knee pain, surgery and "physiotherapy"
Discussion
Having had major knee surgery last year I'm in the process of trying to get the knee healed and leg strong again. Physiotherapy seems to consist of 15 minute appointments every few weeks, being shown a list of exercises to do in order to build the muscles and then being sent on my way.
The exercises are so basic, some of them are just contracting muscles for 10 seconds. The hardest ones are body weight only (sit to stand, wall squats, bridges, etc). Even for an unfit lardy doing a hundred repetitions would still not fatigue the muscles......just irritate the joint and cause pain. With two dodgy knees the most challenging aspect of the whole process is getting down on the floor to do them.
I can't help but wonder wouldn't it be better to just be doing heavy resistance for 5 or 6 reps to actually work the muscle. I mean how can you strengthen muscle without actually fatiguing it.
Honestly I'm starting to question if there is any benefit to physio beyond the placebo effect of seeing someone in medical setting? I'm sure those with self-limiting problems like a pulled back do get better, but they would have done so anyway.
Maybe there is a physiotherapist here that can convince me otherwise?
Ps. Has anyone had knee surgery and regretted it?
The exercises are so basic, some of them are just contracting muscles for 10 seconds. The hardest ones are body weight only (sit to stand, wall squats, bridges, etc). Even for an unfit lardy doing a hundred repetitions would still not fatigue the muscles......just irritate the joint and cause pain. With two dodgy knees the most challenging aspect of the whole process is getting down on the floor to do them.
I can't help but wonder wouldn't it be better to just be doing heavy resistance for 5 or 6 reps to actually work the muscle. I mean how can you strengthen muscle without actually fatiguing it.
Honestly I'm starting to question if there is any benefit to physio beyond the placebo effect of seeing someone in medical setting? I'm sure those with self-limiting problems like a pulled back do get better, but they would have done so anyway.
Maybe there is a physiotherapist here that can convince me otherwise?
Ps. Has anyone had knee surgery and regretted it?
I've had surgery on both knees - the first one to make as good as possible on snapped and torn cruciate ligaments and the second to deal with a torn meniscus.
Granted, the first one was a much bigger task, surgery wise,(surgeon said 'well I've done my best...') but it took months of painful hobbling and frustration with useless physiotherapy / physiotherapists before I stopped attending, ignored their pathetic photocopied handouts and started swimming.
Properly swimming - paying for lessons with a teacher who coached competitive swimmers, and going several times a week on top, and powering up and down the pool as fast and for as long as I could.
In combination with manually (ie by using my hands to move my leg) moving my knee through as wide an angle of movement as possible on any given day, I was able to build the strength of the muscles around my knee to the point where I don't miss the absent cruciate ligament any more (at least so far as I ever needed one).
I don't consider entering cross-country runs, but I can break into a run after a bus these days, and I can ride a bike, and chase after my kids, crawl on all fours, sit on my heels etc. - all things I hadn't been able to do for several years.
The recovery from the second surgery (on the other knee) using the same approach took so little time I can't even remember it.
Granted, the first one was a much bigger task, surgery wise,(surgeon said 'well I've done my best...') but it took months of painful hobbling and frustration with useless physiotherapy / physiotherapists before I stopped attending, ignored their pathetic photocopied handouts and started swimming.
Properly swimming - paying for lessons with a teacher who coached competitive swimmers, and going several times a week on top, and powering up and down the pool as fast and for as long as I could.
In combination with manually (ie by using my hands to move my leg) moving my knee through as wide an angle of movement as possible on any given day, I was able to build the strength of the muscles around my knee to the point where I don't miss the absent cruciate ligament any more (at least so far as I ever needed one).
I don't consider entering cross-country runs, but I can break into a run after a bus these days, and I can ride a bike, and chase after my kids, crawl on all fours, sit on my heels etc. - all things I hadn't been able to do for several years.
The recovery from the second surgery (on the other knee) using the same approach took so little time I can't even remember it.
I think it is like anything else there are good and bad.
I've not had surgery but I did keep getting pain in my knee running, I saw a physio who was a private rather than NHS (does that make a difference?)
Anyway my sessions were about an hour a time and they were very positive, but I did have to go away and do simple exercises every day to improve the mobility.
It worked for me, I consider myself fairly active, and the exercises did seem silly, but it helped to be consistant.
I've not had surgery but I did keep getting pain in my knee running, I saw a physio who was a private rather than NHS (does that make a difference?)
Anyway my sessions were about an hour a time and they were very positive, but I did have to go away and do simple exercises every day to improve the mobility.
It worked for me, I consider myself fairly active, and the exercises did seem silly, but it helped to be consistant.
