Posted on Wednesday, December 2, 2015

Q & A: Rehabilitation for a Total Knee Replacement

Q. I’m going in for a total knee replacement. I wondered what type of advice you could give me so that I’m better prepared. Thanks! -Judy

A. Great question, Judy! A total knee replacement is often referred to as a total knee arthroplasty (TKA). It’s really more like a resurfacing of the knee joint. TKA is most often used as a treatment for those suffering from moderate to severe osteoarthritis in the knee. Other common causes for the procedure include Rheumatoid arthritis and injury. Knee replacement is more common among women and the likelihood of replacement increases with age.

The following information on total knee arthroplasty (TKA) and rehabilitation is not meant to be all inclusive, but to serve as a starting point as to what you will likely experience during rehabilitation. Each person’s rehabilitation process is likely to vary depending on his/her particular needs.

Four basic steps are performed in a Total Knee Arthroplasty (TKA):

Prepare the bone. The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.
Position the metal implants. The removed cartilage and bone is replaced with metal components that recreate the surface of the joint.
Resurface the patella. The undersurface of the patella (kneecap) is cut and resurfaced with a plastic button. This is not performed with every procedure unless necessary.
Insert a spacer. A medical-grade plastic spacer is inserted between the metal components to create a smooth gliding surface.

Proper rehabilitation is a critical component to overall success with this procedure. In most cases, a physical therapist and possibly an occupational therapist will be involved in the rehabilitation process. I tend to classify the rehabilitation into the following four major stages.

Stage I Rehabilitation

This is the initial post-surgical recovery stage in the hospital with physical therapy (typically the same day). The goal is for you (the patient) to be upright and walking with an assistive device, such as a walker, in order to initiate very basic motion in the knee.

Although same day procedures can be performed, you will typically spend two to three days in the hospital following this procedure. With the new surgical techniques utilized, most patients will not have any weight bearing or other mobility precautions.

There are risks of complications with any medical procedure. The biggest risk initially is falling either from the newly operated knee giving way or complications from medication (which can cause dizziness, lightheadedness or other symptoms). Other possible unlikely complications include: loosening of the prosthetic within the bone; blood clots; and infection.

Prior to leaving the hospital, pain management is a priority. In addition, you need to be able to walk at least to a bathroom (typically with some assistance to maintain safety).

Four typical options for discharge:

Discharge home and continue rehabilitation with in-home care.
Discharge home and initiate physical therapy in an outpatient clinic.
Discharge to a skilled nursing facility. This is typically reserved for those who are expected to need an extended recovery.
Discharge to a sub-acute rehabilitation facility. This is typically reserved for those who may need additional medical care, but who can tolerate a more intensive rehabilitation program.

Regardless of the discharge location, the initial treatment is very similar. Focus on pain management. Improve your ability to ambulate. Initiate RICE (Rest, Ice, Compression, and Elevation). Start with basic range of motion (ROM) exercises (as described in Stage II). Also, please refer to Total Knee Replacement Rehabilitation Exercises for many of the most common exercises you may perform depending on your individual need.

Medication Management

A major component of the rehabilitation will be to insure proper pain management. This is typically through pain medication (both narcotic based and/or acetaminophen). It is important to maintain proper pain management because it allows you to perform necessary activities of daily living (ADLs) as you progress through your rehabilitation. Additional medication management may be necessary if you’re taking blood thinning medications in order to decrease the risk of blood clots.

RICE

Rest. Your body has just undergone a major surgery. It will require more rest initially to properly heal and recover. Although exercise and movement will be critical to your recovery, additional rest will be needed. Limit walking on any hard surfaces, such as the flooring in grocery stores, for at least the first three to four weeks in order to minimize pain and swelling.
Ice. Apply ice to the painful areas especially in and around the knee. The rule for icing is to apply ice no more than twenty minutes per hour. Do not place the ice directly against the skin, especially if you are using a gel style Cold Pack. A bag of frozen peas can be ideal. Individuals with poor circulation or impaired sensation should take particular care when icing. Often, your physician will prescribe a machine known as an IceMan (or something comparable) to help with cryotherapy to reduce pain and inflammation.
Compression helps to prevent and decrease swelling. Swelling can cause increased pain and slow the healing response, so limit it as much as possible. You may utilize a common ACE wrap or your physician may recommend wearing TED hose which helps with swelling and decreases the risk of blood clots.
Elevation. When resting, keep the leg as straight as possible and elevated above the level of your heart to help reduce swelling (edema). Try not to prop anything under the knee because it would cause flexion (bending). You want the knee to move straight into full extension.

Stage II Rehabilitation

Stage II typically starts on about day three to five. It can last up to six to eight weeks depending on your recovery. Continue to progress with pain management, edema management, gait/ambulation training, RICE, and range of motion as initiated in Stage I.

Movement

Regaining range of motion (ROM) is one of the primary goals with TKA rehabilitation. Knee extension (straightening) and knee flexion (bending) must be regained as quickly as possible. There is a limited window of time that ROM must be restored. Aim for full recovery of ROM within the first six to eight weeks (if not sooner).

