RANGE OF MOTION

Range of Motion (ROM) is the measurement of the amount of movement of a joint.  I am referring specifically to ROM for knee joints here.  A goniometer (see picture below) is used to measure ROM.  It is a metal or plastic handheld device with two arms which works like a protractor.  So we can easily use a protractor which can be found in most homes to measure ROM.

Pain, swelling and stiffness are common symptoms of arthritis.  If we suffer from these symptoms for many years, our ROM would be greatly affected.  In serious cases, the limitation of the ROM may impair our functions and our ability to perform normal daily activities.

My ROM before TKR had already been affected.  I was only able to squat maybe halfway down.  Today, after almost 16 months post my bilateral TKR, I finally measured my ROM with a protractor and it's around 120 degrees.  If my knees weren't so fat, maybe I could bend a little more.  I know that my ROM now is the same as before TKR because the degree that I could bend and cross my legs while sitted is the same as before.  When I saw my OS for a follow-up check at two weeks after TKR, he examined my knees and said that my ROM was 90 degrees.  At three months, he said my ROM was 110 degrees.  Then he told me that I had to achieve maximum ROM within six months after TKR otherwise, it would be difficult to improve further.   When I complained to him about the stiffness and tightness, he told me that its due to muscle scarring.  He said that when muscles are scarred, they will always contract.  And he also told me that the more ROM I achieve, the better the stiffness would be.  Well, after months of trying at my own pace, I found that my ROM could not improve any further.  And my stiffness is still there (see post on swelling and stiffness).

I raised a question to my TKR forum members whether ROM can still improve in advanced recovery.  And to my surprise, they said Yes!  Some of them discovered that they still see improvements even after more than a year of recovery without doing anything much.  So that was a relief to me  and I stopped worrying about trying to increase ROM.  One day recently, while I was doing something, I suddenly noticed that my knees could bend a little more than before.  I thought that was a pleasant surprise.  It's strange that sometimes when we stopped trying and worrying, then something unexpected but positive happens.

From my TKR forums, I noticed that a lot of members are very concerned about their ROM in early recovery.  In fact, some are so impatient about it and would work their butts out. Then they will complain why their knees are so painful, swollen and stiff.   Yes, it can be very painful and the PT's mantra is "No pain, No gain".  But this concept is causing a lot of pain, swelling and stiffness which will eventually lead to a delay in recovery.  It can be an emotional trauma too for most people and that's why PTs have earned the name "Physical Terrorists". 

It's also quite typical that most people can achieve more ROM when they work very hard with a PT.  But the minute they go home, they find that their ROM has reduced and so, they feel disappointed.  This is because their knees have become swollen and stiff as a result of working too hard. So if you have a chance to choose your own PT, I would suggest that you choose one that is more caring and compassionate.  After all, we are not training for the Olympics.  Recently, I learnt that some people hardly do any PT and they ended up fine with reasonably good ROM.  So that's another interesting discovery. Well, I am glad that I did not have to go through this because I only had the PT at the hospital for a few days.  After that, I just did it on my own at home.  I did not pushed myself too hard.  I just did the exercises up to the point of discomfort.  So I did not suffer from prolonged pain and swelling and as a result, I had a reasonably fast recovery.

Contrary to the usual "No pain, No gain" mantra, our Bone Smart Forum's mantra is "No pain, More gain". The rationale is that this will lead to faster recovery.  All we need to do is rest, ice, elevate and take pain meds accordingly.  One important thing I learnt from this forum is that our knees are in charge in terms of the healing process, not us.  So if we become impatient and overwork them, they will be very angry and we will face a set back in recovery.  But if we do our physical therapy exercises gently at a slower pace and give our knees a lot of TLC, naturally they will heal faster.  I believe that once our knees are stronger and the wounds have healed quite a bit, then we can start to do more intensive exercises to gain more ROM.  It will not be too late as a lot of us are living proof of that.

