The best gym exercises for knee replacement rehabilitation are those that improve range of motion and strength. A stationary bike is a great option as it improves mobility and lower body strength. Before getting started, make sure you know the best and the worst exercises after a knee replacement.
The gym offers many options to help strengthen your legs after a knee replacement. Stick to machines like the stationary bike and leg press, while avoiding activities like jumping or running, which can put too much stress on your new joint.
Knee replacement surgery, also known as knee arthroplasty, is a good choice for those people who have severe pain due to osteoarthritis, says the Mayo Clinic. These people have difficulty doing things like walking, climbing stairs and standing up out of a chair.
This procedure involves removing the damaged bone and cartilage from your kneecap, shinbone and thigh bone and replacing it with an artificial joint that is made of special metal alloys, as well as polymers and high-grade plastics.
The surgery has an excellent recovery rate, with more than 90 percent of patients saying they have a big reduction in pain and improved ability to do activities, reports the American Academy of Orthopaedic Surgeons (AAOS).
You may be surprised to find out that you may start moving and exercising your new knee the day after surgery, says the AAOS. Once you are released from the hospital, listen to your physical therapist or doctor as they can help you choose the best exercise machine for knee rehabilitation.
The best exercise machine for knee rehabilitation after surgery will focus on increasing range of motion and improving strength. The AAOS recommends exercising for 20 to 30 minutes, two to three times a day, and walking for 30 minutes to regain your strength and mobility after surgery.
The stationary bike is a great post-knee-replacement exercise machine as it improves range of motion, flexibility and blood flow. The AAOS says to raise the seat of the bike so the bottom of your foot just touches the pedal.
Another post-knee-replacement exercise machine that will help regain function is the leg press. The University of Wisconsin recommends the supine leg press with minimal weight (20 to 40 pounds), progressing to more weight as tolerated. This machine helps strengthen your entire lower leg, which is an important part of recovery. When you are at home, you can replicate this machine with mini squats.
Walking is one of the best exercises you can do after surgery. The AAOS recommends initially using a walker and progressing gradually to a cane at two to three weeks after surgery. You can stop using a cane once you can walk without a limp.
Once you can move around without a cane, the treadmill is a good post-knee-replacement exercise machine. Keep the incline level and the speed slower initially, progressing it as your strength and endurance improve. Do not run on the treadmill, as this puts too much stress on your new knee.
Stairs are a great exercise, but avoid the stair stepper machine immediately after knee replacement surgery as you may injure yourself until you build up your strength and coordination. The AAOS suggests finding a flight of stairs and using the handrail to go up the stairs with your good knee, and down the stairs on your recovering knee to build up strength and mobility.
The Mayo Clinic states that excessive activity can wear out your artificial knee and cause the replacement to become loose and painful. Therefore, it's safer to avoid high-impact activities, such as running and jumping. Lifting more than 50 pounds can overload your knee joint, so stick to lighter weights.
Luckily, there are plenty of activities you can do after a knee replacement, including swimming, golfing, driving, light hiking, dancing and Pilates. Start slowly, listen to your body and stop any activity that causes pain or discomfort.
You may have some pain or swelling after exercise, but it shouldn't last longer than 24 hours. Ice your knee and elevate it after your exercise routine to help decrease pain and inflammation. Talk to your doctor about any concerns you may have.
Flotation processes are based on the different surface wettability properties of materials (Wang etal., 2015). In principle, flotation works very similarly to a sink and float process, where the density characteristics of the materials, with respect to that of the medium where they are placed are at the base of the separation. Sometimes a centrifugal field is applied to enhance separation. Flotation works in a different way in the sense that in a liquid medium, usually water, a carrier is introduced, air bubbles, responsible to float hydrophobic particles that adhere to the bubbles with respect to the hydrophilic ones that sink. According to surface plastic characteristics, this technique can be profitably applied, in principle, to separate waste polymers (Fraunholcz, 2004). To enhance or reduce plastic surface characteristics (i.e., hydrophobic or hydrophilic) appropriate collectors, conditioners (Singh, 1998; Shen etal., 2002), and flotation cell operative conditions (i.e., air flow rate, agitation) can be utilized. Usually plastic flotation is carried out in alkaline conditions (Takoungsakdakun and Pongstabodee, 2007). Once floated, hydrophobic polymers are recovered as well as the sunk ones (i.e., hydrophilic) at the bottom of the cell. This technique, even if it is well-known (Buchan and Yarar, 1995) and in principle quite powerful is not widely used mainly for three reasons: (1) it is a wet technique, this means that water has to be recovered and processed before reutilization, due to the presence of the reagents and contaminants, (2) polymer surface status (i.e., presence of dirtiness/pollutants and/or of physical/chemical alteration) can strongly affect floatability, and (3) large variation of waste plastics feed in terms of composition. Flotation allows to separate PS, PVC, PET, PC, and mixed polyolefins (MPO).
