Chiropractor Chandler AZ
Knee replacement surgery, also known as total knee arthroplasty (TKA) is generally an effective way of eliminating pain and range-of-motion limitations for patients with severe osteoarthritis. In a study conducted by an orthopedic surgeon following 250 operations, 90 percent of the patients had no postoperative complications.
However some patients will continue to experience pain, stiffness and swelling that limits their daily activities. For those patients, it’s important to have the situation evaluated as soon as possible, first to eliminate any pathological causes such as infection inside the joint, blood clot or loose prosthesis, and second, to effectively treat other issues such as scar tissue build-up before the situation requires a second procedure.
In studies done on post-operative knee pain, researchers have found a variety of underlying causes, ranging from long-standing gait problems to infection inside the joint, diabetes, rheumatoid disease, a history of prior surgeries, prosthesis failure and build-up of scar tissue.
In his own study of postoperative knee pain, Dr. Pierce Scranton Jr., MD, an orthopedic surgeon said: “The postsurgical TKA patient, in effect, is in a race to regain motion between the limits of pain tolerance versus the limits of the knee tissues’ healing response.” (Scranton, 2001). In other words, begin your rehab as soon as surgery is over: pursue it as aggressively as is tolerable.
If, despite this, you continue to experience pain, swelling and limited range of motion, it’s time to consult your healthcare provider to determine the cause. Diagnosis may include additional imaging and bloodwork to rule out infection, reactive neurodystrophy (complex regional pain syndrome) blood clot or failed prosthesis. Range of motion needs to be sufficient to perform activities of daily living. Good range of motion is 0-120 degrees of flexion. To go up and down stairs the knee needs to flex at least 90 degrees (100 for a higher riser). Walking on even ground requires 67 degrees of flexion.
One of the primary culprits for knee stiffness and pain that fails to subside over time is soft tissue pain and scar tissue that builds up around the surgery site. Build up of scar tissue can cause the joint to pop at the extremes of range of motion, and limit your ability to flex and fully extend your knee. If caught early enough, this scar tissue can be broken up non-invasively using Graston Technique, Shockwave Therapy, and Deep Tissue Laser. However if the problem becomes severe, it may require arthroscopic or surgical release.
Other problems that can exacerbate knee pain following surgery are gait abnormalities, lack of strength and/or flexibility in the quadriceps, hip flexors, gluteal muscles and hamstrings, and lack of dorsiflexion in the foot: the ability to point your toes towards your knees which should be at least 20 degrees.
As with any surgical procedure, patients can expect a certain amount of post-operative soreness. Your surgeon may recommend anti-inflammatory medications, compression hose, rest, ice and elevation to address the swelling. He or she will also have you begin passive motion exercises to restore range of motion in the joint. You will most likely begin active motion as part of inpatient physical therapy: physical therapy continues after you leave the hospital with home exercises. We highly recommend a post-operative assessment by a physical therapist and a physical therapy rehabilitation program.
The following symptoms are “red flags”: indicators that your recovery is not progressing optimally:
Individuals who are at higher risk for postoperative complications and knee pain include:
Rest, ice, compression and elevation or RICE is a tried-and-true method for reducing inflammation. We like the large reusable gel ice packs because they are easy to mold around the knee.
Your healthcare provider may suggest using a walker or cane immediately after the surgery to keep weight off the joint replacement. While it is important to keep moving, you should limit stair climbing and descending immediately after surgery. Plan to live on one floor for several weeks.
Over-the-counter anti-inflammatory medications including NSAIDS, aspirin and acetaminophen can reduce swelling and control post-operative pain.
A physical therapist may recommend ultrasound or transcutaneous electrical nerve stimulation (TENS) to control your pain at home. Continuing to perform both passive and active range of motion activities will minimize stiffness and can help to prevent scar tissue and fascial adhesions from developing in and around the surgery site.
Exercises often need to focus on hip, calf, and ankle muscles. Problems in the joints above and below the knee often create excessive pain post surgery. Correcting muscle imbalances and flexibility issues can dramatically decrease soft tissue pain around the knee. Specific exercises depend on your situation.
