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