Regaining both full knee extension and flexion are critical to long term success. Once you regain full ROM, you must maintain it throughout the process. Movement helps tissues receive the needed nutrients and can help with pain management. Movement, including frequent toe tapping and ankle motion along with knee ROM, can also help to reduce swelling and prevents blood clots.

If the patient doesn’t regain adequate motion through the rehabilitation process, I find that knee pain usually remains a long term issue along with poor mobility. The goal for TKA ROM is usually 0-120 degrees of motion. (Zero meaning that the knee is perfectly straight. The 120 degrees is how far backward you can bend the knee.) For a point of reference, touching your heel to your buttock is usually about 150 degrees of motion. Your knee will not have the same available ROM as a healthy knee joint, but it will be functional for most tasks.

Restoring full ROM can be accomplished in many ways. The gentlest way is to perform heel slides by lying on your back and sliding your heel toward your buttock (as demonstrated in Total Knee Replacement Rehabilitation Exercises). A stationary bicycle is also very helpful. These exercises should be performed within a mild to moderate amount of pain and discomfort. Although ROM exercises can be a little painful, they don’t damage the new joint and ultimately, the ROM will help to decrease pain.

Ambulation

In most cases, your initial ambulation will require an assistive device such as a front wheeled walker (FWW), crutches or a cane for safety and pain relief. Initially, the knee motion will be limited. Pain and swelling will affect the strength of the leg. This means that the leg could have a tendency to give way or be unsteady. This should improve quickly over the first several days, but I always recommend an assistive device initially.

Walking with an assistive device also gives you the opportunity to walk with a normal gait pattern which will help improve your knee’s range of motion and aid in your recovery. Your physical therapist will work with you to help restore as normal and safe a gait pattern as possible. It is common to feel or even hear clicking during ambulation and movement due to the plastic and metal components. This is normal (particularly, early in your rehabilitation when the knee is swollen and ROM remains restricted).

Strengthening

Increasing your leg strength is an important part of your recovery, but it will not necessarily be an initial focus of your recovery. The primary goals for rehabilitation initially involve proper ambulation, reducing the swelling, pain relief, and range of motion for your knee. Adequate strength throughout the lower extremity is important. The primary focus will be on quadriceps strengthening and hip abduction (gluteus medius) strengthening. These two muscle groups tend to be the most important in regaining full functional mobility after TKA.

Stage III Rehabilitation

Similar to Stage II, rehabilitation in Stage III continues to focus on range of motion (ROM). At this point, you would typically ride a stationary bike regularly while working to maintain full ROM (0-120 degrees). Movement helps tissues receive the needed nutrients and can help with pain management. Movement also reduces swelling and prevents blood clots. This stage is typically eight to twelve weeks after the operation.

The Stage III exercise program (as demonstrated in Total Knee Replacement Rehabilitation Exercises) is designed to improve strength of the entire lower extremity while still focusing on quadriceps and gluteus medius (hip abduction) strength. Balance and gait drills are typically introduced. The goal is to ambulate without any noticeable abnormalities from the TKA and to reduce the risk of falls (particularly if you’re no longer using an assistive device).

During Stage III rehabilitation, I would generally expect that you have proper pain management without the use of narcotic medications. Mobility for basic daily tasks is usually quite good and the intensity of the rehabilitation has increased. In this stage, you’re working hard on self-rehabilitation and may be continuing formal rehabilitation in an outpatient physical therapy clinic.

Stage IV Rehabilitation

Stage IV usually occurs four to nine months after the operation. Exercises should be designed to help maximize your mobility and desired mobility outcome/goal. Increased exercise intensity and more dynamic balance training are introduced. A return to full functional mobility is the desired outcome. In this stage, a majority of the exercises are performed independently. You may intermittently consult with a physical therapist to progress in rehabilitation to insure that you’re meeting your goals.

Each person’s rehabilitation process is likely to vary depending on his/her particular needs. Always be open and honest with the medical professionals who are assisting you. If you feel as though something is not quite right, don’t hesitate in discussing the issue.

During your recovery, don’t forget the basics! Proper hydration and consuming nutrient dense food is critical to providing your body with the necessary building blocks to optimize your recovery. Proper hydration is critical in reducing your risk of blood clots. It also helps the body to deliver much needed hydration and nutrients to your healing tissues.

Physical therapy will be an important component to your recovery and rehabilitation. If you don’t already have a physical therapist that you are comfortable working with, The American Physical Therapy Association offers a wonderful resource to help find one in your area. Depending on how you progress during your rehabilitation, you will likely work with multiple physical therapists while at the acute care or rehabilitation hospital, during in-home care, and/or at an outpatient clinic.

Thank you, Judy, for your question. Good luck with your procedure! I hope your rehabilitation for your knee goes smoothly and that you recover quickly!

Have you undergone a total knee arthroplasty (TKA)? What was your experience like? Please share your best tips for recovery.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer: The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice. No health care provider/patient relationship is formed. The use of information on this blog or materials linked from this blog is at your own risk. The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Do not disregard, or delay in obtaining, medical advice for any medical condition you may have. Please seek the assistance of your health care professionals for any such conditions.

