Tag Archives: treatment techniques

total knee replacement

Physical Therapy Following a Total Knee Replacement

- Blog, Knee

Physical therapy following a total knee replacement

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.

Physical Therapy Month 2017 – Managing Pain Safely

- Blog, Events

This Physical Therapy Month we want patients to try physical therapy first! Physical therapy is a safe non-invasive form of treatment for patients experiencing musculoskeletal pain or injuries.

PHYSICAL THERAPY is a safe and SMART alternative to opioids.

Great candidates to be referred to physical therapy instead of prescribing pain pills include:

  • A patient that has had pain for more than 90 days
  • A patient that complains of pain disturbing their sleep or daily activities
  • A patient that has a history of substance abuse or has been on pain medication for an extended period of time
  • A patient that expresses an interest in avoiding opioids

Try physical therapy and see the difference!

SI pain physical therapy

Women’s Health: The Sacroilial (SI) Joint and How It Affects You

- Back, Blog, Women's Health

It has been estimated that about 95% of the population will experience low back pain at some point during a lifetime. Low back pain may be due to many different causes and anatomical structures, one such structure is the SI joint. Here is some pertinent information about the SI joint and how it may affect your general health.

8 FUN FACTS:

What is the SI joint?
It is a joint connecting the sacrum and the ilium, 2 bones included in the pelvis. The pelvis connects the upper body to the lower body, more specifically the spine to the hips.

What does the SI joint do?
It helps to stabilize your core during functional and work activities and helps with shock absorption during weight-bearing activities including walking. Stability is also assisted by the ligaments, fascia, and muscles that attach to the joint. This includes back, gluteal, hip, and pelvic floor musculature.

Who feels SI pain?
People with leg length discrepancies, asymmetrical lower extremity weakness, scoliosis, pregnant women due to increased ligamentous laxity, women > men due to pelvic anatomy, and those who have experienced a traumatic event such as a fall or a motor vehicle accident or that perform repetitive activities with poor body mechanics including lifting and bending.

Where would you feel SI pain?
Directly over the SI joint, in the buttock, lateral or posterior thigh, or sometimes in the groin.

When may you feel SI pain?
Rolling in bed, rotating your trunk, walking, stair ascent or descent, standing from a sitting position, single leg activities

What positions/activities should be adopted?
Sleep with a pillow between your lower extremities, perform slow, controlled movements, maintain equal weight-bearing through lower extremities with transitional movements and standing, log roll during bed mobility to keep lower extremities symmetrical, swing lower extremities out of the car before standing up to prevent trunk rotation.

How can PT help?
Physical therapy has been found to help patients with SI pain get pain relief, reduce inflammation and muscle spasms, improve healing, muscle extensibility, joint mobility and range of motion, strength, muscle control, and gait mechanics.

What does PT treatment for SI pain involve?
Stretching, mobilization techniques, education on proper body mechanics with functional activities, massage, myofascial release, modalities including electrical stimulation for pain modulation and ultrasound to assist with healing and inflammation, muscle energy techniques, and a core stabilization and strengthening exercise program, tailored to the individual patient. If a leg length discrepancy is found, a heel lift may be helpful to restore abnormal forces being placed through the SI joint with weight-bearing activities. An initiation of a home exercise program is also an integral part of physical therapy treatment.

applied functional science AFS

What is Applied Functional Science (AFS)?

- Blog, Sports and Fitness

The unique and wholistic practice of Applied Functional Science (AFS) requires extensive education and training beyond the traditional education received by rehabilitation clinicians.

AFS vs. Traditional Therapy

Traditional Therapy
Local Joint Focused
TREATMENTS INCLUDE:
• Focused on correcting the injured joint or muscle
• Therapeutic exercise focused on the muscles around the affected joint
• Manual treatments to improve movement in the affected joint
• Successful treatment evaluated by reduction of pain and improved joint strength

Functional Approach
Whole Body Focused
TREATMENTS INCLUDE:
• Source of pain and cause of pain are rarely the same
• Focused on correcting the underlying cause of the injured joint or muscle
• Therapeutic exercise individual developed based on patient-specific mechanics and affected functional tasks
• Manual treatments utilized to help facilitate normal functional mechanics
• Successful treatment evaluated by restoring pain free function lost due to injury

Body, Mind, and Spirit Do I need a Specialist?
Applied Functional Science (AFS) is a unique approach that uses the collaboration of the physical, biological and behavioral science used to treat patients as a whole. AFS uses biomechanics affected by the everyday forces of life to identify and treat the underlying cause of an injury.

