INERTIA: A Therapist's Thoughts

INERTIA - Archive

10/22/2009

ACL Rehab: Three Weeks Post-Op

With the patient now three weeks removed from ACL reconstruction, we are continuing to see steady progress. During this appointment, the patient reports the knee feeling a little warm and still a bit sore. Both are not unusual complaints at this point as some effusion or joint swelling is still present from surgery. Looking at the knee, we see the incision is healing well, swelling is minimal and there are no signs of active infection. OK to proceed.

After a brief bike warm-up, a few manual therapy techniques are used to work the scar and to mobilize the kneecap. I then do a few range of motion exercises for knee flexion and extension. A new measurement is taken and we record further progress: The patient's knee flexion has increased to 135 degrees. The patient's knee extension or straightening has also increased so that now there is actually about 2 degrees of hyperextension. Most people have at least a degree or two of hyperextension with some having as much as 10 degrees. So this finding is completely normal.

The same exercises performed at the last session were again repeated with progression of either increased weights or repetitions. The patient progressed with balance exercises to include the use of resistive bands to provide additional challenge. In addition to these progressions, we added both forward step ups on a 6" step and side step downs on a 2" step. Both the step ups and step downs are excellent functional exercises as they closely relate to the task of climbing and descending stairs and work on quad strength and hip control, both important concepts in ACL rehab.

Posted 4:24 PM

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10/9/2009

ACL Rehab: Two Weeks Post-Op

Our ACL patient is now two weeks removed from surgery. On this date, the patient reported that her knee still "feels tight but there is not much pain." The patient presented to the clinic wearing a compression stocking to assist in controlling the swelling in the knee. At this point, residual swelling is still very normal after an ACL reconstruction and will be one of the primary reasons for continued discomfort be it pain or tightness in the knee. The swelling is also the main reason that knee range of motion is not yet normal.

On this date, the patient presented to the clinic no longer using crutches. The patient's walking gait was not quite normal yet but close enough to ditch the crutch. The patient presented with improved knee range of motion. The knee flexion measurement increased to 127 degrees (normal being 140-145 degrees) and knee extension was 0 degrees or completely straight, which is normal. The patient demonstrated improved isolated quadriceps contraction again.

At this visit we were also able to progress the strengthening exercises quite a bit. I had the patient start using the leg press, which is like a squat machine, using both legs at first and then some with just the repaired knee. The patient also progressed with balance activities including the use of a balance board and increased holds on single-leg-standing to further progress proprioception. We also initiated the use of the stationary bike for light aerobic conditioning. I continue to use ice and electrical stimulation at the end of the treatment to help decrease remaining swelling and inflammation.

Overall the patient is progressing well and as expected. Next week a few new exercises will again be added.

Posted 10:35 AM

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Time to get the upper extremities involved in the "Exercises I Love" series. We treat a lot of shoulder injuries in the Sports Medicine Center, so I want to make sure to include some of the exercises that I use a lot for these injuries also.

Prone Scapular Strengthening

Some call these “Y,” “I” and “T” exercises, and I understand that I am kind of cheating adding three exercises into one here, but they go together well and I usually give them out all at once. Most people do not address the posterior shoulder stabilizers with workouts, and combining that with poor posture, leads to weakness around the shoulder blade. I hate to say all, but I’m pretty sure that all of my patients with shoulder issues get these exercises (or some variation) as part of their home program.

Prone Extension

Lie on stomach with involved arm hanging off the table. Set shoulder blades back and hold position. In a thumb-up position, slowly raise your arm behind you to table height keeping your elbow straight.

Prone Shoulder Abduction

Lie on stomach with the involved arm hanging off the table. Keeping the elbow straight, pull the shoulder blades back and hold. In a thumb-out position, slowly lift arm sideways to table height and maintain the retracted position as you return to the starting position.

Prone Shoulder Flexion

Lie on stomach with the involved arm hanging off the table. Keeping the elbow straight, pull the shoulder blades backward and hold. Slowly lift arm forward to table height and maintain the retracted position as you return to the starting position.