Posted on Wednesday, November 25, 2015

Astronauts Resistance Train and So Should You

Space travel has long been in the hearts and minds of men and women. The Martian, a bestselling book and recent movie starring Matt Damon, depicts a manned mission to Mars. (Personally, this is something I hope to see in my lifetime!) Damon stars as an astronaut who is mistakenly presumed dead and left behind on Mars, and who then fights to survive. Among the many potential hazards of space travel, one not so well known issue is osteopenia and/or osteoporosis. The lack of gravity and weight bearing activity causes demineralization and weakness in the bones. This significantly increases one’s risk of a bone fracture.

In space, bone loss starts within a few days and escalates between 2-5 months. On earth, it tends to be a more gradual loss. Bone density tends to peak in a person’s mid-twenties and worsens as a person ages. Statics conclude that in individuals over 50, one in two women and one in eight men will have an osteoporosis related fracture within their lifetime.

For NASA, learning the causes of space induced osteoporosis and prevention methods is critical to long term space travel and any potential manned mission to Mars. The treatment for osteoporosis is quite straight forward on earth and taking steps to prevent osteoporosis is critical. The sooner, the better! Regardless of age or severity of the condition, it’s never too late to start.

Osteopenia and osteoporosis can occur for many different reasons, but the most common reasons include:

Gender. Females are more likely to experience bone loss.
Certain ethnic groups. White Anglo-Saxons are more likely to develop these conditions.
Smoking.
Prior family history.
Alcoholism.
Medication side effects.
Lack of proper nutrition, including vitamin deficits such as low Vitamin D3 levels.
Hormonal dysregulation.
Lack of weight bearing exercise.
Being bed bound. Studies conclude that completely immobilized bones can lose up to 15% of mineral density within three months.
Lack of resistance exercise.
Certain genetic disorders.
Space travel. The lack of gravity and weight bearing activity causes demineralization and weakness in the bones.

Treatment Strategies for Osteopenia and Osteoporosis:

Start Early

As we age, our bones will normally start losing some bone density and flexibility. (They become more rigid.) It’s important to work on optimizing bone density early in life. Bone density is best developed under 30 years of age.

There are also studies that indicate pregnancy may also help to improve bone density. This assumes a healthy diet with adequate calcium levels is consumed during the pregnancy and while breastfeeding.

Weight Training

Weight training is like living on a planet with increased gravity. Weight training (particularly barbell training) loads the skeleton progressively over time, which can decrease bone loss and increase bone mineral density. It also positively affects hormones, such as human growth hormone (HGH) and testosterone, needed to improve bone density and muscle strength. Barbell training is the most effective method due to the progressive load on the skeletal system, and the muscle pull being exerted on the bone, which also stimulates bone formation.

Resistance training (other than through barbell training) can also be beneficial. Since space is an anti-gravity environment, it’s impossible to load the skeleton via weight training. Astronauts can resistance train by utilizing strong elastic bands and cords. This allows variations of pushing or pulling exercises that exert a force on the muscle, which stimulates muscle and bone development as well as optimizes vital hormone function. Depending on the type of exercise, the resistance bands can mimic skeletal loading and gravity.

The key to maintaining and improving bone density is always axial skeletal loading and the associated pull of muscles against the bone during activity (particularly, strenuous activity). Examples of such exercises include squats, lunges, and dead lifts.

Weight Bearing Activities

This refers to any activity, such as walking, jogging, hiking, climbing stairs, and dancing performed against gravity. Biking and swimming are examples of exercises that are not weight bearing and therefore, they are not as beneficial for bone development. In space, nothing is considered a weight bearing activity because of the lack of gravity. Any attempt of weight bearing activity will need an outside resistive force to accomplish the task until science can actually create an artificial gravity environment.

Vitamin D3

Vitamin D3 is critical to the absorption of calcium, through the intestinal wall, which is important for bone health. Although calcium is a critical component of bone health, I cannot recommend extra supplementation because of the potential cardiac risks to over supplementation. A healthy varied diet will typically supply adequate calcium levels (assuming that adequate Vitamin D3 levels are present for absorption and that you are avoiding drinking soda). Vitamin D3 is also a critical nutrient in maintaining a healthy immune system.

Increase Your Intake of Vitamin K1 and K2

Research indicates that Vitamin K can help to reduce bone loss by helping the body regulate osteoclast function with in the bone. An osteoclast is a type of bone cell that breaks down bone tissue. These very important cells are integral in maintaining proper bone density and insuring an appropriate amount of calcium in the blood stream. Without adequate calcium, many critical cell functions can be affected, including heart function. Both Vitamin K1 and K2 have been proven to reduce the risk of fractures, including hip and vertebral.

Vitamin K, found in green leafy vegetables, has anti-coagulation benefits. If you take blood thinning medications, your physician will need to know how much you consume on a regular basis.

