Tag Archives: Knee replacement

winter injuries

Winter Is A Great Time To Take Care Of Injuries

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As Mother Nature keeps bringing on the winter wind, now is the time to think about spring and summer!  We were promised an early spring by Punxsutawney Phil, so it must be right around the corner.  Nagging winter injuries that you don’t address now, could end up hindering your return to the great outdoors. Waiting to take care of these injuries when the first fair day arrives can be too late. No one wants to lose weeks to months of fun in the sun because of  a lengthy rehabilitation. By taking care of these injuries now, you can have plenty of time to enjoy your favorite activities in the best kind of weather.

BACK INJURIES
From picking up leaves in the fall to shoveling snow, low back injuries are common this time of year. While a simple back ache may dissipate in a day or two after shoveling out after a winter storm, if it lingers longer than a week, chances are it’s not going away on its own. Waiting until the first round of golf to find out that you can’t complete the back swing due to low back pain not only severely hinders the golf game, but can also severely hinder the recovery. The more chronic the pain is, the longer it takes to eliminate the pain once treatment is started. Pain management becomes more complex; muscle strength atrophies; and bad spinal mechanics become a difficult habit to break. Fortunately, from a simple muscle strain to a herniated disc, all low back injuries have the opportunity to be conservatively managed quickly if treatment is sought out quickly.

JOINT REPLACEMENTS
Fear of slipping and falling is often the biggest rationale people wait to have their much needed joint replacement surgeries. While a legitimate concern, the process of recovery and length of time for recovery is often overlooked by patients. For a typical total hip replacement, it can take 12 weeks or more to feel “normal” again. For a total knee replacement, that time line can extend to six months. By waiting until spring to have the surgery, patients forego their fun-in-the-sun for recovery and rehabilitation. However, if that same surgery were elected to be performed in the late fall or winter, then plenty of warm weather is still left in the year to enjoy the capabilities of the new joint. To address the fear of falling, simple precautions can easily be taken to minimize the risk of slip and fall in the snow following the surgery. As an added benefit, patients in the winter often experience less swelling then those in the summer, as a result of the reduced humidity.

ROTATOR CUFF REPAIRS
Similar to joint replacement surgery, shoulder surgeries are often avoided in the winter due to the fear of falling. However, again, similar to joint replacement surgeries, the length of time for recovery from this surgery is grossly underestimated. Returning to swing a golf club, throwing a ball, or even swimming laps in a pool will take a
minimum of 12 weeks of physical therapy. While a neighborhood teenager may need to be hired to shovel the snow, the winter hibernation season is an idea for resting and mending from a rotator cuff repair surgery. After completing a comprehensive rehabilitation program with your physical therapist, you will be ready to tee off with your regular golf league and enjoy your planned summer vacation without restrictions.

SPORTS EVALUATIONS AND CONDITIONING
Winter is not only the time to remedy nagging injuries, but it’s the perfect time to prepare for the athletic season ahead. Whether you are a runner, a golfer, or an over-40 league softball player, preparing for the upcoming outdoor activities can help prevent future nagging injuries. During the “off-season” is the best time to undergo performance and biomechanical evaluations with physical therapist trained in motion analysis. From this evaluation deficiencies can be addressed and a plan for improvement implemented. Furthermore, winter is a perfect time to re-strengthen after the holidays and to condition yourself into the shape you need to be in in order to enjoy those outdoor activities and minimize the concern for strains and sprains. In just a few simple visits to physical therapy, conditioning tips and technique changes can help make the warm weather even more rewarding and enjoyable.

The winter is long and it would be unfortunate to miss enjoying any of the warm, sunny weather heading our way in a few months. Addressing lingering winter injuries now will help ensure a fun spring and summer without restrictions. Always discuss your medical options with your Doctor first. Then, call your physical therapist to help accelerate your recovery and be a picture of health.

physical therapy knee pain

How Physical Therapy Helps Knee Rehabilitation

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PT&Me Knee Rehabilitation

Physical therapists can provide more than pre/post surgical knee rehabilitation for patients experiencing knee pain.

What Causes Knee Pain?
The knee is a relatively simple joint required to do a complicated job…to provide flexible mobility while bearing considerable weight. While walking down the street, our knees bear three to five times our body weight. When the knee is overstressed in sports or in everyday activities, these structures can break down — and a knee injury occurs.

