Tag Archives: walking

Physical Therapy Following a Total Knee Replacement

October 12, 2017 Teresa Stockton - Blog, Knee

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.

Treating Childhood Obesity With Activity

October 5, 2017 Teresa Stockton - Blog, Pediatrics

When talk focuses on childhood obesity in the United States, words like “critical” and “epidemic” are often used. The tried-and-true prescription of more exercise and better nutrition still holds true, but overweight children face unique challenges when it comes to weight loss.

Why Has Childhood Obesity Increased and What Are the Effects?
The statistics are disturbing. Not only are the overall obesity rates increasing, the heaviest kids are heavier than they were 30 years ago. Why is this happening? Experts who have studied childhood obesity attribute it to a change in lifestyle. The active lifestyle of the past—walking to school, playing outside, and engaging in after-school activities—has been replaced by a sedentary lifestyle of watching TV, playing video games, and using electronic devices like phones, computers, and tablets. Eating habits have changed noticeably, with convenience foods that are higher in fat and calories replacing fruits and vegetables.

The consequences of obesity are significant. A child who is obese may develop high blood pressure, high cholesterol, and type 2 diabetes. These conditions can increase the risk of cardiovascular disease such as a heart attack and stroke. In addition, older teens who are obese may have an increased risk of death during adulthood.

Obesity can also affect emotional health. A child who is obese may have emotional problems in school, and struggle with low self-esteem and depression.

What Is One of the Best Solutions?
Exercise is one of the main tools to fight childhood obesity. The US Department of Health and Human Services encourages children of all ages to be physically active. If your child is overweight, obese, or even of normal weight, recommendations to improve your child’s health include:

Encouraging your young child (aged 1-4 years old) to actively play daily in a safe environment
Encouraging your older child (aged 5 years and up) to participate in moderate to vigorous activity every day—Your child should aim for at least one hour per day of moderate to vigorous activity. At least 3 days out of the week should be vigorous activity.

Since children often engage in shorter bursts of activity throughout the day, it is okay to count these times as exercise.

Examples of different types of physical activity include:

Moderate-intensity: Brisk walking, hiking, skateboarding, baseball, rollerblading, and bike riding
Vigorous-intensity: Jumping rope, running, and playing sports like basketball, hockey or tennis

The main difference between moderate- and vigorous-intensity exercises is the demand on the body. Vigorous activities force the body to work harder. The heart beats faster and breathing becomes more rapid, but energy is used up faster.

Rollerblading
Learning karate
Playing organized sports (field hockey, soccer, football)
Swimming
Gymnastics
Strength training with weights
Rock climbing
Cross-country skiing

Before your child jumps into a new fitness routine, it is important that you work with your child’s doctor. Being obese can put a strain on muscles and bones, possibly causing back pain and foot or ankle problems. The doctor can assess your child’s overall health and recommend safe exercises.

What Else Can Be Done to Encourage Activity?
Another important piece to the puzzle is to focus on screen time. Screen time refers to how many hours per day your child spends in front of a screen—whether it be watching TV, playing video games, or using electronic devices. These are sedentary activities that contribute to obesity. The NHLBI recommends that screen time should be limited to less than 2 hours per day, which leaves more time for exercise. You can further encourage your child to be active by planning family outings, like going on a hike, riding bikes, or playing flag football. That way, the whole family can become healthier together.

by Patricia Kellicker, BSN and Rebecca J. Stahl, MA

RESOURCES:
American Council on Exercise
http://www.acefitness.org

Shape Up America
http://www.shapeupus.org

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

Healthy Alberta
http://www.healthyalberta.com

REFERENCES:
Aerobic, muscle, and bone-strengthening: What counts? Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/physicalactivity/basics/children/what_counts.htm. Updated June 5, 2015. Accessed March 2, 2016.

Chapter 3: Active children and adolescents. US Department of Health and Human Services website. Available at: http://www.health.gov/paguidelines/guidelines/chapter3.aspx. Accessed March 2, 2016.

How much physical activity do children need? Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/physicalactivity/basics/children/index.htm. Updated June 4, 2015. Accessed March 2, 2016.

Krul M, van der Wouden JC, Schellevis FG, van Suijlekom-Smit LW, Koes BW. Musculoskeletal problems in overweight and obese children. Ann Fam Med. 2009;7(4):352-356.

NCHBI integrated guidelines for pediatric cardiovascular risk reduction. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 12, 2013. Accessed March 2, 2016.