Avoid Soda

Excessive soda intake (particularly diet soda) has been linked to poor bone density. The exact cause isn’t entirely clear. Many theorize that the acidic nature of the soda along with the chemicals and additives cause increased osteoclast activity in the bones. This releases more calcium into the blood stream in order to help fight the negative effects of soda consumption. It is clear that too much soda is bad for your health and bones.

Magnesium

Magnesium is a critical component of bone health and health in general. Magnesium helps the body to regulate calcium levels. This has a positive effect on bone health and also has been proven to reduce the risk of kidney stones. I also use magnesium as a sleep and recovery aid. I consume it at night to help me sleep. Magnesium can also reduce muscle soreness, cramps, and/or spasms. You can take Mag Glycinate in pill form or by eating foods higher in magnesium such as spinach, artichokes, and dates.

Most people are deficient in the amount of magnesium they consume on a regular basis. I recommend beginning with a dose of 200 mg (before bedtime) and increasing the dose in 100 mg intervals as needed. I would caution you that taking too much magnesium can lead to diarrhea. Mag Glycinate in its oral form is the most highly absorbable. Although not quite as absorbable, Thorne Research Magnesium Citrate is also a fantastic product.

Stop Smoking

If you smoke, please stop. It not only affects your bone density, but it has negative effects on every other body system. It also increases your risk of cancer and heart disease.

Eat Healthy

Do not eat anything that comes in a package. A diet with proper vitamins and minerals is not only imperative to preventing osteoporosis, but it is the key to preventing most disease and illness. Most of our food should be from low sugar fruits and vegetables as well as protein and healthy fats (primarily from plant sources such as avocados and coconut or olive oil). Any animal fat should be from organic and grass fed animals. Your body tissue needs nutrients to be able to perform at a high level.

Avoid processed food as much as possible. Limit sugary food and add more protein and healthy fat in your diet. Maintaining a diet with adequate healthy fats is essential in providing the nutrients to support all hormone function in the body as well as support the brain and nervous system. Adequate protein intake is necessary to support muscle health and development. A healthy diet equates to healthy bones.

In space, astronauts must eat a healthy diet and get plenty of exercise to prevent disuse osteoporosis. Similar steps can be taken to prevent osteoporosis on earth. Maintain a balanced diet rich in calcium, Vitamin D3, Vitamin K, and magnesium. In order to prevent or alleviate osteoporosis and osteopenia, implement weight bearing exercise and resistance training; a lifestyle free of smoking and alcohol; and regular bone density screenings. It’s never too late to implement these strategies as you maintain a healthy lifestyle. For additional information, please refer to Q & A: How to Self-Treat Osteopenia and Q & A: Which Type of Imaging to Use.

Which strategies can you implement in order to prevent and self-treat osteopenia and/or osteoporosis? Please leave your comments below.

Posted on Wednesday, November 18, 2015

Longevity through Physical Therapy

http://hartmanmedia.com/ls43/

The Longevity and Biohacking Show

November 12, 2015

Increasing your lifespan without increasing your health span is basically a self-torturing program. If you don’t have quality of life in your later years, why would you want them? Our guest, Ben Shatto, tells us about physical therapy and how it can be used as a preventative medicine to ward off many of the prominent illnesses attributed to aging. Humans were designed to move much more than our current lifestyles afford us. Get up and move! Listen to the show

Posted on Wednesday, November 11, 2015

Getting Started

With the cost of healthcare on the rise, I help proactive adults of all ages to understand how to safely self-treat and manage common musculoskeletal, neurological, and mobility related conditions in a timely manner so they can reach their optimal health.

I am old enough to remember the days without the Internet, and I attended higher education during the transition to the Internet. I can attest that it is much easier to perform research with the Internet than without! However, online research can be confusing and it may be difficult to find reputable information. Most of the time, my research is geared toward scientific journals and peer reviewed articles, but the average non-medical person doesn’t typically have the time or training to fully synthesize the information.

This is most evident within the popular news media today. In an attempt to rush to publish new medical research, the data is often misinterpreted from the true meaning, if any, from the scientific research. This leads to misinformation and confusion. My desire is to filter the research and present it to you in a logical, useful and practical way so you may implement it into YOUR life! Continue Reading

Posted on Wednesday, November 4, 2015

Q & A: My Top 5 Tips on How to Self-Treat Osgood-Schlatter Disease

Q. For the past several months, my 12 year old son has been experiencing pain below his knee cap just to the top of his shinbone. He typically experiences pain when playing soccer or other sports. The pain goes away when he rests. It’s getting to the point that it’s hard for him to participate in sports. He hasn’t had any injuries. What do you recommend? -Chandra

A. Thanks for your question, Chandra. I’m sorry to hear about your son’s knee pain. Unfortunately, it’s a common problem in children (particularly, boys). The symptoms that you are describing sound like Osgood-Schlatter disease although other potential causes could be Patellar Tendinitis or Patellar Femoral Pain Syndrome. Due to his age, gender, and activity level, it’s most likely Osgood-Schlatter disease.

