HR 101

“We must recognize that each one of our employees comes to us with a unique personality and a backlog of experiences that will influence the way they work.”
My experience at Sam’s Club plays a large role in my choices as a physical therapist. Sam Walton was still alive during my first years working for the company. There were some major rules that we had to follow as employees of Sam’s Club. The first rule is the 10 foot rule. This means that any time that I come within 10 feet of a Sam’s Club member I must make eye contact and acknowledge that person. It seems so simple to just give a hello, but we all know that customer service is lacking in many companies. Customer service is the reason we are doing what we are doing. Without the customer we have no income. In healthcare, we can substitute the word customer with the word patient. Without the patient I have no income. I need to ensure that that patient is well taken care of, and that starts just by acknowledging that the patient is a person. Other things that I learned from Sam’s Club is that hard work is rewarded. I was given many merit raises during my first three years at the store. In 2003 I was the best employee out of the 200 employees. This is not subjective on my part, but I was awarded with the employee of the year award. At that time I knew I had to quit. This is another thing that I learned about myself while working at Sam’s Club. I have a drive to improve and to consistently and constantly get better. Once I have reached the top of a certain position, then it is time for me to try new things and strive to be the best. 
“… More than 30,000 physical therapy jobs that will go unfilled in 2016, it is difficult to understand why a practice owner wouldn’t make the effort to appropriately care for their therapist.”
It is easier to take care of the good people that you have working for you than to find a good person In the sea of applicants to a business.  
“Daniel Pink, In his wonderful book, Drive: the surprising truth about what motivates us, point out that people want to believe they are contributing to something meaningful.”
When I worked for Sam’s Club, we had a core group of people that we would go to bat for. We worked hard in order to make up for any shortcomings of the people that were around us. When everybody is pulling in the same direction, great things can be done. I believe that. At the time I worked at Sam’s Club we were doing great things. I currently work with a group of people at small community-based hospital in which we all have our niches. We are all really good at our specific specialties and it is fun to be a part of this team. We don’t have the newest equipment, but we are all share a passion for patient care. It is demonstrated in both our outcomes and our patient satisfaction. We are playing our part in the changes that are occurring in healthcare, which emphasize patient outcomes and improving overall health status.
“Creating strong company values, and a clear mission statement, are necessary to motivate and engage staff. Period. More than 70% of all employees were disengaged at work. Disengaged employees tend to create drama… And subtly communicate their unhappiness to patients.”
This correlates with the old saying idle time will provide for the devils handiwork. If we have something to do and are passionate about doing that activity, we will provide customer service. We have to be engaged more with our patients than with our cell phones or Facebook. 
” Pink suggest that most people are innately motivated by autonomy. Essentially his philosophy is that we should hire good people and let them do their job.”
I love this quote! The problem though is that not all companies hire good people. When you surround yourself with people who are going the extra mile, they push you to go the extra mile. I would much rather play on a team with scrappers, then play on a team with a bunch of superstars. My job is to make my teammate better and their job is to make me better, in the end the patients get better because of the team.
“Too often we repetitively train, and retrain, an employee who is falling short rather than letting them go in order to preserve the overall atmosphere within the clinic. As difficult as it is to terminate an employee, we must put the needs of the whole clinic above the negative behavior of one person.”
This couldn’t be said any more clearer. Politics unfortunately cloud judgment. Legalities cloud judgment. Dave Ramsey has said it many times over if I wouldn’t re-hire that person, then that person should no longer work here.
Excerpts from:

Stamp K. HR 101: The art of managing people. IMPACT. Aug 2016:29-30. 

Outline to back pain presentation

žCentralization

žCentralization, although first described by McKenzie14, has been replicated in multiple research studies15,16,17.

žCentralization is the movement of symptoms from an area distal to the spine to a more proximal segment14,18.

žPeripherilization is the movement of symptoms, originating from the spine, from a more proximal and central location to a more distal location14.

žThe centralization phenomenon, when produced in patients, correlates with good outcome9,10,18,19.

žPatients presenting as non-centralizers are six times more likely to require surgical intervention19.

žCentralization is shown to highly correlate with a discogenic lesion20.

