Knee Replacement

[Kirk]

I had a client last week who had knee replacement on her right knee 11 mos ago. She has been in PT off and on since then and they have currently stopped the stretches and are letting her exercise on the machines. Her problem...her leg will not straighten. They can make it straight, but it springs right back. She has gone back to the doctor where they put her to sleep and manipulated it, but it just isn't holding. I spent an hour working on her legs...the left one where she was compensating for the right one being hurt, is just as bad. She has major tightness down the entire length of her legs, anterior and posterior.

I did MFR leg pulls as well as neuro, with hot stones and it was much looser, but still pretty tight. I told her there were no guarantees we could straighten her leg, but her muscles should certainly feel better. She agreed that her muscles felt much better at the end of the session and booked another appt for Tuesday for further work. What do you recommend I do? And is there even a chance that her leg could straighten?

 

[Naomi]

I would do Post isometric relaxation stretches on the hamstring and gastroc on the affected leg, plus on the psoas.
Other than restrictions within the actual joint these are what is keeping the knee bent.
The MFR release leg pulls, great as they are will not be able to take these to the full range of movement as will for example a straight leg raise stretch for the hamstring.
Also the muscles in the front of the thigh should be checked in case their level of tension is producing a reaction in the hamstrings

 

[Sandralynn]

cross fiber friction? on the origin/insertion points? isolate the muscle, shorten in and then pull away in the opposite direction to see if that can get it free. takes a lot of work and kudos to you for helping her out. you probably also have some major scar tissue to work through unless they got her up walking and working pretty quickly post op.

 

[Pompal 09.]

I would do Post isometric relaxation stretches on the hamstring and gastroc on the affected leg, plus on the psoas.
Other than restrictions within the actual joint these are what is keeping the knee bent.
The MFR release leg pulls, great as they are will not be able to take these to the full range of movement as will for example a straight leg raise stretch for the hamstring.
Also the muscles in the front of the thigh should be checked in case their level of tension is producing a reaction in the hamstrings

:banghead: I didn't even think of PIR. Thanks for all your advise.

 

[catinhat]

cross fiber friction? on the origin/insertion points? isolate the muscle, shorten in and then pull away in the opposite direction to see if that can get it free. takes a lot of work and kudos to you for helping her out. you probably also have some major scar tissue to work through unless they got her up walking and working pretty quickly post op.

Thanks... I'll see if we make any progress on Tuesday.

 

[eEz]

I worked at a PT clinic and of all the Knee replacement surgeries I have seen the majority were not able to completely straighten out there knee afterwards.

If is frustating for you to not be able to get it straight ...take a look at this virtual knee replacement surgery and also click on the actual pictures of one. Might help you understand why it may never.
http://www.edheads.org/activities/knee/

 

[cassidy s]

Just last Wednesday a 62 year old male client w/ bilateral knee replacements and I were able, after 8 months, to straighten his R knee completely by using strain counterstain techniques and orthobionomy in combination. He is a diligent user of all post PT exercises, etc. and has been thoroughly frustrated by the lack of complete extension in the R knee until that day!!! Since he is an extremely athletic outdoorsman and avid sportsman, it was a banner day for him.......... he even called back to the office 2 hours post-massage to relate that he had been able to climb onto and off of his gigantic zero turn lawn mower with ease and grace...................

for what it's worth.........

 

[Pavlovs Dogma]

I worked at a PT clinic and of all the Knee replacement surgeries I have seen the majority were not able to completely straighten out there knee afterwards.

If is frustating for you to not be able to get it straight ...take a look at this virtual knee replacement surgery and also click on the actual pictures of one. Might help you understand why it may never.
http://www.edheads.org/activities/knee/

Wow...very interesting site. Thanks!

 

[David H]

Just last Wednesday a 62 year old male client w/ bilateral knee replacements and I were able, after 8 months, to straighten his R knee completely by using strain counterstain techniques and orthobionomy in combination. He is a diligent user of all post PT exercises, etc. and has been thoroughly frustrated by the lack of complete extension in the R knee until that day!!! Since he is an extremely athletic outdoorsman and avid sportsman, it was a banner day for him.......... he even called back to the office 2 hours post-massage to relate that he had been able to climb onto and off of his gigantic zero turn lawn mower with ease and grace...................

for what it's worth.........

It's worth much! Thanks...and I have located the book by Kathy Kain that was suggested on another thread when I looked up Ortho-bionomy. Maybe it will give me enough basics to help when combined with the other techniques mentioned. And much time...

