2 YEARS POST BTKR

Yes, its been two years since I had my bilateral TKR, 14 April to be exact.  Actually, I have never been so excited about anniversaries but this is a special one for me.  Its so personal, its part of my body and it has given me my life back.  So I try not to take things for granted and be grateful everyday for my pain free knees.  Some people told me that after a few years out of TKR, they have already forgotten about it.  But for me, I still have vivid memories of the events leading up to my surgery and the recovery itself.  Perhaps with all the research that I am doing and the constant observation of my knees, its hard for me to forget.  In fact, I don't want to forget and I want to learn more about it.  I have never been so passionate about anything but this TKR experience has certainly stirred up some serious interest in me.  And looking at the bright side, it has become a blessing for me because I have made some positive changes in my life. 

 


Its interesting that I still experienced improvements in my knees even in the last few months.   In January 2012, I went to Bangkok, Thailand for a holiday and that was about nine months after my bilateral TKR.  At that time, I walked a lot but my knees felt quite stiff and tight.  In Bangkok, the most convenient way to travel is by tut-tuts (see picture on the left). It is a really cool way to travel and we loved it. However, I struggled to climb into the tut-tut because it was quite high and my knees could not bend so much.  So the driver had to stop at the curb by the road side just like the picture shown here so that its easier for me to climb in.  As for getting out of the tut-tut, I had to literally slide myself out on my butt.  It was quite embarrassing actually.

Now fast forward another year in January 2013, I went there again for another holiday and this time, I could feel the difference.  The stiffness was reduced even after the long walks and I could climb in and out of the tut-tut much more easily.  So that was a pleasant surprise for me.  In fact, I was so grateful that I could go shopping for hours everyday that I was there without any pain and that also means that I could go anywhere to enjoy the food and the sights.



The other thing I noticed recently is that I could get out of the back seat of a car much more easily than before.  You see, I have no problem getting out of cars from the front seat because it is much more spacious and I usually drive myself.  However, sometimes when I sit in the back of someone else's car, I always struggled to get out from the car as the space is much more constrained and my knees could not bend as much.  But I noticed recently that it is easier to get out from the back seat because my knees could bend more which means that my range of motion has improved.  Each time an improvement like this took place, my mind will be conscious of it and I will be smiling away as if I am congratulating myself for another milestone achievement.

I also noticed that the clunking sensation (i.e. the friction between metal and plastic) has reduced.  Actually, when I walk, it feels quite natural now in the knees.  Its only when I bend my knees or climb staircase that I could feel the tightness and the clunking.  For a long time after TKR, I did not feel comfortable wearing heels so I would wear flats most of the time.  Now, I feel comfortable wearing a two inch heels but I prefer them to be platform heels instead of stilletos.



Of course, I still have stiffness after prolonged walking, sitting and standing but it has reduced.  I am happy to see this slight improvement because realistically, I know that the stiffness may not completely heal due to damage of muscles and ligaments caused by the progression of OA.  Even the tight band feeling is still there but it has improved.  I have been diligently doing my deep tissue massage on a daily basis and about three times a week, I will practise my improvised method of kneeling and walking as described in my post on Massage for stiffness and tightness.  Since then, I can now kneel on the pad and walk a little back and forth without any support.  I can't do it for very long though as it is painful but I know that it will get better in time.  Already it has helped me to overcome my fears of kneeling especially when I get up from the floor.

On the health front, my regular consumption of green smoothies and alkaline diet (see posts on green smoothies and pH balance) has proven to be very effective.  And I am glad to see quite a lot of interest from readers lately on these two topics.  Overall, I feel so much healthier with more energy and vitality.  My immune system has improved tremendously and as a result, I am saving on medical costs.  These days, I am doing more indoor walking exercises with a DVD program which progresses to light jogging and prancing and some core exercises with light weights.

Recently, I started to go back to Batu Caves for exercise (haven't been there for a few years).  Batu Caves is a sacred place for the Hindus in Malaysia.  It consist of three main caves and a number of smaller ones.  The caves are made of limestone and there is a long staircase of 272 steps to reach the entrance of the cave (see picture on the left).  I went there twice and the first time was about a month ago.  At that time, I could only climb up once and my legs were already wobbly and I was huffing and puffing away. The second time I went there, I did a lot better.  I was able to climb up twice i.e. a total of 544 steps!  Its another milestone achivement for me and you know what? The knees felt great. Actually, before my bilateral TKR, I could also climb up twice but after that, my knees would be so sore, stiff and painful.  The big difference now is that I do not have to take pain killers and use medicated plasters for the knees.  Now my goal is to get fitter and be able to climb up three times, hopefully.  After learning that more activities is okay for the implants (see Exercise post TKR), I do not worry anymore about it while exercising as long as I know that I am not overdoing anything.

