• Advantages of Progressive Strengthening After Your Knee Replacement

    Total Knee Replacement

    Many people after a total knee arthroplasty (TKA) never achieve the same level of function as a similarly aged person without knee problems.  However, a recent study published in Physiotherapy Theory and Function indicates that a progressive strengthening program will likely bring their function to higher levels than those who do not receive that type of care.

    Progressive strengthening, in this case, means that the study participants received a number of physical therapy visits after surgery during which strengthening exercises were given. These were progressively increased to maintain maximum effort for 3 sets of 20 for all exercises.  The normal standard of care group focused primarily on range of motion, cycling and straight leg raising exercises without weight.

    The study found that a larger portion of patients who received progressive strengthening exercises achieved normal clinical and functional scores.  This indicates that although all patients may not achieve normal function after a TKA, those receiving this type of treatment have a better chance of returning to normal function.

  • Arthritis Tips for Winter Weather

    -Layer up! Think about under layers for your clothes, scarves for your neck, gloves and extra socks. Keeping the cold out is priority one when venturing out on those extra cold days, especially if your joints are feeling stiff and achy.

     -Get your vitamin D. Vitamin D is usually gotten through diet and sunlight but short winter days may leave your levels low. People with rheumatoid arthritis and other inflammatory conditions display more severe pain when their vitamin D levels are low. Aim for 600 IU of vitamin D daily through supplements or food unless otherwise directed by your doctor.

     -Stay active. Exercise helps reduce pain levels, increases joint mobility and increases strength. All necessary components of maintaining healthy, happy joints. When your joints are very sore, even gentle range of motion can be beneficial in reducing pain and dysfunction.

    -Heat up. Heat helps boost circulation and can relax tight muscles and relieve joint stiffness.  Anything from a warm shower to a heating pad or even a warm cup of coffee in your hands can be helpful.

     -Stay safe on slippery surfaces. Exercise caution on icy or snowy stairs, slopes or even perfectly level sidewalks. You can use slip on traction spikes for over your own shoes or even something like trekking poles that hikers use to help with balance and safety so that you to get out and walk safely in winter weather.

     -Try out compression gloves. These gloves provide light compression and warmth to achy joints in the hands and wrists and may help reduce swelling, pain and stiffness.

     Wintery, cold weather doesn’t have to equal pain and stiffness in your joints. Use some of these options to stay comfortable and active until warm, sunny days return.

     

     

    -Stephany Primrose, P.T.

  • Finally, Some Good News About Back Pain

    Back pain is a huge problem in developed nations worldwide. It has or will affect most of us. The current estimate is that 80% of people will experience back pain at least once. It is the single biggest cause for disability, the third most common reason for doctor visits, and one of the most common reasons for missing work.

    It's also expensive. Back and neck pain makes up the biggest healthcare expense in the US, totaling $134 billion spent in 2016. The next two most expensive conditions were diabetes — $111 billion in spending — and ischemic heart disease at $89 billion.

    Diabetes and heart disease being so expensive to treat doesn't surprise most folks - they can both lead to other major problems, require long term medication, could require surgery, and both can be fatal. Back pain won't kill you, usually doesn't require long term medication, and usually doesn't require surgery either. Why is it so expensive?

    The first reason is that it's so common. The second reason is that our current system isn't very good at treating it. Current recommendations include starting with activity modification, and active treatments like physical therapy. Research backs this up, showing better outcomes and lower costs with early PT. Unfortunately, only 2% of people with back pain start with PT, and only 7% get to PT within 90 days. At the same time, a study looking at about 2.5 million people with back pain in JAMA showed that 32.3% of these patients received imaging within 30 days of diagnosis and 35.3% received imaging without a trial of physical therapy. Both of these things go against current practice guidelines for treatment of back pain.

