- Get a good ice pack! This is a big surgery with a lot of post-operative swelling. The knee is a large joint get a good sized silicone cold pack that covers the entire knee. You might get 2 so you can rotate them once they defrost. Use a thin cloth barrier to avoid frost bite and secure it firmly in place with a strap or elastic wrap.
- Learn the basic first aid principles to control pain/swelling
- Educate yourself about the surgery, common complications, and the recovery process. This book written by my friend and Langston University colleague Chris Easton PT may be a good resource.
So you finally had enough of dealing with that painful and stiff arthritic knee that has been hindering your activities for years. You decided it’s time to take control of your joint pain and get a new joint installed (hopefully with a lifetime warranty). You have researched all the different types of joint implants available (metal alloys, ceramic material, or strong plastic parts) and designs available (posterior stabilized design, cruciate retaining design, bicruciate-retainig designs, uni -compartmental design, etc.). You have researched all the local surgeons who perform these procedures. Some are even using robots to do it now!
What you need to also consider is how are you going to recover after this very invasive procedure? You should consider the idea of visiting a PT for some pre-operative rehab/conditioning to prepare your body for the challenges of post-operative recovery. The better shape you are in before surgery, the better your results will be after surgery. Before surgery, your physical therapist will teach you exercises and get you familiar with different walking aids and transfer techniques you will need to use after your operation. Your therapist will also discuss precautions and home adaptations, such as removing loose rugs or using shower chairs to bath. Ways to protect the incision while it heals to prevent infection, using a chair so that you can sit instead of squat to get something out of a low cabinet. It's always easier to learn these modifications before you have surgery when pain and the effects of medication do not greatly hinder your cognitive processes.
Have you researched which therapist is most skilled and qualified to assist you with your recovery? Just like surgeons have different skill and ability levels so do physical therapists. Look for a therapist with specialization in Orthopaedics (OCS). These board certified specialists have the experience and knowledge base to safely and efficiently return you to the highest level of function possible.
Are you comfortable going to a large facility (possibly even owned by your surgeon) with lots of people around and sharing the attention of your physical therapist or even your physical therapy assistant with several other patients in the same shape as you? A study has revealed that those treated in a facility owned by their surgeon had twice as many visits and received a less intensive more group oriented rehab program as compared to patients treated in PT facilities in which the surgeon had no financial interest. Remember your surgeon is legally obligated to disclose financial interest in any ancillary services he recommends to you (PT facilities, labs, imaging facilities, etc.).
Should you do your physical therapy with a home health agency or go directly to a therapist in an outpatient setting? A study on this situation found that those who went straight to outpatient PT within 1 week after surgery reached their treatment goals an average of 20 days sooner than those who spent a few weeks in home health before going to outpatient therapy.
Are you comfortable allowing a PT assistant (2 year degree) or even a PT technician (on the job training) provide your post-operative care? A study has shown that those patients who underwent rehab at facilities with high utilization of PT assistants and/or PT technicians required more visits and had lower functional outcomes at discharge. Or are you more comfortable seeing the evaluating therapist (Doctorate level PT with Orthopaedic specialization) each and every visit in a one on one session in a quiet comfortable environment? Those patients treated in a PT facility which the surgeon has no financial interest such as a private PT owned practice are more likely to have fewer visits and more individualized, one-on-one care. I don’t know about you, but if I am going to be charged for physical therapy services that run on average of $100 per session or more, I would want it to be provided by a licensed and qualified physical therapist. What about you? My patients here in Oklahoma City, OK see me each and every visit the entire time they are being treated. I have documented the functional outcomes of 103 patients treated following knee joint replacement surgery. These patients had an average initial Lower Extremity Functional Scale (LEFS) score of 24/80 and at discharge their LEFS rose to 50/80 (9 points is considered clinically significant change). They received an average of 14 visits over a 6 week period.
A few tips and useful information to prepare for your surgery:
Best of luck! I hope you have a pain free uncomplicated experience. If you are in the Oklahoma City, OK area let Stover PT assist you in your recovery. I promise to work endlessly to give you the best possible outcome.
Have you or someone you know experienced pain on the bottom of the foot just in front of the heel bone that is especially severe when first getting out of bed in the mornings or after resting for a long time? This pain will force you to limp like an old man until you get moving for several minutes then it usually begins lessen to a more tolerable level. Until the next time you take a rest, then the whole sequence of events repeats over and over again for weeks or even months at a time. Plantar fasciopathy is a term used to describe this overuse problem of the muscles and tendons on the bottom of your foot that insert on the heel (plantar fascia). This causes tissue damage and subsequent pain on the bottom of your foot close to the heel as I described earlier. Plantar fasciopathy is considered to be a self-limiting condition that can last several weeks to several months. Plantar fasciopathy can be divided into to two types. Type 1 is inflammatory (plantar fasciitis) characterized by constant dull ache that increases with activity that loads the inflamed fascia. Type 2 non inflammatory (plantar fasciosis) that is characterized by intermittent pain that is produced only when load is placed on the abnormal or scarred tissue and subsides quickly upon rest. It is not uncommon for a person to go from one type to the next depending on their activity level. The condition is often caused by one or more of the following:
Treatment for plantar fasciopathy consists of reduction of stress to the area by avoiding or modifying the activity that is aggravating or causing the condition. Wearing sensible shoes with good arch support and cushioning on the heel. If you must train wear a supportive wrap or tape the arch to protect the injured area. No high heels and no flip flops! Avoid going barefooted. If your running shoes are over 6 months old, replace them. Other key treatments include the following:
Less common and more aggressive treatments may include:
To prevent plantar fasciopathy from reoccurring once it is resolved.
