Ask A Doctor - Physical Therapy

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Q.
What type of physical therapy is administered after partial knee replacement surgery?
A.
A partial knee replacement involves replacing only the inner or the outer half of the knee. This involves less surgical cutting and may have a quicker recovery time. In the few weeks following surgery our role in physical therapy is very much like the total knee replacement of restoring mobility and reducing pain/swelling. The long term goals is to have our clients be able to walk smoothly, negotiate stairs and return to recreational activities. This is accomplished through an individually designed therapeutic exercise program.

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Q.
How long is the recovery period after a full total hip replacement and what kind of therapy is administered?
A.
Recovering from a total hip replacement is different for everyone due to many factors including the surgical procedure, pain, age, fitness level, other medical conditions, and lifestyle. Physical therapy can last up to 6-8 weeks and focuses on education for self care and exercise for strength, flexibility, and recovery of function. 80% recovery is expected at about 3 months when post operative restrictions are lifted. You and your physical therapist will establish goals that will fit your lifestyle. You will continue to gain in strength and confidence over several months. Maintaining a home exercise program upon discharge from physical therapy is highly recommended to ensure good stability to your new hip.

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Q.
Lately my knees seem tight and painful when bending. I have never had knee problems or injuries - can physical therapy help?
A.
The knee consists of bones, cartilage, ligaments, muscles, tendons, nerves and blood vessels that come together to form a rather complex joint. Typically most individuals think of the knee as a “hinge joint” that only allows for bending and straightening. However, the joint also moves in rotational and side to side motions during our normal activities. Furthermore, when going about our functional activities, such as walking, climbing stairs and squatting, the knee is assisted by the ankle from below and the hip from above. A physical therapist can perform a thorough evaluation to deterimine if in fact the cause of your pain is musculoskeletal in nature. An individualized treatment program will be designed by your therapist to address those findings. This would most likely consist of specific stretching and strengthening exercises.

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Q.
I am a 51 year old man with a right adductor tear and some scar tissue. What additional things can I be doing to assist my rehab other than rest and massage? Is there a typical/average time to get back on the field? What is the best strategy for preventing this in the future?
A.
The hip adductor muscles are located in the upper inner thigh region and their main job is to move the femur (thigh bone) inwards. Once your pain has significantly reduced gentle stretching should be started, focusing upon the hip/groin and knee musculature. Avoiding lateral movements, pivoting, twisting, and quick directional changes are recommended. As you feel fewer symptoms, aerobic conditioning should be maintained by cross-training with low impact activities such as deep water running, elliptical or biking. Furthermore, a common rehabilitation error is to solely focus upon the injured region; therefore, it is critical than you condition the muscles above and below the adductor muscles (i.e. trunk muscles, gluteals, and knee muscles). Consultation with a physical therapist will help you with an effective program. Depending on the severity of the tear and health and fitness level, an injury like this may take 6-12 weeks to rehabilitate. In order to reduce the susceptibility to re-injury care should be taken to perform a pre-and post-exercise / sporting activity stretching regimen.

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Q.
About 3 months ago I had a knee dislocation on my left knee. After the knee was put back in place, I wore an external fixture for about 2 months. It has since been removed and I can’t seem to bend my knee all the way back to sit down. I can only do about 40%. I am assuming since my leg was straight with the rods it stiffened, however how do I get it to bend again, it’s really stiff?
A.
The knee joint needs to move normally to be healthy. If you have not had any physical therapy following your time in the brace, it’ is important that you start. When the joint is immobilized muscles, tendons and ligaments all tighten. A certain amount of tightening is desired so the knee no longer dislocates. Your physical therapist will instruct you in the proper method and sequence of exercises to move the knee joint without causing more knee problems yet allow it to move normally.

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Q.
I was recently diagnosed with a pulled muscle and slight dislocated rib. Could physical therapy help alleviate the pain?
A.
Lifting, sudden twists and turns can strain muscles in the rib cage area. Occasionally the muscle can create stress on the rib attachment to the spine. The physical therapy evaluation will identify the injured structures. If it is muscle only, soft tissue techniques will be used to relieve tension and allow for normal function. If the rib is still slightly dislocated, manual therapy will help ease it into proper position. You will be given self care instructions as well as specific home exercises to ensure full healing.

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Q.
On September 15th of this year, I underwent a procedure to repair a posterior root avulsion of the medial meniscus and Grade IV chondromalacia patella on my left knee. The surgeon used a tunnel procedure to reattach the meniscus. I attend physical therapy weekly. I can bend my knee to 120 degrees and can extend it to the same extent as my normal right knee. However, after each therapy session, my knee swells considerably. Is this normal ten weeks post surgery?
A.
Your surgery was not simple. Both the meniscus repair and the patella work will take time to heal fully. Pain and swelling after a surgery like yours is not unusual. At ten weeks the assumption is that you are performing more advanced rehabilitation exercises, and that in itself may cause increased swelling. If a significant increase in pain accompanies the swelling, your program may need to be modified. If pain is decreasing and strength, motion and weight bearing are increasing, your swelling is less concerning to me. Make sure you also get satisfactory information from your physical therapist and surgeon.

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Q.
I’ve had 2 shoulder operations since Jan. 15 and I saw my doctor today and I am out of my sling. I asked when I start therapy, he said I should work it out at home. Is that normal?
A.
From a physical therapist’s perspective, a course of physical therapy would be rendered after most orthopedic surgeries. After a shoulder surgery, whether it is routine or highly involved, there is a great probability that your shoulder mechanics may have been affected and that you are experiencing post-operative pain. Physical therapists are experts in human movement and are trained to identify abnormalities in human mechanics. In addition, physical therapy can treat faulty shoulder mechanics and post-operative pain through manual therapy, therapeutic exercise, and modalities (i.e. electrical stimulation, moist heat, and ice). After a comprehensive physical therapy evaluation, the therapist will determine how to approach your shoulder rehabilitation. For example you may be a candidate for a course of formal physical therapy or be treated through instruction in a home exercise program with periodic office visits. In your specific case, consultation with a physical therapist would be strongly recommended in order to get you on the appropriate therapeutic track.

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