Tag Archives: Post-Surgical Rehabilitation

post mastectomy physical therapy

Post-Mastectomy Physical Therapy

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The word cancer is a scary one. Even though we all hope that it never becomes part of our lifetime of trials, more often than not, we know someone that has had, or is currently dealing with cancer. It is a testament to the medical community that so many women are able to wear the pink ribbon as a sign of triumph and pride, but we still mourn with those that wear it as a sign of remembrance and loss. More than once, while talking with women that have begun treatment for breast cancer, the topic of whether or not to have a mastectomy has come up. It’s not a decision taken lightly, often one with multiple concerns about what happens after surgery. Will the cancer be gone for good? Will it hurt? How long will it take to recover? A physical therapy post mastectomy program can help address these issues.

Physical Therapy can’t answer all of those questions, but one thing a physical therapy post mastectomy program can do is aid in the overall recovery process by focusing on regaining strength and increasing the range of motion in your shoulder and arm. Early intervention by a physical therapist can help women regain full function following mastectomy surgery, regardless of whether or not a woman has had reconstruction. Rehabilitation is always tailored to each patient’s specific needs. Not every patient experiences the same recovery, and as such physical therapists are prepared to help patients experiencing a multitude of symptoms – some have been highlighted below.

Size, location and the type of mastectomy are important considerations when choosing a type of treatment. Exercises to maintain shoulder range of motion and arm mobility may be prescribed as early as 24 hours after surgery.  These exercises are important in restoring strength and promoting good circulation. As rehabilitation progresses these exercises may be modified to meet new goals.

After mastectomy surgery, patients may experience tightness around the surgical site. This is caused by scar tissue formation. The result can be very dense tissue under the incision, which is painful and can restrict range of motion.  The restricted range of motion puts a woman at risk for a painful condition known as frozen shoulder. Early treatment by a physical therapist can help reduce the pain and help regain functional range of motion and strength.

Numbness and/or nerve sensitivity at the surgical site can develop post-mastectomy. Manual therapy can help restore sensation and relieve nerve pain. In severe cases, a chronic condition known as post-mastectomy pain syndrome may develop.  This is caused by scar tissue impinging on nerves. Physical therapy can be very effective at releasing scar tissue and reducing this nerve related pain.

Axillary node dissection can lead to a condition known as cording or axillary web syndrome.  Cording presents as a moderate to painful tightening, which appears as “cords” emanating from the armpit and extending down the arm. Cording significantly restricts range of motion and arm function. Manual therapy and therapeutic stretching helps to resolve this condition quickly.

Radiation treatment after mastectomy surgery can exacerbate posture and range of motion problems, causing fibrosis and skin tightness. Manual therapy can remediate these issues and may prevent them from ever becoming a problem.

The Benefits of Exercise and Physical Therapy post mastectomy treatment programs can differ greatly as seen above, but there are a few benefits that all patients can benefit from:

  • Improved shoulder range of motion
  • Improved shoulder strength
  • Improved functional mobility
  • Improved posture
  • Decreased pain at the surgical site
  • Decreased edema on the affected side
  • Improved sensation at the surgical site

Meeting with a physical therapist before surgery can help you feel more at ease and more confident in your overall recovery goals. It’s never too early to ask questions! To find a physical therapy clinic near you click here.

For more information on cancer related physical therapy programs click here:

    
lumbar physical therapy

The Phases of Cervical, Thoracic and Lumbar Physical Therapy

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A great cervical, thoracic and lumbar physical therapy program is very important for patients who have experienced surgery. Rehabilitation will be modified based on body region and type of surgery.

Pre-Operative Phase
Prior to surgery, your physical therapist will perform a comprehensive evaluation to assess your mobility, strength, coordination, and function in order to create a customized home exercise program to perform in preparation for your surgical procedure. This program will be important for you to perform until you have surgery to help improve your recovery after surgery.

NON-FUSION PHYSICAL ACTIVITY PROGRAM

Phase 1 Post-Operative (0 – 4 Weeks Post-Op)
During this phase, you will undergo light activities, like walking. During this time, it is imperative that you perform the home exercise program your physical therapist taught you to improve muscle function, and help improve healing. During this time, you may exhibit pain and soreness due to the surgery. This is a normal part of the healing process.

  • Immediately following your surgery, you will be allowed to perform very light, gentle, activities of daily living around your home. However, do not lift more than 10 pounds (a milk jug), and go slowly when bending or twisting.
  • Walking is important to perform consistently as well. Move around your house, ensuring that the area is free of any obstacles which can cause you to fall. Walking around the block should be the limit to what you do in the first 2 weeks. This duration can be increased but should stay under one quarter of a mile for the first 4 weeks.

