At 60 years old Jeff was ready for a knee replacement. He had waited 40 years since the somewhat primitive ACL work that was done when he was in college. Technically the surgery was fine. But scar tissue made quick work of his recovery, and he required an MUA. He discusses his recovery after MUA here.
I can walk with a normal gait, I don’t run yet and I’m not that concerned about running. It’s never been the exercise that I use for fitness, biking is the most important one. And I literally have the seat on my bike down lower than when before I went in for surgery.
“The testimonials about X10: I think that an important part of the learning process is these are real people and I’m a real person. And if you are having a struggle with your recovery after a knee replacement surgery, this is a real-world device that works. That’s important to know.”
Is this for you?
Listen to the podcast or read the text below if you are considering knee replacement and want to make sure you have learned about the latest recovery technology. The audio interview provides a very detailed explanation from a patient’s perspective, about how working with the X10 can solve a challenging knee recovery.
Recovery After MUA
An interview with Jeff Holman by Mary Elliott
Jeff Holman had a total knee replacement surgery. And then two months later he needed to have a Manipulation Under Anesthesia (MUA). What follows is an interview with Jeff conducted by Mary Elliott from X10 Therapy.
What is your knee history?
I had a knee injury in the ninth grade, back when the dinosaurs walked on the earth. They put me in a cast for about six weeks. And then just put me back out in the world.
A few years later I had a fairly substantial knee injury in college. It was a full ACL tear and they just kind of put it back together and then cast it. It was always pretty loose from that point going forward. I was pretty athletic and played a lot of sports. It would, what I call “go out.” and when it would go out it, it would swell up. It was finally when I was skiing in the winter in college that it really went out. And at that point they said, ‘yeah, we need to do surgery’. So, from ninth grade until I think it was my freshman year in college. I just kind of dealt with it being pretty loose.
Ligament Transfer Surgery
The surgery was very antiquated. It was what they call a ligament transfer. It wasn’t really an ACL reconstruction. They took the ligament on the side that was so stretched out and just kind of flipped it. I had very long scars on both sides of my knee. It was a little before arthroscopic surgery and all the things they can do these days.
And so, it worked. It just had gotten very sore over the years, to a point where it was bone-on-bone and there was just nothing left there. It was sort of ‘replacement or nothing’. And I kept hearing, ‘well, you’re too young, you’re too young’. And my wife and I talked it over and said, ‘well, when are we going to be the right age?’ Because I want to do all sorts of things when I’m 60, not when I’m, in my seventies. So anyway, the surgeon agreed.
For me it had been 40 years with an injured knee prior to the replacement. I got to a point where I was having difficulty walking. It was time.
How did you meet your surgeon?
On my initial visit we really got along well. He understood why I was there. He listened, talked to me, understood that it was really impacting my life. He did some tests that day. And honestly, in the first visit he said, ‘yeah, this is something we need to move forward with’. I felt very comfortable with him. I had tons of surgeon recommendations from folks I talked to. He is a very, very busy surgeon, which I think is always a good sign. So, we clicked. I Just felt like he was the right gentleman to work with.
For me it had been 40 years with an injured knee prior to the replacement. I got to a point where I was having difficulty walking. It was time.
What was the strength like in your quads?
The leg we had the surgery done on had all worn out. So it was bone on bone. I was very limited. I could ride a bike, which is very important to me. I could not run, because it would swell up immediately. I haven’t been able to run in 20 years in terms of any kind of length. I played tennis through college and was able to play sports where there was a quick movement, but I couldn’t run any distance. I can tell you that going downstairs was difficult.
At PT I spent 10 visits trying to strengthen around the knee. I could do the exercises. It’s just that I couldn’t walk on it normally. I think it was always getting favored. I just wasn’t forcing it to have the muscle tone of the other knee.
So, you have surgery, you’re confident with your surgeon. What happens next?
I go in and everything goes great. You spend one night in the hospital: I’m walking that night up and down. I’m obviously with a walker and I have a morphine drip actually inserted into the knee. I had no real pain that night. In the hospital, they walk you up and down the hallway: before you can go home. They have you go down to their little PT area and do some exercises to make sure you’ll be okay at home. They had me go up and down stairs, which I could do with one foot next to the other on the way up.
And then the PT said, ‘do a squat for me’. Well, I haven’t done squats for 40 years. I felt lightheaded and I thought there’s something across the front of my knee. I can feel it at the top of the knee. I assumed it was part of the surgery and I said ‘there’s no way’. She said, well just sit down for a minute. I didn’t do the squat. They sent me home.
