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Kayley Usher

Hi Mike,
Thanks for the update! That’s very interesting about the heat pack. It suggests that your lack of ROM is more related to collagen deposition than inflammation, although you will have some level of inflammation present. This also fits with the excessive collagen deposition in Dupuytrens contracture, and I believe that heat is used to treat that as well.
When inflammation is high there are heat shock proteins produced and these contribute to fibrosis and pain. This is why icing is usually recommended in AF. But for you it seems that heat is a better option.
Yes, it’s good to use all of your ROM when stretching, but gently. Everything to do with AF should be gentle! NO “pushing thought the pain”! The heal and toe movement of your foot is a standard thing that physios tell everybody who has had a TKR, it teaches people how to walk properly again and not to hobble. I think you’re probably beyond this stage.
Yes, quads and the other leg muscles help the knee to function, but if you have high inflammation then it’s easy to make matters worse by exercising too much and increasing inflammation even more. The inflammatory cytokines actually cause wasting of muscles, so exercising can be very counter-productive on many levels. Each person has a level that suits them, depending on their own medical situation, so what suits one person may not suit another.
Maybe you could keep a diary of your exercises (duration and intensity), pain and approximate ROM to determine what amount of exercise is right for you. The pain and ROM may not change immediately, but may reduce the next day if you’ve done too much.
Yes, the inflammation from your fall would very likely have affected your AF knee since inflammatory cytokines enter the bloodstream. If you’re able to take daily low dose aspirin and fish oil (check with your doctor) then these will help lower systemic inflammation.
All the best with your CPM purchase. Please let us know how things go.