Orthopedics:  What to Expect from a Total Knee Replacement Surgery!

By Melissa Fournier, PT and Craig Zettergren, PT Cert. MDT

 

            If your knee is severely damaged by arthritis or injury, it may be difficult for you to

perform activities such as walking or going up and down stairs. If you are one of the un-

lucky ones, you may even feel pain when you are sitting or lying down. If you have tried medications, changing your activity level and are using walking supports that are not helping, you may want to consider total knee replacement surgery. A total knee replacement can relieve your pain, correct any deformities and help to increase your functional ability. Whether you have just begun researching treatment options or have already decided to have a total knee replacement, this article will help you to understand more about this procedure and what to expect after your

total knee replacement.

             It is important first to understand how the knee joint works, as it is the largest joint

in the human body. The knee is made up of the femur bone, which rotates on the tibia

and the patella (knee cap) that sits in a groove on the end of the femur bone. Stability of

the knee is given through the ligaments that surround the knee joint and the muscles

of the knee provide strength and durability. The surfaces of the three bones that make

up the knee joint are covered with articular cartilage, which is a smooth substance that

provides cushion for the bones and aides in movement of the knee joint. In a normal

knee, all of these components work in harmony, but arthritis or trauma to the knee can

cause dysfunction, resulting in pain, muscle weakness and decreased ability to perform

functional activities.

             Some of the most common causes of knee pain and disability are arthritis or trauma to the knee.  There are different forms of arthritis but one of the most commonly known is osteoarthritis, which usually occurs after the age of 50.  The cartilage that cushions the bones of the knee wears away resulting in the bones rubbing against one another.  You begin to have pain with 1) going up  and down stairs, and getting into and out of chairs, 2) moderate or severe knee pain while resting, either during the day or at night, 3) chronic knee inflammation and swelling that doesn’t improve with rest or medication, 4) knee deformity, 5) knee stiffness and the inability to bend or straighten your knee, 6) failure to improve with other treatments such as injections, physical therapy or other surgeries. Recommendations for surgery are done on an individual basis and are based on a patient’s disability, not age.

            An important factor in deciding whether to have a total knee replacement is understanding what the procedure can and can’t do for you. A vast majority of individuals who undergo total knee replacement surgery experience a dramatic reduction in the knee pain than they experienced before their surgery. After having a total knee replacement,

it is expected that you will have post  operative pain and swelling in the knee that can last up to 6 months or 1 year.  You will stay at the hospital 3-4 days on average.  Pain management is an important part of your recovery, so talk to your surgeon if postoperative pain is an issue in your case.  Walking and knee movement are very important to your recovery and begin immediately after surgery.  Some pain should be expected when starting activities after surgery but it is important to begin as early as possible.  The physical therapist will assist you in learning how to safely get into and out of bed and walk with your walker or cane.  After being discharged from the hospital, patients are referred for outpatient physical therapy, like Physical Therapy Center of Bristol.  Know your rights as a patient, and they are simple.  You can go wherever you choose for physical therapy.   If you have any questions, you can call me personally or email me, craig@ptcbristol.com, 860-585-5800 or check out our website and read some of the success stories for our total knee population.

            Movement of the knee is very important following surgery, despite the increased pain that you may experience with it. You should expect your knee to be able to fully straighten, 0 degrees of extension and it is optimal to get about 120 degrees of flexion.  This will allow you to get up and done from a low chair in and out of the car and performing stairs which are all needed.

 

            Most knee replacements last more than 20 years but some wear out overtime.  You can speak with your physician in more detail about this issue.  It is important to maintain a healthy and active lifestyle, maintain an appropriate body weight, avoid high impact activities such as jogging and skiing, and avoid kneeling, just to name a few. Deciding to have a total knee replacement is a big decision and can be a long recovery with expected pain with the procedure and rehabilitation process. Most people describe the pain during the rehabilitation process worth

it compared to the pain and limited function they experienced before the surgery.

