The physical therapy providers at Advance Physical Therapy can help you after your orthopaedic knee surgery. We will communicate directly with your surgeon to understand the type of surgical procedure performed and obtain guidelines and post-surgical protocols for your rehabilitation progression. Our providers follow the most current concepts in orthopaedic surgical knee rehabilitation.
After knee surgery, the muscles on the front of the thigh can become weak. This can be due to swelling in and around the knee joint. In the below picture, the right knee shows quadriceps muscle inhibition compared to the non-surgical left knee. This patient is 2 weeks after surgery.
Relearning how to put weight on the surgical leg is a first step towards recovery after knee orthopaedic surgery. After surgery, patients may need to wear a protective brace and use crutches for 3-6 weeks until the muscles and tissues have healed enough to tolerate use with walking, stair climbing and other weight bearing activities. In the below picture, the patient is practicing weight bearing in a seated position wearing their brace.
Unless restricted by the surgeon, early weight bearing using 2 crutches and wearing a brace helps to limit muscle disuse throughout the hips and legs. Without the brace and both crutches, the surgical limb could not support the weight of the body during daily activities.
Practicing how to climb stairs or navigate a curb is an early rehabilitation activity practiced in physical therapy. The patient uses both crutches and wears the brace to help ensure protection of the healing knee. When going up stairs, the patient learns to use the non-operative leg to push up with. When going down stairs, the patient lowers down with the surgical knee first, followed by the non-surgical knee.
Written by Matthew Harwood, PT, DPT OCS. Physical therapist at Advance Physical Therapy.
A recent study published in the journal of Health Services Research found that patients, who visited a physical therapist directly, without first seeing a physician, had fewer visits and lower overall costs than those referred by a physician for physical therapy. These costs were to the global health care system. Also, after 60 days, there was no difference in health care use in persons who accessed physical therapy services indirectly or directly. Study’s like this, support the notion that physical therapy services when accessed directly can be safe and effective. Read our other blog, to learn more about Direct Access and how it can work for you!
Here are some internet links that support direct access to physical therapy services:
http://www.apta.org/Media/Releases/Consumer/2011/10/13/
http://www.wtaecom/r/18891143/detail.html
http://www.bendbulletin.com/article/20111103/NEWS0107/311039998/
Throughout the years, APT has taken pre-physical therapy major college students from UNC. During their affiliation we try to create an experience that fosters critical thinking, direct patient interaction and self reflection. One of our interns has written about her experiences at APT, she started volunteering with us in September of 2011 and will be applying to physical therapy programs in the fall of 2012. Here is what she has written:
I am currently a student at UNC and have been a volunteer at Advance Physical Therapy since September of 2011. The first thing I noticed about the practice was the relaxed and friendly atmosphere. The therapists are passionate about their work and genuinely invested in teaching students. They actively find opportunities for volunteers to observe, and afterwards they gladly answer questions and offer explanations for anything that needs clarification. I appreciate how the therapists at Advance PT also facilitate further investigation and research. I am motivated to understand why certain techniques work, how they work, and for what population they are used. Each week, I leave inspired to explore what I had observed. I am also required to journal about my observations each week, which is reviewed by a therapist and has been a useful tool for learning to clinically. Since starting as a volunteer, I have also noticed a shift in the way I think about the body. Anatomy, physiology and biomechanics courses are the essential backbone for a career in physical therapy, but they can’t substitute for witnessing, in person, the progression among patients week after week. It has demonstrated to me the interdependent nature of the body and the importance of critical thinking during evaluations. Additionally, Advance PT offers a variety of specialized techniques that volunteers are able to observe, which has help me form a clear idea of the type of therapy I would eventually like to specialize in.
I have really enjoyed volunteering at Advance PT, and each week I look forward to my time there. It has given me a chance to learn about things that I wouldn’t have learned in class. I admire the work that the therapists do for their patients and for their volunteers, as well as the philosophies that they teach. Overall, Advance Physical Therapy has given me a foundation for a future career as well as a greater awareness of my own body. It has been, in every aspect, the most positive volunteer experience I have had thus far as an undergraduate and aspiring physical therapist.
-Holli McClendon, Junior at UNC-Chapel Hill
Most persons wanting to access physical therapy services can do so without a physician’s referral. North Carolinalaw allows for “Direct Access” to physical therapy services; North Carolinahas had this law since 1985. This can save you time and money, by accessing the healthcare services that will help you feel better, sooner.
Person’s coming to physical therapy will present with a variety of signs and symptoms. Through appropriate medical screening and special testing, the physical therapist can evaluate a person’s medical condition, assess their physical therapy needs and, if appropriate, initiate a plan of care to treat the condition. When the client’s condition requires care beyond the scope of physical therapy practice, referral is made to the other health care professionals for consultation.
The physical therapists at Advance Physical Therapy welcome persons to call us, email us or just come in “off the street” to ask questions about whether physical is appropriate for them! Some insurance providers, including Medicare, do require a physician prescription before seeing a physical therapy provider. We will work closely with you to direct the health care you need.
