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Is Knee Manipulation Worth It

Knee Manipulation Pros And Cons

Manual Knee Manipulation Procedure – MUA – Update #8

Knee manipulations have the obvious intended benefits of improving knee mobility, increasing the range of movements, and strengthening your knee after it has undergone a trauma. However, it can also pose risks if your bones are degraded or if you have any underlying conditions like diabetes or high blood pressure. You can avoid knee manipulations by going through physiotherapy after knee surgery or taking part in prehab programs.

You can also follow simple knee exercises like knee-straightening exercises, and after you notice a development, you can switch to more advanced techniques. The best way to reassure good results is by daily exercise and following icing and elevating routines.

Knee manipulation is one of the more complicated procedures used to heal stiff sensations in your knee and increase the range of motion in your knees.

These knee problems usually occur after traumatic injuries or even after a surgery where scar tissue appears and obstructs the functioning of your joint.

Through knee manipulation, youll find more comfort when it comes to moving your legs and recovering the strength of your knee.

So what exactly can you expect from a knee manipulation? What are the benefits and risks involved with this procedure? Can you avoid manipulation after knee surgery and resort to alternatives?

What is the best exercise routine to follow to guarantee a speedy and effective recovery? Are there tips to reaping better results from knee manipulation?

Follow Best Recovery Practices: Exercise Ice Elevate

After a knee replacement it is absolutely crucial to be working your knee. This means regular physical therapy complimented by an at-home rehab program. This at-home rehab program will guide you through supplementary knee exercises, movements and cardio to best improve your motion. There is a science to your recovery, so its best to follow your doctors orders and that of a knee replacement rehab program . Overdoing it on your knee can also cause swelling which can lead to stiffness. Under doing it can lock up your knee and cause severe stiffness.

In addition to following the best exercises at the right frequency, you must remember to ice your knee several times a day. You should be icing daily for several weeks after surgery . Pair icing with elevation to cut down swelling, pain, and stiffness.

Best Icing Practices for the First Weeks After a Knee Replacement

  • Elevate and ice for 15-20 minutes at a time.
  • Wrap ice in a tea towel, t-shirt, or thin cloth. DO NOT apply directly to your skin.
  • Repeat icing at least 3-4 times a day.

Read all about the best icing practices after knee replacement surgery to stay on top of your game.

Best Knee Exercises To Improve Mobility

The below leg/knee exercises will help you regain your mobility, whether after a knee replacement surgery or after a knee manipulation .

  • Knee-straightening exercises Lay down and roll a cloth below your heel, to make sure it doesnt touch the bed surface. Now, tighten your thigh and attempt at straightening your knee. Hold this position once fully straightened for about 10 seconds.
  • Sitting knee bends Sit down on a chair and keep your foot behind the heel of your operated knee. Now, bend your knee gradually as much as possible and maintain this position for 10 seconds.
  • Bed-supported knee bends Move your foot towards your bottom, which will bend your knee while keeping your heel on the bed surface. Maintain this bent-knee position for 10 seconds.
  • Once those simple exercises help you regain some knee movement, you can switch to more advanced exercises, like the ones below.

  • Weights Surround your ankle with light weights and repeat those previously mentioned exercises. You can start up with one- or two-pound weights initially and gradually move up the weight as you feel your knees getting stronger.
  • Exercise cycling -This equipment is an ideal way of boosting your knee mobility. Youll have to first fix the seat height to the level that your feet touch the pedal while having your knee upright straight. Start by pedaling backward and once you feel that it isnt so difficult, you can switch to pedaling forwards.
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    Things No One Ever Tells You About Getting A Knee Replacement

    Heres what you need to know thats not in the brochure: 1. You might not be a good candidate.A study published last year by researchers from Virginia Commonwealth University in Richmond questioned the value of knee replacement for some of the people rushing to get it. After analyzing data from a large study of men and women who had the operation, the researchers found that fully one-third of them were not actually good candidates for the surgery, which is why they got only a very modest benefita 2-point improvement on a common measure of knee function, compared with a 20-point improvement for people who started out with really bad knees.