Physical Therapy at Home
I started the next day with in-home physical therapy. They had me doing different things and different exercises. I wasn’t getting much mobility out of the knee, but obviously I’ve just come out of surgery, so I don’t think much of it. Two weeks to a month, that was my next postop visit with the surgeon.
They wanted me to be at 90 degrees on my flexion, and I wasn’t very close to that. I then started outpatient physical therapy. There we did a lot of cranking on the knee and they would try and get me to ride a bike. I kept telling them there’s something across the knee. I know this knee pretty well. Something across the knee is not letting it bend. And I’m not a wimp. I would leave physical therapy literally in tears. And they were pretty frustrated because I think there was this sense that I wasn’t doing what I was supposed to do.
I went back to work after two weeks, even though I was very immobile, but I went back. And so they said to me, well you went back to work too early. I was really frustrated.
What was your first post-surgery visit like with your surgeon?
I had the month visit with the surgeon (I actually met with this PA that visit) and she said, yeah, you’re not getting the range of motion we’d like to see. I was at 70 degrees bending at that point. She said, let’s see you again in two weeks and make a decision on whether or not we go in for an MUA. And I went back to physical therapy and we pushed it, forced on it and then came back. At that second visit I saw the surgeon and he immediately said, yeah, we’re going to go in for an MUA. I didn’t really know what that meant.
It turned out that thing that I kept feeling across my knee was scar tissue. It would not allow my knee to bend. There was no way in heck I was going to have that cranked into a point that that I was going to break it. So, at the six week point I went in for the MUA. After the procedure doctor said, Jeff just go home, you have a spin bike at home and just start spinning. He wasn’t even that much a proponent for the physical therapy. And so that’s when I went home, and we found the X10 for my recovery after MUA.
How was Outpatient Physical Therapy?
I was obviously pretty frustrated. This is not an indictment of the physical therapy world. It wasn’t going to bend. But I was pretty frustrated with physical therapy because it was pretty clear to me this thing wasn’t going to bend. And we just kept doing the same thing over and over. So, there was a frustration obviously that built up in me in the whole process.
How did you end up going forward after the Manipulation Under Anesthesia?
I came out of the MUA and knew that I had more flexibility because I could ride a bike that day. When I came home, I could get it to spin around. I had to flip the seat way up like it barely touched, but I could least get my, my knee to bend enough. So I started with that spinning and I went to the PT that the surgeon had told me they thought they liked, and it was a whole different experience. They were much more about massaging the knee and not cranking on the knee and being much more gentle with it. And in the meantime, because of the frustration with the big PT, and being worried that just spinning wasn’t going to be enough. I was concerned with my recovery after MUA.
How did you find the X10?
My wife just looked on the internet and found the X10 and we looked, and we looked, and we looked because she just assumed that it’s not going to be as revolutionary as everyone is saying.
The testimonials of the people that were moving after they use the X10: it was exactly what I needed to see. And then Ann talked with you and, and she just came and said, I think we need to try this. You know, let’s, let’s try everything. You don’t want to regret that If you’d done something else, you would’ve had moved forward in your knee and Mary, there is nothing like having your knee stuck at 70º it would be life-altering. I couldn’t get in and out of a car. I obviously couldn’t ride a bike. I wasn’t walking well, I couldn’t go up and downstairs. And there’s this real fear that, Oh, I made a huge mistake. I could now not do the things that I could before I went in for surgery.
And you know, I was walking and riding bikes. I hurt a lot, but I could do those things. Your mind is at the point of ‘I would do anything that would make it manipulate better’. So, my wife, she found the X10. I was in a very, very, very dark place. Very frustrated, very concerned that I’ve made the wrong decision. It wasn’t just the information that was on the website. You in terms of the encouragement, and the sense that the people encouraged a lot of movement forward. It was what we needed to hear. So, I thought, okay, I’ve got PT, I can spin in the basement and now I’ve got this X10. For this recovery after MUA, let’s go for it.
Let’s throw everything we can throw at this knee to get it moving. So that’s when we made the decision that the X10 was a fit. I would do PT as well. We do the X10, and we just see where we could get. And that sort of what led us to the X10 and making the decision to move forward with that.
How did the MUA go?
In the manipulation, the doctor got me to 110º to 115º which was transformational when I was at 70º going in. So, my goal was to be at 115º and at the end of my life, you know. I would’ve taken 115º. That meant I could ride a bike. I’d be pretty functional through all ranges. What I’d heard and the PT clinic was 110º was sort of the lowest end of functionality in terms of the sort of the things you can do. So, I figured 115º it would be great.