Obesity in children and adolescents. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 10, 2016. Accessed March 2, 2016.

Last reviewed March 2016 by Michael Woods, MD Last Updated: 3/2/2016

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.

Lower Limb Amputations

March 9, 2017 Teresa Stockton - Blog, Foot, Leg

The goal for every patient with a lower limb amputation is to walk normally again.
A patient with a lower limb amputation faces many challenges when it comes to walking safely in a variety of walking surfaces and without exerting excessive energy. Generally, the higher the amputation level, the more we can expect to see gait deviations or difficulty walking. This is because with each segment of the anatomy is lost to amputation, more muscle, sensory receptors and leverage are also lost. A Physical Therapy treatment program can be designed to assist a patient return to a “normal” walking pattern in terms of posture, step length, stability, balance, rate of speed, and limb positioning.

GAIT TRAINING
Almost all patients with a lower limb amputation will benefit from physical therapy and gait training at some point in their recovery to help them return to a more normal walking pattern. Pre-amputation exercises will assist the patient in arm and leg strengthening to help them prepare for using a walker during gait training with their prosthesis. After amputation surgery a prosthetist will work with the patient to fabricate and align a prosthesis to assure that it will optimize the patients walking pattern.

WHAT TO EXPECT DURING PHYSICAL THERAPY

The physical therapist will typically work with the patient 3 days per week
The physical therapist and prosthetest will remain in close communication with gait training is occurring since any changes in the prosthesis will affect the gait pattern
Initially physical therapy is focused on standing and walking with enough stability to ensure safety (this initial gait training is performed in parallel bars with the assistance of the physical therapist holding the patient with a gait belt for additional safety)
Initial gait training is supplemented with strength and flexibility exercises for the legs and trunk muscles since strong trunk and leg muscles make it easier to progress the patient’s gait training
The physical therapist will also work with the patient to improve balance and coordination to help the patient develop a more normal step length and walking speed

Physical therapists use many different techniques during gait training sessions

LEARNING HOW TO WALK AGAIN
Specialized Treatment Techniques

SPLINTER SKILLS: Technique where the walking pattern is broken down into a sequence of events that are practiced individually before putting them all together to build the walking pattern
WHOLE WALKING: Technique in which the entire gait pattern is performed all at one time without thinking about the individual components of walking therefore relying on the body’s natural tendency to find the most stable and energy efficient way to walk

BUILDING CONFIDENCE
Once the patient feels confident and the physical therapist believes that it is safe, a walker can be used instead of the parallel bars. When using a walker, the focus will change to helping the patient walk on uneven surfaces such as outdoors and walking around obstacles or stepping up and down stairs.

Even patients who have walked with a prosthesis for years can benefit from gait training for a “tune up” of their walking skills or to learn a new skill such as side stepping, tandem walking or even running.

Exercise and Bone Health

September 1, 2016 Teresa Stockton - Aging, Blog, Sports and Fitness

Bone is living tissue that is constantly undergoing a process called remodeling. In remodeling, cells called osteoclasts are breaking down old bone, as cells called osteoblasts are replacing it with new tissue. Many factors can affect the remodeling process and leave you with bones that are less dense and more fragile.

Some factors that interfere with bone health and remodeling are:
• Increased age
• Low vitamin D—The body makes vitamin D in response to sunlight. You can also get vitamin D by eating certain kinds of food or by taking a supplement.
• A diet low in calcium
• Smoking
• Lack of exercise—especially weight bearing and resistance exercise

Why Exercise Is Good for Bone Health
Regular weight-bearing and resistance exercise helps build muscle, as well as maintain and increase bone strength. Exercise causes the muscle to contract against the bone. This action stresses or stimulates the bone, and the bone becomes stronger and denser. The 3 main types of exercise are (some activities can be more than 1 type):

Aerobic (Cardiovascular) Exercises to Improve Bone Health
In aerobic exercise, you continually move large muscles in the legs, shoulders, and buttocks. This action causes you to breathe more deeply, and your heart to work harder pumping blood, thereby strengthening your heart and lungs. Examples include:
• Walking
• Jogging
• Running
• Aerobic dance
• Bicycling
• Swimming

Weight-Bearing Exercises to Improve Bone Health
In weight-bearing exercises, your bones and muscles work against gravity, and your feet and legs bear the weight. Your bones adapt to the weight and pull of the muscle during weight-bearing exercise. Examples of weight-bearing exercises include:
• Jogging
• Walking
• Stair climbing
• Dancing
• Soccer