    “Pain that doesnt go away and moderate to severe arthritis are necessary for a knee replacement to do its job,” Lajam says. “If you have the surgery, but its actually a problem of nerve pain, hip pain, or circulation, its not going to help you.” The advice here is not to wait until your knees are completely destroyed before seeking surgery, but to make sure that youve tried other measures first and that you meet both criteriaconsistent pain and advanced arthritis.

    Are Cortisone Injections Good Or Bad For Arthritic Knees

    Knee ACL and Lower Extremity Injuries: Can we prevent them in our young ...

    HealthDay Reporter

    TUESDAY, Dec. 21, 2021 — Cortisone injections have gotten a bad rap in recent years as a treatment for arthritis pain, because steroids are known to damage cartilage and could potentially cause the joint to further deteriorate.

    But a new study suggests that if used wisely, cortisone shots are as safe as another type of injection used to treat knee arthritis.

    Occasional cortisone shots don’t appear to cause knees to deteriorate any faster than injections of hyaluronic acid, a substance injected to lubricate joints stiffened by arthritis, the researchers said.

    “Knee replacement rates were, if anything, a little bit less in the group that got the cortisone injections,” said senior researcher Dr. David Felson, a professor of medicine and epidemiology at Boston University School of Medicine.

    However, Felson added that the study only looked at people who’d gotten infrequent cortisone shots to their knee, and shouldn’t be interpreted as giving the green light to regular injections for years to come.

    “What we know from the study that we can trust is that a few cortisone injections won’t really cause much trouble,” Felson said. “It’s conceivable that repeated injections every three months for years won’t cause any trouble, but you can’t say that.”

    “If you use it enough, it will damage the cartilage,” said Leber, who had no role in the study.

    Comparing two types of shots

    Unlike cortisone, hyaluronic acid gel isn’t harmful to cartilage.

    Wise use is crucial

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    Engage In A Prehab Program

    PreHab before a knee replacement essentially means, to actively try and improve your mind and body for surgery, with the aim of having a better outcome and recovery. Those who follow a guided PreHab program, like PeerWell, will have improved flexion, extension, and muscle strength surrounding their joint on surgery day. The best indication of knee range of motion and stiffness after surgery is what your range of motion was like before surgery. Those who are stiffest after their replacement generally had the poorest range of motion, flexion and extension going into surgery.

    When Will An Md Consider Flexion Manipulation Of A Total Knee

    The Surgeon will start considering a total knee manipulation for flexion if:

    • It is about 8 weeks or more post-surgery.
    • The knee has less than 90 degrees of flexion.
    • Outpatient physical therapy series of treatments have failed to gain the desired flexion.

    Flexion range of motion is much more time forgiving than extension, and my personal experience has been that I can gain more flexion in a patients total knee, even at 3 months post-surgery, although FULL flexion may require manipulation under anesthesia.

    Full range of flexion motion is not required to have full functional range of motion.

    Full range of motion of the knee is not usually limited by the knee joint itself, the limitation is the calf muscles hitting the hamstring muscle.

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    Downsides Of A Knee Mua

    • Possible Bone breakage. Applying pressure to break-up adhesions around your knee joint requires force. Applying this force without breaking any bones requires a skillful surgeon. If youre bones are very degraded or too much force is applied, bones could break. Although low risk, it is a risk you should be aware of. The risk increases for those who have osteoporosis, weak bones, are older etc
    • Added risk factors . Going under anesthesia is very low risk, but is a risk. Anesthesia is taxing on your body and comes with mild-moderate side effects. If you have any secondary conditions then anesthesia is more risky. Talk to your doctor about the different types of anesthesia that may be available .

    A MUA is not the sole cure for larger complications that could be caused by a technical surgical error. A MUA alone may not cure all stiffness.