žOTHER CONSIDERATIONS

  • Spinal Stenosis= reduction of the surface area of the spinal canal or foramen

–No clinical feature or diagnostic test can confirm that stenosis is the cause of symptoms

–A literature review determined that “all studies favored decompressive surgery for improvement of pain, function and quality of life, as well as in terms of patient satisfaction” compared to conservative care24

  • The advantage of surgery was noted within 3-6 months and remained constant for up to 4 years.
  • Surgery is more cost-effective for this group of patients
  • Appropriate for patients that have not improved with 12 weeks of conservative care.

žEPIDURAL STEROID INJECTIONS

žThere are multiple systematic reviews demonstrating that ESI’s can be effective in the short term and long term for managing back pain for both discogenic pain and stenotic pain21,22

žFollowing an ESI, about 45% of patients then demonstrate centralization and report 90% satisfaction of results after 1 year23

žAny questions?

žreference

1.Garzillo MJD, Garzillo TAF. Review of the Literature: Does Obesity Cause Low Back Pain? JMPT 1994;17(9):601-604.

2.Hill JC, Whitehurst DGT, Lewis M, et al. Comparison of stratified primary care management for low back pain with the current best practice (STarT Back): a randomised controlled trial. Lancet. 2011;378:1560-1571.

3.Walker BF, Williamson OD. Mechanical or inflammatory low back pain. What are the potential signs and symptoms? Manual Therapy 2009;14:314-320.

4.Fritz JM, Cleland JA, Speckman M, et al. Physical Therapy for Acute Low Back Pain: Associations with Subsequent Healthcare Costs. Spine 2008;33(16):1800-1805.

5.Shin G, Mirka G. An in vivo assessment of the low back response to prolonged flexion: Interplay between active and passive tissues. Clin Biomech 2007;22:965-971.

6.Kelsey JL, Githens PB, White AA, et al. An Epidemiologic Study of Lifting and Twisting on the Job and Risk for Acute Prolapsed Lumbar Intervertebral disc. J Orthop Research 1984;2:61-66.

7.Pople IK, Griffith HB. Prediction of an Extruded Fragment in Lumbar Disc Patients from Clinical Presentations. Spine 1994;19(2):156-158.

8.Natural history of lumbar disc hernia with radicular leg pain: Spontaneous MRI changes of the herniated mass and correlation with clinical outcome. J orthopedic surg 2001;9(1):1-7.

9.Long A, Donelson R, Fung T. Does it Matter Which Exercise? A Randomized Control Trial of Exercise for Low Back Pain. Spine 2004. 29(23):2593-2602.

10.Long A, May S, Fung T. Specific Directional Exercises for Patients with Low Back Pain: A Case Series. Physiotherapy Canada 2008;60:307-317.

ž

  1. Kovacs FM, Urrutia G, Alarcon JD. Surgery Versus Conservative Treatment for Symptomatic Lumbar Spinal Stenosis: A Systematic Review of Randomized Controlled Trials. Spine 2011;36(20):1334-1351.
  2. Urquhart DM, Bell R, Cicuttini FM, et al. Low back pain and disability in community-based women: prevalence and associated factors. Menopause 2009;16(1):24-29.
  3. Konstantinou K, Dunn K. Sciatica: Review of Epidemiological Studies and Prevalence Estimates. Spine 2008;33(22):2464-2472.
  4. McKenzie R, May S. The Lumbar Spine: Mechanical Diagnosis and Therapy. 2nd ed. Waikanae, New Zealand: Spinal Publication Ltd;2003.

15.Delitto A, Cibulka MT, Erhard RE, et al. Evidence for an extension-mobilization category in acute low back syndrome: A prescriptive validation pilot study. Phys Ther 1993;73:216-228.

16.Donelson R, Silva G, Murphy K. The centralizaiotn phenomenon: Its usefulness in evaluationg and treating referred pain. Spine 1990;15:211-215.

17.Donelson R, Grant W, Kamps C, Medcalf R. Pain response to sagittal end-range spinal motion: A multi-centered, prospective randomized trial. Spine 1991;16:S206-212.

