When is it time to get surgery?

surgery

This months blog is on another common questions that we as therapists get asked on a frequent basis.  This can often be a loaded question with multiple right answers, but I’m going to give you my best recommendation on when it may be best to get a surgical consult

1.When the constant pain is bad enough you can’t live off 2 Aleve a day.

  • This is a quote I heard from an orthopedic surgeon that got asked the same question at a physical therapy conference.  It isn’t very specific when it comes to function, but if pain is a main driving factor, then this may be a reasonable answer.

2.  When you can’t do your normal activities of daily living without pain.

  • This is a more typical answer from a physical therapist.  We are always working towards function and your ability to return to the activities that you love.  We basically follow 3 levels on your return to your activities.  First, get you out of constant pain, or at least make it liveable.  Two, return you to a level of pain free(or less pain) function with activities of daily living.  Third, return you to your recreational activities.  If you can’t get to level two without decreased pain, then it may be time for surgery.

3.  When your losing strength and ROM even with an exercise program.

  • This can vary quite a bit depending on the patient, but basically if you are loosing your strength and ROM even while doing therapy then it may be time to get the surgery done.  You can actually wait too long to get surgery done, especially when it comes to a total joint replacement.  If you are seeing muscle loss or decreased ROM, despite trying to strengthen/stretch it.  It may be time to get the surgery done, before you have even more rehab to do after.

There are obviously a lot more reasons why you may or may not be a surgical candidate, but these are just a few of the things we look at when helping you decide your next course of action after therapy.  We are always here to answer questions!

Women’s Health

Pain During Pregnancy

pregnancy-back-pain

The pregnant woman’s body is continuously changing during pregnancy and during the post-partum period. Many women experience problems that may be effectively treated in physical and occupational therapy – cervical, thoracic, and lumbar pain, sacroiliac (SI) joint pain, sciatica, foot pain, postural dysfunctions and carpal tunnel syndrome.

 

The most common complaint experienced during pregnancy is low back pain.  According to the May 2000 issue of Physical Therapy, 87.5% of women report low back pain during pregnancy, and 33% of women report pain during the post-partum period.  Hormonal changes early and late in pregnancy can lead to ligamentous laxity and contribute to joint instability.  It has been shown that SI joint mobility can increase as much as four times in pregnant women.

 

Biomechanical changes in posture that occur during pregnancy also increase the risk for low back pain.  As the center of gravity moves forward, lumbar lordosis and anterior pelvic tilt increase, placing the low back and SI joint in an inherently unstable position. In addition, as the abdominal muscles elongate they lose their mechanical advantage for force production and trunk stabilization.

 

Physical therapy intervention during pregnancy can decrease acute low back pain allowing women to be more active and may promote healthier pregnancy.  Furthermore, intervention during pregnancy may decrease the incidence of post-pardum low back pain.  Our very own, Kim Saunder’s, PT, DPT is professionally certified in treating women during and after pregnancy.  So make an appointment today!

 

Problems

Diastasis recti

Postural dysfunction

Soft tissue restrictions                                    

Fatigue and deconditioning

Limited sitting/walking tolerance

Joint dysfunction/instability

Post -Caesarian scar tissue

Carpal tunnel syndrome                                  

Physical Therapy Solutions

Education on labor and delivery positions

Joint mobilization/ stabilization

Rebalancing strength/ flexibility

Postural Re-education

Core Stabilization

Kinesiotaping

Soft tissue release

Habit modification

Shoe wear advice

External stabilization belts

Fitness/exercise advice

Wrist splinting

What is Kinesio Taping?

kenisio

 

This past fall, during the Rio Olympics, many of the athletes could be seen wearing these multi-colored strangely configured tape jobs.  Many of the viewers at home were left wondering….what are those crazy things on the volleyball players shoulders?  And my shoulder hurts, should I be getting that done as well?

What is it and what does it do?

First let me explain a little bit about what kinesio tape is and what it does.  Kinesio Tape is a form of elastic tape that has has the ability to stretch 30-40 percent of its original length. Its a dynamic, pliable, elastic tape that can be used for several corrective therapeutic techniques.  It can be used for a variety of reasons including mechanical correction, fascial correction, Ligament/tendon correction, and even lymphatic correction.