 

If you are going to have a knee replacement or you have had one recently, see your doctor and ask for a prescription for physical therapy to Physical Therapy Center of Bristol, LLC.   Then call our office, Bristol 585-5800, Plantsville 272-8490 or email craig@ptcbristol.com.  You can always stop by the office and we will get you on the road to recovery.                  

Physical Therapy Center of Bristol, LLC has two locations serving the communities of Bristol, Burlington, Terryville, Plainville, Southington, Plantsville, Cheshire and Meriden.  In Bristol, we are located at 135 Middle Street, 585-5800 and in Plantsville we are at 1090 Meriden Waterbury Turnpike, 272-8490.  

Physical Therapy Center of Bristol, LLC is central Connecticut’s most trusted name in Physical Therapy since 2003.  We specialize  outpatient physical therapy in orthopedics, sports, postoperative, spine, women’s health and vestibular disorders.

Cervical Headaches- A Pain in the Neck?

Crystal DeBiaso, DPT

 

       Cervicogenic headache is a term that describes a headache that is caused by an injury to the neck.  Damage to the soft or bony tissues can occur either as a result of a trauma, such as whiplash, or with wear and tear over time.  It is possible that you may experience pain in your neck and/or arm as well.

If you have frequent headaches, there is a chance that the underlying cause is somewhere in your neck.  Cervicogenic headaches often go misdiagnosed as migraines, as the pain is quite similar.  A physical therapist trained in mechanical examination and treatment of spinal disorders can help you to determine the source of the pain, along with treatment to the source of the pain. This is done via posture correction, manual therapy techniques and proper exercises to help you spine be realigned in its proper position.  This is a non-surgical, non-manipulative technique.  The techniques have been researched extensively at the McKenzie Institute, the leader in mechanical diagnosis and treatment of spinal disorders. To find out more you can visit www.mckenziemdt.org.   Physical Therapy Center of Bristol LLC has trained McKenzie therapists on staff to assist you in your recovery.  Our goal is to assist you in getting over this episode of pain and teach you techniques that you can use daily to prevent recurrence of your symptoms.  The physical therapists are also trained to look out for red flags that may point to a more serious cause of your headaches, for which we will refer you back to your physician for further examination.

There are many studies reporting the effectiveness of physical therapy treatment of cervicogenic headache.  The majority of subjects report a decrease in use of pain medication, and a decrease in the frequency and severity of headaches.  Many subjects report continued relief from headache pain 12 months following treatment.

If you think going to physical therapy is a burden,  it is important to understand how it can actually save you a lot of time, money, and suffering in the long run.  The key is to see a physical therapist trained in mechanical diagnosis and treatment of spinal disorders from the McKenzie Institute.  It has been reported that passive modalities on this population has no effect on the functional outcome of patients. Thousands of dollars are spent by cervicogenic headache sufferers on unnecessary diagnostic imaging, repeat visits to the doctor, unnecessary pain medication, passive modalities and lost time from work.  Not only can a physical therapist treat your condition in just a few short weeks, they will also give you the tools you will need to treat your own pain for the rest of your life! 

If you have frequent headaches, see your doctor and ask for a prescription for physical therapy to Physical Therapy Center of Bristol, LLC.   Then call our office, Bristol 585-5800, Plantsville 272-8490 or email craig@ptcbristol.com.  You can always stop by the office and we will get you on the road to recovery. We will perform a thorough examination and determine if your problem can be solved using our methods or if we need to refer you to a specialist. So, if you want to stop using medications and take a pro active approach to your symptoms for headache give us a call and we will help.

           

Physical Therapy Center of Bristol, LLC has two locations serving the communities of Bristol, Burlington, Terryville, Plainville, Southington, Plantsville, Cheshire and Meriden.  In Bristol, we are located at 135 Middle Street, 585-5800 and in Plantsville we are at 1090 Meriden Waterbury Turnpike, 272-8490.  