Osgood-Schlatter disease (OS) is an overuse injury with pain located just below the knee where the patellar tendon ends (inserts) on the Tibial tuberosity. A boney nob may start to develop in this area and usually occurs as the condition progresses. This occurs due to the excessive stress on the skeletal system during a period of rapid growing combined with stress from activity of the quadriceps muscle pulling on the patellar tendon at its insertion site on the bone. If a bump forms, don’t worry as it is benign with OS. It will likely continue to be there as your child ages. There are typically no long term effects for this condition except for pain over the raised area of bone when kneeling on a hard surface.

Risk Factors for Osgood-Schlatter disease include:

Boys who are 11-13 years old.
Period of rapid skeletal growth.
Adolescents who regularly participate in running, jumping, and sports with many cutting or rapid changes in direction.

Symptoms for Osgood-Schlatter disease include:

Pain and possible swelling below the knee located near the top of the shinbone.
A bump or boney growth on the front of the upper shin at the Tibial tuberosity that is typically painful to touch.
Pain with running, jumping, and cutting sports.
Decreased pain or no pain at rest.
Possible loss of knee range of motion, typically flexion.
Possible pain and tightness with quadriceps stretching due to the pull on the patellar tendon.
Loss of quadriceps strength which mostly due to pain inhibiting its use.
Painful kneeling.

OS typically begins with mild soreness. The condition is typically self-limiting because of pain. Continuing to push through the pain can cause significant long-lasting pain resulting in limited function. Early intervention is usually very helpful.

My Top 5 Tips on How to Self-Treat Osgood-Schlatter Disease:

RICE

RICE, which stands for Rest, Ice, Compression, and Elevation.

Rest. In this case, rest would indicate tapering down from your regular exercise activity or any activity that involves running and jumping or that is causing knee pain.

Ice. Apply ice to the painful area–typically the sooner, the better. The rule for icing is to apply ice no more than twenty minutes per hour. Do not place the ice directly against the skin, especially if you are using a gel pack style. A bag of frozen peas can be ideal. Individuals with poor circulation or impaired sensation should take particular care when icing.

Compression helps to prevent and decrease swelling. Swelling can cause increased pain and slow the healing response, so limit it as much as possible. You can utilize a common ACE wrap. If you have a friend who is medically trained, many different taping techniques can also assist in decreasing swelling. You may also consider a compression sleeve or garment.

Elevation. If there is swelling, then elevating the leg may be helpful.

If it hurts, don’t do it!

Modify the activity or discontinue it completely. If your knee is hurting when performing your sport or activity whether you are running, jumping or even weight lifting, then discontinue the activity temporarily. If you are able to modify and perform the exercise or activity pain free, it would be okay to continue in most cases.

Improve your range of motion (ROM).

The primary goal of a rehabilitation program is to regain full pain free ROM for knee flexion (bending) and extension (straightening). This can be accomplished in many ways. Perform heel slides by lying on your back and sliding your heel toward your buttocks. Consider using a pole to assist in performing deeps squats. Another stretch would be to hang onto a pole or a doorframe, and bring your heel toward your buttocks as you perform a quadriceps stretch.

These exercises should only be performed within a mild to moderate amount of discomfort in order to regain full pain free ROM. If you experience muscle tightness and soreness, I recommend using a foam roller to assist with any myofascial symptoms. To learn how to use a foam roller, please refer to Foam Rolling for Rehabilitation.

Work on strengthening.

The primary goal of a strengthening program is to work on the quadriceps and glutes medius (hip abduction). Weight lifting is an appropriate choice, but you may have to initially limit your range of motion (ROM). Most of my clients begin on a non-weight bearing program, then progress to partial weight bearing, and eventually, full weight bearing. The more severe the symptoms, the longer it will take for an individual to progress to more difficult exercises or to increase the resistance (load).

To initiate a physical therapy program, please refer to Osgood-Schlatter Disease Rehabilitation Exercises. This exercise guide is designed to address the muscles that I find to be the weakest in most individuals. The exercises are listed from easiest to most challenging and are designed to primarily improve quadriceps and hip strengthening. Initially, focus on full ROM.

Weight training exercises (with machine weights or free weights) should be geared toward general leg strengthening and may include: squats; leg press; hip abduction machine; step ups; dead lifts; and straight leg dead lifts. If further instruction is needed, search YouTube to watch the proper technique for a specific exercise. Do not perform any seated knee extension exercises.

Kinesiological taping.

Besides pain relief, the purpose of Kinesiological tape is to provide compression over the Tibial tuberosity and to facilitate additional blood flow to the area. It also provides proprioceptive input which can help the knee during activity. I have had luck using Kinesio Tape, Rock Tape, and Mummy Tape brands. There are many other useful taping techniques which utilize different forms of tape. (You could also utilize Spider tape or KT TAPE.) To visually learn how to apply the tape, please refer to Kinesiological Taping for Osgood-Schlatter Disease. For application and removal tips, please refer to Skin Care with Taping.