Physical: Functional mechanics of the joints and muscles as they respond to everyday activities

Biological: Functional application of neuromuscular properties in everyday activities

Behavioral: Why are you here? Incorporating personal driving factors and goals for betterment in your individualized treatment plan

This information was written by Plymouth Physical Therapy Specialists, an outpatient physical therapy group with 17 locations in Michigan. Plymouth Physical Therapy Specialists was established in 1994 by Jeff Sirabian PT, MHS, OCS, Cert. MDT, CSCS. With over 20 years of experience in orthopedics and sports medicine, Jeff has established a state of the art physical therapy practice with 17 locations to conveniently serve you. For more information click here.

Protect Yourself from Tickborne Illnesses

- Blog, General Information


They may be small, but the bite from just one infected tick can cause symptoms that range from fever and chills to severe infections. However, you can protect yourself from tickborne illnesses, such as Lyme Disease and Rocky Mountain spotted fever, by avoiding areas where ticks are present and preventing ticks from getting on your body.

AVOID TICK HABITATS
Ticks can be found in the northeastern, northwestern, mid-Atlantic, or upper north-central regions of the United States. They are most active in warmer months from April to September. However, they can be active when temperatures are above 40°F (4.4°C).
Tips for reducing your exposure to ticks include:

  • Avoid moist, shaded, wooded, or grassy areas.
  • Stay on cleared, well-traveled paths, and walk in the center of trails to avoid overgrown grass and brush.
  • Avoid sitting on the ground or on stone walls.
  • You can discourage ticks from your property if you:
  • Remove leaf litter, brush, and woodpiles from around your home and the edges of your yard.
  • Mow the grass often.
  • Discourage animals that carry ticks from coming onto your property.

PREVENT TICKS FROM GETTING ON YOUR BODY
Proper clothing can help protect you from tick bites when you enter areas that may have ticks. When spending time outdoors:

  • Wear long pants and a long-sleeved shirt. Light-colored clothing will make it easier for you to see any ticks that may get on you.
  • Tuck your shirt into your pants and tuck your pants into your socks.
  • Wear a hat. Braid or tie back long hair.
  • Wear closed toed shoes.

Insect repellant can also prevent tick bites. Repellents containing 20%-30% N,N-diethyl-meta-toluamide (DEET) can be applied to clothes and exposed skin. Repellents that have 0.5% permethrin can be applied to pants, socks, and shoes, but not to skin. Be sure to read product instructions carefully. For example:

  • Do not apply near your eyes, nose, or mouth.
  • Do not apply to children’s hands.
  • Reapply as directed.
  • Wash your skin when you return indoors.

PERFORM TICK CHECKS
After you spend time outdoors in a high-risk area:

  • Use a mirror to do a full-body tick check on yourself. You should also check any children who are in your care. Make sure to check for hidden areas, such as the hair, around the ears, under the arms, and in skin folds.
  • Examine your clothing for ticks that may attach to you after you come home.
  • Take a shower and wash your hair within 2 hours of coming indoors.
  • Put clothes worn outdoors in the dryer on high heat for 10 minutes to kill any unseen ticks.
  • If you have pets that spend time in high-risk areas, perform daily tick checks to prevent them from spreading to humans.

REMOVE TICKS FROM YOUR BODY

  • If you do find a tick, remove it by doing the following:
  • Use a pair of fine-pointed tweezers to grasp the tick by the head, as close to the skin as possible.
  • Pull directly outward. Use gentle but firm force. Do not twist the tick out. Try not to crush the tick’s body or handle it with bare fingers. This can spread the infection.
  • Wipe the site with an antiseptic to prevent infection.