Your physical therapist can work with you on a rehabilitation plan to strengthen the quadriceps and correct any muscle imbalances that may have developed, fix gait abnormalities caused by structural foot problems such as overpronation, tibial inversion or lack of lateral hip strength, address tightness in the hamstrings that may be due to weak gluteal muscles, etc.
If scar tissue has developed in the surgical area, the earlier you address and correct the problem, the better. All of the stretching in the world won’t fix knee pain and stiffness if scar tissue is the cause, and the longer you wait, the more opportunity scar tissue has to build up and limit your mobility. A very successful technique that aims to break up scar tissue and allow the knee replacement to heal properly is the Graston Technique.
Graston technique is an effective, non-invasive method for breaking up scar tissue that can build up in and around the surgery site. Graston technique uses stainless steel instruments designed to break up scar tissue by sheer force. When the tool slides along the skin it pulls one layer of tissue past the other. The scar tissue that has developed is pulled apart, which triggers the body’s healing mechanisms to replace the scar tissue with healthy fibers. Treatment with Graston Technique speeds up healing and can dramatically reduce pain following knee replacement surgery.
Class IV cold laser or low level laser therapy is an excellent modality for decreasing pain and inflammation. Specific wavelengths and frequencies help to shut off inflammatory cells that continue to create swelling in the area. Swelling slows down the healing process and makes the area sensitive to touch. Different wavelengths and frequencies turn on repair and healing processes inside cells. Cold laser speeds up the delivery of adenosine triphosphate (ATP) to the knee. ATP is “fuel” for your body that is created from the blood sugar made from food. The repairing cells use this energy to lay down healthy fibers faster, speeding up healing and repair processes in addition to decreasing inflammation.
In order to return to optimal function following knee replacement surgery, you will need a physical activity program that includes aerobic exercise (e.g. walking), muscle strengthening, flexibility, balance and agility. Knee replacement surgery alters the geometry of the joint. This affects not only the knee with the prosthesis, but the opposite knee as well. It also impacts the way the feet, ankles and hips function.
Balance exercises are intended to help you move more efficiently and reduce your fall risk. They may include tandem stance, single leg stance, square dance, the clock, door frame touch etc. Step-ups and step-downs help you to navigate stairs and step on and off of curbs. Sit-to-stand exercises reduce the stress on the knee that occurs when you perform this activity with improper form.
Lateral stability exercises address muscle imbalances in the quadriceps. It is common to see the lateral outside muscles become strong and tight, while the medial muscles, especially the VMOs (vastus medialis obliques) become weak or in some cases, shut down completely. In addition, exercises such as glute bridging help to develop strength in all three sets of gluteal muscles (maximus, medius and minimus), while squats and lunges help to boost strength in both the glutes and quadriceps. For more information, see the section on lower body exercises.
If you have any of the symptoms described above that indicate the possibility of a blood clot or infection, it’s important to contact your surgeon immediately. On a similar note, excessive joint laxity that may indicate a failed prosthesis also requires immediate medical attention.
If over-the-counter medications fail to control postoperative pain, your healthcare provider may recommend a corticosteroid injection to reduce the pain and inflammation.
Extracorporeal shockwave therapy utilizes a percussive instrument to break up muscle tightness and fascial adhesions around the surgical site. It is very effective for reducing tightness in the lateral quadriceps, IT bands, patellar tendon and lower legs.
If you are experiencing postoperative pain, it’s important to seek treatment early on while conservative methods can still be effective. An experienced provider can prevent chronic knee pain from lasting months or years. Call Alpha Chiropractic today to resolve your postoperative knee pain at (480) 812-1800.
Our Chandler Chiropractic & Physical Therapy clinic treats patients with a variety of muscle, tendon, joint and ligament injuries. The clinic provides treatment for endurance athletes and weekend warriors in addition to common headache, neck and back patients traditionally seen in Chiropractic, Physical Therapy, Massage Therapy clinics. We work with all ages and abilities of the residents of Ahwatukee, Phoenix, Tempe, Gilbert, Mesa and Chandler, AZ.