  1. Werneke MW, Hart DL, Cutrone G, et al. Association Between Directional Preference and Centralization in Patients with Low Back Pain. JOSPT 2011;41(1): 22-31.
  2. Skytte L, May S, Peterson P. Centralization: its prognostic value in patients with referred symptoms and sciatica. Spine 2005;30(11):293-299
  3. Laslett M, Oberg B, Aprill C, McDonald B. Centralization as a predictor of provocation discography results in chronic low back pain, and the influence of disability and distress on diagnostic power. Spine Journal 2005;5:370-380.

ž

  1. Manchikanti L, Kaye AD, Manchikanti K, et al. Efficacy of epidural injections in the treatment of lumbar central spinal stenosis: a systematic review. Anesth Pain Med. 2015;5(1):e23139.
  2. ManchikantiL, Buenaventura RM, Manchikanti K, et al. Effectiveness of therapeutic lumbar transforaminal epidural steroid injections in managing lumbar spinal pain. Pain Physician. 2012;15(3):E199-245.
  3. van Helvoirt H, Apeldoorn AT, Ostelo RW, et al. Transforaminal Epidural Steroid Injections followed by mechanical diagnosis and therapy to prevent surgery for lumbar disc herniation. Pain Med. 2014;15(7):1100-1108.

ž

If the shoe fits

  • SHODDY FOOTWEAR

Understanding the difference among shoes with regards to function

Vincent Gutierrez, PT, MPT, cert. MDT

  • OBJECTIVES

1.To briefly relate the history of the modern athletic shoe

2.To explain the differences regarding functionality among dress shoes, classic footwear, minimalist footwear and barefoot.

3.To provide general recommendations of footwear for varying populations.

  • The Shoe
  • The worlds oldest shoe is roughly 6,000 years old and was meant for foot protection. Prior to this it is theorized that all activities took place barefoot1.
  • Through the years
  • First athletic shoes
  • Keds Champions: unchanged since 19172,3
  • Modern (Classic) Shoe
  • Designed with the foot anatomy in mind (i.e. motion control)3,4,5
  • Minimalist shoes
  • In the recent years these shoes have noted increased sales and are advertised to mimic barefoot activities.
  • These shoes offer no support and increase the intrinsic/extrinsic strength of the foot musculature
  • WALKING
  • When compared to barefoot, wearing standard walking shoes increases stride length by 6%14.
  • Heel strike is more pronounced with larger stride length and varum stresses at the knee were found (9%).
  • Impact on medial compartment OA.
  • For every 1% increase in stress, there is 6x greater risk of knee OA
  • “Flat flexible footwear are associated with significant reductions in dynamic knee loads during ambulation, compared to supportive, stable shoes with less flexible soles.”15
  • Running
  • (1980) It was advised to buy a shoe with built in support mechanisms for the arch and cushioned heel7
  • The authors make this recommendation based on the gait cycle and apply the same gait cycle to running.
  • Recent running analysis challenges this basis of running as fast walking
  • To understand this lets talk GFR
  • http://links.lww.com/CSMR/A3
  • By incorporating arch supports, there is a reduction in elastic recoil of the spring ligament and posterior tibialis, thereby reducing force output at the foot intrinsic/extrinsic3
  • Running
  • Minimalist shoes are more economical compared to classic running shoes in that the the runner utilizes less energy to run9
  • The weight of the shoe was controlled for by using ankle weights.
  • Neuropathic foot8
  • Most ulcers occur in forefoot
  • Study compares barefoot walking in patients with DM neuropathy and those without neuropathy
  • Results
  • Pt with neuropathy place more stress on the forefoot when barefoot (2x more) than controls
  • Possibly due to hammer toe formation and a lack of distribution among toes
  • Unable to feel increased stresses at the forefoot resulting in injury under met. Heads.
  • Balance
  • 100 older women (mean=82 y/a) examining usual footwear vs. barefoot on balance6
  • 68% required AD
  • 42% wore walking shoes, 17% sandals, 11% moccasin
  • Subjects with poorest balance (BBS) benefitted most from usual footwear
  • Post CVA subjects demonstrate increased gait speeds when using a classic shoe compared to barefoot or slippers11
  • Wearing dress shoes (>.5 inch heel) resulted in 15% worsening of balance testing compared to barefoot and a 12% worsening when changing from standard shoe to dress shoe. The TUG improved in standard shoes compared to barefoot12.
  • Healthy older adults demonstrate increased postural sway when wearing traditional walking shoes compared to barefoot13
  • Authors postulate due to sensory deprivation due to footwear
  • Pediatric population
  • “Influence of footwear on the prevalence of flat foot”
  • Study of 2300 children between 4 and 13 y/a
  • 1555 used footwear and 745 never wore shoes
  • 9% of shodded children presented with flat foot and only 3% of children without footwear presented with flat foot.
  • Closed toed shoes appeared to inhibit arch formation moreso than sandals/slippers.
  • The authors suggest that children should play barefoot or in sandals/slippers.
  • Recommendations
  • Running:
  • Classic Running shoes influence a RFS, which increases impact loading into the LE and runners sustain 2.5x more injuries (LBP, LE pain) when running with a RFS3,9
  • Barefoot running fosters a FFS, which strengthens the muscles of the foot3,10
  • Balance:
  • Those with poor balance are advised to wear shoes6 and avoid higher heeled shoes12
  • Healthy individuals are advised to wear minimalist shoes for static balance
  • Neuropathic foot
  • Therapeutic shoes to reduce plantar pressure at the metatarsal heads
  • Walking
  • s/p CVA should wear classic shoes for improved gait speed.
  • Healthy individuals are advised to wear minimalist/barefoot shoes to decrease risk of knee OA
  • Kids
  • barefoot or minimalist shoes
  • QUESTIONS:
  • What’s the difference between running barefoot and running in standard/classic shoes?
  • What are two benefits and limitations of classic shoes?
  • Did this presentation add to your knowledge base and is there a change in your confidence level when recommending shoes for patients/friends?
  • References

