physical therapy

Post op Total Knee Arthroplasty (TKA)

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.

Orthopaedic/Orthopedic Protocol

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

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.

Tennis Elbow

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.

Thoracic Spine

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

Vibram Five Fingers Footwear

A recent article written by a physical therapist in British Columbia, Canada and posted on the BCLocalNews.com site claims that wearing flip flops often lead to plantar fasciitis. The article goes on to state that shoes with poor arch support such as flip flops and cleats are a common culprit when looking into causes of plantar fasciitis.

Included in the brief article is a nice general explanation of what plantar fasciitis is, why some people develop it, and some common physical therapy assessment techniques and treatments.

Not mentioned in the article is the possibility that perhaps people spend too much time in footwear that is actually too supportive. It could be that we rely too much on this artificial support rather than developing strong intrinsics and arches. Maybe a good recommendation would be to spend more time barefoot or wearing less supportive and more natural, barefoot-like footwear such as Vibram Five Finger shoes.

Read the full article here.

Tai Chi for OA

A recent study by the The George Institute for International Health has found that regular practice of Tai Chi can result in significant benefits to arthritis sufferers. They reported that Tai Chi has a positive effect on pain reduction and in reducing disability and that their study is “…the first robust evidence to support the beneficial effects of Tai Chi”.

The study is among the many that support the improvements that arthritis sufferers can experience through regular exercise.

The The George Institute for International Health is “an internationally-recognised health research organisation, undertaking high impact research across a broad health landscape.”

From: Medical News Today

OA Knee

A recent study published in the Australian Journal of Physiotherapy found that arthroscopic surgery  in osteoarthritic knees offered no significant benefits, when used in conjunction with physical therapy and medications as opposed to physical therapy and medications alone.

The subjects of the study had moderate to severe OA of the knee and did not experience improvements in physical function, pain or health-related quality of life when arthroscopic surgery was added to their regimen of physical therapy and medications.

Read the abstract

(from Pubmed)

According to medgadget – the internet journal of emerging medical technologies, the US FDA has just approved the use of the Scandinavian Total Ankle Replacement (STAR) system from Small Bone Innovations, Inc.. It is hoped that the new proceedure can replace the typical fusion proceedures that often result in less than ideal results.

From the article: “ This device offers another treatment alternative to fusion surgery, and more closely imitates the function of a natural ankle,” said Daniel G. Schultz, M.D., director of the FDA’s Center for Devices and Radiological Health. “For the first time in the United States, a patient may retain some ankle mobility with this non-constrained, mobile-bearing device.”