  • Healing is most important during this phase and post-surgical pain and soreness is normal.

Phase 2 Post-Operative (4 – 6 Weeks Post-Op)
During this phase, you will start physical therapy. Physical therapy during this phase will involve exercises to improve your mobility, strength, and stability. Due to an increase in activity during this time, it is normal to exhibit increased muscle soreness with physical therapy. The soreness will resolve as your muscles get stronger.

  • Formal physical therapy as prescribed by your surgeon will start.
  • Physical therapy will include a comprehensive evaluation to determine the appropriate treatment to improve mobility, strength, stability, and coordination.
  • It is normal to experience muscle soreness during this time with your program. Each person’s body has a different activity threshold that needs to be reached to make physical improvements and muscular soreness is a healthy, safe response to working in this threshold.
  • As your activity threshold level improves, the soreness will resolve.

Phase 3 Post-Operative (7 – 10 Weeks Post-Op)
During this phase, physical therapy will focus on dynamic exercises and activities emphasizing multiple planes of motion. During this time, you can expect more complicated exercises to challenge your coordination and stamina for reaching your goals.

  • During this phase, physical therapy will increase intensity in regards to your appropriate activity threshold.
  • Exercises and activities will become more challenging, more dynamic, and will involve multiple planes of motion to simulate and retrain muscles to complete your daily or recreational activities.
  • Your custom physical therapy program will include specific activities and exercises to prepare you for return to your functional goals.

Information provided by PT and Me physical therapy partner, Rehab Associates of Central Virginia. R.A.C.V. has 13 locations throughout central Virginia. More information about Rehab Associates of Central Virginia can be found on their website at www.racva.com.

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.

postoperative physical therapy

Postoperative Physical Therapy

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Postoperative physical therapy after a Total Hip Replacement is essential to your recovery. Your physical therapist will follow your physician’s protocol and will focus on range of motion exercises, progressive strengthening exercises, gait training, balance training, and activity specific training to meet your specific needs. Modalities such as ice and e-stim may be used to help reduce discomfort and swelling. It is very important to complete your home exercise program as directed by your physical therapist and physician.

RANGE OF MOTION EXERCISES
Swelling and pain can make you move your knee less. Your physical therapist can teach you safe and effective exercises to restore the range of motion to your knee so that you can perform your daily activities.

STRENGTHENING EXERCISES
Weakness of the muscles of the thigh and lower leg is typical after surgery. Your physical therapist can determine the best strengthening exercises for you with the goal of no longer needing a cane or walker to walk.

post op

BALANCE TRAINING
Specialized training exercises can help your muscles “learn” to adapt to changes in your world such as uneven or rocky ground. When you are able to put your full weight on your knee without pain, your physical therapist may add agility exercises so that you can safely and quickly change directions or make quick stops or starts. They may use a balance board that will challenge your balance and knee control. These exercises will be safe and fun.

GAIT TRAINING
Your physical therapist will work with you in retraining your gait following your surgery using appropriate assistive devices such as a walker or cane. They will make sure that you will be able to safely and confidently go up and down stairs, negotiate curbs, and inclines, etc.

ACTIVITY SPECIFIC TRAINING
Depending on the requirements or your job or the type of recreational activities you enjoy, your physical therapist will tailor your program so that you can meet your specific demands.

This article about postoperative physical therapy was written by STAR Physical Therapy, an outpatient physical therapy group with over sixty locations in Tennessee. Established in 1997 with one clinic and one mission – to serve. Today, they have grown to offer that direct service in more than 60 clinics, and 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.

Common Football Injuries

Common Football Injuries

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Football is one of the most popular sports played by young athletes, and it leads all other sports in the number of injuries sustained. In 2007, more than 920,000 athletes under the age of 18 were treated in emergency rooms, doctors’ offices, and clinics for football-related injuries, according to the U.S. Consumer Product Safety Commission. Physical therapy can provide specific treatment to a number of specific football injuries. Here are a few injuries that can happen during a football game or practice:

KNEE INJURIES
Knee injuries in football are the most common, especially those to the anterior or posterior cruciate ligament (ACL/PCL) and to the menisci (cartilage of the knee). These knee injuries can adversely affect a player’s long-term involvement in the sport. Football players also have a higher chance of ankle sprains due to the surfaces played on and cutting motions.

Physical therapy treatment for knee injuries may include:
• Exercises to help promote recovery. Specifically, therapists will design a program to strengthen the whole leg as well improve its range of motion.
• Balance exercises to allow the return to daily activities (including work and sports) while decreasing the risk of falls and reinjury
• Hands-on treatment to keep the knee joint from becoming stiff
• Ice and vasopneumatic pressure to reduce swelling and pain

SHOULDER INJURIES
Shoulder injuries are also common. The labrum (cartilage bumper surrounding the socket part of the shoulder) is particularly susceptible to injury, especially in offensive and defensive linemen. In addition, injuries to the acromioclavicular joint (ACJ) or shoulder are commonly seen in football players.