1.Ravilious, K. National Geographic News. June 2010. Available at: http://news.nationalgeographic.com/news/2010/06/100609-worlds-oldest-leather-shoe-armenia-science/. Accessed on July 10, 2013.

2.Keds Shoes Official Site. July 2013. Available at: http://www.keds.com/store/SiteController/keds/ourstorypage. Accessed on July 10, 2013.

3.Altman AR, Davis IS. Barefoot Running: Biomechanics and Implications for Running Injuries. Curr Sports Med Reports. 2012;11(5): 244-250.

4.Griffith I. Choosing Running Shoes: The Evidence Behind the Recommendations. February 2011. Available at: http://sportspodiatryinfo.wordpress.com/2011/02/02/choosing-running-shoes-the-evidence-behind-the-recommendations/. Accessed on July 10, 2013.

5.McPoil TG. Footwear. Phys Ther. 1988;68: 1857-1865.

6.Hrogan NF, Crehan F, Bartlett E, et al. The effects of usual footwear on balance amonsgst elderly women attending a day hospital. Age and Ageing. 2009;38:62-67.

7.Heckman B. Selection of a Running Shoe: If the Shoe Fits-Run. JOSPT. 1980;2(2):65-68.

  1. Mueller MJ, Zou D, Bohnert KL, et al. Plantar Stresses on the Neuropathic Foot During Barefoot Walking. Phys Ther. 2008;88:1375-1384.
  2. Perl DP, Daoud AI, Lieberman DE. Effects of Footwear and Strike Type on Running Economy. Med Sci Sports Exer. 2012;44(7):1335-1343.
  3. Lieberman DE. What We can Learn About Running from Barefoot Running: An Evolutionary Medical Perspective. Exerc Sport Sci Rev. 2012;40(2):63-72.
  4. Ng H, McGinley JL, Jolley D, et al. Effects of footwear on gait and balance in people recovering from stroke. http://ageing.oxfordjournals.org/. Accessed on July 6, 2013.
  5. Arnadottir SA, Mercer VS. Effects of footwear on Measurements of Balance and Gait in Women Between the Ages of 65 and 93 Years. Phys Ther. 2000;80:17-27.
  6. Brenton-Rule A, Bassett S, Walsh A, Rome K. The evaluation of walking footwear on postural stability in healthy older adults: An exploratory study. Clinical Biomechanics. 2011;26:885-887.
  7. Keenan GS, Franz JR, Dicharry J, et al. Lower limb joint kinetics in walking: The role of industry recommended footwear. Gait and Posture. 2011;33:350-355.
  8. Shakoor N, Sengupta M, Foucher K, et al. The effects of Common Footwear on Joint Loading in Osteoarthritis of the knee. Arthritis Care Res. 2010;62(7):917-923.