Common Knee Problems Seen by Our Physical Therapists:

  • Strain / Sprain
  • Arthritis Pain
  • Muscle Weakness
  • Ligament Sprains
  • ACL Tears
  • Tendinitis (ie: Patellar, Pes Anserinus)
  • Chondromalacia Patella
  • Patellofemoral Syndrome / Knee Pain
  • Pre / Post Operative Therapy

How Physical Therapy Provides Knee Rehabilitation
Rehabilitation acutely after knee surgery or a knee injury primarily centers around decreasing swelling in the knee joint. Even a small amount of fluid inhibits the quadriceps muscle on the front of knee by slowing the signal for movement traveling from the brain to the muscle. Manual techniques to decrease muscle spasm and improve length tension relationships of soft tissue are also incorporated. Gradually, exercises to increase strength, range of motion and functional mobility are introduced.

Treatments Offered Include:

  • Comprehensive evaluation with an emphasis on determining the source of the problem
  • Individualized and specific exercise programs
  • Manual therapy (hands-on treatment)
  • Modalities as needed
  • Work and sport specific simulations
  • Progressive home program to help restore independence and self-management

Knee Rehabilitation Goals:

  • Reduce Pain
  • Improve Mobility
  • Movement Awareness/Gait Training
  • Functional Strength
  • Patient Education

For more information on knee injuries visit our PT & Me Knee Injury Center page by clicking here.

The PT & Me Injury Center goes over diagnoses on how physical therapists treat specific injuries.

To find or search for a local participating PT & Me physical therapy clinic in your local area please click here.

total knee replacement

Physical Therapy Following a Total Knee Replacement

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There are over 600,000 total knee replacements done each year in the U.S. As the workforce ages and as obesity levels continue to rise, this number is expected to increase.

Candidates for a knee replacement include patients experiencing difficulty doing simple daily activities, including walking or going down steps, and where conventional treatments are no longer helping. Common causes that lead to a replacement include pain with simple ADL’s (activities of daily living), pain at rest, chronic swelling, inflammation not improving with medication, knee deformity, knee stiffness, or trauma to the joint. When you are scheduled for a total knee replacement, ask to see your physical therapist for a pre¬surgical exercise and stretching program. This will help your knee recover its range of motion and strength.

Surgery consists of resurfacing the knee’s damaged and worn joint surfaces with artificial parts made of metal or plastic. Most patients are in the hospital for an average of 3¬5 days. And more than 90 percent of people report significant decrease in pain and improvement in ability to perform ADL’s within one month after surgery. Currently, many knee replacements are lasting 20 years or more with appropriate activity modification. One of the most important factors in success after a total knee replacement is follow up with physical therapy and a lifelong exercise program. Physical therapy typically starts during the hospital stay with the goals being to get the individual up and walking decreasing swelling in the knee and increasing knee ROM (range of motion). Upon hospital discharge, patients either go home and receive home physical therapy for one to two weeks, or to an extended care facility to continue their therapy.

Typically, patients need outpatient physical therapy after therapy at home, which usually begins two to four weeks after surgery. Outpatient physical therapy is recommended for three times a week for up to three months. Therapy goals initially are to reduce swelling and pain, and improve knee range of motion in both directions. To achieve these goals, treatment may consist of soft tissue massage to increase circulation and decrease swelling, stretching to improve flexibility, patellar mobilization, range of motion exercises, and modalities such as ice and electrical stimulation to help decrease pain and swelling. Physical therapy will progress to lower extremity strengthening exercises, balance activities, and fine tuning the gait pattern. Various activities and techniques will be used to improve strength, balance, and gait. As patients reach the end of their course of physical therapy, a personalized home exercise program is developed with the focus on independence with all ADL’s and returning to activities such as walking, swimming, dancing, golf, and biking. It is important for patients to stay active and maintain strength, flexibility, and endurance.

PREHAB Knee Replacement

PREHAB Move to Improve Your Goals: Total Knee Replacement

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PREHAB Home Preparation
Before total knee replacement surgery there are a few simple things you can do in your home to make it safer and more comfortable during recovery.