Many doctors prescribe opioids to people with low back pain. Prescription opioids are a main source of the increasing rate of drug addiction and overdose deaths in the USA. In 2014, the Centers for Disease Control and Prevention (CDC) reported that prescription opioids killed 29,000 people. Last week the American College of Physicians published a new guideline for noninvasive treatments of adults with back pain that urge medical professionals to avoid the use of opioid medications as a primary treatment. Instead, the guidelines recommend non-pharmacological treatments be used. The guideline recommends different treatment options for acute back pain/sub-acute back pain (0-12 weeks duration), and chronic back pain (>12 weeks duration).
For acute and sub-acute back pain non pharmacological treatments such as superficial heat, massage, acupuncture, or spinal manipulation should be tried. If pharmacological treatments are desired nonsteroidal anti-inflammatory drugs (i.e. Ibuprofen) or skeletal muscle relaxants should be used.
Those with chronic back pain should try non pharmacological treatments such as exercise, multidisciplinary rehabilitation, tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation. Pharmacological treatments should be considered only if the previously mentioned treatments have failed. Non-steroidal anti-inflammatory drugs (i.e. Ibuprofen) should be used as a first line pharmacological treatment, and tramadol or duloxetine (Cymbalta) as a second line pharmacological therapy. Opioids should only be considered after the previously mentioned treatments have been attempted and proven inadequate, and only if the potential benefits outweigh the risk of opioid medication use.
As a physical therapist that treats people with painful spinal conditions on a daily basis, I have seen many patients gain control of their pain using their own movements and positions with a classification based treatment system known worldwide as the McKenzie Method (aka MDT). The system uses exercise, spinal manipulation, and patient education as the primary means of treating mechanical spinal pain. This system can be successful for those with acute, sub-acute, or chronic back pain. This method of evaluation and treatment can quickly identify (usually 1-5 visits) those who are capable of responding to this form of treatment. The small percentage of non-responders can be triaged to other forms of non-pharmacological or pharmacological treatments as described above.
If you have back pain try MDT and avoid the pitfalls of opioid medication use. If you live in the Oklahoma City metro area give Stover PT a call to see if MDT will work for your pain. If you live elsewhere you can find a clinician with expertise in this form of treatment at The McKenzie Institute USA
Low Back Pain (LBP) is a very common life experience that is estimated to affect 31 million Americans at any given time. 85% of all LBP cases are considered “nonspecific”. This means that despite all of the sophisticated imaging studies available the exact anatomical source of the pain cannot be accurately detected. What is known is that most LBP is mechanical in origin. So what is mechanical LBP? Mechanical LBP is caused by overloading or overstretching the various soft tissues (muscles, tendons, capsules, ligaments, discs, etc.) that are innervated by the vast network of free nerve endings located in and around the joints of the spine. There are a few different situations that can make this happen:
So what typically causes LBP to develop? Our life styles and habits play a major role in the development of these disorders. The most common predisposing factors in our lifestyles that most often cause LBP are the frequency of bending in our work and play habits, and poor habitual sitting posture.
Many treatment options are available for LBP and many different types of caregivers are available to deliver treatment (PT, chiropractic, massage therapy, acupuncture, personal trainers, pain management, surgeons,etc.). I believe the best person to treat your LBP is you and the best method in which to treat it is with your body’s own movements. You have firsthand knowledge of how your pain effects your movements and activities and with appropriate guidance you can be taught the right movements and positions to fix it!
In my clinical practice I have evaluated and treated hundreds of patients with LBP utilizing a system known as Mechanical Diagnosis and Therapy (MDT) to determine the cause and provide in many cases a rapid resolution to the patient’s LBP. MDT is a system that utilizes the patient’s own movements and positions to identify mechanical pain syndromes that readily respond to mechanical therapy exercises and techniques. The clinical phenomenon known as centralization that commonly occurs during the MDT assessment process is the key to identifying those likely to rapidly recovery with such treatment. Centralization of pain is the progressive retreat of the most distal extent of referred or radicular pain toward or to the lumbar midline.
Centralization occurs in over 50% of LBP cases. Physical therapists formerly trained in MDT have demonstrated the ability to more frequently identify centralization compared to those who are not trained in MDT. The patient who centralizes will have better outcomes if they are prescribed movements in accordance to their directional preference (DP). DP is a term used to describe the specific direction of end range spinal movement that causes the patients symptoms to rapidly decrease, centralize, and eventually abolish.