    When Recovery From Knee Surgery Hits A Wall

    Was It Worth Having My Knee Replacement? – Knee Replacement #119
    Part I of III

    Total knee replacement surgery is one of the most commonly performed orthopedic surgeries in the U.S. for individuals older than 40. Given historical trends, these procedures are anticipated to increase in volume by an estimated 143% by 2050.

    Knee replacement surgery is widely considered a safe and effective surgical option for patients with end-stage osteoarthritis or inflammatory arthritis of the knee. The surgery aims to maximize the quality of life for patients by reducing pain and improving joint functionality. Unfortunately, research estimates between 1 and 10 percent of patients may experience persistent pain, limited range of motion and loss of function after surgery. This rare but devastating outcome is thought to be associated with arthrofibrosis or scar tissue build-up around the joint which ultimately has a negative impact on an individuals daily activities and affecting emotional well-being and satisfaction. Thankfully there are remediation treatment options to consider in this situation. One non-invasive, safe, and effective possibility is manipulation under anesthesia .

    What is Manipulation Under Anesthesia ?

    A Patient’s Experience: Pre-MUA

    When is the Best Time to Consider MUA?

    Risks Associated with MUA

    Expected MUA Outcomes

    A Patient’s Experience: Post-MUA

    Final Thoughts

    This column is a monthly feature of Health & Exercise Forum in association with the students and faculty of Geisinger Commonwealth School of Medicine.

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    How Much Does It Hurt After Mua

    What are the usual results of MUA? The patient normally experiences an immediate improvement in their condition, generally including increased mobility and reduced pain. There is generally some soreness after the procedure, as the muscles and joints have been worked on thoroughly, but this fades after a day or two.

    How Do I Prepare For Knee Manipulation

    Your healthcare provider will tell you how to prepare for your procedure. He or she may tell you not to eat or drink after midnight the day before your procedure. He or she will tell you what medicine to take or not take before your procedure. You may need to stop taking blood thinner medicine or NSAIDs several days before your procedure. Ask someone to drive you home and stay with you for at least a day after your procedure.

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    When Will An Md Consider Extension Manipulation Of A Total Knee

    • A surgeon will start thinking about manipulating a total knee at about 3 weeks after surgery if extension is 10 degrees or more short of full extension.
    • The actual manipulation would usually take place between 6 and 12 weeks post-surgery

    Extension is special after a total knee replacement surgery!

    There is a window of opportunity to gain full extension of the knee but that window of opportunity starts to quickly close at about 6 weeks.

    After about 8 weeks post-surgery, if the knee is still more than 10 degrees short of extension, the therapist has a near impossible task of getting that knee out straight without the surgeons help of manipulating the knee under anesthesia to break that scar tissue.

    Why Is My Knee So Tight After Knee Replacement Surgery

    Knee Pain Treatment

    Arthrofibrosis is also known as stiff knee syndrome. The condition sometimes occurs in a knee joint that has recently been injured. It can also occur after surgery on the knee, such as a knee replacement. Over time, scar tissue builds up inside the knee, causing the knee joint to shrink and tighten.

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    What Increases The Risk Of Requiring Total Knee Manipulation

    According to a study in The Journal of Arthroplasty, increased risk of a total knee needing a manipulation include:

    • Patient is younger than 65 years old.
    • Patient is a smoker.
    • Patient has had a prior surgical procedure before the total knee replacement.

    The study looked at 1,729 total knee replacement patients that had undergone a knee manipulation after the surgery.

    Of those 62 patients that had their total knee manipulated after surgery, the average age of the patient was 55.2 years old.

    The average age of all 1,729 patients was 65.3 years old.Read this study from The Journal of Arthroplasty here..

    Is Manipulation Under Anesthesia Painful

    Less force is applied during the procedure making it painless and often effective. MUA is performed by trained and certified doctors who work in chiropractic medicine, rehabilitation, osteopathy, or orthopedics. It is considered to be a subspecialty which means it may not be available in every clinical office.