  • Consider keeping a cordless phone near you or carry your cell phone in your pocket.
  • Move furniture to keep a clear wide path to your kitchen, bathroom and bedroom.
  • Remove throw rugs that may cause you to slip or trip. Tape down any loose edges of large area rugs that cannot be removed. Make sure extension cords are out of traffic areas or tape them down if needed.
  • Wear rubber sole shoes to prevent slipping.
  • Keep commonly used items in your home at waist level within easy reach. This will prevent you from bending over to reach items. Use a reacher to grab objects and avoid excessive bending at the knee.
  • Make sure there is adequate lighting in the house. Add night lights in hallways, bedrooms, and bathrooms.
  • It may be helpful to have temporary living space on the same floor if your bedroom/bathroom is located on the second floor of your home. Walking up/down stairs will be more difficult immediately following surgery and could increase your risk for falls.
  • Arrange for someone to collect your mail and take care of pets or loved ones if necessary.
  • Prepare frozen meals in advance to assist you with cooking.
  • Stock up on groceries, toiletries, and any needed medications you might need.
  • A shower chair or a tub bench will make bathing much easier. Do not take soak baths until your physician allows you to do so.
  • An elevated toilet seat will be helpful with toilet transfers and with following post surgical precautions or guidelines.
  • Assistive devices for dressing such as a reacher, extended shoe horn and / or sock aid may be necessary during your post operative recovery.

While it’s important to prepare your home before surgery, PREHAB should also include physical therapy. Physical therapists will work with patients to create an exercise program before surgery that can help improve performance and decrease recovery times after a total knee replacement. Talk to a PT near you and learn about the benefits of PREHAB before total joint replacements.

Total Knee Replacement Prehab: Move to Improve Your Outcomes

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Many people with arthritis favor their joints over time in an effort to relieve pain and thus become weaker in their leg muscles or lose range of motion. However, the better shape you are in before surgery the better your results will be after surgery so it is important to strengthen your leg muscles and work on your range of motion. Before surgery your physical therapist will teach you appropriate exercises to help improve strength, range of motion, and balance. They will also teach you how to walk with an appropriate assistive device such as a walker or cane in the immediate post operative recovery period. Finally, they will discuss precautions and advise you in a few short term home adaptations such as removing loose rugs to help make your recovery easier and safer.

Prehab Goals
• Develop an exercise program with your PT to help you
• Improve strength
• Improve range of motion
• Improve balance
• Gait training — Review walking with an appropriate assistive device such as a walker or cane in the immediate post operative recovery period
• Discuss precautions and review a few short term home adaptations that can help make your recovery easier and safer

walker lady

Pre Surgery Exercise Plan
Make every effort to begin these exercises as early as possible before your surgery. Only do what you are able to do without increasing your pain. It is important for you not to exacerbate your pain prior to surgery. Ice packs for 15 minutes following your exercises may be helpful to reduce any soreness in your knee.

This information was written by STAR Physical Therapy, an outpatient physical therapy group with 60 locations in Tennessee, offering more than 15 comprehensive specialty services. STAR Physical Therapy was established in 1997 with one clinic and one mission – to serve. Today, they’ve grown to offer that direct service in more than 60 clinics. While they’ve grown, one thing that has not changed is their commitment to you, their communities, and their employees. For more information click here.

More about knee replacements and physical therapy can be found here:

total knee replacement

PT News

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This Month in PT News. Featuring articles from PTandMe partnering clinics!

1. Exercise after Knee Replacement Surgery
Written by the Therapy Team at Cornerstone Physical Therapy – Gahanna, OH

If you’ve been undergoing treatment for knee arthritis and haven’t gotten any pain relief yet, your doctor may recommend a total knee replacement surgery. Read more

2. Low Back Pain and Sciatica Workshop
Written by the Therapy Team at Oregon Spine & Physical Therapy – Eugene, OR

If you are suffering with chronic back pain or sciatica and you’re looking for some help… why don’t you start by attending one of our Educational Workshops so you can make a better, more educated and more informed decision about your options to ease it. Read more

3. Inflammation and Your Diet
Written by Cheryl Schwieters, Physical Therapist Assistant at the Center for Physical Rehabilitation – Grand Rapids, MI

Throughout the day the body is constantly being bombarded with substances that can trigger inflammation. Read more

Recovering from knee surgery

Self-Care: Safe Positions & Movement After Knee Surgery

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ACTIVITY GUIDELINES
Recovering from knee surgery does not have to prevent you from moving or taking care of yourself. Listed below are guidelines on how to do some common movements and activities without hindering the healing process.