Resistance Exercises to Improve Bone Health (Strength Training)
Resistance exercises use muscle strength to improve muscle mass and strengthen bone. Examples include:
• Weight lifting, using:
• Free weights
• Weight machines
• Elastic tubing

• Calisthenics such as push-ups and chin-ups

Tips for Beginning:
Aerobic or Weight-bearing Exercises to Improve Bone Health
• Warm up for 5 minutes before activity. This can consist of dynamic stretches that involve movement and a light walk.
• Start the activity slowly for the first 5 minutes.
• Slowly increase your intensity so that your heart rate increases. A person doing moderate-intensity aerobic activity can talk. A person doing vigorous-intensity activity cannot say more than a few words without stopping to take a breath.
• Gradually increase your workout until you are working out at least 150 minutes a week at moderate–intensity or 75 minutes a week at vigorous intensity.

Resistance Exercises to Improve Bone Health
• Begin each exercise with light weights and minimal repetitions.
• Slowly (over weeks) increase weight, never adding more than 10% in a given workout.
• Do these exercises 2-3 times a week. Allow for 1 day between each workout for your bones and muscles to rest and repair themselves.
• Gradually increase the number of repetitions to 2-3 sets of 8-10 repetitions with a rest period of 30-60 seconds between sets.
• Although stiffness the day after exercise is normal, if you are in pain, you did too much. Decrease the intensity or the duration of your exercise.

Before starting any type of exercise program, check with your doctor about any possible medical problems you may have that could limit your ability to exercise.

by Mary Calvagna, MS

RESOURCES:
National Osteoporosis Foundation
http://www.nof.org

The President’s Council on Physical Fitness, Sports, and Nutrition
http://www.fitness.gov

CANADIAN RESOURCES:
Canadian Orthopaedic Foundation
http://www.canorth.org

Public Health Agency of Canada
http://www.phac-aspc.gc.ca

REFERENCES:
2008 Physical Activity Guidelines for Americans. US Department of Health and Human Services website. Available at: http://www.health.gov/paguidelines/guidelines/default.aspx#toc. Published October 2008. Accessed January 21, 2016.

Bone remodeling. University of Washington website. Available at: http://courses.washington.edu/bonephys/physremod.html. Updated March 30, 2007. Accessed January 21, 2016.

How much physical activity do adults need? Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/physicalactivity/everyone/guidelines/adults.html. Updated June 4, 2015. Accessed January 21, 2016.

Osteoporosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 13, 2015. Accessed January 21, 2016.

Skeleton keys. Smithsonian Museum of Natural History website. Available at: http://anthropology.si.edu/writteninbone/young_old.html. Accessed January 21, 2016.

Last reviewed January 2016 by Michael Woods, MD

True or False: A Person With a Serious Head Injury or Concussion Should Be Kept Awake

August 16, 2016 Teresa Stockton - Blog, Head, Industrial Rehab, Sports and Fitness

All head injuries should be treated seriously. While most won’t cause lasting effects, if improperly treated, they can lead to long-term disabilities or even death.

The most common type of head injury is a concussion. It is a jarring trauma to the brain that can cause a person to lose consciousness or have amnesia.

What do you do if you are around someone who experiences a serious head injury or concussion? You may have heard that you should not let the person go to sleep, but is this true? Most health professionals don’t think so. It is generally considered safe for people with head injuries or concussions to go to sleep. In some cases, a doctor may recommend waking the person regularly to make sure his or her condition has not worsened.

Evidence for the Health Claim
Many people will go to great lengths to keep a person who has had a head injury from falling asleep. They argue that keeping the person awake will decrease the risk that he or she slips into a coma.

This misunderstanding probably stems from hearing about a rare occurrence known as a lucid interval that has been associated with certain types of severe head injuries. A lucid interval occurs when the initial bleeding in the brain does not cause loss of consciousness. The bleeding eventually worsens and brain structures become compressed. The person’s condition can rapidly deteriorate, requiring emergency brain surgery.

Evidence Against the Health Claim
Most medical professionals say it is fine—sometimes even advised—to let people sleep after incurring a head injury.

The American Academy of Family Physicians states it is not necessary to keep a person awake after a head injury. If a person needs to be watched that closely, a doctor will most likely admit him or her to the hospital. The Dartmouth College of Sports Medicine advises that it is fine to go to sleep after a concussion so long as someone wakes you up every two hours. They are to check to make sure you can be easily awakened and aren’t displaying symptoms of a worsening condition.

