physical therapy

Clinical Orthopaedics and Related Research recently published an article entitled “Quadriceps and Hamstrings Muscle Dysfunction after Total Knee Arthroplasty.” The article discusses a study of dysfunction in the quadriceps and hamstring muscles following Total Knee Arthroplasty (TKA).

Using bilateral isometric strength tests and EMG measures of quads / hams co-activation the study found that the difference in loss of strength between the muscle groups was not significant; both were weakened equally.

The authors claim that in post TKA rehab the hamstrings are often neglected  relative to the emphasis placed on quadricep strengthening and retraining. Their conclusion from this study is that the hamstrings should be included with the quadriceps as the primary focus in post total knee arthroplasty rehabilitation.

View the official abstract here.

Many physical therapists use orthopaedic/orthopedic rehab protocols frequently throughout their daily practice. Former Calgary Flames and Canadian Olympic Team Physical Therapist, Terry Kane, runs a website called OrthopaedicProtocols.com . The site links to dozens of orthopaedic/orthopedic protocol documents from all over the internet. The documents included come from sites such as:

• Advanced Orthopaedics and Sports Medicine
• Bringham and Womens Hospital
• Cappagh National Orthopaedic Hospital
• Cochrane Review
• WorksafeBC
• Massachusetts General Hospital
• Cincinnati Sportsmedicine and Orthopaedic Center
• Dr. Millet / Steadman Hawkins
• Gundersen Lutheran
• PureSportsMed
• University of Kentucky
• University of Minnesota Orthopaedics
• University Sports Medicine – University of Buffalo
• Massachusetts General Hospital
• Kevin Freedman MD, Orthopaedic Specialists

…and many more. Protocol documents available are varied,  from ankle sprains to post-op artificial discs and almost everything in between. Outcome and radiological documents are also available.

From the site:

Ownership / Editor: The site is 100% privately owned and edited by Licensed Canadian Physical Therapist, Terry Kane (www.terrykane.ca)

Authors: This database consists of hypertext links to protocols authored by licensed healthcare professionals or academic institutions. All protocols are currently part of the public domain on the internet or have been submitted by the authors themselves.

Mission: The site was designed to help students and clinicians find diagnostic, treatment and rehabilitative protocols to help them in managing their patients.  The protocols are not presented to replace the care and advice of a licensed healthcare professional but rather for educational purposes of healthcare professionals only. This website does not endorse any of the protocols presented, but rather, provides them as a library for visitors to access and evaluate for themselves independently.

Target Audience: The site was designed and authored for an audience of licensed healthcare professionals and students.

Terry has put together a very useful resource with this vast collection of protocols available online. Much can be learned from studying the differences and similarities between the many available. The site also offers the ability for practitioners to submit their own protocols to be added to the system.

One feature that I would like to see added to the site is the ability for site visitors to rate the various protocols available. Doing so would require that users register with the site, something that is not currently required or possible. I believe the lack of registration required is for ease of use and to prevent people from being concerned about privacy issues. However, I feel that allowing those interested in registering to give their ratings would make the site even better.

Check out the site at OrthopaedicProtocols.com

A great deal of snow has fallen in many parts of the world this year and with it has come the usual flood of shoveling-related injuries. The Omaha World-Herald has a timely story outlining many points that should be considered when venturing out to clear your walks and driveways. Some of the important ones include:

• know your limits
• set limits for yourself
• don’t lift if you can push instead
• avoid twisting
• wear footwear with good traction

Most of the tips are simply common sense but a quick reminder can often prevent unnecessary injuries. For more on these and other snow shoveling tips, see the original article here:

Omaha.com – The Omaha World-Herald: Living – The scoop on proper shoveling.

Knee Arthroplasty - side view

The Journal of Bone and Joint Surgery has a new review article titled ‘What’s New in Adult Reconstructive Knee Surgery.’ The review primarily discusses articles that appeared in The Journal of Bone and Joint Surgery (American Volume), The Journal of Arthroplasty, and select articles from Clinical Orthopaedics and Related Research in 2008.

Topics covered in the discussion include:

• Economic Factors and Performance Measures
• Unicompartmental Arthritis
• Surgical Approaches
• Computer Navigation in Total Knee Arthroplasty
• Perioperative Management
• Prophylaxis Against Venous Thromboembolism
• Outcomes After Total Knee Arthroplasty
• Complications
• Evidence-Based Orthopaedics
• Evidence-Based Articles Related

Read the full article here.

Boing Boing has an interesting article on the (fairly) new AlterG treadmill. From the article: “The AlterG is no ordinary treadmill, though. It is a super fancy, super-expensive treadmill that isolates the lower body in a vacuum and literally takes off percentages of your body weight using technology developed by NASA.”

The treadmill can significantly reduce stress through the joints during ambulation or running and allows the user to set what percentage of their body weight they have to support. It sounds like a great way to enable early rehabilitation or to allow physical activity for disabled and overweight people who might otherwise not be able to get effective cardiovascular exercise. It can also be used to allow injured athletes to train through injuries.

