Help - what PT exercises are safe?

[Munchie]

Hi newbie here.

I am hoping someone can help me. I had knee arthroscopy and had my plica removed in June 2009. Two weeks later at my second PT session I presented with a swollen calf which was painful and hot to touch (classic dvt signs). The PT missed it and massaged my calf and gave me some calf stretching exercises to do on top of my knee rehab ones.

Four weeks later with my leg still swelling and being painful, especially after walking on it for 20 mins plus, I was referred to hydrotherapy. PT there asked how I was getting on with my knee PT exercises and if I had any other problems. Told him about my calf etc and straight away said I should see my GP.

Long story short, had dvt diagnosed end July and am now on warfarin for 6 months. Had to stop all PT exercises and was told by one PT not to do any exercise at all for 6 months but my orthopedic consultant and anti coagulation clinic said it is ok to do some exercise especially now I am within my INR range.

I tried swimming (just a few widths) and the pain the following day had me in tears. Have now been going to the gym doing 10 mins on bike and treadmill at a steady pace. My leg swells a bit and the pain is manageable. Would it be ok to continue doing this and then slowly increase the time.

Are there any other exercises that I can do to help with the rehab of my knee that are safe for my dvt?

Many thanks.

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[Munchie]

Just bumping up to see if anyone can help?

[iliastolos]

Hi munchie!

Exercise after DVT diagnosis has not proven to be so effective as expected to! Although exercise increases blood flow, it is questionable whether venous blood flow (particularly deep venous) is improved when DVT is present. I would suggest to 'test and try'. That is very mild exercise and watch for symptoms. If 10 minutes of bike or walking causes light pain and swelling, then do not increase time or intensity unless you have no such symptoms. Keep on with medication and perform mild exercise until symptoms disappear.

As for your knee rehab exercises, since the knee is part of the lower extremity, it is almost certain that any exercise could aggravate symptoms. Therefore, try mild exercise, such as leg raises in supine or prone and definitely without resistance.

Looking forward to hearing from you. Unfortunately, research data is poor concerning exercise and DVT. So, be gentle with whatever you do!

ilias

[Munchie]

Thanks for your response ilias.

I have been walking quite a bit to try and encourage blood flow.

You are right about there being little information with regards to exercise whilst having a dvt. Unfortunately it seems that individual medical staff have their own ideas on what or how much to do.

I have been told to not do anything other than just walking whilst also being told that some form of exercise, which doesn't cause too much pain or swelling is ok. I have also been told that I should try and stretch out my hamstrings by lying down and raising my leg upright and pulling my toes down towards me (I hope you understand what position I am describing ). I have also been told I can do some leg curls with a very small weight to help my knee rehab. With regards to supine or prone positions - do this mean whilst lying on either my back and front, I raise my leg up straight and hold to help my muscle?

I won't be doing anything too quickly or with any resistance for a while, especially with the pain I felt after I went swimming.

Thanks again.

[iliastolos]

Munchie,
Look at the following link for a straight leg raise exercise YouTube - Straight Leg Raise

In your case, forget about the extra weight, hold your leg for 2-3 seconds and perform at least 8-10 repetitions. You can try it with your toes looking at the outside (for vastus medialis) or upwards. This is supine. In prone position (with your front body facing the bed), try the same for hip extensors (gluteus, hamstrings) as well as back extensors. The other leg lies straight, it can't be bent in this position as in supine.

Concerning stretching, be careful at the following: 'stretching' can be achieved only by a constant elongation for at least 20-30 minutes. When applying the stretching exercise for the hamstrings you described, you 'relax' the muscle. That is different from stretching. If you relax the muscle, then the muscle pumping mechanism you want to improve for helping arterial and venous blood flow is less activated, because a relaxed muscle has a lower muscle tone at that time (and you want to increase it to help blood going back to the heart through the veins). On the other hand, that would be the case for exercise, to improve pumping mechanism. Since I'm not aware of effectiveness of stretching in DVT, I would suggest the same as for exercise, that is test and try.

You will find many others having their own opinion just because there is no specific evidence. So, your body will be your guide.

ilias

[Munchie]

Cheers for that Ilias

I will see how I get on with your advice.

Many thanks for answering my questions.

[iliastolos]

Take care and inform me of your progress!