KNOW THE SIGNS OF TICKBORNE ILLNESSES

Symptoms of a tickborne illness can occur weeks after exposure. Even if you have taken precautions, be sure to contact your doctor right away if you have recently spent time in a high-risk area and have fever and chills, aches and pains, and a distinctive rash.

by Cynthia M. Johnson, MA

RESOURCES:
Centers for Disease Control and Prevention
http://www.cdc.gov

Healthy Children—American Academy of Pediatrics
https://www.healthychildren.org

CANADIAN RESOURCES:
Canadian Paediatric Society
http://www.cps.ca

Health Canada
http://www.hc-sc.gc.ca

REFERENCES:

Preventing ticks on your pets. US Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/ticks/avoid/on_pets.html. Updated June 1, 2015. Accessed March 24, 2017.

Symptoms of tickborne illness. US Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/ticks/symptoms.html. Updated June 1, 2015. Accessed February 20, 2017.

Tick avoidance and removal. EBSCO DynaMed Plus website. Available at: https://www.dynamed.com/topics/dmp~AN~T901539/Tick-avoidance-and-removal. Accessed February 20, 2017.

Michael Woods, MD June 2017

Last reviewed June 2017 by Michael Woods, MD

EBSCO Information Services is fully accredited by URAC. URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation.

Industrial Rehab Physical Therapy PTandMe

Health Aging for a Sustainable Workforce

- Aging, Blog, Industrial Rehab

What Can Employers Do to Protect an Aging Workforce?

Employers can start by revisiting job descriptions and knowing every detail each work task entails in order to help prevent costly and unnecessary workers’ compensation claims. Meanwhile, they should continue to promote health and wellness programs for all employees. Because older workers bring many benefits, from their experience and knowledge to their motivation and good work ethic, the advantages of employing older workers will outweigh the possible worker’s compensation claims, with preparation and planning.

Companies must utilize and implement preventative safety efforts. Specifically, companies should develop slip-and-fall prevention tactics, considering that slips and falls account for 33 percent of all injuries sustained by workers 65 and older, according to the National Safety Council. Safety training should consist of more than just scripted lectures, distributed
pamphlets and orientation videos. Employees should be taken through the physical movements and tasks that are specific to their job description–a hands-on learning experience. Because younger workers account for the majority of accidents while older workers have longer recovery periods, safety training benefi ts all employees and the employer. Bring in external experts such as physical therapists from the community to teach proper techniques and protocols.

  • Modification of work environment
  • Ergonomics and wellness programs
  • Industrial Athlete approach to exercise
  • Return to work accommodations

AGING WORKFORCE SERVICES:

Education:
A full battery of educational programs are available for both the professional staff of an employer to that of the general employee population such as slip and fall or back injury prevention.

Preventative Maintenance Testing:
A brief test – approx. 15 minutes that looks at the essential and critical factors of the job – usually body part specific and set up as a repeated test – every three to four months on a high risk job position – looking for trends or patterns of degradation of range of motion or strength of employees.

Fitness Programs for the Industrial Athlete:
Detailed stretching programs are customized per high risk job based upon historical injury determinations. The program is set up for employee participation prior to work, returning from lunch and at the end of the workday.

Physical Ability Maintenance:
A custom built strengthening program designed to maintain the physical abilities necessary to perform everyday work.

For more information about staying healthy and injury free in the workplace – try the links below:


       

Adapted from Fit2wrk Article 1.10   For more information on Fit2wrk click here.

get active square

PT News

- Blog, PT News

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

1. No Equipment Outdoor Workouts
Written by the Therapy Team at Momentum Physical Therapy – San Antonio, TX

We have an idea you might not hear often- take a break from the gym. How? Well, instead of being inside, take your work out ‘out’ and sweat outdoors without any equipment at all. Read more

2. Sensitive Pain
Written by the Ryan Beck, MPT at Oregon Spine and Physical Therapy – Eugene, OR

One of my favorite analogies!! I have used this on several patients and I’ll never forget a few years ago working with a particular patient when this analogy popped into my mind and I’ve used it so many times to help people who are having a lot of pain. Read more