So what does that mean for my pain you ask…well it means it can probably help in one way or another.  The primary use of kinesio tape is to help with “drawing up” or reducing inflammation.  Basically, as the tape is stretched over the skin, it draws up the superficial layers of the skin and allows for increased blood flow to the vessels underneath.  This then promotes circulation of blood/inflammation/lymph back to the heart or lymphatic drainage sites.  So if you were to have suffered an ankle sprain where you amassed a good amount of swelling.  Kinesio tape would be used in a fan like manner to decrease swelling and inflimmation.  See example below…

ankle-spain

Another very common application for kenesio taping is tendon “unloading” or “correction”.  In this form of kinesio taping the physical therapist will tape certain body parts in different ways that help relieve some of the pressure tendons have during certain movements.  A common example would be the patellar tendinitis.  If a runner comes in with “runner’s knee” or patellar tendinitis, one treatment technique that can be used is to unload the patellar tendon by adding kinesio tape.  See example below…

patellar-tendonitis

And I’ll share with you one last common use of kinesio taping, although there are several more.  Often times during musculoskeletal injuries certain muscles can become overactive or underactive.  Kinesio taping has been found to have the ability to inhibit or facilitate certain muscles dependent upon the way it is placed.  Kenesio tape that is placed from the insertion of the muscle to the origin of the muscles is said to have an “inhibitory” effect.  Where as if the tape is placed from origin of the muscle to insertion of the muscle, it is thought to have a more “facilitative” affect on the muscle.  So when you see all these different ways of taping during the Rio Olympics, often times they were trying to enhance performance by facilitating or inhibiting certain muscles.  See example below…

U.S.'s Kerri Walsh in action against Norway in a beach volleyball match  at the Chaoyang Park Beach Volleyball Ground at the Beijing 2008 Olympics in Beijing, Thursday, Aug. 14, 2008.U.S won 2-0.  (AP Photo/Natacha Pisarenko)
U.S.’s Kerri Walsh in action against Norway in a beach volleyball match at the Chaoyang Park Beach Volleyball Ground at the Beijing 2008 Olympics in Beijing, Thursday, Aug. 14, 2008.U.S won 2-0. (AP Photo/Natacha Pisarenko)

At Foothills Orthopedic and Sport Therapy, we have several physical therapists who are certified in Kinesio Taping and if you think any of these taping methods may benefit you, please come in and check us out!

Five KEY Factors For Identifying an Ergonomic Office Chair

Five key factors to consider while choosing an ergonomic chair(according to your physical therapist):

chair2

Seat height: This should be adjustable. Depending on your height, this should be between 16 to 21 inches from the floor. When sitting, your feet should be flat on the floor and your thighs horizontal (or parallel) to the floor.

Seat width and depth: Standard seat width is 17-20 inches. The depth (from the front to the back of the seat) needs to be enough so that you can sit with your back against the backrest with about 2-4 inches between the back of the knees and the seat of the chair. The forward or backward tilt of the seat should be adjustable because the right inclination can significantly reduce the strain on your lower back (call us to learn more)

Backrest: The ideal backrest should be 12 to 19 inches wide. It should be able to support the natural curve of the spine. The more we sit, the more we tend to slouch. Therefore, proper lumbar support provided by your chair’s backrest is very important to help support your spine.

Armrests: Office chair armrests should be adjustable. They should allow your arms to rest comfortably and shoulders to be relaxed. The elbows and lower arms should rest lightly, which means the armrests should neither be too high nor too low.

Swivel: This allows you to easily rotate to reach different areas of your desk without straining your spine.

Picking the right office chair can help you avoid the agony of low back pain or neck pain associated with full-time desk jobs. Too much time at the computer or several hours a day on the phone can also put your spine at risk. To learn more about ergonomics and correct body mechanics, give us a call right away.

What to expect when your expecting…..a total knee replacement!

kenisio

Above is a picture of a what the inside of total knee replacement looks like.  It’s definitely not all fun and games, but compared to not being able to walk, run, play, it’s worth it.

I frequently get asked, “What should I expect with a total knee replacement?” or “How long does it take to recovery from a knee replacement?”  Well, in this post I would like to share with you what I would say a normal recovery(with physical therapy) from knee replacement surgery might look like.

Day 1: The Surgery!

So depending on how extensive the knee arthritis and/or injury is to your knee, the actual procedure time may vary, but usually takes around 90 minutes to 2 hours.  If you have your surgery done in the morning, there is a very likely chance that you will see a physical therapist at least once, if not twice that day.  Crazy right!  Yup, we will get you up only a few hours after surgery to have you stand or even start walking.  This helps to get your bowels moving, blood pressure stabilized, and get you a little more oriented with your new knee.  Actually, most people will tell you the first day isn’t too bad, as you still have the anesthesia in place.  Nausea may be a problem however, as many times our stomachs don’t agree with the initial pain medication.  But overall, usually day 1 isn’t too bad.

