Manipulation

Today’s post is both retrospective and current because today I had my third manipulation. A manipulation is recommended when flexibility is limited by scar tissue or other factors. In my case I had my fist manipulation eight weeks after being discharged from the hospital. At the time I could not flex my leg beyond 65-70 degrees because scar tissue had completely enveloped my kneecap, preventing motion. For that manipulation I received an epidural (pain killer in the lower back) and a femoral nerve block. The nerve block is accomplished by giving a shot of painkiller to the femoral nerve, located in the groin area on the same side as the injured leg. The trick is that to find the correct nerve they have to stick a wire in your groin and poke around until the correct part of your leg contracts. The other end of the wire is attached to some kind of battery that sends small electric pulses to the nerve, causing the muscles it serves to contract. During this process I felt like a lab rat as first one, and then another group of muscles contracted involuntarily. Finally, the quadriceps (upper thigh) contracted, indicating that they were poking the femoral nerve. At this point they injected numbing medicine, and for my first manipulation they also inserted a small catheter attached to a tennis-ball-sized rubber ball of medicine that gradually deflated over 24-36 hours, delivering a steady dose of pain killer around the femoral nerve.

Once the pain killers were in place they wheeled me in to surgery and put me to sleep. During the surgery they cut away the scar tissue that was locking up my ligaments, tendons, and even muscles. Then they forcibly bent my leg to 130 degrees. The cutting is done through several tiny holes around the knee. Upon waking up in post-op my upper leg was like a bowl of jello from the nerve block. The back of the leg or knee is not affected by the nerve block so it does feel pain unless you are given other medicine via an IV or orally. The first manipulation required so much cutting of scar tissue that they kept me in the clinic for two nights to recover. During this time I had a drain in my knee to let the blood and other fluids escape and reduce the swelling. The drain consists of a clear tube attached to a waffle-sized suction pack that inflates as it sucks out the fluid. This reservoir must be emptied periodically. For those three days and two nights I worked a lot in my CPM machine to flex my leg, and packed ice around the knee to reduce pain and swelling.

Although the doctor was able to bend me to 130 degrees in this first manipulation, I only retained to 90 degrees. For this reason, just over a week later the doctor did another manipulation. This second manipulation only involved bending, not cutting. I received another femoral nerve block but no epidural and I did not spend the night in the clinic. I was in horrible pain after the second manipulation, probably because I still had fresh trauma from the first manipulation. As I sat in the recovery room the pain kept increasing and my heart rate was rising so much that they decided to block the nerve in the back of my leg. Unfortunately, after repeatedly poking me with a needle behind my knee they could not find the correct nerve so they just shot some pain killer in there. This helped a bit but I was in bad shape from the pain and poking.

Despite intensive physical therapy, four weeks after the second manipulation I could only bend my leg to 100 – 110 degrees and the doctor sensed that my knee was locking down again. Thus I went in today for my third manipulation. Once again I had the femoral nerve block but no epidural. They attempted to give me a nerve block catheter but after poking me a dozen times with a needle and the electrodes they could not find the nerve! Apparently they need an ultrasound to find it but none was at hand so I just went without the catheter. As in the first procedure I again had a scope in which they cut scar tissue around my knee. This time the doctor got me to 5 degrees extension, 125 degrees flexion. As in the first procedure I have a drain in my knee and I will go back to tomorrow to have that removed. I just got out of an hour or so in my CPM and now I am working on extension by propping my leg up on a stack of towels, trying to straighten the knee. So far the pain from this manipulation is much less than that from the first two, probably because my muscles and tendons have been increasingly subjected to stress since I began putting weight on the leg last week. Thus, these tissues were less stressed by the manipulation. Of course, once the nerve block wears off I will know just how much pain I really have! At the moment I am about to pass out from the drowsiness caused by the drugs….so I bid you adieu. Hopefully the third time is the charm and I am finished with manipulations forever!