I'm having a bit of physio on my knee due to patella pain - something to do with the outside muscles of my leg being stronger than the inside ones, and pulling the kneecap at a funny angle.
Anyway. I see a private physio & sports massage guy. Appt is about 40 mins, they release some of the tight muscles, check muscle activation in the weak ones, and do me an exercise programme. It currently involves weights (3 x 15 reps) for certain muscles groups.
Is it worth paying for 2-3 private physio sessions with a good private physio?
Anyway. I see a private physio & sports massage guy. Appt is about 40 mins, they release some of the tight muscles, check muscle activation in the weak ones, and do me an exercise programme. It currently involves weights (3 x 15 reps) for certain muscles groups.
Is it worth paying for 2-3 private physio sessions with a good private physio?
What operation did you have?
Are you doing the exercises prescribed?
Are you in pain?
My experience of physios is generally good, the exercises like the ones where you squeeze down on a muscle for 10 seconds I've found to be some of the best. Physios have to cater their advice for all types of people, if you're a Jean Claude Van Damme of course some of the advice might not fit exactly to your body and life style but in general they know what they're talking about.
Are you doing the exercises prescribed?
Are you in pain?
My experience of physios is generally good, the exercises like the ones where you squeeze down on a muscle for 10 seconds I've found to be some of the best. Physios have to cater their advice for all types of people, if you're a Jean Claude Van Damme of course some of the advice might not fit exactly to your body and life style but in general they know what they're talking about.
dreamer75 said:
Anyway. I see a private physio & sports massage guy. Appt is about 40 mins, they release some of the tight muscles, check muscle activation in the weak ones, and do me an exercise programme. It currently involves weights (3 x 15 reps) for certain muscles groups.
Is it worth paying for 2-3 private physio sessions with a good private physio?
Yeah I can kind of buy into the idea that massage / myofascial release can help. What I can't really buy into is the idea that strengthening exercises that are not really challenging the muscles do any good. Is it worth paying for 2-3 private physio sessions with a good private physio?
Then again I had the leg realigned (i.e. sawing through bones) and arthroscopy release surgery on the knee too. So I can't go doing heavy squats, leg presses or anything. Frustration is setting in as 4 months on one leg is noticeably smaller and weaker than the other.
Physio / doctors say conflicting things like "Well don't push it too hard it shouldn't be painful" and "Well it will be fairly sore doing these exercises but it is the only way".
I am tempted to see someone privately, what do you pay for your 40 min sessions? I'm wondering if a personal trainer might be of help as well.
Edited by VolvoT5 on Thursday 10th March 21:43
In my experience NHS physio can be a little bit of a disappointment, the sessions are short, and often generic rather than tailored to your needs. (This is the feedback I have received). A lot of people seem to then go to a private physio, and come back delighted that the sessions are more tailored to them, and that they are now seeing improvements. As much as I hate to admit it, it's getting to the stage that I will often recommend private over NHS physio for those who can afford it, as the outcomes do appear to be better, and the feedback far more positive.
VolvoT5 said:
Yeah I can kind of buy into the idea that massage / myofascial release can help. What I can't really buy into is the idea that strengthening exercises that are not really challenging the muscles do any good.
Then again I had the leg realigned (i.e. sawing through bones) and arthroscopy release surgery on the knee too. So I can't go doing heavy squats, leg presses or anything. Frustration is setting in as 4 months on one leg is noticeably smaller and weaker than the other.
Physio / doctors say conflicting things like "Well don't push it too hard it shouldn't be painful" and "Well it will be fairly sore doing these exercises but it is the only way".
I am tempted to see someone privately, what do you pay for your 40 min sessions? I'm wondering if a personal trainer might be of help as well.
I pay £40 for a 40 min session with a sports massage guy who is at the same physio office as my physio, which means he has full access to all my notes etc. i.e. not a "sports massage" at a gym, but a sort of cross with physio. The physio is £45 for 30 mins. I see them both for other issues (back and a ligament injury on the other knee), and the sports massage guy diagnosed this knee issue. Then again I had the leg realigned (i.e. sawing through bones) and arthroscopy release surgery on the knee too. So I can't go doing heavy squats, leg presses or anything. Frustration is setting in as 4 months on one leg is noticeably smaller and weaker than the other.
Physio / doctors say conflicting things like "Well don't push it too hard it shouldn't be painful" and "Well it will be fairly sore doing these exercises but it is the only way".
I am tempted to see someone privately, what do you pay for your 40 min sessions? I'm wondering if a personal trainer might be of help as well.