One school’s take on educating the future

One school’s take on educating the future.

 

This was a refreshing article regarding the creation of a progression to a doctoring program for a school in Australia. Although this school is a world away from my practice, they face the same situations that we do here in the states. I was impressed with the thoroughness of the article’s message and am excited to see the students that graduate from a program like the one described. I would love to see this type of program offered in the states, as I personally don’t feel that this type of education is being offered. At least I haven’t seen many students that possess these traits in my clinic yet. Those that do, I am uncertain if they were learned in school or through inherent characteristics.

 

  1. “Chronic disease management requires holistic, patient-centered care, with collaborating and respectful teams of interdisciplinary providers (physicians, nurses, pharmacists, and allied health workers).”

 

I see where the authors are going with this, in that they are creating the lead in for the rest of the article. On a side note…I can remember in 6th grade reading/composition learning how to make a house in order to get a point across. You had to start with the roof, which is the overall theme and then build the house down from the roof by adding in the thesis and supporting points. Mrs. Hart..I didn’t forget. With that in mind…that analogy doesn’t apply to this type of writing, as I simply brainstorm and just try to keep up with my thoughts on paper.

 

Back to it. We should be collaborating for all patients, not just chronic illness based patients. All patients should expect the same high level of care, which involves calling other professionals with results if need be. I see way to often the lack of communication when working with patients in the clinic. Luckily, no one has suffered greatly from the lack of communication, but luck shouldn’t be my basis of success.

 

  1. “health care ‘now requires large enterprises, teams of clinicians, high-risk technologies, and knowledge that outstrips any one person’s abilities’”

 

I beg your pardon?! I am very capable mind you…just kidding. No one person can know all of all things. It is important for a PT, or any one for that matter, to know his/her weaknesses and place him/herself in a position to leverage strengths, while hiding weaknesses. For instance, I am very good at orthopedics, which means that if I work in a clinic that sees more than just orthopedic patients (which I currently do), then I have to partner my skills with those of someone that is very good at everything else. Luckily, I have. If I were to ever leave to open up my own practice, I would have to either 1. Work on my weaknesses (I’ve never been a fan of that) or 2. Be so good at treating orthopedic conditions that I can refer those patients that encompass my weakness to a colleague or a friend at another clinic. WHAAA?! Turn away patients…sacrilegious! I wouldn’t want my mother to see me if she had Dandy Walker syndrome…it’s not my specialty.

 

  1. “The Centers for Medicare & Medicaid Services recently implemented bundled payments for hip and knee replacements…the hospital that performs the surgery will be accountable for the costs and quality of related care for the episode of care…The payment structure incentivizes better coordinated care”

 

SIGN ME UP! Accountability paired with incentives to improve patient outcomes. This is a great thing. Some people are scared of this bundled payment thing, as they talk only about loss of profits. I only see rewards for fixing patients quicker, with fewer complications, leading to increased pay.

 

EVERYONE NEEDS TO WAKE UP THOUGH! This is happening. You need to do a better job of choosing your provider. If you ask a friend and learn that the friend got crappy care from their provider…don’t go there! Even if others (namely health care professionals) are trying to push you in that direction, make more informed decisions. Get a second opinion before going there.

 

  1. “The curricula need to engage students to develop the necessary attributes, knowledge and skills in health leadership, policy, advocacy, and research…physical therapy curricula need to be forward thinking and innovative.”

 

AWESOME SAUCE! Now…I’ll believe it when I see it. I totally agree that PT’s need to be better trained when coming out of a Doctorate program, but unfortunately tradition appears to be taught more so than forward thinking…or thinking in general. We have come past the recognition and regurgitation aspect of therapy. We need to do a better job of teaching how to think.

 

The rest of the article went deeper into the curriculum for the program. I highly recommend any and all teachers of health care to read this article. It touched on some very important points and I look forward to practicing alongside those that graduate from a program like the one described in the article.

