actually helping me in strengthening my middle quad muscle! I had a revision 21 months ago, and until I found a Per trainer that knew about knees, I was going in circles! I spent 1 1/2 years in PT with minimal results. Abby and Jill have gotten my quad muscles to respond better than I could have hoped for!
I am walking 1.3 miles in 22 minutes now, climbing stairs alternating feet, doing planks, a static push-up, yogalates, which combines yoga and Pilates, squats, and lots of other stuff! I am. Living life again and God has been guiding me every step of the way!

Keep us informed. Yeah, if aqua feels right to you, then that would be the way to go.

And so if ROM was limited before, it may be slow to increase. The average expected bend is 120. I was thrilled to get 110 and am (I think) 130 now. If I worked at it I could probably improve my bend but I have a knee that doesn't like to be pushed, so I don't.

I can pull my knees up to my chest and fold them down now in yogalates! I never thought I would be able to do that! Things just keep getting better. I alternate between the pool and exercising. M,W, F cardio and resistance,
T, Th, Cardio in the Pool!

Scooter, Sonya in post above is a fine example of the outcome of patience and persistence after very difficult TKR challenges. You'll get there but go back to my earlier post about the approach immediately post-TKR. We have to keep the tissues "cool" (non-inflamed) and be very minimalistic, and then increase efforts only when the bend is exceeding, say, 90 and it's "out of the woods."

Good luck tomorrow. We say here that TKR is a marathon, not a sprint; if so, then a TKR with scar tissue (or infection, as in Sonya's case) is an Iron Man competition! In 3-4 weeks you'll be breaking out the keg (or champagne or smores) in celebration of your newly bending knee.

We will be your biggest cheering section!