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Total Knee Replacement --massage therapy

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Ask a PT View Drop Down
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  Quote Ask a PT Quote  Post ReplyReply Direct Link To This Post Topic: Total Knee Replacement --massage therapy
    Posted: Aug 18 2008 at 5:01pm
Our user asked: "I have a patient who's friend had both knees replaced. On the first knee she had conventional rehab but on th second she had massage therapy only and felt it was much nicer and had just as good results. I have never heard of massage only for a Total Knee. Do you have any info on this? I know the knee was done in Salt Lake City. Thank you"
 
Ask a PT Response: "After speaking to a few colleagues we have not heard of just massage therapy being performed on a patient who has underwent a total knee replacement. We will have to look further into the literature in regards to utilizing massage therapy only vs PT with manual therpay incorporation. One would think it would be difficult to achieve gains with ROM if ROM and stretching exercises are not accompanied with the manual therapy treatment (massage). Another issue to consider would be if insurance would cover charges for massage therapy only for treating a patient s/p TKA as in most cases massage is not considered a skilled service. I'll let you know if we find anything else. Thanks for your submission."
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pks4000 View Drop Down
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  Quote pks4000 Quote  Post ReplyReply Direct Link To This Post Posted: Jun 23 2011 at 7:22am
I am now 5 weeks post op from TKR. The operation was very successful.
My best 2 hours were in the operating room. I was awake for the procedure but sedated. A great choice.
 
A TKR patient is bombarded with pain and pain management post op.
 
I have had 2,  1 1/2 hour massage sessions in the last 2 weeks which inlcluded the knee area.
 
Massage therapy by a good therapist (Mine is really quite exceptional)  has proved more effective than a really good PT session in increasing range of motion ..... flexion  and extension... and ..........a lot less painful.
 
The feeling of well being  from massage is welcome in a post op world of self induced "no pain no gain"  TKR rehab. 
 
Unfortunately the reults of both PT and massage fade over next few hours.
 
I now take serious issue with the default post op PT script for total knee replacement.
 
It's simple logic.
1. The TKR op seriously trautmatizes muscles (and all soft tissues) which have been atrophied for years.
(I assume many TKR  patients have severe Quad atropy going into surgery.... essentially you have weak underdeveloped baby muscles and tendons there )
 
2. Now the PT comes and stresses these heretofore grossly undeveloped soft tissues to the point of agonizing pain ......required to break adhesions.......... WHY?
 
3. Expert massage therapy can loosen these adhesions with less pain and "pave the path" to really productive PT.
 
I get the feeling that my 6-7  PT instructors (so far) feel that massage is beneath them when it is really above them in recouperative protocol. 
 
The new script should read:
 
Massage area until  soft tissue begins to release  (You can feel it) One would probably need medical training from an orthopedic expert to do this properly, 
then begin PT as always.
 
I am convinced that this "massage first and PT second"  approach would greatly decrease the number of patients who dont, or wont do, all the solo PT due to the pain involved.
 
 
 
 
 
 
 
 
 
 
 
 
Most sincerely
JOhn
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gelundy View Drop Down
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  Quote gelundy Quote  Post ReplyReply Direct Link To This Post Posted: Jun 23 2011 at 4:27pm
I am seven weeks post op TKR and like John, mine was very successful as well.  I also have a seven year old TKR on the opposite knee and that was as successful.  The latter has enabled me to ski once again and at a fairly high level.
 
I agree with John on most accounts here, and he has submitted an interesting dilemma: old school PT or innovative PT coupled with some TLC.  With my first TKR, my therapist was very tough - an advocate of the "no pain, no gain" school of thought.  I never thought I was going to get through the brutal flexion and extension exercises.  She left me alone with a weight on my knee, foot suspended on a chair, for 30 minutes.  I almost chewed my arm off thinking that might be relief.  However, her "wind down time was with ice and massage... every time.  She gently massaged the knee for 20 minutes every session.  I finally got through it all and the knee was great.
 
This time, my PT administrators are very empathetic toward my pain and their philosophy is vastly different in that they are not in as big a rush to "break through lesions", etc.  I asked for massage the other day and got a great one. 
 
I must say the overall experience with this new TKR over the seven year old one is much improved and the pain management has improved as well.  That is not to say that this stuff is for the faint of heart... this is major surgery and it takes a long time to rehab.  It's well-written, intelligent observations like John's that contribute toward future modifications to the process and happier, healthier patients...
 
One other stumbling block: how does one's insurance deal with PT vs. massage?  Most will not cover a good therapeutic massage at a reputable place... absurd.  While physical therapists are well-versed in some massage techniques, there are many certifications that licensed massage therapists carry and the wealth of knowledge thereof.  Insurance should wise up on this one...
 
I can't wait to ski this winter!!!
 
 
 
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jacabethen View Drop Down
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  Quote jacabethen Quote  Post ReplyReply Direct Link To This Post Posted: Dec 14 2011 at 12:22am

Hi every one

  Nice sharing! Really interesting information of knee replacement and massage therapy. The share keep posting!

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Bryana Butlar View Drop Down
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  Quote Bryana Butlar Quote  Post ReplyReply Direct Link To This Post Posted: Dec 15 2011 at 5:33am
Massage after total knee replacement is one of the most effective treatments. After knee replacement massage is generally done to relief muscle tension and tightness. It also relaxes the patient from pain. I have found a speed recovery in patients through the massage. But massage gives good results only when combined with physiotherapy.
Success is never final. Failure is never fatal. Courage is what counts. – Sir Winston Churchill
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pks4000 View Drop Down
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  Quote pks4000 Quote  Post ReplyReply Direct Link To This Post Posted: Dec 15 2011 at 7:47am
Yes Imtotally agree that PT MUST be a part of the rehab.
BUT
Docs should lobby the insurance Cos so that massage therapy by prescription should be covered by insurance....otherwise few can afford this wonderful healing and relieving process.
Most sincerely
JOhn
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BillSimmons View Drop Down
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  Quote BillSimmons Quote  Post ReplyReply Direct Link To This Post Posted: Jun 07 2012 at 5:05am
You say lot of massage but in case of the problem is very hard that need to knee replacement, in this case the massage is not very effective. Massage is good for relaxing for the pain but in the last end you have to replace the knee. Knee replacement
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  Quote pks4000 Quote  Post ReplyReply Direct Link To This Post Posted: Jun 07 2012 at 5:55am
Yes we are saying massage therapy is very thereputic AFTER TKR not in place of TKR.
Most sincerely
JOhn
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  Quote amoskowitz Quote  Post ReplyReply Direct Link To This Post Posted: Jun 22 2012 at 5:53pm
If massage helps you then you can see a massage therapist concurrently with a physical therapist.  Physical therapists don't focus on pure massage and don't take up a whole visit doing massage.  So you may go to a massage therapist to extensively reduce swelling and release muscles, and then go see a PT to do your range of motions stretches so you can now move that knee into flexion and extension and use the mobility for desired daily tasks.  Make sure the massage therapist is professional and knowledgeable in this area.  Ask your physical therapist for referrals. 

Aaron
High Quality Online CEU Courses
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pks4000 View Drop Down
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  Quote pks4000 Quote  Post ReplyReply Direct Link To This Post Posted: Jun 23 2012 at 6:22am
Good advice from Aaron.
 
Yes the 2 (physical therapy and massage ) should be used concurrently.
 
Pks 4000
Most sincerely
JOhn
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