3. Certified Hand Therapists: Helping People Live Their Lives
Written by Jan Taylor, OT Fellowship Director and OT Resource Coordinator at ARC Physical Therapy Plus – Overland Park, KS

The hand is so critical to every minute of our daily lives that when you lose function of it your world is turned upside down. Read more

physical therapy cancer

How Physical Therapy Can Benefit Cancer Patients

- Blog, Cancer Related Care

HowPhysicalTherapyCanBenefitCancerPatients_FBsize

Mesothelioma can be one of the most difficult forms of cancer to treat. It is an aggressive illness that starts in the interior lung lining after exposure to asbestos fibers and it quickly spreads to the chest and lungs. As such, an equally intensive form of chemotherapy is often employed as a way to combat the spreading cells. However, this can leave the patient feeling fatigued and distressed. In order to deal with such side effects, many medical professionals recommend alternative treatments, such as physical therapy cancer related fatigue programs as a way for patients to begin feeling better during the recovery process.

Improved Mobility

One of the biggest benefits that physical therapy cancer programs can have for individuals is providing them with a way to improve their mobility. This can be invaluable in improving the patient’s mood as well. With more mobility, the patient will be able to exercise more efficiently, which can lead to a greater degree of independence. Patients can enjoy other activities that they used to engage in as well, such as drawing or walking, and the greater degree of mobility can also be invaluable in reducing long-term pains from staying in bed. As such, physical therapy is often recommended early for those who feel as though they have been cooped up in bed for too long as they recover.

Improved Overall Fitness

Because physical therapy cancer programs are designed to fight against muscular dystrophy, it can be one of the best methods to keep patients healthy. Because so much of the early chemotherapy process requires for individuals to stay relatively stationary to recover, it is not uncommon for many to begin losing muscle mass and feel weaker overall. Physical therapy helps exercise muscles, bringing necessary strength back to the patient as they continue to recover. As the body becomes stronger, the patient will be able to fight against the mesothelioma more efficiently, reducing potential issues in the future of the recovery.

cancer_patient

Improved Respiratory Health

Because of how dangerous the growths are, they can severely impact the way the individual breathes. With poor respiratory health, the patient may feel distressed, and the recovery process may be more difficult that it needs to be. Through physical therapy, the patient is able to improve their ability to breathe, reducing their risk of running into future respiratory issues. Improving breathing function also provides the patient with more support on a cellular level. As lung function improves, the mesothelioma begins to slowly lose ground, resulting in a smoother and more enjoyable healing process for the patient.

Those who are interested in learning more about their physical therapy options should be sure to contact their medical professionals as soon as possible. Through the right basic exercise system, it can be easy for individuals to start to feel better and get their strength back. Like any other such recovery process, however, it is vital for patients to take the recovery slow to build up their strength and improve their outlook in the future.

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

    
McKenzie Method

McKenzie Method: Mechanical Diagnosis and Treatment

- Blog, Manual Therapy

McKenzieMethod2_FBsize

The McKenzie Method is a philosophy of active patient involvement and education that is trusted and used by practitioners and patients all over the world for back, neck and extremity problems.

McKenzie Method – Three Steps to Success:

1. A logical step-by-step process to evaluate the patient’s problem quickly. This mechanical examination can “classify” most patient conditions by the level of pain or limitation that results from certain movements or positions. A McKenzie assessment can eliminate the need for expensive and/or invasive procedures.

2. McKenzie treatment prescribes a series of individualized exercises. The emphasis is on active patient involvement, which minimizes the number of visits to the clinic. For patients with more difficult mechanical problems, a certified McKenzie clinician can provide advanced hands-on techniques until the patient can self administer.

3. By learning how to self-treat the current problem, patients gain hands-on knowledge on how to minimize the risk of recurrence and to rapidly deal with recurrence if it occurs. The likelihood of problems persisting can more likely be prevented through self-maintenance.