SLEEP & POSITIONING
• It is very important that when recovering from knee surgery you get enough rest following your surgery. If you cannot get comfortable in your bed, please talk to your therapist.
• Sleep on a bed with a firm mattress. Ideally, the bed should come up to your mid-thigh while you stand.
• Sleep flat on your back and position your leg so your toes and kneecaps point at the ceiling.
• Do not place pillows under your operative leg. If you wish to elevate your leg, support the whole leg with pillows while keeping the knee straight.

Sitting Up In Bed:
• If possible, get out of bed toward non-operated side so that the operated leg is supported as much as possible.

From Sitting on the Side of the Bed to Standing with the Walker:
• Straighten the operated leg in front of you before standing.
• Ensure you have good sitting balance with the walker close in front of you.
• Push up from the bed with both hands and keep weight on the non-operative leg.

From Standing to Getting Into Bed:
• Sit down on the edge of the bed; place at least one hand on the bed as you lower yourself. Remember to keep the operated leg further ahead to avoid straining it.
• Enter your bed leading with the operated side if possible.
• Bring your legs onto the bed while lowering your upper body with your hands then elbows.

BATHING/SHOWERING:
You may shower in a bathtub or shower stall only after your doctor has given their permission.

Getting Into the Tub to Take a Shower:
• Have the tub bench or tub chair placed in the direction facing your shower faucets.
• Using your walker, back up to the bench.
• Reach back with one hand to the bench and sit down with your legs outside of the tub.
• Place one leg at a time into the tub.

Getting Out of the Tub:
• While seated on the tub bench/chair turn your body and place your legs one at a time outside of the tub.
• Push up from the tub bench and stand using both hands on the walker.

knee brace

TOILET TRANSFERS:
When recovering from knee surgery the low surface may cause excessive painful bending at the knee. If this is the case, your therapist may help you with getting a raised toilet seat or a three-in-one commode that can be used over your toilet.

Getting Up and Down From a Toilet:
• Back up to the toilet.
• Reach back for the armrests/raised toilet seat/seat.
• Slide your operated leg slightly forward and lower yourself slowly onto the toilet.
• To stand, use a grab bar or place your hand at the middle of the center bar of the walker.
• Stand up and get your balance before placing both hands on the walker.

DRESSING:
• Put on your top or shirt as you normally would while seated.
• Do not twist the knee too much when dressing or putting on shoes.
• Your therapist may recommend a sock aid, dressing stick, reacher or long-handled shoe horn to help with dressing.

STAIRS:
You should only try to go up or down stairs when your doctor or therapist says it is okay. Do not try to use stairs while using a walker.
• When going up the steps, first step up with your non-operative leg, followed by the operative leg.
• When going down steps, first step down with your operative leg, followed by the non-operative leg.
• Complete only one step at a time and always have help.

CAR TRANSFERS:

While you are recovering from knee surgery you will need someone to help you with getting in and out of the car for both your safety and comfort. The seat would ideally be at the height of your mid thigh. Avoid cars with low or bucket seats.
• Have someone slide the seat back as far as possible prior to entering the car, preferably on the front passenger side.
• Slightly recline the seat back if possible.

The Cost of an Abnormal Gait

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ThinkstockPhotos-485012894

 

Knee osteoarthritis remains a significant problem among US adults 60 years and older. A recent study suggests knee arthritis rates as high as 37 % with women showing higher rates vs men (42% vs 31%) and higher rates among those with significant weight problems.

As a result, many of these patients opt for a total knee replacement. However, patients often suffer from pain and have difficulty walking for many years before deciding to proceed with such surgery. Living with pain for an extended period of time typically causes changes in how a patient walks in an attempt to relieve the pain associated with knee arthritis. Sometimes this is even done subconsciously, but it can lead to additional problems, such as low back pain (LBP). An example of this would be a knee flexed position that leads to leaning forward when walking. This changes at the pelvis which all contribute to low back pain.

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