Knee Replacement

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Kirk

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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?
 


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
 


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.
 


jeffh said:
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. :)
 


livingwell said:
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. :)
 


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/
 


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.........
 


Shannon said:
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!
 


AnastasiaB said:
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...
 


AnastasiaB said:
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.
 


TouchofGrace said:
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).
 


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.
 
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.
 


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.
 


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.


WaltFritz said:
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! :)
 
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  34. Lulu1980:
    Phoenix Blossom Spa ๐ŸŒน๐ŸŒน๐ŸŒน2 girls๏ผŒNina ใ€Cindy ๐Ÿ”ฅ๐Ÿ”ฅ๐Ÿ”ฅ5124 Dundas St W Etobicokeโ˜Ž๏ธ416-817-3366๐Ÿ‘ Table Shower Sea Salt Bath Body Scrub๐Ÿ˜˜ Japanese girl Nina โค๏ธ Natural Big Boobs 38 DD ๐Ÿ˜˜Pink Mini Nipples Hot body slide, super enjoyable๐Ÿ˜˜๐Ÿ˜˜๐Ÿ˜˜๐Ÿ˜˜ very provocative service๐Ÿ˜˜๐Ÿ˜˜๐Ÿ˜˜, professional super New girl โ—๏ธSuki, sexy girl .pretty boobs 36D๐Ÿ˜˜Superb service ๐Ÿ‘ massage, has therapeutic effect to loosen bones and relieve muscle pressure and will bring you unexpected service effects, she will bring
  35. SL East Spa:
    ๐Ÿ’†โ€โ™€๐Ÿ’–WooHoo Wed๐Ÿ’– Ultimate destination for Asian massages๐ŸŽ‰ Two fab spots: Richmond Hill & Oakvilleโœจ Your passport to paradise with 9 enchanting girls fr China, HK, Japan & Korea โ€” ๐Ÿ†•Akino, Cindy, Coco, Luna, Amber, JPN Yui, Cici, Jasmine & Lucyโ€” ready to pamper you๐ŸŽ๐Ÿ Ring us ๐Ÿ“ž647-695-6354 or text us ๐Ÿ“ฑ647-578-8169โœจ 160 East Beaver Cr., Unit 12, RichmondHill ๐Ÿ’ฐWhere Eastern charm meets Western comfort - your bliss awaits๐Ÿ™Œ
  36. luckywellness:
    Lucky Wellness Center 4379721888 295 Eglinton Ave E,Unit 7,Mississauga We had two girls today, Niko and Kiki. They were both young, pretty and cute. The massage and back massage were great.
  37. AliceSpa:
    WEDNESDAY at ๐—”๐—Ÿ๐—œ๐—–๐—˜ ๐—ฆ๐—ฃ๐—” 416-298-0898, 4915 Steeles Ave. E, Scarborough 3 very nice girls here today. Open 10am to 9pm: APPLE: from Hong Kong, very small body, 5' 100Lbs, petite with natural C Cups, small waist, pretty baby face, smooth skin, very clean. Shaved tight Pu**y, strong professional massage. Available FS bbbj cim cof rim. BEBE is a young slim Vietnamese girl with a beauty face
  38. Nu spring spa888:
    ๐ŸŒน๐ŸŒน๐ŸŒนsexy hot Philippine ๐Ÿ’– ๐Ÿ’– Malaysia ๐Ÿ’– ๐Ÿ’– Korean girls ๐Ÿ‘working at Nu spring spaโ˜Ž๏ธ416-669-8508๐ŸŒน๐ŸŒน๐ŸŒน
  39. wilson holistic centre:
    ๐Ÿ’•๐Ÿ’•Beautiful Korean girl working at 382 Wilson Ave ๐Ÿ’•๐Ÿ’•โ˜Ž๏ธโ˜Ž๏ธ416-840-0071โค๏ธโค๏ธ
  40. Lilyspa1:
    Lily Spa :๐Ÿ’•๐Ÿ’• Wednesday Schedule ๐Ÿ‡ฎ๐Ÿ‡ณ๐Ÿ‡ฎ๐Ÿ‡ณKajal 23, Punjabi girl ๐Ÿ˜ˆGFE & bbbj โค๏ธโค๏ธElena ( Latino ) Big Nature Boobs & SuSu ( Asian )Slim , ๐Ÿ˜๐Ÿ˜Porn Service ๐Ÿ”ฅDuo ๐Ÿ”ฅ,โ˜Ž๏ธ 6475318288
  41. Jennyโ€™s Spa:
    ๐ŸŽ‰๐Ÿ’JENNYโ€™S SPA๐ŸŽ‰๐Ÿ’ โœ…5170 DUNDAS STREET WESTโœ… ๐Ÿ‘ŒETOBICOKE ONTARIO M9A 1C4๐Ÿ‘Œ โ˜Ž๏ธ( 647-893-5196)โ˜Ž๏ธCall or Text โ˜Ž๏ธ( 437-888-3759)โ˜Ž๏ธCall Only (ETOBICOKE) OPEN 10am to 9pm MONDAY to SUNDAY ๐Ÿ”ฅโœ…GRAND OPENING๐Ÿ’ฏNEW GIRLS EVERYDAY๐Ÿ”ฅEXCELLENT MASSAGE + SERVICE QUEENS NOW AVAILABLE AT JENNYโ€™S SPA FOR ALL YOUR MASSAGE AND SPECIAL EXTRA NEEDS๐Ÿ”ฅ๐Ÿ’ฏ๐Ÿ˜˜๐Ÿ”ฅโค๏ธ๐Ÿ‘Œ ๐Ÿ”ฅTWO BEAUTIFUL NEW YOUNG ASIAN GIRLS EVERYDAY๐Ÿ”ฅ ๐Ÿ’ฏREAL PICTURES OF ATTENDANTS๐Ÿ’ฏ ๐Ÿ”ฅ๐Ÿ’‹Limited Time Special Promotion๐Ÿ”ฅ๐Ÿ’‹ โœ…๐Ÿ’ฆ30 Minutes Nude Mass
  42. Moneylee:
    Full season wellness center: Young girl Big-breasted big big butts Aris , Young girl big breasted beautiful buttocks charming temperament big boobs Rose,Young girl big breasted beautiful buttocks charming temperament big boobs Julia ,Young beautiful face sexy body and good deep massage maggie,Enchanting sexy petite deep massage Mary. ๐Ÿ  2560 Shepard ave Mississauga unit 1 โ˜Ž๏ธ 4379857899 ๐Ÿ‘…๐Ÿ‘…๐Ÿ‘„๐Ÿ‘„๐Ÿˆต๏ธ๐Ÿˆต๏ธ๐Ÿฆต๐Ÿฆต
  43. Golden Flower Spa:
  44. BlueXado Therapy & Spa:
  45. Pink Flower Spa:
  46. Annie Spa:
    ๐ŸŽ‰๐Ÿ’ANNIE SPA๐ŸŽ‰๐Ÿ’ โœ…7-1001 SANDHURST CIRCLEโœ… ๐Ÿ‘ŒSCARBOROUGH ON M1V 1Z6๐Ÿ‘Œ โ˜Ž๏ธ (647) 891-9688โ˜Ž๏ธ โ˜Ž๏ธ (416) 291-8879โ˜Ž๏ธ (FINCH & MCCOWAN) OPEN 9:30am to 9pm MONDAY to SUNDAY ๐Ÿ”ฅโœ…NEW MANAGEMENT๐Ÿ’ฏNEW GIRLS๐Ÿ”ฅ๐Ÿ”ฅ ๐Ÿ”ฅGORGEOUS NEW YOUNG ASIAN GIRLS - TODAYโ€™s ROSTER INCLUDES: ๐Ÿ”ฅ Feifei๐Ÿ˜˜Our new Taiwanese beauty Feifei specializes in creating an intimate and deeply relaxing massage experience tailored to your desires. Her soft, skilled hands glide effortlessly, easing tension and awakening your senses
  47. HollywoodSpa:
    Wednesday at ๐ŸŽญ๐—›๐—ข๐—Ÿ๐—Ÿ๐—ฌ๐—ช๐—ข๐—ข๐—— ๐—ฆ๐—ฃ๐—”๐ŸŽญ, 4578 Yonge St, Unit 100, North York, ON: NICOLE & SISI. โ˜Ž๐Ÿฐ๐Ÿญ๐Ÿฒ-๐Ÿฎ๐Ÿฎ๐Ÿฎ-๐Ÿฑ๐Ÿฑ๐Ÿฑ๐Ÿฐโ˜Ž NICOLE is petite, slim and very pretty, with C Cups , long hair & a slim waist. She has nice massage and great services. SISI is a sweet slim beauty, 5โ€™2โ€, with a beauty ass, excellent massage, and amazing services. Come and see why she is so popular. When you visit ๐ŸŽญHollywood
  48. HolidaySpa:
    Wednesday at ๐ŸŒด๐Ÿ˜Ž๐ŸŒ…๐“—๐“ธ๐“ต๐“ฒ๐“ญ๐“ช๐”‚ ๐“ข๐“น๐“ช๐ŸŒ…๐Ÿ˜Ž๐ŸŒด3517 Kennedy Rd, Unit 4, Scarborough โ˜Ž๏ธ๐Ÿฐ๐Ÿฏ๐Ÿณ-๐Ÿฎ๐Ÿฐ๐Ÿณ-๐Ÿญ๐Ÿญ๐Ÿต๐Ÿตโ˜Ž๏ธ: EMILY, KIKI & CINDY. EMILY is a VERY tiny petite SPINNER superstar of the highest quality. Emily has a pretty face, natural A Cups, slim waist, and a lovely spinner bottom, topped off with the very best of services. Kiki is very attractive, young, about 5โ€™4โ€ and 110 Lbs., slim with a banging body.
  49. wonderspa:
    ๐ŸŒบ๐ŸŒบWonder spa,(9421Jane st unit127)call416-5000-800โ˜Ž๏ธbest massage in vaughan,Wednesday RMT available,๐Ÿ’„sexy very young girl Joey natural c cup,very good looking nice body slide,really popular ๐ŸŽlong hair Q Lucy good strong to relax oil massage, Relieve pain and remove stress,more experience,young very beautiful new girl Cici, back walk ,body slide,amazing the end,give you warm and comfortable time must try๐Ÿ”ฅ๐Ÿ”ฅ
  50. SugarLoveSpa:
    Wednesday at โค๏ธ๐Ÿ’™ ๐Ÿ’œโŽ๐—ฆ๐—จ๐—š๐—”๐—ฅ ๐—Ÿ๐—ข๐—ฉ๐—˜ ๐—ฆ๐—ฃ๐—”โŽ ๐Ÿ’–๐Ÿ’—๐Ÿ’˜: LISA, LUNA, SUSAN & TIFFANY. 1270 Finch Ave W (at Keele St), Unit 18. North York, ON โ˜Ž ๐Ÿฐ๐Ÿฏ๐Ÿณ-๐Ÿฏ๐Ÿฒ๐Ÿฑ-๐Ÿฎ๐Ÿฒ๐Ÿด๐Ÿด โ˜Ž LISA is a cute & petite Thai/Chinese mixed beauty with decent massage skills and liberal services. LUNA is a slim, VERY PETITE and capable Vietnamese beauty, nice natural 34C Cups. Luna can do everything. SUSAN is small, slim
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