Another interesting thing which I did recently was going bowling with my children and their partners and it was so much fun.  It felt good being able to bowl and thereafter, did not have to suffer from stiffness, soreness and pain in the knees.  In fact, I felt so energetic and was standing up most of the time.  My highest score was 114 out of three games which was not  bad considering that I haven't bowled for so many years.  Well, I can certainly see more bowling activities in the future for me.

So after two years, do I have any complaints?  Absolutely not. In fact, I am happy to report that after so long, improvements can still happen.  I believe that its due to being physically active with daily activities,  regular exercise and massage. Would there be more improvements? I don't know but I recently had two similar dreams that I was squatting down all the way and sorting out some books at the bottom of the shelf.  Then I woke up and for a moment, I was confused.  I thought to myself - am I able to squat down all the way now?  Then I realised that it was just a dream.  Is this some kind of a sign?   I really don't know and  I don't expect any miracle to happen soon. Anyway, what's important is that my overall function is not impaired and I am able to lead an active lifestyle   In fact, I feel that this experience with TKR is a blessing for me because I have learnt so much about arthritis, diets and health in general and I will be sharing more on this with you.  So watch out for it!

Bangkok Intl Airport

MASSAGE FOR STIFFNESS & TIGHTNESS

Based on the search keywords for this site, I noticed that there is a lot of concerns about stiffness and tightness post TKR.  I have earlier written two related posts on Swelling and Stiffness as well as PT & Massage after TKR.  Since then, I have done a lot more research and also experimented on various methods to help reduce stiffness and tightness.

In my earlier post on OA still exist after TKR?, it was explained why we have stiffness before and after TKR.  Stiffness is due to muscle and ligament damage during the progression of arthritis as described using the analogy of the "tent".  Some studies have shown that if patients have stiffness before surgery, then they are more likely to have stiffness after surgery.  These studies suggests that among the variables evaluated such as age, gender, medical condition, body size etc., the pre-operative stiffness was the only significant predictor of post-operative stiffness.

After TKR, most of us will experience a tight band feeling across the knee.  Some people may be fortunate enough to have experienced a reduction or elimination of this feeling after some time.  But for the rest of us, we may still have it after months or years post TKR. This tight band feeling is actually caused by adhesion (scar tissue).  According to Bone Smart, all the structures in the body, muscles, tendons, ligaments, even gut and lungs need to be able to glide over one another smoothly to let our bodies work.  To enable this "glide-ability", the body produces a special viscous fluid approximately the consistency of egg white, which lubricates everything with great efficiency.  When one tissue such as the skin is cut and has to mend, the skin generally makes itself a nice thin little line of fibrous tissue which may fade and disappear over time.  This is called a scar which is primary scarring.  When two bodies of tissues, like muscles, ligaments and surrounding structures are split apart and then nature sticks them back together again, they usually resume normal relations in terms of being close together but with glide-ability.  However, sometimes they fail to restore the needed moistness that allows this and so they get stuck together and the result is adhesion which is secondary scarring.

Adhesion or scar tissue can decrease our range of motion which may give us a feeling of tightness or not being able to move our joints normally.  If the adhesion affects a nerve from moving properly, we can get abnormal sensations like numbness, tingling and pain.  If it affects a muscle, we will have a decrease in strength, a decrease in range of motion and the muscle may feel stuck.  This may result in a feeling of pulling or dragging sensation when we move.  Scar tissue often hurts when touched or during weather changes (which is inexplicable).

Some people seem to make more scar tissues than others. In fact, some people go through a surgery to break scar tissues but this may even cause more scar tissues.  Recently, I read about a woman who had a stomach surgery and subsequently suffered severe scar tissue problems.  Thereafter, she had several surgeries to break down the scar tissues but it did not improve her condition.  She lives in a debilitating state with constant pain and poor posture.  This is an eye opener for me because I did not know that scar tissues could lead to such major problem.