The flotation process depends on several design and operational variables. We consider a superstructure that includes the following three flotation stages: the rougher, which processes the feed; the cleaner, which generates the final concentrate; and the scavenger, which generates the final tailing, as shown in Fig. (1). This is a simple superstructure but is used here as an example.
The objective is to maximize the total income with respect to the operation conditions and process design. The decision variables to be optimized are divided into design and operating variables. The design variables include equipment dimensions, such as the cell volume and total number of cells for each stage. The operating variables correspond to operating times for each cell at each stage and the directions of tails and concentrate streams. In stochastic problems, the operating variables (second level variables) are able to adapt to each scenario to increase the total income. Moreover, the design variables (first level) are the same for all scenarios.
The flotation process depends on several design and operation variables. We consider a superstructure that includes three flotation stages: rougher, scavenger and cleaner stages, as is shown in figure 1. We allow for the consideration of multiple scenarios. The model consider constraints that enforce the kinetics of flotation and the mass balance on each flotation stage, the behavior at the splitters and mixers, the mass balance at the splitters and mixers, direction choice in the splitters, the penalty the seller must pay for arsenic content in the concentrate, cell volumes, and the costs associated with the flotation cells.
For the deterministic, model we have only a single scenario, and the model then simply maximizes the total income subject to the dynamic and economic constraints. In the stochastic models, we assume we have more than one scenario. Because of this, we need to replace the objective by the maximization of the expected total income. For this, we need the probability of a given scenario. In addition, we know that some of our decision variables can depend on the scenarios. This model corresponds to a stochastic MINLP.
In flotation process, the gas or air bubbles are introduced through culture suspension, and the microalgal biomass get attached to gaseous molecules and accumulated on the liquid surface. This method is particularly effective for thin microalgae suspension that could be simply gravity thickening . The basic variations of this process are dispersed air flotation, dissolved air flotation, electroflotation, and ozone flotation [55,56,57]. The ratio of gaseous molecules to microalgae is one of the most important factors affecting the performance of the flotation efficiency. Several researchers have confirmed that ozone flotation was more effective than other methods [58,59]. Also, ozoflotation could improve lipid recovery yields and modify fatty acid methyl ester (FAME) profiles. The ozone flotation could increase the cell flotation efficiency by modifying the cell wall surface and/or releasing the active agents from microalgal cells . Moreover, the ozone flotation can also improve the quality of water by lowering the turbidity and organic contents of the effluent . Flotation separation efficiency relates to bubble size . Smaller size of gas bubbles has lower rise velocity and higher surface area to volume ratio. This enables their longer retention time and better attachment efficiency with the microalgae cells and leads to the increasing in harvesting efficiency by floatation . Thus, one of the most efficient ways of achieving maximum attachment is by generating as many small bubbles as possible [61,62,63]. Combinations of flocculation with flotation have been also used to increase the harvesting efficiency [64,65,66].
In using these equations, however, one must use parameters with consistent units.(1-3)E=(Ci-Co)/Ci(1-4)E=K/(Qw-K')(1-5)E=(6Kpr2hqg)/(qwdb)whereE = efficiency per cellCi = inlet oil concentrationCo = outlet oil concentrationQw = liquid flow rate, BPDKp = mass transfer coefficientr = radius of mixing zoneh = height of mixing zoneqg = gas flow rateqw = liquid flow through the mixing zonedb = diameter of gas bubble
The froth flotation process is more than a century old and was developed over a long period of time . It takes advantage of the surface chemistry of fine particlesif one particles surface is hydrophobic and another is hydrophilic, upon generation of air bubbles, the hydrophobic particles tend to attach to the air bubbles and float, allowing for a separation between particles in the froth and those in the main body of the liquid.
Typically three different types of chemicals are used in the froth flotation process: collector, frother, and modifier. First, the collector is added to the iron ore slurry to selectively coat the iron oxide particles, making the surface hydrophobic. The slurry then goes to a flotation cell, where air bubbles are generated using an impeller and aerator (Figure 1.2.4). At this step, the frother (for example, fuel oil) is added to the ore slurry to form stable froth and air bubbles. Iron oxide particles stick to the air bubbles and float. Floated and concentrated iron ore slurry is then skimmed from the surface of the bath, and water is removed using a filter press. If the desired iron content is not achieved, the process is repeated. A modifier is added in some cases to enhance the performance of the collector. Frother is the most important chemical that must always be present. Without the generation of stable air bubbles, hydrophobic particles will not have anything to attach to and will not separate from the bulk solution.