In a study in the September-October 2005 issue of the Journal of Head Trauma Rehabilitation, researchers reported greater levels of fatigue in people who have had head injuries, compared with those who have not. The researchers concluded that regular rest breaks and increasing intervals of restful sleep should be a part of the rehabilitation from head injury.

Conclusion
If you are around someone who has a head injury or possible concussion, monitor the symptoms closely. It is important to call a doctor or go to a hospital immediately if the person has worrisome symptoms such as:
• Open wound in the scalp or misshapen deformity of the skull
• Severe or progressive worsening headache
• Changes in behavior (eg, confusion, restlessness, irritability, lethargy)
• Dilated pupils or pupils of different sizes
• Convulsions or seizures
• Difficulty waking from sleep
• Trouble walking or speaking
• Bleeding or drainage of fluids from nose or ears
• Unusual sleepiness or decreasing alertness
• Severe or persistent nausea, or vomiting more than twice
• Weakness or numbness in the arms or legs

When a head injury is serious enough to require medical care, a doctor will give you instructions on how to monitor and treat the injury once the person is released from the hospital or clinic. These instructions will generally not include keeping the person awake and alert.

by Krisha McCoy, MS

More PTandMe articles about concussions can be found here:

REFERENCES:
Head injuries. KidsHealth.org website. Available at: http://www.kidshealth.org/parent/firstaid_safe/emergencies/head_injury.html. Accessed November 5, 2008.

Head injuries: what to watch for afterward. Familydoctor.org website. Available at: http://familydoctor.org/084.xml. November 5, 2008.

Head injury: concussion. Dartmouth College of Sports Medicine website. Available at: http://www.dartmouth.edu/~sportmed/concussion.html. November 5, 2008.

Radiology for traumatic brain injury. Trauma.org website. Available at:http://www.trauma.org/neuro/neuroradiology.html. Accessed July 23, 2006.

Subjective reports of fatigue during early recovery from traumatic brain injury. Journal of Head Trauma Rehabilitation. 2005;20:416-425.

Self-Care: Safe Positions & Movement After Knee Surgery

August 11, 2016 Teresa Stockton - Blog, Knee

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.

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.

PT News

July 23, 2015 Kevin - Blog, PT News

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

1.Degenerative Disc Disease and the Role of Physical Therapy
Written by the therapy Team at The Jackson Clinics Physical Therapy

The symptoms of degenerative disc disease are varied but regardless, it can limit the patient’s mobility and ability to perform daily activities. Painkillers can help patients with degenerative disc disease but they also benefit from physical therapy. Let’s take a look on the role of Oregon Spine & Physical Therapy in Eugene, Oregon in managing degenerative disc disease. Read More

2. Early Signs of Dehydration
Written by the therapy team at ARCH Physical Therapy & Sports Medicine

You have commonly heard the phrase, “MAKE SURE YOU ARE DRINKING ENOUGH WATER.” Hydration is important for the body not only as a daily practice, during physical activity, but also plays an important role in the aid of weight loss. The human body is made up of approximately 50-75% water. The percentage of water varies based on age and gender. Read More

3. You Win Some, You Lose Some- Lessons Learned as a Marathon Walker
Written by Tiffany Basore PT, DPT at The Center for Physical Rehabilitation

Growing up I was an athlete. While being a perfectionist and competitive by nature helped me reach some goals, it has also held me back. There were times in my life where I avoided things because I was afraid to fail. In 2009, I took a chance and trained for a ½ marathon. Despite playing multiple sports, long distance running has never been “my thing”. I was nervous to participate for fear of failure, but I put these thoughts aside and I trained. I followed a plan, I was consistent, and I didn’t get hurt. When race day rolled around I was nervous but I felt I had prepared well. I had been experiencing some mild health issues at the time which had altered my diet, but I didn’t worry too much about it. I woke up the morning of the race with my legs feeling like lead. I attributed this to being nervous and over-thinking things. I started the race hoping I just needed to get into my rhythm, but I never did. I trudged on for 12 of the 13.1 miles willing my non-cooperative body to keep moving. Just past mile 12, there was a hill. I knew there was no way my body would carry me to the finish line if I tried to run up it. My entire body was letting me down in a way it never had during any of my training runs. As I began to walk, a medic asked if I was okay. I stubbornly said yes, but when asked to walk a straight line, I couldn’t come close. He checked my blood pressure, oxygen, and blood sugar, all of which were too low. I had to stop. My body had failed me. I had failed. Read More