Some doctors will recommend patients to go through a procedure called Manipulation Under Anaesthetic (MUA)  in order to break scar tissues and improve range of motion.  While the patient is asleep and relaxed during MUA, the surgeon forcibly bends the knee until the adhesion give way.  This may result in a backlash of swelling and soreness which at first results in poor flexion but after a period of recovery, the real flexion may surface. However, the result is not guaranteed so most people are hesitant to do it. 

Even after almost two years post TKR, I still have some tight band feeling.  I kept wondering what are other alternatives for breaking down scar tissue and so I did some research.  According to Dr. Barry Triestman, D.C. who specialises in chiropractic care, the reason the scar tissue do not go back to normal is that the body needs to have ideal bio mechanical force put on it and then the tissues will go back to normal.  He uses a patented Active Release Technique which is a soft tissue system to treat scar tissues amongst other things. 

I discovered an interesting video by Knee Pain Guru through the internet showing that one of the ways to break scar tissue is to kneel and walk with our knees so that the force will slowly make the tissues go back to normal.  Of course, this is easier said than done.  How many of us feels comfortable kneeling after TKR?  Not many, I should think. And certainly not me. But as an alternative, I have an improvised method.  I kneel on a thin pad at the edge of my bed and I use the bed to support my upper body just like doing a prayer.  Then I walk with my knees a little back and forth. After that, I just stand on my knees without any support and hold for 20 to 30 seconds.  Oh boy, it does feel painful but it feels good to be able to do this and it gets better with more practice. Already I am finding that I can get down and up from the floor a lot easier.  Now if any of you are game to try the Knee Guru method, please check out the video below.  It might just be the fastest way, not to mention the most painful way to break scar tissue or adhesion.

There are many other non-invasive methods to break scar tissue which you can find in the internet.  There is one method called the Decompression Massage Therapy which I have not tried before but it looks promising to me.  You can check out the the video below which I obtained from the internet. The most practical method for me is deep tissue massage.  Massage therapy has been proven effective to break down scar tissues without any known side effects. Of course, for some of you who have blood or other medical issues, please consult your doctor first. We can seek the services of professionals or we can do it ourselves.  I have started practising deep tissue massage recently on my own and am starting to see improvements in the tightness.  It feels painful and sore initially because we need to apply more pressure preferably using our knuckles on the areas around the knees and on the points of the legs that feels tight and painful.  The good news is that old scar tissues can still respond to deep tissue massage except that it might take a little longer.  If you have just gone through a TKR, it is advisable to wait at least three months or longer until the wound is totally healed. You can check out the video below which I obtained from the internet to see how deep tissue massage can be done.  This video shows a deep tissue massage for an ankle surgery but the routine can be the same for TKR.

According to Bone Smart, a therapist described her technique to reduce scar tissues by applying pressure to the scar with fingertips, hands next to each other like when you are playing a piano and the scar is where the keys are.  Then pull and stretch the scar gently in as many opposite directions as possible to break up all the collagen fibre adhesion.  Eventually work in one specific line of force (only stretching the tissue in one way) to align all the collagen fibres in one direction instead of a chaotic "mesh-like" pattern they can be in when we started.  We need to keep doing this on a regular basis.

 

I realise that to use our fingers to massage can be very tiring so I discovered these cheap little handy plastic massager  (see picture on the left) which comes in all shapes, colour and sizes.  Do not underestimate them as they are very effective and handy to carry around.  Now all we need to do is to apply some massage or baby oil on our legs and then with some pressure just glide the massager all over the thighs, knees, calfs and down to the ankles.  We can also use it to apply pressure on the points of knees where it feels tight.  I use a combination of my fingers, knuckles and the handy plastic massager.

Its amazing what massage can do for our body. I have been able to eliminate the tension headaches at the back of my head while sleeping in the past just by massaging my shoulder, neck and head using my fingers and knuckles while watching television every night.  So I actually kill two birds with one stone.  If I am unable to sleep, I will use my fingers to massage my eyebrows, the temple of my face right up to the back of my ears and it works for me all the time.  Occasionally, I will treat myself to a  full body massage by a professional massage therapist which is so therapeutic. 

Massage therapy improves blood circulation and lymphatic fluid throughout the body, allowing for increased oxygenation of the body's tissues and organs and reduction of swelling and stiffness.  Additionally, the simple fact that human touch, something that we all need and benefit from, is involved in massage therapy and accounts for much of its physical and mental healing qualities. 

My self-massage technique