Depending on the type of collector, either iron oxide or silica particles can be floated. An anionic collector is added to float the iron oxide particles, a cationic collector for the silica particles . Depending on the situation, the pH of the slurry can be adjusted by adding acid to the solution, which may also enhance the properties of the collector.
The basic objective of a flotation device is to keep the pulp in suspension and provide the air bubbles. The size of air bubbles matters as it controls flotation kinetics as well as the carrying capacity of the bubbles. The design technology determines the characteristics of the machine, resulting in concomitant factors like how the collision and contact between air bubbles and particles takes place. The two resultant products, concentrate and tails, need to be evacuated properly. The most widely used flotation machines can be broadly classified into mechanical and pneumatic depending on various factors. The former use impellers or rotors, which are absent in the latter.
The shape of a mechanical flotation tank is essentially rectangular, U-shaped, conical or cylindrical, according to the cell type and size. It is fitted with an impeller/rotor and stator/diffuser. Air enters into the device through a concentric pipe surrounding the impeller shaft either by self-aspiration or aided by a compressor. The function of the rotating impeller is to keep particles in suspension by thoroughly mixing the slurry and dispersing the injected air into fine bubbles through a diffuser. It also provides conditions for promoting particlebubble collisions.
There is a necessity for the generation of three different hydrodynamic zones for effective flotation. The region near the impeller comprises of a turbulent area required for solids suspension, dispersion of air into bubbles and bubbleparticle interaction. Above the turbulent region lies a quiescent zone where the bubbleparticle aggregates move up in a relatively less turbulent sector. This zone also helps in sinking the amount of gangue minerals that may have been entrained mechanically. The third region overhead the quiescent zone is the froth zone serving as an additional cleaning step, and improves the grade of the concentrate. Particles that do not attach to the bubbles are discharged out from the bottom of the cell (Vazirizadeh, 2015). Fig. 5.33 shows a typical schematic of a mechanical cell.
Mechanical cells are arranged in a series called a bank, having enough cells to assure the required particle residence time for adequate recovery, the subaeration cells are arranged in cell-to-cell flow, while the supercharged machines are placed in an open-flow design.
The strongly hydrophobic and optimised-sized particles are likely to float first in a bank of flotation cells. Sluggish flowing particles float in diminishing order, and so forth, giving rise to total recovery of about 100%. A minimum of four cells is required for coal flotation with a residence time of 5 minutes (Euston et al., 2012). The residence time, pulp volume and flotation kinetics play a vital role in determining the selection of the number of cells required in a flotation circuit. To prevent loss of floatable coal along with tailings, it is advisable to put cells in series. Fig. 5.34 indicates the coal recovery through multiple cells (in series) in a bank. Fig. 5.35 demonstrates arrangement of cells both in series and parallel, the series arrangement gives optimum recovery of combustibles.
The most common examples of pneumatic cells are the column cell and the Jameson cell. As shown in Fig. 5.36, a flotation column is typically a tall vertical cylinder. It is fed with coal pulp at the top third of column. It has no mobile parts or agitators. Air bubbles are injected either through external or internal spargers at the bottom. These bubbles rise up in countercurrent with the descending flow of the pulp. Hydrophobic particles attach to the air bubbles forming bubbleparticle aggregates and move upwards. The zone where this process takes place is called the collection zone. The ascending bubbleparticle aggregates accumulate in the upper part of the column called the cleaning or froth zone, and then overflow into a launder as a concentrate. Wash water is sprinkled at the top of the column to wash off entrained gangue (hydrophilic) particles, which are sent back into the collection zone. The application of wash water helps stabilise the froth and produce high-grade froth concentrates. The hydrophilic particles, along with misplaced hydrophobic particles, are finally released at the bottom of the column.