PT & MASSAGE AFTER TKR

Physical Therapy (PT)is primarily concerned with the remediation of impairments and disabilities and the promotion of mobility, functional ability, quality of life and movement potential through examination, evaluation, diagnosis and physical intervention carried out by the Physical Therapists (Wikipedia).

After TKR, most of us are subjected to physical therapy to help with the improvement in range of motion and strengthening of the muscles. PT can be a very painful experience and if we worked too hard, our knees become more stiff and swollen afterwards. And this will cause  delay in recovery as experienced by many TKRers.  I feel that PT is necessary but it should be done gently and at our own pace as the wounds from the surgery needs healing, not beating up.

In my home country, outpatient rehab is not very popular. I was taught to do some PT exercises at the hospital and was advised to continue doing them at home after I was discharged. I was so glad that I did not pushed myself too hard when I did the PT at home. I did it gently twice a day, sometimes once and sometimes, I had even forgotten to do it. I believed that because of this, I did not suffer from prolonged swelling and stiffness due to the swelling.  In fact, my rate of recovery was quite fast. It was only when my knees felt better and stronger, then I started to exercise more intensively and my range of motion improved gradually.

Massage is described as the manipulating of superficial and deeper layers of muscle and connective tissue using various techniques, to enhance function, aid in the healing process, and promote relaxation and well being (Wikipedia).

Besides PT, I believe that we should consider doing massage as well. I understand that massage after TKR helps to speed up recovery. It helps to move the fluid and get the scar tissue moving, reduce pain and increase range of motion. I also understand from one expert in muscles that after TKR, we should massage the entire thigh area, front and back. This helps to reduce stiffness at the knees and improve range of motion.

In general, massage is good for us.  I enjoyed doing body massage all along as I would feel very relaxed and re-energised afterwards. Some people like traditional massage that uses lots of strength when applying pressure which can be very painful. I prefer the more relaxing massage because its very therapeutic for me.

Among some of the benefits of massage are:-

· Improve blood circulation

· Promote tissue regeneration and reduce scar tissue

· Reduce anxiety, tension and fatigue

· Produce endorphins, a natural feel good drug

· Enhance immune system

· Reduce body aches and pain

· Reduce stiffness and improve range of motion

· Improve sleep quality 

Going for regular massage can be quite costly. But we can minimise it by massaging ourselves particularly on areas that we can easily reach.  I do this every night while watching TV, so it has become a routine.  Occasionally, I will go for massage by a professional massage therapist.  There are many techniques of massage but there is no evidence of which one is the most effective.  You can google to check out various techniques of massage and how it is applied.  Try out some of them and see which one works for you.

Here's something to share with you. I discovered a website and video by Heather Wibbels, a Licensed Massage Therapist which is interesting and may be beneficial.

Click this link below to go to her website.

http://www.massagebyheather.com

Click this link below to watch her video on scar and adhesion massage to loosen tissue and help range in motion which we can do ourselves.

http://www.youtube.com/watch?v=1vMvAJYikxo

 

Click this link which is contributed by a BoneSmart Forum member in relation to lymphatic drainage for faster recovery after surgery.

http://www.fortcollinslymph-massage.com


Click this link below to watch a massage on the thigh area.

http://www.youtube.com/watch?v=y_DwyZyozhA

WATER & ARTHRITIS

In our quest for better health, most of us will resort to consuming any health supplement that we hear is good for our body.  But we tend to forget that one of the most basic thing that our body need is water. Yes, plain old water which is freely available and cheap.  Most of us are quite dehydrated and we don't even realise or think much about it.  We all seemed to know that water is good.  But how many of us will consciously drink enough water to hydrate our body and how many of us are aware that dehydration can cause diseases including arthritis?

Some time ago, I discovered a book called "Your Body's Many Cries for Water" written by the late Dr. F. Batmanghelidj who had spent many years researching about dehydration which is most enlightening for me. His research revealed that unintentional dehydration produces stress, chronic pains and many degenerative diseases.  I have also done some research on dehydration and personally experienced the benefits of increasing water consumption drastically.