Day 2-4: The Hospital Stay

The next 2 to 4 days you will stay in the hospital where you will have nurses/physicians/OT/PT all helping/pestering you!  Usually, you will have your nurse or nurses aids check on you every 2 to 4 hours for pain meds and vitals.  You may or may not see your physician, but in most cases you will, and he/she will be able to answer any questions you have at that time.  You will see a physical therapist at least twice a day, and an occupational therapist at least once.  With physical therapy you will work on walking with a walker, knee range of motion(ROM), car transfers, and even possibly stairs.  You may or may not be put in a continuous passive motion machine(new research shows it doesn’t lead to any improved outcomes, so don’t worry if you aren’t given one) which will bend and straighten your knee for you.  Your knee WILL become more painful over these next 2-4 days.  Remember what you had done!(see above picture), but the nurses will help to make sure your pain stays under control. Then discharge planning will come in on your 3rd or 4th day and decide where you will head to next.

Day 4-3 weeks: Early Recovery

So depending on what type of help you have in place at home, you will spend your next few weeks in 1 of 3 places.  If you have a spouse at home who can care for your, or friends and family that can stay with you, you will go home.  If you have this option, it’s usually the best, so try to find somebody who can help you out those first 2-3 weeks.  If you go home and have someone who can drive you, you will come to see me in outpatient physical therapy.  If not, you will get a home health physical therapist for 2-3 weeks until you can drive yourself to therapy.  If you don’t have anybody at home, you will most likely go to a skilled nursing facility where you will get therapy at least 1 time a day.  If you have both knees done at the same time(you crazy folks you), you are eligible to go to a rehab center where you will get therapy 3 times a day.

Now for the therapy part….let’s focus on those of you who went home and either received home health PT or outpatient PT.  Your therapist will see you 3 times a week for the first 3 weeks, and will mostly be working on regaining your ROM.  It is very important to get this back early in your rehab, before the harder scar tissue gets laid down.  I’m not gonna lie, you knee is going to hurt these first few weeks.  You won’t be able to sleep very well, and finding a comfortable position may be quite difficult.  It’s essential that you are consistently icing and keeping your knee bending and straightening.  I usually recommend getting a pedalor or recumbent bike that you can use 3 to 4 times a day to keep your knee from getting swollen and stiff.  Stay on top of your pain meds, and let your therapist know how your feeling.  What we do in therapy is going to hurt, but it should not leave you miserably sore for 3 to 4 days.

Days 3 weeks to 6 weeks: Middle Recovery

These are the days when you will start to see your swelling go down, and you will make some real gains in therapy.  Your knee will still hurt a good amount, but not as bad as the first 3 weeks.  You will hopefully start to get more sleep, be able to start driving(some will), and get a little of your life back.  In therapy, you may go down to 2 times a week.  You will still be working hard or regaining full ROM and especially full knee straightening.  Getting your knee straight is very important in being able to walk correctly, so focus a lot of your home exercise effort at regaining a straight knee.  This bring up another very important factor, you HAVE to be doing your home exercises/stretches!  Therapy is only about 3 hours a week, which isn’t nearly enough to get all your ROM back, so you need to be stretching it 3-4 times a day at least.  Don’t overdue it and make yourself really sore, but do work on stretching it as often as possible.

Days 6 weeks to 6 months/1 year: Late Recovery

After six weeks, most total knee replacement patients will tell you they seem to turn a corner.  The pain should get moderately to significantly less, and walking, standing, and doing some household chores will become easier.  Therapy will continue to work on regaining every last bit of ROM, but will also start to focus a lot more on strength.  Specifically functional strength, meaning your ability to do everyday things like stairs, getting out of low chairs, squatting, and walking longer distances.  You should still be doing your home exercises at least 2-3 times a day.  Outpatient therapy will typically last about 12 weeks, but possibly longer depending on how therapy went in early/middle recovery.  After 3 months, you will still notice stiffness every time you sit for a while and after getting out of bed, but the pain should be minimal.  It is still important to stretch and exercise your knee 1-2 times a day, to get the full benefit of having a new knee!

If you are consistent with your therapy, do your home exercises, and avoid any crazy last minute ski trips, falls, or biking accidents, almost all new knee patients are completely happy after 1 year.  The medical feat of a knee replacements is truly remarkable!.  For those of you who have had one done already, I hope this did some justice to what you went through.  And for those of you who need one, hopefully this gives you a better idea of what to expect when your expecting :).