In spite of improved separation performance, low capital and operational cost, less plant space demand, low maintenance cost, ease of operation, lower energy consumption and adaptability to automatic control (Wills and Napier-Munn, 2006), axial mixing can significantly reduce the overall performance, particularly in larger-diameter columns. Axial mixing can be decreased by different methods (Kawatra and Eisele 1999, 2001):
A Jameson cell is schematically presented in Fig. 5.37. A high-pressure jet, created by pumping feed slurry through the slurry lens orifice, enters a cylindrical device called a downcomer. The downcomer acts as an air entrainment device which sucks air from the atmosphere. The jet of slurry disseminates the entrained air into very fine bubbles after plunging upon the liquid surface. Then, it creates very favourable conditions for collision of bubbles and particles, and their attachment. The particlebubble aggregates move down the downcomer to the cell and float to the top to form the froth. The hydrophilic minerals sink to the bottom and exit as tailings. Tailings recycling is practiced to reduce feed variations to the cell so that the downcomer can operate at a stable feed pressure and flow rate. This helps to ensure steady operation. The downcomer provides an ideal situation for particlebubble contact and minimises the residence time due to rapid kinetics and separate contact zone. Thus, the Jameson cell is of much lower volume compared to equivalent-capacity column or mechanical cells. There is also no requirement for agitators or compressors besides the feed pump.
The dissolved air flotation process takes advantage of the principles described above. Figure 7-104 presents a diagram of a DAF system, complete with chemical coagulation and sludge handling equipment. As shown in Figure 7-104, raw (or pretreated) wastewater receives a dose of a chemical coagulant (metal salt, for instance) and then proceeds to a coagulation-flocculation tank. After coagulation of the target substances, the mixture is conveyed to the flotation tank, where it is released in the presence of recycled effluent that has just been saturated with air under several atmospheres of pressure in the pressurization system shown. An anionic polymer (coagulant aid) is injected into the coagulated wastewater just as it enters the flotation tank.
The recycled effluent is saturated with air under pressure as follows: a suitable centrifugal pump forces a portion of the treated effluent into a pressure holding tank. A valve at the outlet from the pressure holding tank regulates the pressure in the tank, the flow rate through the tank, and the retention time in the tank, simultaneously. An air compressor maintains an appropriate flow of air into the pressure holding tank. Under the pressure in the tank, air from the compressor is diffused into the water to a concentration higher than its saturation value under normal atmospheric pressure. In other words, about 24 ppm of air (nitrogen plus oxygen) can be dissolved in water under normal atmospheric pressure (14.7 psig). At a pressure of six atmospheres, for instance (6 14.7 = about 90 psig), Henry's law would predict that about 6 23, or about 130 ppm, of air can be diffused into the water. In practice, dissolution of air into the water in the pressurized holding tank is less than 100% efficient, and a correction factor, f, which varies between 0.5 and 0.8, is used to calculate the actual concentration.
After being held in the pressure holding tank in the presence of pressurized air, the recycled effluent is released at the bottom of the flotation tank, in close proximity to where the coagulated wastewater is being released. The pressure to which the recycled effluent is subjected has now been reduced to one atmosphere, plus the pressure caused by the depth of water in the flotation tank. Here, the solubility of the air is less, by a factor of slightly less than the number of atmospheres of pressure in the pressurization system, but the quantity of water available for the air to diffuse into has increased by the volume of the recycle stream.
Practically, however, the wastewater will already be saturated with respect to nitrogen, but may have no oxygen, because of biological activity. Therefore, the solubility of air at the bottom of the flotation tank will be about 25 ppm, and the excess air from the pressurized, recycled effluent will precipitate from solution. As this air precipitates in the form of tiny, almost microscopic, bubbles, the bubbles attach to the coagulated solids. The presence of the anionic polymer (coagulant aid), plus the continued action of the coagulant, causes the building of larger solid conglomerates, entrapping many of the adsorbed air bubbles. The net effect is that the solids are floated to the surface of the flotation tank, where they can be collected by some means and thus be removed from the wastewater.
Some DAF systems do not have a pressurized recycle system, but, rather, the entire forward flow on its way to the flotation tank is pressurized. This type of DAF is referred to as direct pressurization and is not widely used for treatment of industrial wastewaters because of undesirable shearing of chemical flocs by the pump and valve.
The behavior of coal in the flotation process is determined not only by a coals natural floatability (hydrophobicity), but also by the acquired floatability resulting from the use of flotation reagents. The general classification of the reagents for coal flotation is shown in Table12.1 (Laskowski, 2001).
The use of liquid hydrocarbons (oils) as collectors in flotation of coal is characteristic for the group of inherently hydrophobic minerals (graphite, sulfur, molybdenite, talc, coals are classified in this group). Since oily collectors are water-insoluble, they must be dispersed in water to form an emulsion. The feature making emulsion flotation different from conventional flotation is the presence of a collector in the form of oil droplets, which must collide with mineral particles in order to enhance the probability of particle- to-bubble attachment. The process is based on selective wetting: the droplets of oil can adhere only to particles that are to some extent hydrophobic. The effect of emulsification on flotation has been studied, and its beneficial effect on flotation is known (Sun et al., 1955).