Edited by VolvoT5 on Thursday 10th March 21:43
I know what you mean about the exercises - if they aren't challenging the muscles.... maybe a specialist would be able to give you exercises which target those particular muscles? e.g. using soft balls and resistance and stuff. I know for my knee, and my back, there are muscles which simply don't activate, leaving other muscles to do their job - being able to activate them (they're v weak to start with) and then build them up helps but it does look odd in the gym doing exercises with my finger dug in / resting on certain bits of my body !!!!! One thing (for example) the sports massage guy has me doing is leg presses at the gym. The usual 3 x 15, but then also 2 x 30 of v quick repetitions but only at a certain part of the movement (not the whole leg press) for things like quick muscle activation vs sustained.
In terms of a personal trainer, the ones I've come across have nowhere near enough medical training or knowledge for me to be comfortable with. One wanted me to do some rigorous twisting exercises while I was building strength up after a spinal fusion - I didn't go back to him. I'm in Surrey and happy to recommend my physio & sports massage guy if that's any help?
Obviously I have zero medical training so this is all just a lay person's advice!! I have been through a lot of treatment for back injuries, and as I'm hypermobile and do a lot of sports (mountain biking, skiing etc.) various bits of my body do give out with reasonable frequency so I know the physios quite well!
VolvoT5 said:
Then again I had the leg realigned (i.e. sawing through bones) and arthroscopy release surgery on the knee too. So I can't go doing heavy squats, leg presses or anything. Frustration is setting in as 4 months on one leg is noticeably smaller and weaker than the other.
Physio / doctors say conflicting things like "Well don't push it too hard it shouldn't be painful" and "Well it will be fairly sore doing these exercises but it is the only way".
I am tempted to see someone privately, what do you pay for your 40 min sessions? I'm wondering if a personal trainer might be of help as well.
Who says what? Tbh you've had major surgery so 4 months is fairly early but if the surgeon says push then they should have a better idea of how the bone is healing.Physio / doctors say conflicting things like "Well don't push it too hard it shouldn't be painful" and "Well it will be fairly sore doing these exercises but it is the only way".
I am tempted to see someone privately, what do you pay for your 40 min sessions? I'm wondering if a personal trainer might be of help as well.
That said, if you do 6 reps and it stuffs you up for the rest of the day...
You get good and bad in all walks, and the good can have off days.
(I'm an NHS physio but had my own practice for 8 years or so.)
I see a private physio from time to time and can't recommend him enough. £30 for an initial one hour consultation with subsequent visits costing £20 per 30 minutes. My last visit was for a knee problem and it only took the initial consultation as there was no hands on work that could be done so I was just given a range of exercises, squats, lunges and various stretches so it was down to me to follow the regime and it worked very well for me.
VolvoT5 said:
Honestly I'm starting to question if there is any benefit to physio beyond the placebo effect of seeing someone in medical setting? I'm sure those with self-limiting problems like a pulled back do get better, but they would have done so anyway.
Physio, unlike some other practices, is supposed to be evidence based. So if you're seeing a physio who's any good, has read the literature and applied it appropriately it isn't just placebo.That said I've certainly had similar experiences with some NHS ones. A private one may be money well spent but personally I wouldn't touch anyone whose profession isn't evidence based after surgery.
0000 said:
Physio, unlike some other practices, is supposed to be evidence based. So if you're seeing a physio who's any good, has read the literature and applied it appropriately it isn't just placebo.
That said I've certainly had similar experiences with some NHS ones. A private one may be money well spent but personally I wouldn't touch anyone whose profession isn't evidence based after surgery.
Well the ones I've had so far have both suggested and applied Kinesio Tape which my research is suggesting is little more than a fashion statement (and doesn't help anyway). So I'm not sure about evidence based. That said I've certainly had similar experiences with some NHS ones. A private one may be money well spent but personally I wouldn't touch anyone whose profession isn't evidence based after surgery.
Just feeling naffed off as it is still it is a struggle to drive for more than a few miles. I may have to change my car if things don't improve.
Quite a few years ago now, but when my brother broke his leg playing football, he was advised that it takes about a month per week of immobility to get back to full strength, starting slowly and then building.
If you had problems with the knee in the first place, I doubt there is a short cut to "fitness", whatever that means for you.
Never had knee surgery, but had plenty of physio for all sorts of bumps and scrapes. Some of the simplest exercises, done properly, really tested the muscle groups, even though they seemed too simple. Does your physio check on your technique before sending you on your way ? Mine always did this, no matter the injury.
If you had problems with the knee in the first place, I doubt there is a short cut to "fitness", whatever that means for you.
Never had knee surgery, but had plenty of physio for all sorts of bumps and scrapes. Some of the simplest exercises, done properly, really tested the muscle groups, even though they seemed too simple. Does your physio check on your technique before sending you on your way ? Mine always did this, no matter the injury.
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