 

[Im back for my TC title]

Just last Wednesday a 62 year old male client w/ bilateral knee replacements and I were able, after 8 months, to straighten his R knee completely by using strain counterstain techniques and orthobionomy in combination. for what it's worth.........

I have had similar experiences with both knee and hip replacement clients. Ortho-Bionomy works very well with these clients and I haven't seen one that did not respond very favorably to the work. One client who felt she did not benefit from 6 weeks of PT could completely straighten her knee for the first time after 3 OB sessions. Don't get me wrong, I love JFB-MFR, use NMT a lot, and am a big fan of PIR and AIS, but for joint replacements I haven't seen anything work as well as OB.

 

[lil miss awsomeness]

Did you use OB on the hip, knee, and tibia/fib each time...or just the knee?

 

[DRO]

Did you use OB on the hip, knee, and tibia/fib each time...or just the knee?

Depended on the client's individual requirements. All clients received work on the knee/hip (depending on what was replaced). Knee clients could also receive work on the hip, foot, ankle, and sometimes the pelvis. Hip clients almost always received pelvic and psoas work in addition to the hip itself. It's almost always a mistake to work only the replaced joint area because many of these people have underlying postural conditions that led to joint replacement. Failure to correct these underlying problems leads to pain and possibly even early failure of the artificial joint (or surrounding tissues).

 

[blacknwhite93]

Thanks...the only thing I know about OB is from a book I checked out at the library by Kathy Kain with Jim Berns. During my last session I did the exercises for the iliopsoas, knee, and lower leg.

 

[Lea~ is a "Mean Girl"~]

OB and Knee Replacement

Whoops! My gf caught this one...I guess I just do some things automatically and don't think to mention them. In addition to the knee points you see in Kathy's book it is very important to release the patella. I know this doesn't make sense to a lot of people that read this but it's true. The knee cannot extend properly if the patella doesn't move correctly. Time spent on the patella is well worth it and I always include it with knee work whether it's a joint replacement or not. Patella work is also often useful for hip and pelvic issues.

 

[paultopg]

I have to take issue with the comment about MFR leg pulls not addressing what straight leg hamstring work will do. I, too, deal a lot with post hip and knee replacements clients who's results are less than stellar. The MFR leg pull is only a small part of the arsenal of MFR. Others above have commented on the need to treat the patella, anterior and posterior structures of the lower leg, knee, and upper leg, as well as the pelvis. Pelvic obliquities are quite often the long term cause of knee and hip degeneration. Treating the pelvis after the fact will reduce or eliminate the asymetrical restrictions that led to the joint breakdown, reducing pain and reducing the chance for repeated breakdown. Long, progressive cross hand releases to the entire knee will reach deep inside, deeper than simply the muscular attachments, to open up the final piece of tightness. I'm not familiar with the other types of work that were mentioned, but it appeaers that the outcomes are quite similar. Work with what you know!

With the client supine and the leg as extended as able, is the patella loose? Does it have mobility in all directions or is it bound down. Might be a place to start.

 

[Big]

SatMassage: Whoops! My gf caught this one...I guess I just do some things automatically and don't think to mention them. In addition to the knee points you see in Kathy's book it is very important to release the patella. I know this doesn't make sense to a lot of people that read this but it's true. The knee cannot extend properly if the patella doesn't move correctly. Time spent on the patella is well worth it and I always include it with knee work whether it's a joint replacement or not. Patella work is also often useful for hip and pelvic issues.

I have to take issue with the comment about MFR leg pulls not addressing what straight leg hamstring work will do. I, too, deal a lot with post hip and knee replacements clients who's results are less than stellar. The MFR leg pull is only a small part of the arsenal of MFR. Others above have commented on the need to treat the patella, anterior and posterior structures of the lower leg, knee, and upper leg, as well as the pelvis. Pelvic obliquities are quite often the long term cause of knee and hip degeneration. Treating the pelvis after the fact will reduce or eliminate the asymetrical restrictions that led to the joint breakdown, reducing pain and reducing the chance for repeated breakdown. Long, progressive cross hand releases to the entire knee will reach deep inside, deeper than simply the muscular attachments, to open up the final piece of tightness. I'm not familiar with the other types of work that were mentioned, but it appeaers that the outcomes are quite similar. Work with what you know!

With the client supine and the leg as extended as able, is the patella loose? Does it have mobility in all directions or is it bound down. Might be a place to start.

Thanks!