February 19, 2016
The focus for anyone after you’ve had knee replacement surgery should be on getting as much range of motion (ROM) back as fast as you can. This means developing a consistent daily routine of exercising, along with elevation and icing to manage your swelling.
Some people ask “Yeah, but how long do I have to do that?” The answer is, basically, “as long as you have to”. You can use your “good” leg for a reference (that is, if it really is good). You want the ROM of both legs to be relatively even. So, that means that you’re not finished working on ROM until they match. This may take several months or even a year. Just keep it moving.
But getting ROM back right after surgery is a lot different than if you had your surgery a while ago. In the beginning, you may have been taught how to do scar massage. But, if you’ve had multiple surgeries a simple scar massage probably won’t work.
If you have had several surgeries, then you’re going to have more scar tissue and have a greater amount of knee replacement adhesions.
Most ortho docs will probably want to “manipulate” (put you under anesthesia and forcefully bend the knee to break up the scar tissue – it sounds worse than it is.) the knee and free it up. And then from there its more rehab for maintaining and gaining more ROM.
It’s better if you can get the ROM back without having to have a manipulation.
But what if I’ve already had a manipulation and I still don’t have a good ROM?
Well, If you’ve had a manipulation and still don’t have good range of motion there are some different approaches that some people consider. Especially if you’re sure your limitations are due to scar tissue.
Scar tissue is made up of “soft tissue”. Soft tissue includes muscle, tendon, fascia, etc. So, if you’re in the boat of having a “stuck” knee and you’re sure it’s because of scar tissue, It may be beneficial to find a physical therapist that specializes in something called “soft tissue mobilization”.
But wait! Soft tissue mobilization is a “catch all” phrase that includes techniques as general as basic massage to the more specialized osteopathic techniques of “strain-couterstain” and “muscle-energy” techniques.
There are some pretty specialized physical therapy approaches to scar massage and mobilization. Two that come to mind are the Graston Technique, and ASTYM. Physical therapists can get certification in either of these approaches to soft tissue mobilization and they can be used along with the well known ROM exercises that most TKR patients are familiar with.
Npw, you may or may not have therapists in your neck of the woods that know about these two techniques. However, it’s easy to do the research just by going online. If you can’t find a therapist listed in your area, you can go to the respective websites above to see how to locate certified clinicians.
And, even if you don’t have anyone right in your area, don’t give up hope. Reach out to the nearest clinician that you can find, or, even use the contact form on the official website. Let them know your predicament and see if they have any suggestions. They can only say “no” and even so, you won’t be any worse off than you are right now.
So, whatever, you do, don’t give up looking for new solutions. You probably already know what hasn’t worked in the past. So, steer clear of those things you’ve already tried. But, look in other areas. Sports therapists, massage therapists, Chiropractors can all be good resources and may have insights you may not have considered yet.