    Physical Therapy Center of Bristol, LLC is central Connecticut’s most trusted name in Physical Therapy since 2003.  We specialize  outpatient physical therapy in orthopedics, sports, spine, women’s health and vestibular disorders.

 

 

References:

1. Nilsson N, Christensen HW, Hartvigsen J.  The effect of spinal manipulation in the treatment of cervicogenic headache.  J Manipulative Physical Therapy 1997; 20:326-330
2. Jull GA, Stanton WR. Predictors of responsiveness to physiotherapy management of cervicogenic headache.  Cephalalgia. 2005; 25:101-18
3. Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine. 2002; 27:1835-1843
4. Biondi D. Physical treatments for headache: a structured review.  Headache. 2005; 45:1-9
5. Fleming R, Forsythe S, Cook C. Influential variables associated with outcomes in patients with cervicogenic headache.  J Manual and Manipulative Therapy. 2007; 15:3: 155-164
6. Hall T, Chan HT, Chistensen L, Odenthal B, Wells C, Robinson K. Efficacy of a C1-C2 self sustained natural apophyseal glide (SNAG) in the management of cervicogenic headache. Journal of Orthopedic and Sports Physical Therapy. 2007; 35:3: 100-107

Improve Your Posture and Reduce Your Back and Neck Pain!

By: Tricia Rose, MPT, DPT, Cert. MDT

Do you suffer from intermittent back pain, neck pain or headaches?  Have these symptoms lasted a few weeks or even months and did they begin for no apparent reason?  Your pain may be due to poor posture while sitting or standing. 

     Good sitting and standing posture begin in the lumbar spine.  It is important to maintain a good lordosis, the natural inward curvature of the lumbar spine, to prevent your shoulders from rounding and your head from sitting too far forward.  Your head should be in a position where your ears are over your shoulders and not in front of them.  Too often, some people slouch because it is less demanding on their abdominal and posterior spinal muscles.  However, prolonged slouching elongates the posterior lumbar and thoracic spinal muscles, which in turn weaken them, making it even more work to sit up straight. This is definitely the case where “if you don’t use it, you lose it.” 

    Prolonged poor posture further weakens abdominal, or core, muscles because of a lack of use.  Physical therapists address core strengthening as an essential part of treating low back pain in order to increase the stability and strength of the spine.  Poor posture and back pain is a negative cycle that continues until a conscious effort is made to end the cycle. 

    One of the foremost experts studying back pain is Robin McKenzie, a prominent New Zealand physiotherapist.  In one study, cited below, McKenzie found that use of a lumbar roll was shown to significantly reduce back pain and referred leg pain by improving the lumbar lordosis in the sitting position.  A lumbar roll is a foam support placed behind your back specifically designed to improve your posture while sitting.  As a service to our patients, we have these McKenzie lumbar and cervical rolls available at our clinics. We also have available, a copy of McKenzie’s book Treat Your Own Back.  This is the world’s largest selling book on how to prevent back pain. It is helpful for those who are experiencing intermittent lower back and neck pain. 

    Being aware of and maintaining good posture is something that everyone can do, and a person does not need professional help to achieve it.  However, if you are at the point where you are experiencing back pain, and are unable to alleviate the symptoms yourself, you may need to seek professional intervention for help. During examination, from a trained McKenzie therapist, a thorough history of the pain behavior will be taken, a detailed examination of your posture and spinal mechanics to repeated movements will be assessed.  We will then determine if mechanical physical therapy is an option for you.  The most important things our therapists provide in regard to treating back and neck pain is postural education.  We also provide as patient education tools for self-management of your symptoms, manual therapy, therapeutic exercises including core strengthening and body mechanics training to prevent recurrence.