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    Tips For A Successful Knee Manipulation

    Your surgeon may advise you to practice a daily exercise session for about 20 minutes, 2 or 3 times a day. Even a walk for at least 30 minutes 2 or 3 times a day will help you with a speedy recovery.

    In your first few weeks of recovery, you must follow the exercise, ice, elevate, and rest protocol explained before since it helps soothe this tiresome recovery process.

    Some surgeons may even recommend using a CPM machine known as the continuous passive motion machine until about three weeks after your knee manipulation.

    A pedal exerciser that looks like a mini stationary bike will also help you through this process.

    Sometimes, if youre not experiencing a positive outcome as youd expected, your doctor may also recommend using a dynamic splint, which is somewhat of a mechanical hinge that helps reduce stress on a restricted joint.

    How To Dodge Needing Knee Manipulation After Knee Surgery

    I May Never Be Able To Say The Knee Replacement Was Worth It… Here’s Why – Knee Replacement #158

    Knee manipulation is usually resorted to after 6-12 weeks post-knee surgery.

    A 2017 study revealed that out of 21 patients, 16 patients who had total knee replacements needed a knee manipulation afterward as well.

    If youre already recovering from knee replacement surgery and you want to increase your chances of not needing knee manipulation as much as possible, these tips and tricks will help you pick alternatives more suitable to your needs.

  • Prehab programs Prehab programs help you build up your mindset as well as your body to have better outcomes and speedy recovery from knee surgery. It guides you to improve your muscle strength, flexibility, and extension so that you wont have to rely on knee manipulations.
  • Ice By icing your knees several times a day, it will help deal with any swelling or even numb the pain.
  • Elevate your knees By elevating your knees above along with icing will help you minimize pain, stiffness, and swelling.
  • Daily exercise You definitely need to work out your knee after surgery to improve your motion. With doctors orders, you can follow an at-home knee exercise session to make sure your knee doesnt lock up in stiffness with non-use of the knee.
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    What Is A Knee Manipulation Under Anesthesia

    A manipulation under anesthesia may be necessary to improve range of motion in some patients. The MUA is a second procedure after a knee replacement. During the procedure, your surgeon will break-up the scar tissue, fibrous materials and adhesions that are causing stiffness . During this procedure, no incisions are made. Your surgeon will position your leg in several different positions, applying pressure and breaking up the tissue. Your surgeon will be able to see and hear the tissue breaking away. Lastly, the leg will be flexed and extended to its maximum range.

    All of this will be performed while you are under anesthesia , so you will not feel any pain.

    A manipulation under anesthesia for knee surgery is most common and effective around the 6-12 week mark after surgery.

    Surgeons wont consider the procedure until a minimum of 6 weeks out from surgery. On the other end, a MUA may be recommended months after a knee replacement. However, if done years after a replacement, it may not be as effective as a manipulation that took place closer to the 12 week mark.

    In a study that recorded knee manipulations under anesthesia over a 6 month period, researchers found that the average MUA took place 13.2 weeks after the initial knee arthroplasty

    How Is Manipulation After Total Knee Replacement Performed

    After placing the patient under general anesthesia or a spinal block, the surgeon applies a steady progressive manual pressure until the surgeon hears and feels an audible pop produced by the breaking of the restrictive scar tissue.

    No further force is applied after the initial breaking of the scar tissue.

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    Is Total Knee Manipulation An Outpatient Procedure

    A total knee replacement manipulation to gain extension and/or flexion does not require being admitted to a hospital, however, the manipulation will be done under general anesthesia either in a hospital or outpatient surgical center.

    If the total knee surgeon is located in a fair-sized city and is doing a lot of total knee replacements, there is a high likelihood that the surgeon will be using an outpatient surgical center instead of the hospitals operating room.


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