I mean after 70º, 115º sounded like the end of the world. So, I came out with the surgeon sort of at the same place that we really expected that I would end up, between 110º and 115º flexion.
I should say Mary, that during the original PT, my extension was always fine. I was always able to get beyond 0º. So, it wasn’t the extension, it was always the flexion. When I talk about that, my goal, it was always from the flexion side. So, I came out with a goal from the flexion side of 110º to 115º.
So, tell us what happens next, now that you have the X10 in your home, you start using it and…
I have a wonderful coach, of course. There are two coaches you folks provide. The unit was brought into our home, which was, by the way, the easiest thing. The young man brought it in. He taught me everything I needed to do. We went through all that, all the books on it, and got me set on my original starting point.
So, my coach, Candice, said, ‘Jeff it’s like a clock. Each degree is like one second’. We set my goal to get one degree out of each of the three sessions each day. Each time I sat down in it.
And I may have done one that night and, Mary, you can probably look it up, but think I got to maybe 95º pretty early on.
Days with X10
And then I went to 97º, 99º and 100º. The mornings were always the best. I’d get up to do it around six in the morning and then I had to work. And so, I would get home and would do two sessions. So, my goal was 6:00 AM and I would do it at about 6:00 PM and then at about 9:00 PM. I would do three a day. And Candice had me doing warm-ups, where I would do five minutes, then 10 minutes, and then what I got to the point, I was just doing the first 10 minutes to be my warm-up and then I could cook, you know, sort of kick it up.
In the very beginning, it was three times a day. And I think they stuck around 100º for a few days. I could just tell that I needed to move slowly. And in the meantime, I’m going to this new PT clinic and they’re very good awesome tissue manipulation. So, I got very lucky that’s who I was going through. There was no cranking anymore, that was just a lot of manipulation and a lot of massage on the knee and then a lot of biking: they had a great team. They said motion is lotion. I really liked that concept of just getting it moving.
And they were very good at warming me up with the manipulation in the massage and putting me on some weight-bearing things. But a lot of it was just getting motion to the knee.
Do I tell the clinic about my secret weapon?
So Mary, my wife and I made a decision that we weren’t going to tell the surgeon and we weren’t going to tell the PT people that I was using the X10. Because we didn’t want anyone to say, well you did that and that’s why this didn’t work. Or well, if you’re doing that, then you’re not going to get our care. We just figured they didn’t need to know. I loved the X10. It was working for me. So I just kind of didn’t make it a big deal to anyone. I did it behind the scenes, but I would go to PT and they were seeing these phenomenal changes in my knee going from 90º to 110º. I don’t care how they viewed it, but they thought they were doing really wonderful work. And I was glad that I was doing both, but the X10 was doing it and they would say, why, gosh, we got you to 110º today. And I’m like, yeah, well I’m at 115º now on the X10.
Candice’s Guidance on X10
So anyway, to go back to the start with the X10, Here’s how we want you to do it. Don’t go fast, just take your time. But do try to get a little bit of progress each day and with each workout. And I was religious with my work out on the X10. And to the point where I loved them. I mean, I looked forward to them because it really did, it loosened me. I would come home from work and my knee had been tight all day. Really, you’re stuck at work, you can’t get up and move around as much.
At 6:00 PM, I’d sit down and the X10 would loosen it up. The X10 would slowly but surely loosen up the knee. And that’s when I knew I was on the right route because the X10 would loosen it up before it would tighten up. I could get it loose three times a day. And then I would go to PT a couple of times a week and I then could start to move the seat down on my bike. So, I was seeing that it was working, and that was transformational for me because I felt like there was finally a light at the end of the tunnel.
Well, okay, so now you did hit the 115º, but you didn’t stop there. What happened?
I like to set goals and I work hard to meet my goals. So, I had met that goal we had originally set. I had set up to have the machine for three weeks. I was like, ‘I don’t want to let go of this, my new friend here’. So, we called, and I got the X10 for another three weeks. Thank goodness it was available and they said, yes we can leave it your home.
And then I got to 122º and then I got the 124º and then I got to 130º. The wonderful thing about the X10 is when you get to the point where the X10 takes your knee to your goal it then dwells for 10 seconds. The dwell is the working thing. It holds it at that place that it’s having a little bit of tightness and then it moves it back out. And then it brings it back to that spot and holds it. That was what I liked – perfect for my recovery after MUA.
