Kelowna Manual Therapy Centre Blog

Physiotherapists have long advocated that patients should try to improve their strength and mobility prior to undertaking any orthopedic surgery.

A previous blog showed the evidence for manual therapy and exercise in treating osteoarthritis of the hip and knee.  If the physiotherapy is not effective or if the pain continues to increase then a total joint replacement may be necessary. A recent study published in the journal of strength and conditioning showed that individuals who undertook a ‘prehabilitation’ program prior to undergoing a total knee replacement demonstrated improved strength and function i.e. walking and stair climbing.

It is very common due to the pain and swelling that the leg muscles become weak. The good news is that no matter how bad the pain is an exercise program can be prescribed to improve strength and mobility.

The exercise program consisted of walking, as well as strengthening and range of motion exercises for the hip and knee muscles. So if you do have to undergo a total knee replacement you should consider seeing a physiotherapist to learn an appropriate ‘prehabilitation program’.

Many times patients wonder how long does it take to recover from hip replacement.

A recent study in the Journal of Sports and Orthopedic Physical Therapy looked at recovery time and disability after a total hip replacement.
http://www.jospt.org/issues/articleID.2569/article_detail.asp

The authors found that the most rapid recovery takes place during the first 12-15 weeks. Progress was found to plateau between 30 and 40 weeks.

Another study found continued hip weakness and muscle atrophy up to 2 years post surgery. Other researchers found that an exercise program 4-12 months post hip replacement which targeted weight bearing and balance exercises resulted in improved strength, balance and reports of function.

These studies demonstrate how important it is to continue with an exercise program consisting of range of motion, stretching, strengthening, balance and cardiovascular exercises. This study and the other studies mentioned illustrate how important it is to continue with the home exercise program for up to 40 weeks post surgery.

Physiotherapists commonly see patients attending physiotherapy for ankle sprains.  While there is commonly swelling and pain there is also a lack of mobility in the ankle joints.

Manual physiotherapists have known for a long time that early manual therapy (including joint manipulation and mobilization) in conjunction with exercise and modalities allows people to resume activities or sports earlier and with less difficulty.

This 2009 research study confirms the benefit of manual therapy. See the Research here in the Journal of Orthopaedic Sports Physical Therapy:http://www.jospt.org/issues/articleID.2257,type.2/article_detail.asp

The authors found that those that benefited most from manual therapy reported they felt worse with standing and squatting, had signs of increased foot flattening and had a lack of ankle joint mobility.  The authors found that manual therapy combined with exercise allowed for quicker recovery, compared to exercise alone.

So if you sprain your ankle seek out treatment early on.  The treatment should include manual therapy.

Knee pain is a common complaint of clients attending physiotherapy. One of the more common conditions is pain around the kneecap termed ‘patellofemoral pain syndrome’ or PFPS.

This condition is more common in young women and is typically worsened with physical activity, walking down stairs or hills, squatting and sitting with the knees bent.

Abnormal tracking of the kneecap creates irritation of the soft tissue around the knee resulting in pain.  There are numerous factors that contribute to the abnormal tracking.

These factors can be divided into:

Bony / Structural

• Rotated hip bones
• Increase leg angulation (i.e. wider pelvis)
• Kneecap position
• Excessive probation of the foot (i.e. flattening)

Soft Tissue

• Muscle tightness around the hip and knee
• Muscle weakness, especially of the hip and quadriceps muscle

Training Changes

• Increase in training load or unaccustomed activities
• Change in training surface
• Change in footwear

The patient typically attends physiotherapy complaining of a generalized ache in the knee, sometimes more outside than inside.  The pain can be worsened with stairs, squatting, kneeling, and sitting.  There also may be complaints of crunching or grinding in the knee, which is termed ‘crepitus’. There may also be complaints of knee swelling or puffiness.

The physiotherapy exam will consist of a thorough history and physical examination to determine the causes of the PFPS and come up with a treatment plan to reduce and eliminate the symptoms.

Typical manual physiotherapy treatment will consist of correcting any lack of mobility in the spine, pelvis, hip, knee and ankle/foot. A common finding is tightness in the soft tissue around the kneecap pulling the kneecap to the outside.

A taping technique called McConnell taping (named after the Australian physiotherapist who discovered the taping) is very useful in realigning the kneecap. This realignment improves the tracking of the kneecap in the groove. With correct taping, symptoms are typically reduced immediately.

While the kneecap is taped and the pain is reduced, a strengthening program can be initiated. The strengthening will focus on the Vastus Medialis Obliqus (VMO) and hip muscles. The VMO is the only quadriceps muscle that helps pull the kneecap to the inside. With re-training, the VMO can resume controlling the kneecap. The hip muscle’s strength is important in controlling and stabilizing the knee.

In summary, manual physiotherapy can effectively reduce PFPS through a combination of manual therapy, taping and exercise.