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Dec 24, 2019 · Nocturnal Leg Cramps - Help! in Bones, Joints & Muscles

This concept is great but I am having a hard time visualizing the sock. Can you post a picture? I can’t seem to understand how to sew the tail on it so you can still allow your foot into the sock.

Dec 24, 2019 · Scar Tissue in Joint Replacements

Thank you for this info and link. I love your comment that PT is forever…..maybe not paying someone but one definitely has to be motivated to continue on their own, and it's lifelong like it or not. Your comment about pain is true. I know for me, I was told it would be managed by medications but in all honesty- ice was the only thing that really helped me manage my pain. Maybe the meds took the edge, but I didn't have the normal or usual response like my colleagues after knee surgery.

Dec 24, 2019 · Herniated discs at Levels L4/L5-S1 in Bones, Joints & Muscles

I haven't heard about stem cell for this issue but the jury seems to be out for strong evidence to be used for other conditions. As a PT, I can tell you that most herniated discs do get better in time, on their own and physical therapy can help one learn how to manage their conditions. I don't know all your issue but surgery is not always the answer and many patients have more issues after surgery.

Here is a link of an abstract related to the healing process known as disc resorption. There is also plenty of evidence to support that the majority of the population has a herniated disc but are asymptomatic.

Dec 24, 2019 · scar tissue after knee replacement in Joint Replacements

There is current evidence that indicates that CPM (continuous passive motion) machines are not effective in more desired outcomes in uncomplicated knee replacements. I haven't see any literature about the use of machines in more problematic knees. The biggest issue is that the machine is passive and active motion is always preferred over passive for lots of reasons.

Dec 24, 2019 · scar tissue after knee replacement in Joint Replacements

I am now totally against being extremely aggressive- and even in clinic practice, I never saw the value to being over aggressive. It's the patient that leaves the clinic in agony, not the therapist. There is no literature or evidence to say this aggressive approach results in more desired outcomes. I do feel that you have to shove gently- push to your limit but then a bit further. For those that have a low or poor pain tolerance, you have to push through.

Dec 24, 2019 · scar tissue after knee replacement in Joint Replacements

Hello @babette
As PT, I appreciate your comments and insight and you are right about PTs sometimes being too aggressive. I have seen PTs push way to hard and they wonder why things are worse (rebound effect). Sometimes other things need to occur (massage, soft tissue work, etc) before stretching. But there is the flip side in which some people are too passive and barely do anything and then blame the doctor or PT for their lack of progress. I do think there needs to be more education and explanation upfront about all the pros and cons before surgery. With my knee replacement surgery (and I am a PT) not one single person mentioned any risks other than infection or rejection including the lingering pain and scar tissue build up or sizing issue with the prosthesis (my issue). I never realized that a prosthesis could be too small or large! I'm not even sure how scar tissue is determined other than going back into the joint, which in itself is another traumatic event for the joint.

I do know from my experience- persistence and continuing your exercises daily, pushing a bit past your tolerance, is necessary.

Dec 10, 2019 · Has anyone had a tight band feeling after total knee replacement? in Joint Replacements

I have considered trying Astym but my PT doesn’t feel it will work for several reasons, many as he doesn’t think scar tissue is the root cause of my pain. However, I have used it on my hip but minimal relief. My biggest issue with this that you can’t do on your own to carry over after therapy is done.
I read up on Prolotherapy and it’s an interesting theory (how it works) but the evidence to support it for optimal outcomes is very limited. When they mention the cost, upwards to $1000, I am assuming it’s per injection and several injections are suggested. I look forwards to hearing others experience with this.

Dec 8, 2019 · scar tissue after knee replacement in Joint Replacements

I don't know all the issue with your circumstances but you may want to ask your PT about some manual therapy- my professional experience and from personal experience is that you can stretch and stretch (with no results) but until you release the underlying tissue (fascia)- your issue will continue. Some examples of manual therapy include: cupping, instrument assisted soft tissue mobilization (IASTM), or Rock Blade- there are a few other types of this, use of foam roller, or even deep tissue work.
I don't know how they exactly measure the amount of scar tissue nor how they determine it's no longer forming. My clinical experience is that this is very subjective but a therapist can manually feeling tissue tightness. But everyone has their own degree of scar tissue formation due to the degree of collagen in their body and how those bonds form after trauma. I feel fortunate to have not have this issue specifically but I do have less then desired outcomes after my knee replacement, now coming up on two years. If you are not icing after you stretch, you should check with your PT about that as for me, even two years later, ice is still the most helpful for pain management. Better than any medication- prescription or over the counter.