Coal flotation is commonly carried out with a combination of an oily collector (e.g. fuel oil) and a frother (e.g. MIBC). All coal flotation systems require the addition of a frother to generate small bubbles and to create a stable froth (Table 12.2). Typical addition rates for frothers are in the order of 0.050.3kg of reagent per tonne of coal feed. Depending on the hydrophobic character of the coal particles, an oily collector such as diesel oil or kerosene may or may not be utilized. When required, dosage rates commonly fall in the range of 0.21.0kg of reagent per tonne of coal feed, although dosage levels up to 2kg/t or more have been known to be used for some oxidized coals that are difficult to flotate.
PO stands for propylene oxide (CH2-CH2-CH2-O-), and BO for butylene oxide (CH2-CH2-CH2-CH2-O-) Cresylic acids (mixture of cresols and xylenols) that in the past were commonly used in coal flotation are not in use any more because of their toxicity.
PO stands for propylene oxide (CH2-CH2-CH2-O-), and BO for butylene oxide (CH2-CH2-CH2-CH2-O-) Cresylic acids (mixture of cresols and xylenols) that in the past were commonly used in coal flotation are not in use any more because of their toxicity.
The beneficial effect of a frother on flotation with an oily collector was demonstrated and explained by Melik-Gaykazian et al. (1967). Frother adsorbs at the oil/water interface, lowers the oil/water interfacial tension and hence improves emulsification. However, frother also adsorbs at the coal/water interface (Frangiskos et al., 1960; Fuerstenau and Pradip, 1982; Miller et al., 1983) and provides anchorage for the oil droplets to the coal surface. Chander et al. (1994), after studying various non-ionic surfactants, concluded that the flotation of coal can be improved in their presence because of the increased number of droplets, which leads to an increase in the number of droplet-to-coal particle collisions. While the use of oily collectors and frothers is the most common, also a group of flotation agents known as promoters have found application in coal flotation. In general, these are strongly surface-active compounds and are mostly used to enhance further emulsification of water-insoluble oily collectors in water.
Because of environmental concerns associated with tailing ponds, the method for disposing of fine refuse from coal preparation plants by underground injection has been gaining wide acceptance. Unfortunately, many common flotation reagents, including diesel oil, are not permitted when fine refuse is injected underground into old mine works. This is the main driving force for finding replacement for the crude-oil based flotation collectors (Skiles, 2003). An alternative to fuel oil may be biodiesel, a product created by the esterification of free fatty acids generally from soy oil, with an alcohol such as methanol, and subsequent transesterification of remaining triglycerides. Water, glycerol and other undesirable by-products are removed, to produce a product that has physical characteristics similar to diesel oil. The use of some vegetable oils was demonstrated to provide equivalent (and even superior) flotation results when compared with diesel fuel (Skiles, 2003). These are the results of commercial scale tests on a circuit that has 4.25m in diameter columns. The product concentrate ash was 13.5%. The consumption of the tested vegetable oil was about two times lower from the consumption of diesel oil in these tests.
It features both proven technology and the latest technical innovations at the same time. This flotation cell is highly efficient when it comes to costs and operation. It can be easily scaled to various production levels without compromising performance. In short, OptiCell Flotation enhances the performance of the deinking line cost efficiently and ensures a reliable flotation process. The heart of the flotation process is the injector. In the OptiCell system, this has beendesigned with special care, using the experiences of earlier flotation technologies, modern computational fluid dynamics calculations, and new image analysis methods. The combination of these approaches results in a unique injector that represents the latest technology. This injector differs from traditional injectors in following respects:
OptiCell flotation by Metso is based on computational fluid dynamics and uses new image analysis methods. It is designed to provide smooth-flow velocities that allow unobstructed transfer of bubbles to the surface of the pulp mixture or froth, which improves the efficiency of ink removal. The aeration injector ensures optimal bubble-size distribution. The injector is designed based on the experiences gained with earlier flotation technologies combined with modern computational fluid dynamics calculations and new image analysis methods.
The linear structure of the flotation cells has a large surface area, which has reject separation and fiber loss. This flotation cell design also contributes to high sludge consistency (less water in the sludge) by ensuring smooth drainage of froth (Aksela,2008). The elliptical shape of the flotation cells in this technology is optimal for internal pulp circulation for improved ink removal. Moreover, the flatness of the cells intensifies the rise of air bubbles within the available volume. The first OptiCell Flotation system started operation in September 2008 at Stora Ensos Maxau mill in Germany, which has an approximately 1000 t/day deinking facility (Metso,2012b). According to Metso, the brightness from the complete flotation system has increased by two units. A brightness gain of 13 units from thick stock to accept was obtained with the OptiCell process. Reject ash content also improved and fiber losses decreased. As a result of the flotation performance and corresponding brightness improvement, peroxide consumption has decreased significantly in bleaching. In addition, the stickies content was reduced significantly. It was the lowest ever measured at the deinking line 1 at Maxau mill. The benefits of OptiCell flotation are summarized in Table11.8 (Aksela,2008; Metso,2012b).
