Massage helps recovery after total knee replacement

Knee replacement surgery is a technique that removes a diseased knee joint and replaces it with an artificial joint (prosthesis). The most common reason for this operation is severe osteoarthritis, which causes relentless pain, joint deformity and mobility problems. According to the American Academy of Orthopedic Surgeons, statistics show 90 percent of patients undergoing a knee replacement experience a dramatic reduction in pain, and a significant improvement in the ability to perform daily activities.

The recovery and rehabilitation process plays an important role in helping patients getting back on their feet and resume an active lifestyle. Typically patients can return to normal life activities within 3 to 6 months. Postoperative pain, swelling, and bruising are a normal part of the recovery process following knee surgery.

There are some common problems during the recovery process such as: pain, swelling, stiffness, quadriceps weakness and body other part muscle compensation soreness. 

Pain: most postoperative pain due to operation damaged, swelling, and bruising.

Stiffness: causes of stiffness following knee replacement include scar tissue formation, component size and position among many factors. However, the most important factor is the patient's preoperative motion (i.e. preoperative stiffness is likely going to lead to less than optimal postoperative motions)

Quadriceps Weakness: causes by the direct trauma from the surgical incision. The quadriceps muscles are the thigh muscles above the knee and serve as the primary knee stabilizer. If they are not working correctly, it becomes difficult to lift the leg independently.

Compensation soreness: because of rehabilitation exercise, but also posture and gait changes after operation.

To recover from these problems, massage is recognised as a useful part of complementary and alternative medicine. A new study published in the December issue of the American Medical Association's Archives of Surgery, found massage, in conjunction with regular pain medication, significantly improved patient pain and anxiety after major surgery.?

Benefits of massage:

One of the immediate benefits of massage is a feeling of deep relaxation and calmness. This occurs because massage prompts the release of endorphins, the brain chemicals (neurotransmitters) that produce feelings of wellbeing. Levels of stress hormones, such as adrenalin, cortisol and norepinephrine, are also reduced. Studies indicate that high levels of stress hormones impair the immune system.

Some of the physical benefits of massage special for recovery of TKR include:

·        Reduced muscle tension

·        Improved circulation

·        Reduce swelling  

·        Increased joint mobility and flexibility

·        Speedier healing of soft tissue injuries

·        Loosening of adhesions

While working in China, Dr Ron conducted research which demonstrated the efficiency of massage in recovery after total knee replacement. He divided 116 patients into two groups. The first group of 63 patients received physiotherapy plus message, the second group of 53 patients received physiotherapy alone. After three months, RO (range of movement) in the knees of the treated group had increased, on average, by 73% and in the control group by an average of only 45%.

These techniques we employ include:

MASSAGE – consisting of stroking, effleurage (light touching), kneading and friction. These all act to increase circulation, release muscle tension and reduce swelling

MOVEMENT – both active and passive, as follows:

Ankle: Gentle rotation increases circulation and reduces swelling

Knee extension: With the patient lying on his or her back, a cushion with a thickness of 5-10 cm is placed under the heel. Gentle pressure is applied to the patella, keeping the knee extended for 2-3 minutes

Knee flexion: With the patient sitting on the side of the bed, the knee is flexed as hard as he or she can stand for 2-3 minutes. We would normally start this exercise the day after the operation, beginning at 30 degrees and increasing about 10 degrees every day during the first week

Patella: With The patient lying on his or her back, a cushion with thickness of 10-15 cm is placed under the knee. Grasp the patella and push it to the limit of movement in each of four directions, left, right, up and down. Repeat 20 times in each direction

CHINESE ACUPRESSURE – using the thumbs, is applied to each of several classical acupressure points, including: BL40, BL56, BL57, BL60, ST36, SP9, SP6 and GB34. This opens the meridians and makes energy flow;   

Deep Transverse Friction – commenced three weeks after operation. This technique breaks down scar tissue and adhesions

Therapeutic massage is safe and natural, and these techniques can be used by patients as well as experienced masseur. However, it should be noted that there are some situations in which massage is contraindicated. These include poor wound healing, postoperative infection, DVT (deep venous thrombosis) and artificial joint loosening.