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."

 

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:

 

 

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.

 

 

 

 

 

 

 

 

 

 

 

 

 

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!!!

 

 

 

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.

 

Yes the 2 (physical therapy and massage ) should be used concurrently.

 

Pks 4000