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Author Topic: Over Pressure Program Working  (Read 5389 times)

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Offline QBknee

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Over Pressure Program Working
« on: February 12, 2005, 01:45:25 AM »
I am 9 days Post-OP from a procedure designed to restore my extension, loosen my patella, and improve my flexion.   After much research and several opinions, I decided to be treated by Dr. Noyes in Cincinnati.  My surgery was last Wednesday and I am still in Cincinnati working with Dr. Noyes PT dept.  As you all know, proper Post-Op protocol is a must to overcoming scar tissue re-growth so I am doing PT 2X Day for 2-3 hours each sesssion. 

Dr. Noyes performed a Posterior Capsular Release (two 3 inch incisions just below of knee and on the sides).  This has greatly helped my extension which was +10 prior to surgery and now is 0 to -3 and improved my flexion so far to 122, 95 pre-op. While in the hospital, I went into the overpressure program, hanging 20 lbs of weight on top of my elevated knee for 10-15 minutes 6 times/day.  I was under continuous epidural for 4 days.  The weight was increased to 30 lbs at the PT clinic.  It's immense pressure, but it is doing the trick loosening tissue behind the knee and keeping my extension at 0.

In addition to the posterior releases I had a scope to clean out scar tissue under patella/fat pad area and others areas around the knee.  I thought going into the procedure Dr. Noyes would partially re-open my incision from last surgery, but was pleasantly surprised he did not.  I am sure this would have made things more difficult on me post-op.

While in the hospital I worked with PT 2X/day and was able to bend the leg with PT to 130 1-2 days post op and get extension to 0.  Upon being released from hospital I had severe withdrawl from the epidural Sunday night(Super Bowl night) and was forced into the ER.  After 6 hours we were able to get my attack under control and was released at 4 am. 

I have been in PT twice a day since this past Monday Feb 7.  Since I am in Cinci from out of town, I might as well get in all the PT I can and devote my entire day to it. There is a machine in Noyes PT clinic called an ERMI. You place your foot on a pedal and you crank an arm which bends the knee toward you while sitting in a folding chair.  It is an excellent contraption and gets me more flexion than any other bend I have previously done.  I am getting agressive patella mobs, and my patella has been staying relatively loose.  This was a major concern of mine prior to surgery, and hopefully the patella will maintain its flexibility.  It barely moved prior to surgery.  The mobs, the ermi and hanging weights are my most important exercises. 

So far so good. I know weeks 2-4 are the key weeks, so I will continue PT 2xday through this Wednesday and then return home and work with PT 1x day, everyday for several more weeks. 

Dan

5/90 - Microfracture, 11/02 - ACI harvesting scope, 09/03 - Bone graft-Scar Resection -10/27/03 - Manip w scope 2/2/05- Posterior Capsular Release, Anterior Interval Release/staph infection, 3/14/05 wash out scope 12/11/06- Scar resection, lat/med releases

Offline Jennifer_G

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Re: Over Pressure Program Working
« Reply #1 on: February 12, 2005, 02:04:56 AM »
Glad to hear you had surgery!  Sounds like you had the surgery that I am going to be having March 9th.  I am also getting that ERMI machine at home.  See if you can get one when you go home.  What type of withdrawal did you have from the epidural?  I ask because I am going to be on one as well.  I have been on one before for 4 days and didn't have a reaction that time but am a little nervous about having one again.  Is he putting you on steroids?  He is going to put me on steriods for 3-4 months.  I am nervous about that as well.  Don't know how they are administered and hear I will gain weight!!!  :(  Glad to hear you are doing well.  Keep up the good work!!!   

Jennifer G

P.S.  Have you had the ice cream or pizza that I told you about? 
07/25/03--ACL recon with meniscus trimming
09/19/03--Manip with epidural, scope, and lateral release
02/06/04--Open Debridement, Manip, open release of intrapatellar fat pad, lateral release, Inpatient on Epidural
03/09/05--Open Anterior/Posterior Release, Scope, Inpatient on Epirdural

Offline Jennifer_G

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Re: Over Pressure Program Working
« Reply #2 on: February 12, 2005, 02:09:04 AM »
FYI....for anyone wondering about the ERMI......go to www.ermiproducts.com.  We  are talking about the knee flexionater.  It is every good as he says!  I can get another 10-15 degrees from using it then I can with someone manually bending me.  Check it out! 
07/25/03--ACL recon with meniscus trimming
09/19/03--Manip with epidural, scope, and lateral release
02/06/04--Open Debridement, Manip, open release of intrapatellar fat pad, lateral release, Inpatient on Epidural
03/09/05--Open Anterior/Posterior Release, Scope, Inpatient on Epirdural

Offline arsenal

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Re: Over Pressure Program Working
« Reply #3 on: February 13, 2005, 04:26:43 AM »
Dan, very glad to hear that u are doing great. Good luck!