Was it painful?
I can take pain. But it wasn’t even pain. Everyone wants to ask me what my level of pain was. And I would say it’s not pain, it’s tightness. And it’s just a point where you, my knee was so used to that tightness, and any additional progress was going to affect the memory of the injury that my brain had to relearn that I could push past that. I could take that tightness and then move to the next level and live with that and move to the next level. So, as it would dwell at 120º and then I would come back the next time it would come to 120º it wouldn’t feel tight. And I’d say, okay, I can go to one point and, and I can go to 122º and I got to 130º and you can look at my notes. I got the 130º pretty early.
I think I was at 130º for a couple of weeks. Mary, I was afraid to let the machine go because I thought, my goodness, I don’t want to go backward, you know? The surgeon said the point where it could go back and lock was between eight and 14 weeks. And so when I got past that, I got to the point where I can bike on a regular bicycle outdoors, dropping my seat every day on the indoor spin cycle and my outdoor bike, that’s where I realized the X10 has gotten me to a point where I’m not going backward.
So, it was okay to let the X10 go. So, it’s interesting how your goals with the X 10 can be moved forward. Just that one degree at a time. And my 110º became 130º and it was transformational.
So, what’s life like now? How are you feeling?
My last visit with my surgeon two weeks ago, and he said you were, you’re free to go. I’ll see you in a year. He wants to see it at the one-year point.
Now I’m religious about the spin bike in the morning and then now that we’re still having good weather here in Michigan, I’ve been able to get outdoors every night and ride my bike, which seems to be for me the best exercise.
And then I do a lot of weightlifting with bike riding. Knee extensions and, other exercises with Therabands and so forth. When I knew I was on my way to a new recovery was when I could literally go down the stairs. I could always go upstairs pretty well one leg at a time, but I couldn’t go down the stairs. You have to have enough flexion to go down the stairs. Now it’s very comfortable to go down them.
I can walk with a normal gait, I don’t run yet and I’m not that concerned about running. It’s never been the exercise that I use for fitness, though biking is the most important one. And I literally have the seat on my bike down lower than when before I went in for surgery.
I’m not done. I have to be very careful that I stay on my recovery program and I work at it every day. The reason that I had so much scar tissue was because my body has a tendency to create scar tissue. So that’s going to be something I have to be careful about.
When I answered the question before the MUA where people ask, ‘are you glad you had the surgery’? And I would’ve said no.
And if you asked me now, I say absolutely.
What are you hoping everyone gets out of this conversation we just had together?
Well it is that those moments where the world tells you that things are too good to be true.
I’m not the going to church religious guy, but I have a real high-level belief system and I know somebody put that X10 in front of us on the internet. And, and so what was that? What was important to me when we found the X10 and my wife brought it up to me and I’m lying on my back, my knee at 70º and, she said, what do you think? And we looked at it and I literally looked at it for three hours on the internet. We watched the testimonials and believed these were real people.
You could tell these were not actors. This was a person who said I didn’t have any flexion and I now do. And they were out running or riding. And there was a gentleman that was providing a testimonial who, well, was an engineer. That intrigued me because he was talking about how the computerized part of it works for him and why he thought that was important.
So, I think that the important part of this process is these are real people and I’m a real person. And if you are having a struggle with your recovery after a knee replacement surgery, this is a real-world device that works and that’s important to know.
Anything else you want to say that we haven’t covered?
I just want to thank all the folks at X10. Everyone was so upbeat and easy to work with. Candice was there and cared, and we’d talk. She was always very supportive but would always push, push, push. I loved that. And Mary, you’ve been so easy to talk with and have always been very supportive and that’s very important throughout the process.
So, thank you to the X10 group is all I’d like to say.
We call it a “Meta-Blog.” We step back and give you a broad perspective on all aspects of knee health as with this article on ‘Recovery After MUA’.
In this one-of-a-kind blog, we gather together great thinkers, doers, and writers. All our work is related to Knee Surgery, Recovery, Preparation, Care, Success, and Failure. Meet physical therapists, coaches, surgeons, patients, and as many smart people as we can gather to create useful articles for you. This is for you if you have a surgery upcoming, or in the rear-view mirror. Or maybe you just want to take care of your knees to avoid surgery. Executive Editor: PJ Ewing
To subscribe to the blog click here.
The link to the research study as presented in the blog episode is here: Risk Factors, Outcomes, and Timing of Manipulation Under Anesthesia after Total Knee Arthroplasty. To read more recovery after MUA stories, click here.