Should You Have Pre-Surgery PT?
- Published on Wednesday, 01 April 2015 09:56
- Written by Kateri
I often find myself discussing the effects of a person’s prior level of activity related to his/her current predicament. Say, for example, you have been suffering from debilitating knee pain for years and you have stopped doing your normal activities and limit the amount that you move your knee. 1 month later you have a knee replacement. How will you do in physical therapy?
Regardless of your prior level of disability, physical therapy will work wonders for your knee function; however, there will likely be a hard road ahead of you. Your level of strength and range of motion in that knee prior to your surgery can make a big difference on how quickly you will regain your strength and range. If you were a relatively active and strong individual prior to your surgery, you will likely regain your strength quicker than someone who is deconditioned and does not know the first thing about exercise.
How about range of motion? If you had years of limited movement in your knee, then your muscles have progressively shortened to the range at which they have grown accustomed. In other words, your muscles are still going to be tight after you have had your surgery, so they will take longer to stretch in order to regain full motion.
Now, we know that when you are in pain, you will naturally limit your activity level and degree of motion. This is NOT a shock to us. We just want to clarify that years of limited activity or inactivity can make recovery take longer than for someone who has remained mobile. So this advice goes out to ALL individuals, young and old, who want to avoid extra hassle with recovery from future injury or surgery: the stronger you are prior to injury and surgery, the more likely you will have a successful and speedy recovery. In other words, BE ACTIVE! Exercise, go for walks, play a sport, dance, do yoga, etc. I am not saying that you won’t get better if you did not do these things before an injury, but your recovery will go much smoother if you were active prior.
In addition to simply staying fit and active prior to injury, having PT prior to surgery can also make a difference in recovery outcomes. Research has shown that individuals who have PT prior to ACL reconstruction surgery have better overall outcomes up to 2 years following their surgery. These individuals also had PT following their surgery. This is an example of conditioning muscles prior to surgery having a positive effect on outcomes. Similar positive results were found with individuals who had PT prior to hip and knee replacements. The difference is that these individuals were seen prior to surgery only 1 or 2 visits. With these individuals, their outcomes were improved most likely due to training with walking devices, understanding a preliminary exercise program, and being given an understanding of what to expect following surgery. Either way, PT prior to and following surgery can have a very positive effect on a person’s recovery.
PTinMotion Magazine February 2015 p. 62, 63
Getting Rid of That Pesky Sciatic Pain
- Published on Wednesday, 18 March 2015 10:43
- Written by KateriK
Our last blog detailed what sciatica is and the various causes for this condition. Now, let’s venture into the treatment approach for sciatic symptoms.
So, what treatments are the most effective for this condition? Physical therapists are specifically trained to examine this type of ailment and determine the cause of the problem as well as an appropriate treatment plan. Sciatica is more of a side effect of other underlying conditions; therefore, treatment is often geared at the underlying cause while also addressing symptoms.
At the initial onset of symptoms, using ice on and off along the painful area for 2-3 days can help decrease inflammation. Keep in mind that ice should only be applied for 10 to 15 minute increments in order to be the most effective. Ibuprofen (pain reliever and anti-inflammatory) and acetaminophen (pain reliever) may also assist with decreasing pain.
Bed rest is NOT recommended. I repeat, bed rest is NOT recommended. You may need to reduce your level of activity due to pain, but eliminating activity altogether is not good for your body. Due to the fact that the back is the most common cause of sciatic symptoms, certain activities like heavy lifting or twisting should be avoided, especially within the first month following symptoms. Certain exercises and treatments can be particularly helpful depending on the cause of the problem. Disc herniations, for example, respond well to lumbar extension-based exercises while spinal stenosis responses better to forward bending-based exercises. Piriformis syndrome responds well to stretching, manual treatment, and may requires other techniques to decrease acute symptoms. One particular area that tends to be beneficial universally for sciatica is abdominal strengthening and most treatment programs will include some amount of abdominal/core exercises. A physical therapist can determine which exercises fit the condition best based on the cause of the symptoms and develop an exercise program consisting of those exercises. A PT can also determine if certain manual treatments are necessary for the condition including soft tissue techniques or joint mobilizations.
With the appropriate treatment, sciatic nerve pain can be resolved non-invasively within a relatively short period of time. Occasionally, when pain does not reduce, your doctor may choose to perform an injection to reduce nerve root inflammation. Less commonly, symptoms may stay severe enough to require surgery, but this is typically only when progressive neurologic symptoms or bowel and bladder dysfunction are present.
Getting Rid of That Pesky Sciatic Pain
- Published on Wednesday, 04 March 2015 10:37
- Written by KKateri
Sciatica (pronounced sigh-at-ih-kah) is a result of irritation at the sciatic nerve. It is a relatively common diagnosis which can result from several different problems. For those of you who are unfamiliar with sciatica, the most common symptom is pain running from the low back, down the buttocks, and into the back of the leg to the foot. This is the path of the sciatic nerve. Components of this nerve start at the L3 segment of the low back and combine with each lower segment to form the full sciatic nerve. It then runs down the back of the leg to your foot. Compression of the nerve at any point along this nerve path can create symptoms of sciatica.
In addition to pain along the sciatic nerve distribution, other common symptoms with sciatica include numbness, tingling, or burning along the path of the nerve. In more severe cases weakness in the leg can occur. The condition commonly occurs with individuals in their 50s, typically develops over time versus being caused by a specific trigger, and can be relatively mild or severely debilitating. It usually only occurs along one leg at a time, but can affect both legs. Pain typically increases during sitting activities and can make standing and walking difficult; however, symptom presentation can vary depending on the area of compression.
There are several possible causes for sciatic symptoms. The most common causes are listed as follows:
- Disc herniation
- Degenerative disc disease
- Lumbar spinal stenosis
- Piriformis syndrome
- Sacroiliac (SI) joint dysfunction
Posterior disc herniations along the L3 to L5 segments can cause compression along the sciatic nerve due to the backward position of the disc material pressing on the nerve. Disc degeneration, which is a natural part of aging, ends up decreasing the joint space irritating the nerve root. Spondylolisthesis is when a small stress fracture allows a vertebral body to shift forward on another, thus putting it out of alignment. The narrowed disc space, fracture, and slipping forward of the vertebrae can cause pinching of the sciatic nerve. Spinal stenosis, which could be caused by a bone spur, causes a narrowing of the space that the nerve roots pass through; thus causing increased compression on the nerves. The piriformis is a muscle that runs deep in the buttock region. This muscle can be anatomically split in different ways around the sciatic nerve including the nerve passing overtop, underneath, or through the muscle. Tightness, weakness or irritation in this muscle can increase compression on the sciatic nerve as it passes along the buttock region. SI joint dysfunction can cause irritation at the L5 (lowest lumbar segment) nerve. Other less common causes of sciatica include: pregnancy, scar tissue, muscle strains, spinal tumors, and infection.
So, then, what treatments are the most effective for this condition? Our next blog will explain the best treatment strategies for sciatica.