Physical Therapy Center of Bristol, LLC has two locations serving this population.  In Bristol we are located at 135 Middle Street, 585-5800 and in Plantsville we are at 1090 Meriden Waterbury Turnpike, 272-8490.  Call PTC today and make an appointment so we will help you recover with outpatient therapy or visit us on the web at www.ptcbristol.com

    Physical Therapy Center of Bristol, LLC is central Connecticut’s most trusted name in Physical Therapy since 2003.   We service the communities of Bristol, Burlington, Plainville, Southington, Meriden, Cheshire and Plantsville Connecticut.  One of our trained McKenzie therapists will evaluate you and determine a course of treatment for your symptoms.

 

1. Williams MM, Hawley JA, McKenzie RA, van Wijmen PM.: A comparison of the effects of two sitting postures on back and referred pain. Spine; Oct;16 (10):1185-91, 1991.

 

In the  late Spring or early summer of 2009, Physical Therapy Center of Bristol, LLC  we will be moving our office on Middle Street  to 72 Pine street in  new medical office building that is currently being built.  You can view the new office on our website, www.ptcbristol.com

Physical Therapy Center of Bristol, LLC has two locations serving the communities of Bristol, Burlington, Terryville, Plainville, Southington, Plantsville, Cheshire and Meriden.  In Bristol, we are located at 135 Middle Street, 585-5800 and in Plantsville we are at 1090 Meriden Waterbury Turnpike, 272-8490.  

    Physical Therapy Center of Bristol, LLC is central Connecticut’s most trusted name in Physical Therapy since 2003.  We specialize  outpatient physical therapy in orthopedics, sports, spine, women’s health and vestibular disorders.    

 

 

 

Stroke Rehabilitation- Returning home

Ashley Maritzer, PT MS

 

You have had a stroke, you went to a rehabilitation facility where you learned to stand up, dress yourself, and walk again in order to return home. Now you are home but what is next? You may find that you still have deficits in getting up from a chair, driving, and walking through a grocery store. Outpatient therapy at Physical Therapy Center of Bristol, LLC can facilitate in strength training, gaining ROM, gait training, and improving balance that all lead to improved quality of life.

About 80% of people who have had a stroke have some degree of trouble moving one side, or suffer from weakness on one side of their bodies.¹ The side of the body opposite the side of brain injury has the resultant weakness so if you have had a left sided stroke you will have right sided hemiparesis and vice versa. This weakness can make activities such as reaching for objects, going to the bathroom, or showering oneself difficult.

Spasticity is also a major problem from a stroke. Spasticity is stiffness of muscles making it difficulty to move. Untreated spasticity can result in contractures, pain, and difficulty moving.  Due to spasticity or weakness you may have been prescribed an orthotic to assist with walking. As your spasticity decreases and your strength increases you may wean from your orthotic per your physical therapist. Your physical therapist will know when it is safe to start training without it and will give you the appropriate exercises to wean from the orthotic.

Outpatient physical therapy addresses these issues through exercise, manual stretching, balance, and coordination training. It is also difficult to know when you no longer need the assistance of a device such as a cane, walker, or even a wheelchair. Many people will go home with use of an assistive device but may no longer need it after continued therapy. This will help to regain your life and allow you to feel like you have control again.

According to Werner and Kessler² stroke survivors can make functional gains even up to 3 years after stroke. Continued exercise is essential in making a difference in your post stroke recovery. You may feel like you have lost all control of your life but its up to you to regain it now.  Physical Therapy Center of Bristol, LLC has two locations serving this population.  In Bristol we are located at 135 Middle Street, 585-5800 and in Plantsville we are at 1090 Meriden Waterbury Turnpike, 272-8490.  Call PTC today and make an appointment so we will help you recover with outpatient therapy or visit us on the web at www.ptcbristol.com

 

Physical Therapy Center of Bristol, LLC is central Connecticut’s most trusted name in Physical Therapy!  We service the communities of Bristol, Burlington, Plainville, Southington, Meriden, Cheshire and Plantsville Connecticut. 

 

1. www.stroke.org

1. Werner RA, Kessler S. Effectiveness of an intensive outpatient rehabilitation program for postacute stroke patients. Am J Phys Med Rehabil 1996; 75(2): 114-120