    A new pilot program being rolled out by TRICARE, the insurance system used throughout the US military is waiving the payment owed by the patient for up to three PT sessions in an attempt to improve the use of what the Defense Health Agency calls "high value" treatment for low back pain. The theory is that once a person sees some benefit from PT treatment, they're likely to go back for more. This is the "try it before you buy it" approach - think of the 7-day free trial Netflix offers, free samples poured in wineries and craft breweries, or the folks you see standing around in supermarkets with food on toothpicks. TRICARE's data seems to indicate that it works just as well for healthcare as it does for other businesses. In a press release they state that once people attend one session of physical therapy, they're likely to go back for more, no matter what their co-pay is. But TRICARE found that higher co-pays could be a barrier to people trying that first visit. For the group of patients with the highest co-pays in the system, only 38% of the people prescribed PT attended the first visit. That's about half the rate of attendance found in the lowest co-pay group.

    The fact that such a major insurer is looking into the value of PT is great news for everyone. If TRICARE can show that lowering the cost of PT for patients can improve outcomes and save insurance companies money, other major insurers will likely follow. This could improve the lives of millions of people every year while reducing the huge cost of treating low back pain for the country. That seems like a win for everyone involved.

     

    -- American Physical Therapy Association

  • What should I consider before undergoing joint replacement surgery?

    The number of joint replacement surgeries in the United States has grown exponentially in the last several years. And while it is a common surgery there are some things to consider before undergoing the procedure. 

    Conservative treatments and activity modifications should always be the first line of treatment.   These include things such as weight loss, exercise, injections and physical therapy.  Losing excess weight will help to reduce the amount of force applied to your joints.  According to the John Hopkins Arthritis Center being just 10 lbs. overweight can add up to 60 lbs. of force to your knees.  This excessive force causes more wear and tear to the joint and further destruction of cartilage.  Exercise can help to improve muscular strength providing support to the joint and can help to reduce pain.  Regular moderate intensity physical activity can also help with weight loss goals.  Surgeons can also provide steroid injections into the joint which can provide temporary pain relief and reduce the inflammation.  They can also try injections of a gel-like substance that is based on hyaluronic acid which is a naturally occurring substance in our joint fluid.  It helps to lubricate the joint and, in some cases, can provide some pain relief for 6-12 months.   Participating in physical therapy can improve the strength and flexibility of the appropriate muscles to help support the joint and reduce pain and pressure.  By increasing your strength, endurance and function physical therapy could help to postpone or maybe even avoid surgery. 

    But if conservative methods have failed and joint replacement surgery is the appropriate treatment then there are other things to consider.  First is to select the best surgeon.  You want to look for a surgeon who specializes in joint replacements and performs a high volume of surgeries annually.   Check out outcome data if possible, to see the surgeon’s success rate as well as their complication rates.  Next consider undergoing some “prehab” at physical therapy.  A study in the Journal of Bone and Joint Surgery found that 1-2 sessions of pre-operative physical therapy reduced the post-operative care use by 29%.  The physical therapist can provide you with education regarding post-operative expectations in terms of swelling, and mobility challenges.  They can also evaluate your current strength and mobility deficits and provide exercises for you to start performing to help increase muscle activation.  During the prehab visit the therapist can also help you to plan for your post-operative recovery by instructing you on the proper way to use an assistive device such as a walker or cane for ambulation and teaching you how to climb stairs safely after surgery.  Other things to consider before undergoing joint replacement include having a support system in place post-surgery.  You may need to make some modifications to your home such as removing throw rugs and other possible obstacles, obtaining adaptive equipment such as a shower chair or raised toilet seat to make daily activities easier while your mobility is reduced.  Driving is also typically restricted for at least 4-6 weeks post-surgery.  Rehabilitation after joint replacement starts immediately to help initiate muscle contraction and increase early mobility to decrease swelling, improve range of motion and decrease pain.  The rehabilitation process takes commitment in order to achieve the best results. Generally, after 3 months post-surgery individuals have returned to their normal daily activities, but they may still have some mild swelling and weakness for up to a year post surgery. 

    If you have questions or want to pursue physical therapy to help reduce your joint pain and improve your function, contact our office to schedule an evaluation.  For a consumer-friendly guide to joint replacement go to www.moveforwardpt.com.

     

    References:

    Johns Hopkins Arthritis Center: https://www.hopkinsarthritis.org

    Journal of Bone and Joint Surgery: https://www.jbjs.org/

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