Physical therapy treatment for shoulder injuries may include:
NON-SURGICAL
Most labral tears will respond well to non-surgical treatment and may be just one component of a multi-factored pathology of the aging shoulder. Physical therapy will typically address a labral tear from the biomechanical approach of improving the motion and reducing the repetitive injury. If the inflammation and mechanical stress on the structures can be reduced then the tissue has a chance to heal.
SURGICAL
If the athlete has had surgery to the shoulder, the therapist will follow a specific protocol to apply just the right amount of strain on the shoulder to keep it safe after surgery. A sling may be recommended in the early stages but the therapist will get the arm moving with assistance within a relatively short period of time. Physical therapists will give instructions on how to provide varying levels of assistance to the arm for motion in safe planes in front of the body, and eventually throughout the entire range of motion. Once the tissues are healed, the therapist will begin to put resistance on the support structures in order to improve the mechanics of motion and reduce the risk of another injury.

kid football player

CONCUSSIONS
Football players are very susceptible to concussions. A concussion is a change in mental state due to a traumatic impact. Not all those who suffer a concussion will lose consciousness. Some signs that a concussion has been sustained are headache, dizziness, nausea, loss of balance, drowsiness, numbness/tingling, difficulty concentrating, and blurry vision. The athlete should return to play only when clearance is granted by a health care professional. It is recommended that players go though a concussion baseline test before the start of the season. Results from baseline tests (or pre-injury tests) can be used and compared to a similar exam conducted by a healthcare professional during the season if an athlete has a suspected concussion. More information here.

Physical therapy treatment for concussions may include:
EVALUATION: The physical therapist will take time to talk with you and perform a thorough examination of your condition.
THERAPY: The physical therapist will plan a treatment program suited to your individual condition, which will involve exercises for your balance, vision, inner ear and more in order to restore brain function.
TEACHING: Physical therapists will spend time reviewing information with you regarding your diagnosis and progress as well as answering your questions. This empowers the patient to make a lifelong impact on their health.
RETURN TO SPORT: Physical therapists are uniquely qualified to guide you towards a safe return to sport. A therapist can guide recovering athletes through a stepwise protocol to keep patients symptom free,  and to prevent serious, life-threatening conditions associated with a second head injury due to early return to football.

OVERUSE INJURIES
Low-back pain, or back pain in general, is a fairly common complaint in football players due to overuse. Overuse can also lead to overtraining syndrome, when a player trains beyond the ability for the body to recover.

Physical therapy treatment for overuse injuries may include:
Pain-relieving techniques (such as ice) and decreasing or modifying painful activities. This diagnosis often occurs from muscular tightness or weakness which causes posture to get out of alignment. A physical therapist will educate and assist in proper stretching and strengthening exercises for the back. They may perform hands on, manual therapy techniques to further increase joint flexibility. The final phase of rehab will involve strengthening during functional activities and education to prevent the injury from recurring.

RESOURCES:
U.S. Consumer Product Safety Commission
www.cpsc.gov

Stop Sports Injuries
www.stopsportsinjuries.org

REFERENCES:
Preventing Football Injuries. http://www.stopsportsinjuries.org/STOP/Prevent_Injuries/Football_Skating_Injury_Prevention.aspx

PT News

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

old man tennis

1. Tennis and Golf: Keep Swinging as You Age
Written by the Therapy Team at the Jackson Clinics Physical Therapy – Middleburg, VA

It’s a hard fact to swallow: Age eventually catches up with all of us, no matter how active we may be. Unless we work to maintain strength and flexibility, we slowly lose both as we age. Read more

track girl

2. Bridging the Gap
Written by Jess VandenBerg MS, AT, ATC, CSCS at the Center for Physical Rehabilitation – Grand Rapids, MI

If you have ever rehabilitated an athletic injury, you know there is a big difference between completing your rehab, and returning to competition. You are pain free, have full range of motion, and are completely functional, but are you prepared for the true demands of your sport, both mentally and physically? Read more

spine

3. Is There an Association Between Radiological Severity of Lumbar Spinal Stenosis and Disability, Pain, or Surgical Outcome?
Written by the Therapy Team at Oregon Spine and Physical Therapy – Eugene, OR

Last week I wrote a blog about a new research article about the shoulder and MRI. It helps us better understand the role of an MRI when trying to figure out the best plan to deal with a painful or injured body part. The old belief that an MRI is the “gold standard” is rapidly dying when it comes to understanding what to do with muscle and joint pain. Read more