 

Quotes taken from:

 

Dean CM, Duncan PW. Preparing the Next Generation of Physical Therapists for Transformative Practice and Population Management: Example From Macquarie University. Phys Ther. 2016; 96:272-274

If it hurts it must be bad, or good, or whatever. Vincent Gutierrez, PT, cert. MDT

Louw A, Puentedura EJ, Zimney K, Schmidt S. Know Pain, Know Gain? A perspective on Pain Neuroscience Education in Physical Therapy. J Orthop Sports Phys Ther. 2016;46(3):131-134.

 

  1. “Pain is a normal human experience and essential to survival”

This portion is rarely spoken of in PT school and we spend our time in school learning how to shut down the pain, either in an ideal way of dealing with a mechanical problem or in a way in which we “trick” the brain of not seeing the pain for a short period of time. When working with patients, I often describe the gate control theory as the “Three Stooges” way of treating pain. For instance, if you have a headache and I hit your foot with a hammer, what happened to your headache. I stole the example from my dad, because this is how he would always respond if I told him my arm was sore after baseball practice. This was way back in the 1980’s and he was a laborer by trade. The gate control theory makes sense to most people, but we can also see the example and understand that it is probably not the best way to fix a problem, as we end up with a broken foot from the hammer.

 

  1. “The pain neuromatrix explained our knowledge and understanding of the functional and structural changes in the brains of people suffering from chronic pain”

To simplify, we have pain because our brains tell us that something is painful. This could be due to past experiences, actual painful stimuli eliciting Nociception, super excited nerves , so on and so forth.

 

  1. “biomedical models may induce fear and anxiety, which may further fuel fear avoidance and pain catastrophization”

It is very common for a patient to come into the clinic and say that he/she is avoiding a particular activity because of a history of a herniated disc. There is research that shows that a herniated disc can become “unherniated” (for a lack of a more layman’s term) over the course of 6 months. The patients are never educated regarding this point. Once a herniation, always a herniation is just not true. This biomedical or pathoanatomical (patho=bad and anatomical = body parts) model of health care is outdated and simply is not as useful to use with the general public because research demonstrates that the patient may become “sick listed” and from there stop participating in previously enjoyable activities.

 

  1. “a plethora of papers have been dedicated to a mere 20-millisecond delay of abdominal muscle contraction, yet despite the enormous amount of time, money and energy spent on this science, clinically it has yet to provide results superior to those of any other form of exercise for low back pain”

Doing the vacuum pose while lying down is no better than doing a general squat or learning how to utilize your diaphragm during breathing mechanics. As the layperson, there are many people that want to take your money in the health care industry. (I hate to say it like this, but healthcare is a huge business and the public needs to see it as so.) When the new fad comes out to solve back pain, don’t buy into the infomercial and as a matter of fact, turn off the t.v. and go get a book from the local library. You will spend hundreds of dollars less than what is proposed on the infomercial and be better off after having read the book. Nothing beats knowledge and the smarter you are at taking care of yourself, the better armed you are when you actually get in front of a health care practitioner. Remember, it is a business and we all want your money if you will give it to us. A better use of your time is to come educated so that I don’t have to teach you the basics of posture for 30 minutes, but can instead can teach you how to perform more high level movement patterns instead of sitting properly to reduce your pain. Oh wait, pain is normal. I’d lose my job if I sold this to all of my patients, but instead the patients need to be educated between hurt and harm.

 

  1. “In all health care education, be it smoking cessation, weight loss, or breaking addiction, the ultimate goal is behavior change.”

Speaking as a physical therapist, I can’t stress to the patients enough how the therapy experience is a team. Smart people call it therapeutic alliance, but I’ll settle for team. My part is to educate the patient and attempt to solve the puzzle of the patient’s pain, but it is the patient’s job to take the information that they have gained during the session and go home and apply it to their daily lives. For a patient to do nothing at home, AKA make no changes in behavior, and come to the following session thinking that the pain will go away is similar to :

 

https://spencergarnold.files.wordpress.com/2013/01/snatch-miracle.jpg

 

Patients may come hoping for a miracle, but it is not to be. The patient and therapist have to work together to attempt to solve the pain problem. If one side of the team is not doing their part, then the PT has to be willing to discharge the patient or the patient has to be willing to fire the PT.