As a physical therapist, having used TENS units to help all kinds of patients pains on almost every body part, I was introduced to how powerful a TENS unit can be about 40 years ago, early in my career.
A senior citizen presented to the physical therapy clinic at the hospital where I was the Chief of Physical Therapy. She was referred by a local orthopedic physician for knee pain control. She was very limited in ambulation endurance because of knee pain and was using a cane to decrease the weight-bearing on the knee because of the pain.
After my in-clinic treatment session, the patient had pain relief, but the pain levels remained significantly high.I decided to incorporate the use of a home TENS unit on this painful knee as part of the patients home program. She was to wear the TENS unit as much as she needed it to control the pain.
Upon questioning, the patient told me she was wearing the TENS unit continuously and the TENS unit had completely eliminated her knee pain after our first physical therapy session, allowing her to walk without a cane or any ambulation assistive device, and without pain.
She felt so good she did a lot of walking, even some gardening, and was very active all day the day after she started wearing the TENS unit. She wore the TENS unit all day, even when she was walking and gardening.
I did not expect that result. I had no idea that a TENS unit could be that effective so I had failed to give the patient adequate instructions on activity restrictions if the TENS unit eliminated the pain.
Using a TENS unit for pain control after total knee replacement surgery is a common protocol for many orthopedic surgeons.The use of a TENS unit after a total knee replacement can decrease the patients pain and opioid consumption.
A study, Transcutaneous electrical nerve stimulation for postoperative pain control after total knee arthroplasty published in the US National Library of Medicine confirms that patients receiving a TENS unit after total knee surgery experience less pain and a decreased need of opioid medications.
The more powerful opioid medication issued my patients on discharge from the hospital, such as Norco, are intended to be used as break-through medications and are to be used when the lesser strength opioid, Tramadol, fails to control the pain adequately. Thats usually when the pain reaches 7/10 or more while taking the lesser strength opioid Tramadol.
Break-through opioid medications like Norco are taken on a pain-contingent basis, meaning the patient is to take the medication only when the pain is not controlled with the lesser strength opioid, and is to be taken on an as needed basis within guidelines on the prescription label.It would say something like Take 1-2 tables every 4-6 hours as needed.
Tramadol is used on a time-continent basis, meaning the patient is to take the medication on a regular time interval. Frequently the prescription will direct the patient to take the Tramadol every 4 hours. This is because the doctor wants the patient to have a consistent level of pain medication in their bloodstream.
Norco, the more powerful of the opioids, is to be used intermittently to break a severe pain episode. Norco is used on a pain-contingent basis, meaning the patient takes the Norco in a severe pain episode but as soon as the patients pain is under control using the Tramadol, the patient is to discontinue taking the Norco and rely on the Tramadol to once again keep the pain at tolerable levels, usually at about 6/10 or less.
Unfortunately, a lot of my total knee replacement patients do not have a clear idea of how they should be using these medications. Often the instructions are given to the patient before discharge from the hospital but after the total knee surgery. The patient is already impaired in concentration due to the medications and anesthesia they are already receiving and the ability to understand and remember the medication instructions.Not exactly the best time for the patient to receive simple instructions, let alone complicated instructions about new medication.
The usual instructions from opioid manufacturers recommend opioids not be taken longer than two weeks. Some studies suggest taking these heavy opioids for as little as two weeks can cause the patient to become addicted to the opioid.
Recent studies show TENS causes physiological changes that help decrease pain. These physiological changes take place at the furthest reach of the nervous system, the many kinds of receptors embedded in the skin.
The more pain-stimulus signals these nerve-ending receptors are sending to the bain, the more pain a patient is feeling.The more pain-inhibiting signals these nerve-ending receptors are sending to the brain, the less pain the patient is feeling.TENS changes the signal going to the brain.
TENS targets the opioid and -2 noradrenergic receptors under and around the area of the TENS electrodes causing the receptors to send pain reduction signals to the brain mimicking the same blocking mechanism as opioid medication.
Studies such as Effectiveness of Transcutaneous Electrical Nerve Stimulator for Treatment of Hyperalgesia and Pain have shown that TENS stimulation produces physiological changes in these descending inhibitory pathways making them more effective at pain control.