Isokinetic Devices

Isokinetic Devices for the 21st Century Therapist

- Blog, Leg

Isokinetic Devices

Isokinetic devices have had their time in the spotlight of the rehab world. Like an actor past his prime, these monstrous machines mostly sit in dark lonely corners collecting dust. Some get used regularly but only as a place for sitting and storing odds and ends. However, companies such as CSMi (Computer Sports Medicine Inc.) among others have revived this once proud and prominent piece of equipment and have applied modern technology and rehab principles to bring about a new golden age of isokinetic devices and rehab.

Historically, isokinetics was introduced in the late 1970s and hit it’s stride in the 1980s through the 90s. Various protocols were created in this time and have been researched extensively creating the body of knowledge we now have. Unfortunately, isokinetics lost favor as healthcare laws changed and the industry started the search for more low-cost treatment regimens.

ISOKINETIC DEVICES TESTING
There are now fewer therapists who know how to use the equipment and most that do are unaware of the improvements that have been made over the last twenty years. Historically, joints are measured at two or three varying speeds but only in the concentric mode of contraction. While this is still the gold standard of testing, it fails to assess the all important eccentric mode of contraction. Recently, CSMi introduced the interrupted stoke test on their machine, the Humac Norm, which allows the therapist to separate concentric and eccentric modes. Our muscles function as eccentric controllers of motion and the ability to test this provides us with a better view into the muscle’s strength and function.

There are other testing modes available as not all patients are appropriate for isokinetic testing. Isometric testing is something all therapists use daily in the form of manual muscle testing(MMT). However, this is not a precise measurement and can vary between therapists. Testing a patient isometrically on a machine is a safe, effective and precise test for your older, untrained and post-surgical patients. It provides an exact amount of torque as compared to the MMT 5-point system. Additionally, proprioception can be assessed for either velocity or joint position matching.

TREATMENT
In addition to testing, isokinetic devices offer various treatment modes are where these machines show their true capability. Continuous Passive Motion can be utilized for regaining range of motion, reducing swelling and pain, reducing apprehension and muscle guarding and regaining musculotendonous mobility.

Active Assisted Programs can be utilized to regain end-range motion and multi-angle isometrics can be utilized to increase joint stability and neuromuscular control within the entire available range of motion. Also, proprioception training can be utilized to enhance positional and motion control.

Strength training with eccentric loading allows for targeted strengthening by isolating the eccentric beginning in slower speeds and progressing into deceleration training to mimic plyometric loading.

Isotonic strengthening programs are available for various purposes. One is power training which is utilized to increase concentric explosiveness. Another is used to prepare patients for an independent gym program. Finally, dynamic isotonic control training includes the ability to load the concentric and eccentric motions at different torques and utilizes games and other programs as visual feedback to the patient.

ARGUMENTS AGAINST ISOKINETICS
One argument against isokinetics concerns patellofemoral, post-op ACL and knee osteoarthritis patients. Open chain knee extension has been labeled public enemy number one for these patients and while this has been examined extensively, steps such as limiting the range of motion, using anti-shear devices and techniques, altering patient positioning and matching the appropriate treatments to the patient reduces shearing and compression, improves safety and ultimately debunks this myth.

Now, I know that critics of isokinetics will also argue that isolating muscles is not functional. That would be true if a therapist utilized these machines as the sole treatment. But by incorporating it into an eclectic approach, patient outcomes are maximized. Your lower extremity patients will still perform scapular and thoracic control exercises and you will still strengthen the core. Soft tissue work and joint mobilization will still be needed and functional training must still occur. However, if one link in the chain is weak, the entire chain will fail. Utilizing these machines throughout the course of rehab to find and isolate those weak links is what will take your patient’s recovery of function to the next level. This is true for all of your extremity patients, nit just knees. Remember, a functional movement cannot occur with a dysfunctional or unbalanced segment.

This information was written by Daniel Bodkin, PT, DPT, ATC – STAR Physical Therapy, Columbia (North), Tennessee
Established in 1997 with one clinic and one mission – to serve. Today, STAR Physical Therapy has 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. Their foundational mission is “To Serve.” Their commitment to the patient and physician is to provide clinicians that are “great mechanics of the human body™.” For more information click here.