I learnt from the book that our body consist of 25% solid matter and 75% water.  Our brain tissue is said to consist 85% of water.  It is the water that energises and activates the solid matter.  Even our blood contains 50% of water.  So if we are dehydrated, our blood becomes more concentrated.  In simpler term, it means that our organs need water to function and if we don't consume enough water, our organs cannot function properly and eventually, we start to have symptoms such as pain.  If we ignore the symptoms, then the condition will become worse. 

Some of the symptoms of dehydration includes the following:-

• Headache                                       Dizziness 
• Fatigue                                           Excessive thirst
• Dry mouth                                      Muscle weakness
• Lack of urination                             Constipation
• Dry skin                                         Muscle cramps
• Kidney problems                             Migraine

After learning about the importance of water, I increased my water consumption drastically as I  wasn't drinking enough water in the past. I have been drinking from a bottle so that I know how much water I consumed.  I can drink lots of water at home but going out is a problem.  When I am working in my office, I tend not to drink enough water because of the busy work schedule.  Sometimes, I ended up having headaches when I reached home and I realised that I did not drink enough water at the office.  So I quickly grab my bottle of water and gulped down lots of it.  After a while, the headache was gone.  Its amazing.  I would not have thought about this in the past and I would have swallowed some medicine for it.  But now, I know that the problem was just dehydration.  So the next time any of you have headaches, migraine or pain, try increasing your water consumption drastically and see whether it works.  It could just be a thirst signal.

Another interesting thing I learnt is that our cartilage surfaces of bones in a joint also contain water.  The lubricating property of this "held water" is utilised in the cartilage, allowing the two opposing surfaces to freely glide over one another during joint movement.  Therefore, water lubricates our joint and dehydration can cause joint problem.  Wish I knew about this much earlier.

So the next question is how much water do we really need to drink?  It is recommended that the daily intake of water should be within 2 - 4 litres depending on the size of the person.  The bigger we are, the more water we require.  The more active we are, the more water we need.  Don't forget that we also excrete a lot of water through perspiration due to exercise or heat, urine, bowel movement, sweaty palms or feet and breathing - yes, our lungs expel water through normal breathing and even more during cold weather.

Alcohol, coffee, tea and beverages containing caffeine are not counted as water.  A good indicator for water requirement is the colour of urine.  A well hydrated person produces colourless urine.  A comparatively dehydrated person produces yellow urine.  A truly dehydrated person produces urine that is orange in colour.  Of course, there are concerns about drinking too much water.  Though this is uncommon but those with certain medical conditions should seek their doctors' advice first.

Now some of you may have heard about the benefits of lemon.  Lemons are antiseptic, has excellent digestive properties, cleanses and stimulates the liver and kidneys, good for relief from cold and flu symptoms due to its Vitamin C contents and great as a skin cleanser.  Lemons have been shown to be helpful for reducing some of the symptoms of osteoarthritis and rheumatoid arthritis. They are acidic in its basic state but because of its very low sugar content and high alkaline mineral content, lemons actually have an alkalising effect on the body.  So its good to drink water with lemon.  We could just drop a slice of lemon into our water or squeeze the juice into the water.  I have a slice of lemon in one of the bottle which I drink daily.  There are also claims that lemon can kill cancer cells.  How true is this?  I really don't know but if its true, then it will be a bonus for us.  Anyway, I would continue drinking water with lemon simply for its natural health benefits.  On top of that, they are tasty, refreshing and inexpensive.

We all know that exercise is good for our body. And I also learnt that exercise makes the muscles hold more water in reserve and prevent increased concentration of blood that would otherwise damage the lining of the blood vessel walls. Fat holds less water than muscles. So this gives us another reason to exercise. 

In  summary, I feel that water and exercise are two important factors for good health and they don't burn holes in our pockets too.  So lets drink up!