Before the research demonstrated pain reduction via physiological mechanisms, the only theory to explain how TENS works was to speculate that TENS stimulation filled the same pain pathway to the brain as the activated pain receptors, therefore there too much traffic on the nerve pathway for the brain to receive all the signals from the activated pain receptors.
The use of a TENS unit may promote wound healing of a total knee surgical site by causing the release of substance P and calcitonin gene-related peptide.These two substances present at the surgical site would increase blood flow to the surgical site and speed up the healing of the surgical wound.
The potential to produce this healing effect on a new surgical wound after a total knee replacement surgery is supported by a study in the National Institute of Health: The effects of transcutaneous electrical nerve stimulation on tissue repair.
I have seen many total knee replacement patients that have needed help to control pain, with or without the use of opioids, but I do not see total knee patients that have trouble with healing unless there is an infection involved.
That makes me wonder if the speed-up of the healing process would have any impact on whether or not the infected total knee would have become infected if it had healed faster.That would be an interesting study compare new total knee infection rates and healing time between patients using TENS and patients that did not use TENS.
Infection is a rare occurrence with my patients as Im lucky enough to be working with cutting-edge doctors operating out of university hospitals. The referring doctor that makes up the bulk of the total knees I see has the lowest infection rate in California.
The TENS units we will be discussing are the industry standard two-channel TENS units identified as a TENS 3000 or a TENS 7000. Both allow the patient full control of all functions and both are easy to set their controls.
These pre-sets are fine if the patient responds favorably to the pre-set, but if the settings need some individual tuning to get that particular patients pain under control, well thats another matter.
The reason for the modulation has to do with the bodys ability to adapt to a stimulus by a mechanism called accommodation An easy example is wearing a ring or a watch. After the body gets accommodated to the sensation, the brain no longer pays any attention to the input it receives from the ring or watch and you dont even remember that youre wearing them.
Burst mode, in my opinion, is designed to stimulate acupuncture points in an attempt to encourage the body to produce more endorphins and enkephalins. These are the bodys own anti-inflammatory and painkillers.
Normal mode allows the parameters of pulse width and pulse frequency to be set, just like in the modulated mode, but the TENS unit stimulates at that setting continuously without increasing and decreasing those set parameters. This allows for the brain to accommodate to the stimulation and ignore it.
Here is where the benefit of having a TENS unit allowing the patient to set these metrics pays off big time for patients that do not respond to the pre-set stimulation programs on the more expensive TENS units.
Most of the time these pulse width and frequency settings do the job right from the start and never need to be adjusted again unless the TENS unit becomes less effective at controlling the pain. Then we start to try different settings and strategies.
The timer on the TENS 3000 has 4 settings. Three are timed to shut off after a specific amount of time. The 4th setting, C is continuous and only stops stimulating when the patient turns the unit off.
The TEMS 7000 is set using an LED screen so the timer can be set at any time interval before shutting off. It too has a C setting in the timer that allows continuous stimulation until the patient turns the unit off.
Assuming there was pain reduction, I then ask my patient to tell me how long it took after shutting off the TENS unit, for the pain to return to the pre-stimulation pain or how long it to reach the leveling off point if the pain did not return all the way back to the pain level recorded at the start of the session.
My experience coincides with studies I have read in the past that state a person can have the pain return immediately upon turning off the TENS unit, but the pain reduction can produce pain reduction up to 10 times the amount of time the patient was stimulated by the TENS unit.
In other words, people that wear the TENS unit for 1 hour and the pain returns immediately may have to wear the TENS unit all the time to get the desired pain reduction.Some people will have a residual pain reduction that could last for 10 hours after 1 hour of stimulation.
If the patient has a one channel TENS unit, I would recommend my total knee replacement patient to place the electrodes across from each other at the knee. One electrode on the lateral aspect of the knee and the other electrode on the medial aspect of the knee.
If the patient has a two channel TENS unit, I would place one channels electrodes above and below the knee pain on the lateral aspect of the knee and the other channel on the medial aspect of the knee. AKA as the bracketing method because it brackets the pain.
Most recommendations found online, from very reputable websites, recommend using the criss-cross method of electrode placement. I have some concerns that crossing the electrical current can decrease the effectiveness of the stimulation.
The criss-cross method is what I use when using an IFC (interferential current) machine, trying to get the electrical stimulation deep within the joint to decrease swelling, but not with the TENS unit.
If Im trying to elicit a physiological response to reduce pain instead of trying to block the pain through brain distraction, I will choose burst mode and apply the electrodes to the major acupuncture points associated with the knee.