How to Prevent Osgood-Schlatter Disease:

Be sure to schedule rest between athletic seasons, athletic events, and higher volume training periods. Rest is a critical factor as an adolescent’s body undergoes physical changes. OS is typically associated with overtraining/overuse in combination with a rapidly growing skeletal system. There are times when an adolescent needs to rest. It’s important not to encourage an adolescent to play sports through the pain without adequate recovery, rest, and if necessary, an evaluation by a qualified physical therapist or physician.

As part of a prevention and cross training strategy, implement the exercises demonstrated in the Osgood-Schlatter Disease Rehabilitation Exercises. A proper warm up and cool down is critical when performing in an athletic event or a significant training session.

Warm up prior to exercise. I recommend that you increase your normal warm up time by at least 10 minutes in order to increase blood flow to the area. This allows better mobility and also promotes healing as movement is necessary to bring in the nutrients. Use a stationary bike or the rower machine initially to get the muscles warm and the knee joint more lubricated. Then work on moving into a deep squat position multiple times as part of the warm up. You may need to hang onto a beam or a pole to take some pressure off of your knee as you move in and out of the squat.

Cool down. After performing your exercises, take extra time to cool down and stretch. Use either a stationary bike (at a causal/slower pace) or the rower machine. Both are reduced weight bearing exercises that promote movement and circulation to the knee as well as increasing ROM. This is the perfect time to work through my recommended rehabilitation exercises.

Thank you, Chandra, for your question! I hope these tips will help you assist your son in his recovery and get him back to playing sports as quickly as he is able to without pain! If the pain continues, please seek additional assistance from a qualified physical therapist or physician. The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area.

Do you know an adolescent who may be suffering from Osgood-Schlatter disease? If so, please share my recommendations on how to address this common and treatable condition.

Posted on Wednesday, October 28, 2015

3 Strategies to Start Right Now to Improve Health Span

You have likely heard about the life span revolution in the media. Many feel we are on the cusp of significantly advancing the length a person can live. When in fact, the actual average number of years a person is expected to live has been stable or slightly decreasing. This is entirely due to poor nutrition, lack of physical activity, and environmental factors. Although the promise of a long life is appealing, one must ask an important question: Is a long life really what you want if there is no quality? Increasing the number of years that you live is not as important as increasing the way you can live those added years. Spending an extra 5 or 25 years alive, but ill, is a curse not a blessing.

Today’s pharmaceutical giants, who fund much of this research, don’t want you to feel well during this time. Their intentions are likely not altruistic. Imagine a longer lived population that is chronically ill. Sounds like a lucrative opportunity, doesn’t it?

Now the good news! There are very simple and scientifically proven techniques that will allow you to improve your health span AND life span. Health span refers to the period of time during one’s life that you are generally healthy and free from disease.

Physical factors that address health span include strength, balance, flexibility, and endurance. All of these factors affect your mobility during your life. These same factors all contribute to your body’s physical resiliency. Maintaining your mobility is critical for all body functions and is fundamental in avoiding chronic illness.

3 Strategies to Start Right Now to Improve Health Span:

Weight Training

Weight training (in particular, barbell training) is a critical component in physical resiliency. Lifting appropriately heavy weights is applicable for almost everyone regardless of age and/or present health status. Weight training has positive benefits on: muscle strength; bone density; cardiovascular performance; neurologic performance and adaptability; mental and cognitive function; and proper hormonal regulation.

Barbell training is the most effective method due the progressive load on the skeletal system and the muscle pull which is exerted on the bone. It fights off frailty! It increases your body’s margin for error when illness or injury occurs. With proper guidance and the right exercise prescription/dosage, nearly everyone can improve in strength and benefit from weight training. To quote Mark Rippetoe, “Stronger people are harder to kill than weak people and more useful in general.”

Resistance training (other than through barbell training) can also be beneficial. An example of resistance training would be any type of pushing or pulling exercise that exerts a force on the muscle, which causes it to work harder than it would normally. The key to all training is that the system must be properly overloaded to produce the desired effect. Too little and you will not receive a positive benefit. Too much and you risk injury. This overload principle must guide all exercise routines if there is to be actual success and benefit from the program. Although any properly dosed/prescribed form of resistive exercise would be beneficial, the most effective exercises either activate large muscle groups and/or load the skeletal system. Examples include squats, lunges, and dead lifts.

High Intensity Training (HIT)

High Intensity Training (HIT) or High Intensity Interval Training (HIIT) involves performing short bursts (ranging from 30-60 seconds at a time) of activity followed by a 1-2 minute recovery. The 30-60 seconds should be at a high intensity, meaning that your rate of perceived exertion (RPE) is high and you’re breathing heavy.

The research involving HIT is ever evolving. Thus far, it appears that HIT may provide superior health benefits when compared to almost any other type of exercise. It has significant positive effects on hormone regulation, particularly Human Growth Hormone (HGH). It regulates insulin sensitivity and increases cardiovascular function (VO2 Max). It not only boosts metabolism, but it leads to greater fat loss than traditional forms of exercise.

There is ongoing research on its effects on all forms of chronic disease and illness, including Alzheimer’s disease, dementia, and cardiovascular disease. Preliminary evidence shows that HIT (when performed correctly) leads to superior benefits in much shorter bouts of exercise.