This Tai Chi based practice was developed by Dr. Paul Lam to enable people with physical challenges to incorporate the health and balance benefits of Tai Chi into their lives. It is a short gentle version that can be practiced by anyone at their own level of comfort.
The 8 week introductory series will be taught by Caroline Demoise who has many years of experience in teaching lay practitioners as well as instructors.
The 8 week series will start Thursday, January 12th, from 12 to 12:45pm at our location in Chapel Hill.
Cost is $90.00. Please call 932 7266 to register.
By Matthew Harwood, PT, DPT, OCS
“The purpose of this blog is to show that physical therapy initiated after a surgery is focused on caring for the client’s concerns about walking, restoring movement and foot usage and managing the healing process. In the example below, this client had experienced many years of recurring pain before having surgery. The information in this blog is based on a real client seen in 2011, the identification of the person has been modified only.”
A client, J.W., had surgical decompression of the Tarsal Tunnel of her right foot in late February 2011. Prior to surgery, their medical condition had caused significant pain and functional limitations for 3 years. Her symptoms began in the heel and arch, would gradually worsen throughout the day and were present at night. Sitting did not provide relief. She was an avid power walker, which she enjoyed doing on a lake path around her home. Her physical therapy was started 1 month after the surgery. Since surgery she had been wearing a protective boot and using 2 crutches for walking. Her surgeon did not want her to put any weight through the foot for 2 month. Her rehabilitation goals were to walk around her neighborhood the mall with her daughter without pain. She also wanted to wear regular shoes again. She expressed fear about putting weight through the arch of her foot, as this was what caused pain before surgery.
During the initial evaluation, she was unable to place her right heel on the ground when standing out of the boot. She had swelling around the incision and ankle. Restrictions were identified in the ankle joint and muscles. Active movement was restricted on the right ankle because of the pointed position her foot was kept in while wearing the boot. The tissue around the incision was stiff and painful when touched.
In standing, the client is unable to place the right heel on the ground.
Physical therapy treatments were started the first day. A home program was established to help the client restore movement in her ankle, improve flexibility and gently promote putting weight through her foot and arch.
Stretching activity using towels to help restore flexibility and motion
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Gentle weight bearing activity using towels.
At her second visit, she was feeling better about putting weight on her involved foot and stated her pain was improved. She could move her ankle and foot more than at the first visit. She was using pain management strategies of elevating the foot, warm foot soaking and icing at home. She was starting to walk in her home with the crutches but without her boot. When walking in the community she kept the boot on and used crutches.
Paul and Marlene Zweig from Denver,CO, will come again this year to perform a workshop in ‘Sensory Awareness’.
Sunday, November 6th, 10-4:30.
Cost is $60.00
Please register with us at 932 7266
They will also be at the Chapel Hill Zen Center on Fri Nov 4th from 7pm to 9pm and Sat, Nov 5th from 9:15 to 4:30 pm.
You can find our new page for running expertise from the home page. Click on sports/fitness and the option will appear.
http://advance-physicaltherapy.com/postural-restoration-running-program
This coming weekend we are going to host the Pelvic Floor Restoration course for the Postural Restoration Institute.
38 Physical Therapists are attending, mostly local and from surrounding states.
At our last staff meeting we were sharing the variety of orthopaedic concerns which we as a group have been treating over the past half year. It turns out to be a huge variety.
Our client base is as varied, including people of all age ranges and activity levels, from school aged adolescents to working professionals and athletes.
Here is our list::
• Carpal tunnel syndrome
• Wrist fracture
• Dequervain’s Tenosynovitis
• Tennis elbow
• Biceps tendonitis/osis
• Rotator cuff tendonitis/osis
• Post surgical rotator cuff repair
• Rotator cuff strain
• Calcific tendonopathy
• Frozen shoulder/ Adhesive capsulitis
• Inflammatory arthritis of the shoulder
• Cervical radiculopathy
• Motor vehicle accident related neck and shoulder pain.
• Temporomandibular joint dysfunction
• Pectus
• Thoracic spine kyphosis
• Scoliosis
• Osteoporosis
• Fibromyalgia
• Chronic pain
• Low back pain
• Lumbar Radiculitis
• Lumbar HNP (Herniated Nucleus Pulposus)
• Sciatica
• Sacroiliac joint dysfunction
• Post surgical ORIF of hip joint
• Post surgical Total hip replacement
• Trochanteric hip bursitis
• Anterior hip impingment
• Iliotibial band syndrome
• Hamstring strain
• Post surgical ACL reconstruction
• Post surgical knee meniscus repair
• Post surgical knee arthroscopic debribedment
• Patellofemoral pain syndrome
• Anterior knee pain
• Genu Varum
• Genu Valgum
• Gastrocnemius muscle strain
• Shin splints
• Lateral ankle sprain
• High ankle sprain
• Distal fibular fracture
• Plantar fascia tear
• Pes planus
general | apt-admin April 11, 2012 | 
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