At Stover Physical Therapy, I have compiled the Oswestry Low Back Disability score of over 573 patients with LBP. 55% of these patients demonstrated DP at the initial evaluation. The average initial Oswestry score for these patients with DP was 31% (moderately disabled) and the average Oswestry score at discharge was 11% (minimally disabled).
If you are among the many unfortunate sufferers of LBP, undergoing a MDT examination by a therapist competent in MDT would be a wise first step in learning how to effectively reduce your discomfort. Furthermore the experience is a great way to learn the steps involved in the prevention of these frequently recurrent problems. Many times full recovery can be achieved within a few weeks and without the need for expensive imaging studies. Call me to schedule your MDT assessment if you live in the Oklahoma City metro area.
1. McKenzie RA, May S. Mechanical Diagnosis and Therapy. The Lumbar Spine. 2nd. Waikanae, New Zealand : Spinal Publications; 2003.
2. Donelson R, Aprill C, Medcalf R, Grant W. A prospective study of centralization of lumbar and referred pain. A predictor of symptomatic discs and anular competence. Spine. 1997; 22(10): 1115-1122.
3. Balague F, Nordin M, Sheikhzadeh A,Echegoyen AC, Brisby H, Hoogwoud HM,Fredman P, Skovron ML. Recovery of severe sciatica. Spine. 1999; 24(23): 2516-2524.
4. Brotz D, Kuker W, Maschke E, Wick W, Dichgans J, Weller M. A prospective trial of mechanical physiotherapy for lumbar disk prolapse. Journal of Neurology. 2003; 250: 746-749.
5. Kopp JR, Alexander AH,Turocy RH,Levrini MG, Lichtman DM. The use of lumbar extension in the evaluation and treatment of patients with acute herniated nucleus pulposus. Clinical orthopaedics and related research. 1986; 202: 211-218.
6. Long A, Donelson R, Fung T. Does it matter which exercise? A randomized control trial of exercise for low back pain. Spine. 2004; 29(23): 2593-2602.
7. Skytte L, May S, Peterson P. Centralization: Its prognostic value in patients with referred symptoms and sciatica. Spine. 2005; 30(11): E293-E299.
I woke this morning to a beautiful white blanket of snow in the backyard with heavy snow still accumulating. It was pure pleasure drinking my coffee in my heated glass sun room and watching the snow fall. It reminded me of past trips to the Colorado Rockies, sitting on the balcony of ski lodges and enjoying the fresh mountain air. After a while the bliss ended and I started thinking about the exhaustion of clearing this slushy mess from my walkways and driveways at my home and at my office. I started to remember some statistics I once read about the risk of snow removal. According to the U.S. Consumer Product Safety Commission, in 2015:More than 158,000 people were treated in emergency rooms, doctors' offices, and clinics for injuries that happened while shoveling or removing ice and snow manually. The most significant health risk is heart attack and orthopedic injuries particularly to the lower back and shoulders. Those at greatest risk are individuals that are older or unfit for the task at hand.
The following are tips for safe snow removal.
Choose a snow shovel that is right for you.
Your shoveling technique is very important.
Remember to Stretch!
The pictures above are a few helpful stretches for the lowerback and shoulder to prevent injury when shoveling snow. You should perform 6-10 repetitions each. Take each stretch as far as possible. Perform these stretches before, during, and after your snow removal.
Finally, for those of us who are able bodied, it is always worth remembering neighbors on your block who might not be able to remove the snow from their sidewalks. A few minutes of help can make the world of difference to the wellbeing of a less able bodied person as well as make you a good neighbor! Heres to safe shoveling!
AAOS. (2016, November). Ortho Info. Retrieved January 6, 2017, from AAOS.org: http://orthoinfo.aaos.org/topic.cfm?topic=a00060
SIMA . (n.d.). Safe snow shoveling. Retrieved January 6, 2017, from SIMA.org: http://www.sima.org/discover-sima/public-safety/safety-tips/safe-snow-shoveling
Those who have suffered from adhesive capsulitis aka frozen shoulder know it is no pleasant task to recover from. The following link details the condition and its rehabilitation in detail.
Frozen Shoulder and Mechanical Therapy
The video below demonstrates the rehabilitation process and the results one can achieve with appropriate mechanical therapy.
If you suffer from this condition seek help from a PT experienced in dealing with this conditon. If you in Oklahoma city OK call Stover PT for help. This condition requires motivatiion and guidance over a protracted period of time. You will need someone on your side to re assure and encourage you to succeed.
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Stover PT Blog
Thanks for visiting my blog page. My name is Don Stover. I am a seasoned physical therapist (PT) in Oklahoma City OK. with over 20 years in the biz. I have a lot of knowledge and training in orthopedic PT and spine care. I will be sharing my thoughts on physical therapy for orthopedic problems such as spinal pain, extremity joint pain, sports injuries, and health/fitness, I hope you enjoy reading!
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