Walking after Meals

Diabetes and metabolic syndrome are major contributors to cardiovascular disease and most neurologic disorders, such as dementia. Heart disease remains the number one killer in men and women today. Regulation of blood sugar and insulin levels is such a critical aspect of being healthy in today’s sedentary, high fructose corn syrup filled lifestyle. Proper blood sugar and insulin regulation should be a primary concern of anyone desiring to live a long healthy life.

Walking after meals has been shown to stabilize blood sugar levels. It’s also an excellent way to boost metabolism and connect with friends and family. Frequent walking is the most important physical activity a person can engage in.

Although there are many aspects (mental, social, financial, physical, spiritual, and emotional) to address in order to optimize your health span, it is clear that strength training, high intensity training (HIT), and walking after meals is critical in maximizing your health span and aging well.

What are some practical actions that you can take today to improve your health span? Please leave your comments below.

I would encourage you to sign up to receive each week’s blog post sent directly to your e-mail–making it even easier and more convenient! Advice will be related to physical therapy related topics; physical fitness and performance; health and nutrition; injury prevention and rehabilitation; and successful aging and elder care. I will provide useful and practical types of “how to” information, including methods to safely self-treat and manage common physical therapy related conditions. In addition, you will receive priority when submitting questions to be featured in an upcoming blog post by e-mailing contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Posted on Wednesday, October 21, 2015

My Top 3 Posts on How to Age Well

We are in the midst of a giant generational shift. During this shift, the Baby Boomers are rapidly approaching elder status. At the present pace, over 8,000 baby boomers are turning 65 every day! We have turned to science to find the fountain of youth to help us all live longer (without much success so far). However, health span is just as important as life span. How you spend your years is just as (if not more) important than your actual age. One of the most critical components to aging well and improving health span is physical activity.

Health care costs in the United States continue to outpace almost any other sector for inflation. Unfortunately, this increase in cost has not shown any actual positive change in health status. It is imperative that we all take a leadership role in our own health care by continuing to be proactive.

The Physical Therapy Advisor will continue to the lead the way in providing useful and practical types of “how to” information, including methods to safely self-treat and manage common physical therapy related conditions. My desire is to help you address the aspects of optimizing your life while promoting well-being in order to manage pain, improve mobility, and to age well.My Top 3 Posts on How to Age Well:

How to Age Successfully
My Top 10 Anti-Aging Tips
Why Walking is Critical for Your Health

The American Physical Therapy Association (APTA) has designated October as National Physical Therapy Month. This October, the content focuses on how physical therapy can help you to age well. You can also find local physical therapists (PTs) in your area as well as search for general advice on many physical therapy related conditions at MoveForward.

What does aging well mean to you? How can I help you in this endeavor? Please leave your comments below.

Posted on Wednesday, October 14, 2015

Inactivity Kills

Physical inactivity is responsible for more than twice as many deaths as obesity. A recent study of both men and women over a 12 year period of time clearly determined that inactivity does indeed lead to an untimely death. Increasing your activity level to 20 minutes a day of brisk walking is enough to significantly reduce your risk of death. This was true in those who were obese and normal weight as indicated in the study.

Other recent research indicates that sitting for more than two hours at a time can significantly lessen your life span. Even if you regularly exercise, sitting for more than two hours a day will still lower your life span. Frequent movement throughout the entire day is critical for your health.

Research is clear on the topic of activity. We are designed to be mobile. Regular activity has been clearly shown to:

Reduce the risk of diabetes.
Reduce the risk of heart disease.
Prevent Alzheimer’s disease.
Improve bone density.
Increase and maintain muscle strength, which is strongly correlated to independence in your environment and reducing the risk of falling.
Improve and maintain balance, which is critical to reducing the risk of falling.
Maintain proper hormone levels.
Reduce stress.
Increase feelings of well-being.
Reduce pain levels.

This is not an exhaustive list of the benefits of regular activity. Exercise and regular activity are critical to maintaining a healthy lifestyle. Frequent activity and movement throughout the day is best. Choose a form of activity and exercise that you enjoy and keep it as part of a lifelong pursuit.

What is your favorite form of exercise? Please leave your comments below.

Looking for relevant senior related resources in your community? The Seniors Blue Book is full of relevant resources for seniors as well as helpful articles on successful aging and elder care.

(This article first appeared in the Seniors Blue Book, October-December 2015, pages 106 and 107.)

Posted on Wednesday, October 7, 2015

Chronic Pain: Is There Hope?

By Jerry Henderson on October 7, 2015.

It is clear that to me that there is a chronic pain epidemic in this country. My belief was confirmed by some disturbing results from a cross sectional survey of over 27,000 people on the prevalence of pain. The study was conducted by Johanne and associates in 2012[i] and it showed:

Approximately 30% of the respondents had long lasting chronic pain or recurrent pain, and:
- Most had either lower back pain (8%) or pain from other osteoarthritic conditions (4%).
- Half had daily pain.
- About 1/3 of those reported their pain as severe (at least 7 on a 0/10 verbal pain rating scale).
Prevalence increased with age, lower socioeconomic status, and unemployment.