Dr. Donaldson is dually licensed; physical therapy in 1975 and doctor of chiropractic in 1995. He held credentials of Orthopedic Clinical Specialist in physical therapy for 20 years, QME in California, and taught at USC. He owns and operates an orthopedic physical therapy practice. See "About Me" page.
As a physical therapist, having done thousands of home rehabilitation treatments of total hip recipients, starting within 48 hours of discharge from their 2-day hospital stay, one thing is perfectly...
Mission Statement: Our mission is to share information and our experience, both as senior citizens and physical therapists, to help people age in place independently. Our Mantra: Transcending Aging Independently Dr. Robert Donaldson, DC, PT. Jacqueline Donaldson, OT, PTA.
This site does not constitute medical advice. It provides information to make you a better-informed consumer. Please consult a licensed physician and/or physical therapist in your area for specific medical advice about your condition. Age In Place School is a participant in affiliate advertising programs designed to provide fees by advertising and linking to their products. We are compensated for referring traffic and business to companies linked to on this site.
This ice pack for knee provides long hours of cold therapy thus you can use it throughout the night and it comes with beautiful loop closure straps that allow you to adjust and keep the wrap fit on the knee.
This is an independent educational website where bold women and men meet to take advantage of the free analysis and opinion about products and lifestyle. We come with one of the most realistic and honest opinion, information, and data to give our visitors unmatched advantage while purchasing goods for home use, office, garden, industries and much more.
Affiliate Disclosure: I'm a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon properties. As an Amazon Associate I earn from qualifying purchases when you click over from our site and it won't cost you an extra coin.
People may experience pain when trying to move their joint after undergoing surgery. This can cause them to avoid moving the joint, which can result in stiffness, a loss of motion, and the development of scar tissue.
A person can place the affected body part into the CPM machine and control the machine with a handheld control. For example, they can use the control to start and stop the motion, as well as adjust the levels of movement.
The amount of time a person needs to use a CPM machine for will depend on their condition and which joint they are using it on. A healthcare professional will offer instructions on how to use the machine and for how long.
For example, a person using a CPM machine for hip recovery may use it for 4 hours per day for a period of 4 weeks. Healthcare professionals may advise others to use the machine for 45 minutes at a time and rest between sessions.
If a person has access to Medicare health insurance, they may be eligible for a CPM machine to use at their home. If they meet the criteria and require a CPM machine after undergoing knee surgery, Medicare can provide a CPM machine for people to use at their home for up to 21 days.
Knee problems can be very uncomfortable. Whether you are suffering from simple knee pain, severe pain, inflammation, arthritis, or have undergone a complete knee surgery, no amount of knee problem can be said to be good enough.
In this post, I will focus on one of the many solutions to knee problems; use of ice. I will show you how to use ice machine for knee. How to apply ice on your knee, and what to do to get a quick reprieve from knee related pain using ice.
First, the ice machine for knee forms chilled ice or water. This chilled water is formed through the use of a consistent cooling system. The ice machine comes with a tube that you will use to release the chilled water over your swollen knee.
Next the ice machine is used with an ice pack. The ice pack is wrapped around your knee. Once it is done, the ice or chilled water is directed into the ice pack thats wrapped around your knee using the bladder or tube.
This bladder extends from the ice machine and is fitted inside the ice pack thats around your knee. Once this is done and the machine then releases the chilled water or ice into the main ice pack that you have wrapped around your knee.
NOTE: This is a continuous process. Because of this, it is reliable and will easily help you to manage the inflammation or even the soreness thats on your knee effectively. It does this through the application of the low temperatures and regulated compression until the pain is remedied.
Ice application is one of the ways in which you can resort to if you want a quick reprieve to knee problems. It is good for pain and swollen or inflamed knees. In order to use ice for swollen knee you must have an ice pack.
It is not recommended that you apply ice directly to your knees as this can have very negative effects including causing instant change in temperatures. The best thing is to have controlled application for the best results.
Since your knee tends to be very tender when swollen, painful, or after a surgical procedure. Your ice machine should provide enough comfort. This means having non-toxic ice packs that are made of soft materials.
Considering the fact that you are already in pain. It will do you so much good if the ice pack that you get is easy to use. Powering the ice machine and fitting the tube to the pack shouldnt be much of a technical process.
You have seen how to use ice machine for knee. The technology behind this system is easy to follow and you wont have to break your back about it. Even so, it is important that you get the right type of machine.
You should also understand your needs and the caution behind using ice for your swollen knee. All the same, the result when using the ice pack and ice machine is commendable. You must, however, make sure that you do it routinely.