The decision to return to sports after a knee replacement is one that should be made in consultation with your surgeon and physiotherapist. Your overall satisfaction with the outcome of the surgery and your pre-operative condition would have some bearing on whether you are able to return to sports or not.
Let us look first at what makes up a successful outcome to knee replacement.
- No pain during walking on flat surfaces.
- Return of mobility in the knee joint. You should be able to bend your knee to 105 degrees, which is sufficient for most daily activities such as getting in and out of a vehicle, climbing up and down stairs.
- A feeling of well being. Constant, nagging pain before the surgery may have resulted in a depressed mood. This changes as the person realises the surgery was successful.
- No pain with stair climbing.
If you were an active athlete before the surgery, you would expect to return to sport afterward. However, your doctor and physiotherapist may recommend that you switch from high-impact to low-impact sports such as cycling, swimming, skiing or golf. The reason is that high-impact sports such as running, jumping, soccer or tennis put a lot of stress on the prosthesis. This may lead to premature failure of your knee, loosening of the prosthesis and even fracture of the skeleton around the knee and other trauma.
Some athletes, especially the younger ones, may have had a knee replacement in hopes of increasing their level of participation and may not be satisfied with switching to a less strenuous activity. If that is the case, and they are training to meet that level, the surgeon should explain the risks involved in high-impact sports versus low-impact sports. He should also explain the risk of total knee failure in endurance training, although there are no statistics to support this view.
Patients should also understand that they may have to postpone their activities until the musculature around the knee is sufficiently strong in order to protect the joint and avoid trauma. If they are prepared to take that risk, then they should be allowed to play. Just as long as they keep in close contact with their doctor and physiotherapist.
NOW OFFERING SCAR TISSUE TREAMENT – With Jacquie
The development of scar tissue can cause pain, discomfort, limited range of motion, changes to sensation, heat, swelling, and sometimes distortion to the skin and surrounding structures. With my hands, I use gentle myofascial techniques to assist scar tissue and surrounding fascia to release, regardless of the age of the scar, to help you eliminate pain and ultimately regain normal movement.
There are many reasons why one may develop scar tissue. This may be trauma from an injury involving the breaking of skin, or the tearing of muscles, tendons or ligaments. Scar tissue may also form from surgery, radiation, the presence or past presence of cysts or tumours or from acute or chronic inflammation.
Scars are a normal process of tissue healing where the fibrous tissue replaces normal tissue as a part of the remodeling phase of wound healing. The collagen synthesized initially after trauma is random and disorganised, which eventually remodels along the lines of force. The integrity of the affected tissues and fascia can change from having elasticity to being rigid and immobile.
The way our scar tissue heals is dependent on how much we have rested the area after trauma and what sort of loads it has had to endure during the healing stage. Excess load on the scar, even from just our constant movement can cause the proliferation of more scar tissue to develop and can cause strain on surrounding structures.
The development of scar tissue can cause pain and altered sensation due to disruption to nerve supply, blood flow and lymphatic drainage. One factor behind intrinsic scar pain also appears to be the proliferation of C-fibres during the healing process, which can become a source of ongoing pain and inflammation.
Scars can also cause pain and limited range of motion due to the limitations in the scar tissue itself but also the adhesions it may develop. An adhesion is a band of scar tissue that joins two internal bodily surfaces that are not usually connected. Disruption of normal tissue fibres can result in them being replaced with relatively inelastic granular tissue.
Research has shown that the reasons myofascial techniques can be effective may be due to improving the local mobility of the tissues (including neural and visceral tissues), as well as improving underlying muscle activation through providing more afferent information to the affected area.
Myofascial releases can be incredibly effective for scars which have developed as a result of conditions such as:
- Muscle or ligament tears
- Caesarean and hysterectomy scars
- Orthopaedic surgery
- Oncology related surgery and effects of radiotherapy
- Abdominal surgery
- Endometriosis and polycystic ovarian syndrome (PCOS)
- Chronic inflammation in spinal ligaments, joints or intervertebral discs
- Chronic bowel conditions
- Brain surgery
- Pneumonia and other lung infections
- Surgery to eyes, ears, nose or mouth.
- Gentle myofascial techniques can help your body to release your scar tissue, ease your pain and help you to get back to the activities and sports you desire.
Jacqueline is a Physiotherapist here at Back in Strength. If you feel you, or anyone else, could benefit from scar tissue treatment, feel free to contact us to book an appointment.