An Institute of Medicine report estimates that 116 million Americans suffer from chronic pain and that the combined medical and financial cost due to lost productivity is $635 million per year,[ii] which is more than the annual costs of cancer, heart disease, and diabetes.

Describing Chronic Pain

There are many definitions of chronic pain, but one of the most widely accepted is any pain lasting longer than 12 weeks. Experiencing pain for longer than 12 weeks is simply not normal. In contrast, acute pain, that is, pain lasting for a shorter period of time, is our internal warning system about serious tissue damage.

Think about the difference between the qualities of the pain you experience from a minor skin cut compared to the pain you have probably experienced at some time in your life from your lower back.

The pain from a skin cut feels sharp. You can tell, without looking where the cut is on your skin, and you can estimate whether or not the cut is serious. The lower back pain may initially feel like a sharp, stabbing pain, but after a few days it often develops into a deep aching. You don’t have a good idea of how badly you are hurt, and you have a hard time describing where it hurts. In fact, the location of the pain may change over time.

As the skin cut heals, the pain resolves quickly. As the low back heals, the pain may resolve quickly, but (for reasons that are not well understood) it may not. That deep, aching pain may just continue for weeks, and it may cause complex changes in your brain chemistry that make it even worse. Over time, this type of pain builds on itself to the point that in the worst cases it becomes completely disabling and is often associated with clinical depression.

I often told my patients that pain of this sort is a liar. It may provide important clues about the source of the problem, but that’s all–just some clues. Other than clues, we shouldn’t rely too much on this type of pain to tell us much of anything.

“If I Had a Hammer….”

The old saying, “If you have a hammer, everything looks like a nail,” holds true for chronic pain treatment. The physician tool chest (which includes narcotic medications, injections, surgery, and imaging studies) seems to be woefully inadequate at treating this type of pain.

Use of narcotic medications works great for acute pain, but they are dangerously addicting and have other perverse side effects like making clinical depression associated with chronic pain even worse in some cases. In my experience, the term “Pain Clinics” is often code for drug rehabilitation for patients who have been addicted to narcotic pain medications for their chronic pain.

The dismal record of surgery, particularly spinal fusion, for low back pain is well documented. The New York Times reported on a recent study from the Journal of the American Medical Association indicating that injections for non-specific lower back pain are ineffective, even though they are done routinely[iii].

What is the Answer?

Chronic pain is pervasive, disabling, and costly. It causes untold suffering. It can rob patients of their livelihoods. Typical care for chronic pain isn’t very effective. I believe that physical therapy is the best treatment available.

I find this excerpt from an article published by the National Institutes of Health very telling:[iv]

Self-management of chronic pain holds great promise as a treatment approach. In self-management programs, the individual patient becomes an active participant in his or her pain treatment—engaging in problem-solving, pacing, decision-making, and taking actions to manage their pain. Although self-management programs can differ, they have some common features. Their approach is that the person living with pain needs help learning to think, feel, and do better, despite the persistence of pain. Improving communication with the healthcare provider is part of that empowerment.

Through NIH-supported research, starting successful self-management programs has reduced many barriers to effective pain management, regardless of the underlying conditions. Individuals who participate in these programs have significantly increased their ability to cope with pain. They improve their ability to be active, healthy, and involved members of their communities. In fact, new research suggests that the best self-management programs teach people different ways of thinking about and responding to pain, making their actions to relieve it more effective.

Read that excerpt carefully. Doesn’t that sound like physical therapy?

Physical therapists need to take the lead on being the providers of choice for these types of problems. No one can do it better.

[i] http://www.ncbi.nlm.nih.gov/pubmed/20797916

[ii] http://www.amednews.com/article/20110708/profession/307089996/8/

[iii] http://well.blogs.nytimes.com/2013/07/18/looking-for-alternatives-for-back-pain-relief/

[iv] https://www.nlm.nih.gov/medlineplus/magazine/issues/spring11/articles/spring11pg5-6.html

About Jerry Henderson

Jerry Henderson has been a physical therapist for over 25 years and is passionate about providing his PT colleagues with proven processes and state of the art systems to enable them to excel in delivering excellent patient care. He currently serves as VP for Clinical Community at Clinicient, Inc. http://www.clinicient.com/

Posted on Wednesday, September 30, 2015

How to Apply Kinesiological Tape When Treating Achilles Tendinitis

In this video, I demonstrate one method I use to tape when treating Achilles tendinitis. I recommend following these step by step instructions for Kinesiological Taping for Achilles Tendinitis. For application and removal tips, please refer to Skin Care with Taping.

For specific strategies on how to rehabilitate Achilles tendinitis, please refer to https://www.thephysicaltherapyadvisor.com/MTA. For more tips, check out my guest post, 15 Tips to Self-Treat Achilles Tendinitis, for the Marathon Training Academy.

Have you used Kinesiological tape to treat Achilles tendinitis? If so, how did it work for you? Please leave your comments below.