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.

Advance Physical Therapy can help facilitate rehabilitation after a total joint replacement.  Below is an example of one client’s physical therapy treatment following a knee replacement surgery; the goal of this progression was to help re-gain flexibility, knee extension range of motion and muscle activity.

Passive stretching for muscles in the back of the leg and knee is important.  The Gastrocnemius muscles attach across the back of the knee.  This picture (Figure 1) shows the client stretching these muscles by tightening muscles on the top of the thigh and also pulling his toes up towards him, bending the ankle.

Figure 1

Neuromuscular Re-education is performed early in the rehabilitation process. After surgery, the quadriceps muscles are weakened and inhibited.  This loss in muscle function impacts the ability to actively straighten and support the knee during walking.  Recent research provides evidence to support using electrical stimulation to help restore the muscle contraction activity; it can also help with the management of swelling after surgery.  The client in these pictures is shown receiving this treatment while lying down (Figure 2) and then in a seated position (Figure 3).

Figure 2: Quadriceps muscle neuromuscular re-education lying down

Figure 3:  Quadriceps muscle neuromuscular re-education in sitting

Functional muscle training promotes correct and coordinated muscle activity of the foot, ankle, knee and hip to restore efficient movement patterns.  The client pictured below is shown practicing shifting their weight up onto the right and left legs, a movement that occurs when we walk or step, (Figure 4).  Figure 5, shows the client stepping up onto their surgical leg.  This functional rehabilitation activity helps regain knee extension range of motion, muscle activity and balance.

Figure 4:  Weight shifting and balance activities for the right and left legs.

  Figure 5:  Step up activity onto the left leg to restore active knee and hip extension range of motion and muscle flexibility.

Written by Matthew Harwood PT, DPT, OCS – Physical therapist at Advance Physical Therapy

Lisa Howell provides a free Perfect Pointe Parent’s Manual, this is a must read for all parents whose child is ambitious and pursuing dance, here is a link to receive your copy:   http://www.theperfectpointebook.com/TheParentsManual/ 

Here are some links to ballet Youtube videos showing Lisa Howell (B.Phty)  working with ballet dancers:

1. http://www.youtube.com/user/lisahowell2
2. http://www.youtube.com/watch?v=eEACy8jt7Ko&feature=related
3. http://www.youtube.com/watch?v=wa-0NRMg8ZM&feature=relate

This 8 week introductory series will be taught by Caroline Demoise who has many years of experience teaching lay practitioners as well as instructors. Joe Belding PT and Susan Henning PT will assist her.

The 8 week series will start Thursday, March 15th, from 5:30 to 6:15 at our location in Chapel Hill.

Cost is $90. Call to register 932 7266.

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/

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

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.

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.

“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.

Where : Advance Physical Therapy, 77 South Elliott Road Chapel Hill, NC 27514

When: Saturday November19th from 10:00am to 2pm.

How you can register: Registration can be done on–line at http://www.fleetfeetcarrboro.com/recent-news/postural-restoration-clinic

About the presenter:
Matthew Harwood PT, DPT, OCS has been practicing at Advance Physical Therapy since September of 2010. He is a board certified Orthopaedic Clinical Specialist by the American Physical Therapy Association. Prior to moving to Durham in March of 2010 with his wife, he was living and practicing physical therapy in the Northern Virginia area. He has been practicing physical therapy for 8 years. He has completed 2 half marathons, most recently in Charlottesville, VA in Spring 2011, his first half was in Columbus, OH in 2008 “I began using Postural Restoration in my training for Charlottesville. I saw differences between my two races in regards to improved time and running performance. These concepts are valuable for any runner which is why I want to share them with you”. He is current in training with Fleet Feet for the Richmond Virginia 2011 full marathon.