 

  1. “…when PNE (Pain Nueroscience Education [pain is a normal human response]) is paired combined with either exercise or manual therapy, it is far superior in reducing pain compared to education alone”

From this I take that teaching the patient and then moving the patient is better than just teaching the patient. We can all agree that low level exercise is good for people. If we don’t agree with this, then we are saying that it is safer long term to live like a slug then to get up and walk around the living room. It just isn’t so. People will refuse to get up and walk around the living room when they start experiencing low back tightness, leg fatigue, or the dreaded “Fran cough” (look it up and btw I am an advocate professionally speaking). We as a society have to start moving more and learn about how our body is supposed to work. This can not be done from infomercials that have pictures of pulsating backs or frowning stomach fat.

And this is my two cents for the night.
If you are in need of physical therapy or would like to sign up for a complementary discovery session (a conversation to determine if therapy is right for you), contact me. 

Functional Therapy and Rehabilitation 

(Now part of the Goodlife family)

903 N 129th Infantry Dr. 

Joliet Il 60435

815-483-2440

Rehab post TKA

Piva SR, Gil AB, Almeida GJM, et al. A Balance Exercise Program Appears to Improve Function for Patients With Total Knee Arthroplasty: A Randomized Clinical Trial. Phys Ther. 2010;90:880-894.

Intro: 37% of TKA’s still have functional limitations p one year. Diminished walking speed, difficulty ascending/descending stairs, inability to return to sport are chief functional complaints. During TKA surgery several tendons, capsule, and remaining ligaments are retightened to restore the joint spaces deteriorated by the arthritis. Some of the knee ligaments are removed or released, which may affect mechanoreceptors/balance.

PURPOSE:

  1. To determine the feasibility of applying a balance exercise program in patients with TKA
  2. To investigate whether an F (functional) T (training) program supplemented with a balance exercise program (FT+B) could improve function compared to FT program alone
  3. To test the method and calculate a sample size for a future RCT with a larger sample size

METHOD: Double-blind pilot RCT (very strong evidence)

Inclusion: TKA in the previous 2-6 months (meaning not eligible for study if the TKA was before 2 months previous)

Exclusion: 2 or more falls in the previous year. Unable to ambulate 100 feet with an AD or rest period, acute illness or cardiac issues, uncontrolled HTN, severe visual impairment, LE amputation, progressive neurological disorder or pregnant (interesting exclusion criteria).

All went through a quadriceps muscle-sparing incision (cuts through the fascia of the patella instead of the quadriceps) this may be a factor in reducing rehab stay.

See the appendix for the protocol (6 weeks).

Testing measures:

  1. Self-selected gait speed (interesting, but probably not feasible for our clinic)
  2. Timed chair rise test (5 repetitions): easily added to our testing.
  3. single leg stance time: easily added in
  4. LEFS
  5. WOMAC

RESULTS:

  1. Adherence for both groups is 100% and the HEP adherence was similar (filled out logs)
  2. walking speed continued to improve over the course of 6 months for the FT+B group and was 25% better than the FT only group.
  3. The interesting fact is that improvement continued up to 6 months, when previous literature describes 3 months and done.
  4. Single leg stance: FT+B improved (as expected due to SAID), but the FT group either maintained or worsened on speed and balance.

DISCUSSION: FT+B demonstrates clinically important differences in walking speed, SLS, stiffness and pain, without adverse events. Subjects in the FT+B could balance on average 4 seconds longer than baseline. This may be important for weight bearing during the stance phase of walking. Performance-based measures should be used in place of subjective measures.

TAKE HOME: Patients will benefit from the addition of balance exercises post-surgically. It may be prudent to discuss with the surgeons of increasing the length of stay in therapy and decreasing the number of visits per week, as progress continues to occur past the 3 months initially surmised. Each patient should be tested with one or more of the following:

  1. SLS
  2. Chair rise test
  3. Gait speed: important indicator of function/independence/death
  4. Balance test (excluding Tinetti due to possible ceiling affect when the patient no longer needs an AD).

If you need therapy after a total knee replacement, you can contact me at the following location.
Dr. Vince Gutierrez, PT, cert. MDT

Functional Therapy and Rehabilitation (Now part of the Goodlife family)

903 N Infantry Dr.

suite 500

Joliet, IL

60435

815-483-2440