Nominated by the nurses as the easiest patient on the ward, my Mum's knee surgery went really well. Apart from being a bit overweight, she is amazing healthy for 84 and not taking any other medications so the nurses loved her! These first 3 photos are; the day of the surgery, X-rays of the prosthesis and the day after. She received two MLD sessions 2 & 3 days before the surgery, and her first post MLD was on day 4 after the surgery. Not because we needed to wait, only because I was teaching in Perth and that's the earliest I could arrange for another therapist to treat her.
Inpatient rehab was started on day 3 and this next panel is day 4, 5 & 6 with daily MLD. The rehab physio had heard of MLD which is encouraging. Mum was discharged on day 8 and went home without any issues. MLD number 5 was when I got home on day 11. We saw Mum's usual physio on day 12 and he was very impressed with her progress measuring 115 degrees of flexion before the treatment and 120 degrees after. Extension was only 2 degrees off straight. He modified her exercise program and told her she didn't need the follow-up appointment planned for day 15, so that was re-scheduled for day 21.
We continued with daily MLD and the next panel is days 12, 13 & 14.
Visit to the surgical nurse on day 14 for stitches out and lots of unsolicited comments on how well she is doing with walking and degree of flexion. When MLD was mentioned our nurse said she had heard one of her other patients mention MLD, and that they were also doing better than the usual rate of recovery.
Daily MLD again on days 17 - 20 and the this panel is days 17, 19 & 20. The biro mark on her knee is where it looked a bit red one day so we marked it to track for infection, it wasn't.
Final physio follow-up was on the 3-week anniversary of the surgery and Mum had 125 degrees of flexion and again only 2 degrees off full extension. She can extend and hold the knee over a small bolster for longer than the 30 seconds he asked for, and can lift her leg from the hip unassisted. The physio expects she will gain a few more degrees of flexion and even 100% straighten the knee, and he upped her exercise reps accordingly. These last two photos are before the surgery and after 3 weeks and 12 MLD treatments.
As well as all the MLD my Mum is a stickler for doing her exercises as prescribed. We have also used occasional compression - some figure of 8's around the ankle to move the pooled swelling and bruising, and for the last few sessions some tubigrip around the knee when she is relaxing and elevating, to try and push along the last pocket of swelling around the distal end of the ITB. Physio advises this is often the last pocket to resolve. After the Physio visit I asked my Mum if she was happy with how it was going -
I feel really lucky to have had all this MLD, everyone should be able to have it.
In my previous experience with knee replacement, few people were referred early and most found their way to MLD at around 6 or 8 months, when things hadn't gone as they should and repeated infections, stiffness and unexplained pain were frequent complaints.
After 6 months the opportunity to completely resolve these issues has been lost. We can however always make improvement, especially in pain and swelling.
Applied MLD also uses precise testing techniques to target even the tiniest pockets of inflammation, which can then be effectively drained. This reduces pain and promotes tissue recovery, improving fascia and muscle function. We only needed basic MLD leg sequences for these first 3-weeks with Mum, and the way things are going I doubt she will ever need the more specific techniques taught in the Certificate of Applied MLD.
For more information about about the use of post-operative MLD see the previous #TalkingLymph post on MLD and total-knee-replacement)