The treadmill looks futuristic and comes with a price tag that is also somewhat out of this world coming in at around $24, 500 USD. While this sounds expensive, it’s probably not that outrageous if you were to compare it to the cost of purchasing exercise equipment such as swimming treadmills which aim to acheiving similar goals.

The AlterG is supposedly showing up increasingly often in physical therapy clinics.

A bouncy, anti-gravity workout with the new AlterG treadmill – Boing Boing.

The New York Times has an interesting essay called ‘Physical Therapy and the Camaraderie of Healing.’ The essay discusses the relationships formed between patients and their physical therapists as well as between between fellow physical therapy participants. As author Caitlin Kelly points out, “Everyone ends up in PT.”

“Because we see them so frequently for months, we get to know our physical therapists, and they us, in ways we’ll never know our doctors.”

You can find it here: Cases – Physical Therapy and the Camaraderie of Healing – NYTimes.com.

A study published in the British Medical Journal BMJ suggests that a semi-hard collar or physiotherapy / physical therapy was found to be more effective than a ‘wait and see’ approach to care for radiating neck pain. The study was a randomized trial of 205 patients with early onset radiculopathy and was held in three Dutch hospitals.

The patients were in one of three groups, all of whom were allowed to use painkillers:
1) wore a semi-hard collar for 3-6 weeks

2) physiotherapy with home exercises for 6 weeks

3) wait and see

Physiotherapy treatment consisted primarily of mobilising and stabilising the cervical spine using ‘hands-off’ methods.

The recommedation coming out of the study was to choose the semi-hard collar over physiotherapy / physical therapy treatment as these two options both offered significantly better results than the wait and see policy for pain reduction but the collar was less expensive than the physiotherapy treatments. The study only looked at short term pain relief; it would be interesting to see what the more long term effects would be. It would also be interesting to see if a ‘hands-on’ physical therapy approach would produce even greater benefits to the patients.

See the fully study here.

Published 7 October 2009, doi:10.1136/bmj.b3883
BMJ 2009;339:b3883

The Wii has been been a top seller in the game console market for years and continues to become more prevalent in homes around the world. Unlike gaming systems such as the Xbox and the PS3, playing games on the Wii often involves more gross motor skills than fine motor skills. Used correctly this makes the Wii potentially effective in improving coordination, balance, range of motion as well as general strength.

Physical therapists are increasingly bringing the Wii into the rehabilitation setting. Patients see it as a great alternative to often boring and repetitive exercises programs. The incorporation of gross limb and body movements into a game setting seems to keep patients much more engaged.

Popular therapy games include tennis and bowling as well as games like ‘Wii Fit’ which directly focused on actual balance and strength training. Not only can these games can be played individually but they can also be played by multiple players at the same time, which can increase engagement even more.

The Wii is being used in many different rehabilitation settings such as basic health maintenance in the elderly, youth physical therapy, stroke rehabilitation, post-surgical rehabilitation and brain injury rehabilitation. Clinicians feel that the benefits are even more broad and may aid in stress reduction as well as offering benefits to the treatment of diabetes, asthma and even heart disease. An early case study in PT Journal found that the rehabilitation program of a of a cerebral palsy when augmented with the Wii resulted in “positive outcomes at the impariment and functional levels”.

The price point on the gaming systems is very appealing as well. In an industry where equipment is usually very expensive, the appeal of the small $250 cost of a console, a cost that includes several games and a controller, is hard to deny. Most equipment in a rehab setting is very specialized for the small rehabilitation market; small in relation the the mass appeal of a commercial product like the Wii.

As the Nintendo Wii becomes more prevalent in the treatment programs for many conditions there is one condition that we may see begin to proliferate; the dreaded ‘Nintendonitis.’

A small trial recently showed that a simple eccentric wrist twist exercise can be very effective in the treatment of ‘tennis elbow’ ( lateral epicondylitis ). Adding these simple exercises to a home program dramatically improved functional scores and pain reduction.

The exercise can be performed anywhere and serves the same purpose as very expensive isokinetic machines. Instead of expensive machines the exercise involves the use of a small rubber bar similar in size and shape to a baton used in running relay races. Using the rubber bar, “twist with the wrist of their uninjured arm and then slowly untwist with eccentric wrist extension of the injured arm over a period of about four seconds. Three sets of 15 repetitions were scheduled each day.”

The trial was reported at the annual meeting of the American Orthopaedic Society for Sports Medicine in Keystone, Colo.

Read more at Medpage Today.

A recent article on Dynamic Chiropractic entitled “Update on Manipulation and Exercise – What the Research Says” discusses research examining the connection and synergistic effects of combining spinal manipulation with exercise. While the article does state that not all research finds a positive synergistic effect between the two, it goes on to state that it is “purely logical” that spinal manipulation will have a positive effect on exercise.

A number of studies are briefly discussed, including studies that involved participation of chiropractors, physical therapists and osteopaths performing the spinal manipulations and/or administering exercises. It is interesting to note that one study of patients with chronic low back pain (CLBP) or chronic neck pain (CNP) found “Sixty-four percent of physical therapy patients were prescribed exercise, compared to 33.1 percent of DCs and only 14.4 percent of MDs/DOs.”

Read the full article