Jennifer thank you for the info on ERMI. It sounds great. I have been using the JAS and can never really tell if I am making any improvements. I like the fact that this has a measuring device.

tse
July 1, 2004 Repair Tibia Plateau Fracture - 5 screws + Metal Plate
Nov 18, 2004 LOA, MUA
Feb 23, 2005 LR, LOA, anterior interval release

Offline Janet

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Re: Over Pressure Program Working
« Reply #4 on: February 13, 2005, 07:02:09 PM »
Dear Dan:

I'm glad you finally had the surgery. I know we've talked in the past about the difficulty of finding someone who understands the problem and has protocols to stop the scar tissue from forming again. Keep up the good work, and I hope this is the last surgery you'll ever need!

Janet
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

Offline QBknee

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Re: Over Pressure Program Working
« Reply #5 on: February 13, 2005, 07:36:51 PM »
Jennifer, Janet, tse,

Thanks for your kind words.  Hopefully this is it for a long time.  Today is Day 11 and things still seem to be going well.  I had some fluid, mainly below the patella the past 48 hours.  You could here it squish around when doing patella mobs and bending past 90 degrees.  It seems to have subsided today. 

The patella also seems to be mainting its movement, my biggest concern going forward. I will contine PT 2X day Monday and Tuesday and fly back Wednesday.  I look forward to using the ermi machine alot at home the next 45 days. 

Dan

5/90 - Microfracture, 11/02 - ACI harvesting scope, 09/03 - Bone graft-Scar Resection -10/27/03 - Manip w scope 2/2/05- Posterior Capsular Release, Anterior Interval Release/staph infection, 3/14/05 wash out scope 12/11/06- Scar resection, lat/med releases

Offline favouritesearcher

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Re: Over Pressure Program Working
« Reply #6 on: March 07, 2005, 10:13:09 PM »
Hi again,

I hope your recovery is still going okay.

Can I ask you a question about the over-pressure program?  How do they hang the 20lb or 30lb weights on your leg?  My physio used a hospital bed which could go up and down, and a wide strap which went under the bed; he then raised the bed to put pressure on the meg just above the knee.  At home I put the weights (cans of fruit, or books at work) into a shopping bag and put them over a towel which sits on top of the quad just above the knee.  I've found that this appears to make the quad a bit sore.

Is your method a bit better?

John
Mar 04 - Tibial spine avulsion fracture (skiing). Open surgery to fix, 1 screw.  Max passive ROM 20-75, active ROM 30-45
Aug 04 - Diag. severe arthro. Scar tissue clean up (LOA, removal of scar tissue).
Feb 05 - Discharged from surgeon's care. ROM 3-125.
Apr 05 - Discharged from physio. Same ROM

Offline QBknee

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Re: Over Pressure Program Working
« Reply #7 on: March 07, 2005, 10:58:33 PM »
At home I am using styrofoam packaging about 3-4 inches thick, with two towels on top of it folded.  This creates about 6 inches of height to lay you leg on in full extension.  I then lay three 10 lbs ankle weights on top of my kneecap (actually doing only 25 lbs the last couple of weeks).  I try to create a pyramid to take some of the pressure off the kneecap.   The ankle weights, when the velcro is opened up can lay relatively flat.  They are adjustable anke weights, found in all major sporting good stores.  My PT advised to try and get most of the pressure right on top of the knee.  It is painful, but gives you the best stretch.

Dan
5/90 - Microfracture, 11/02 - ACI harvesting scope, 09/03 - Bone graft-Scar Resection -10/27/03 - Manip w scope 2/2/05- Posterior Capsular Release, Anterior Interval Release/staph infection, 3/14/05 wash out scope 12/11/06- Scar resection, lat/med releases