Tag Archive for: acl recovery

The Week in Research Review, etc 12-10-18

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This week we’re still playing with formats and learning these Instagram changes. With that, in the week in research review 12-10-18, we discussed many topics that I wanted to share!

Surgery vs Physical Therapy for Carpal Tunnel Syndrome

Cost-Effectiveness Evaluation of Manual Physical Therapy Versus Surgery for Carpal Tunnel Syndrome: Evidence From a Randomized Clinical Trial Fernández-de-las-Peñas et al JOSPT 2018.

This Level 1b study looked to evaluate cost-effectiveness differences of manual physical therapy versus surgery in women with carpal tunnel syndrome (CTS).

Performed in Spain, 120 women with a clinical and electromyographic diagnosis of CTS were randomized through concealed allocation to either manual physical therapy or surgery.

They concluded that manual PT including desensitization maneuvers of the central nervous system has found to be equally effective but less costly, i.e., more cost-effective than surgery for women with CTS.

From a cost-benefit perspective, the proposed manual PT intervention of CTS can be considered.

Interesting results but 2 obvious limitations to this study:
1️⃣No control group. What if the symptoms could spontaneously improve over time
2️⃣ They only looked at 1-year improvement and not short-term improvements. I would’ve liked to have seen 3 months and 6 months results as well to see the acute effects.

Not sure what to make of this study but it does seem as if a population of Spanish women may respond to Rx of CTS without surgical intervention.

This could be a huge cost/time saver for society!

Return to Sport Criteria and Reinjury Rates

The Association Between Passing Return-to-Sport Criteria and Second ACL Injury Risk: A Systematic Review With Meta-Analysis  Losciale et al JOSPT 2018.

Not going to lie, this study caught my attention because the results match my confirmation bias.⠀

I’ve been saying for years that hop tests, even combined with other tests, just don’t cut it.⠀

I wrote a blog post about this too for @mikereinold. This study, although with its limitations, did show that passing RTS criteria did not show a statistically significant association with risk of a second ACL injury. 

This review also determined that 12% of those who failed RTS testing suffered a graft injury, compared to 5.9% of patients who passed. 

It seems as if quadriceps strength measured via isokinetic testing or isometric testing may be an important factor to consider for RTS decision making.


Also, hamstring-quadriceps strength ratio symmetry should also be considered.

So with this review demonstrating that current objective criteria-based RTS decisions did not show an association with the risk of a second ACLI, how does this affect your practice?

Physical Therapy vs Knee Scope for Meniscus Tears

💥PT vs Scope for Meniscus Tear 💥
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Effect of Early Surgery vs Physical Therapy on Knee Function Among Patients With Non-obstructive Meniscal Tears: The ESCAPE Randomized Clinical Trial. van de Graaf VA et al JAMA Oct. 2018

Among patients with non-obstructive meniscal tears, PT was equal to arthroscopy for improving patient-reported knee function over a 24-month follow-up period. 

They went on to say that “Based on these results, PT may be considered an alternative to surgery for patients with non-obstructive meniscal tears.”

So basically, if there’s no bucket handle tear present that may be blocking joint range of motion, then it is highly encouraged that the patient #GetPT1st and not do surgery.

Without going out on a limb, I’d say this is a much more cheaper treatment option as well and would save society many costs associated with the surgery and lost time from work.

I do note a couple limitations: the surgical group did not get PT after surgery if they did ‘as expected’ but they could get PT to help improve their symptoms.

The PT group did pretty basic exercises although leg press, lunges, and balance type exercises were included.

Have you read this paper? It was a multi-center, randomized controlled trial performed in 9 hospitals in the Netherlands.

So, are we encouraged or surprised? Let me know by commenting below…thanks!

Shoulder Health Accessory Exercises

by @kieferlammi

Want strong and healthy shoulders!?

Shoulder strength is about more than pushing big lifts like strict pressing, push pressing, etc.

If you want a robust, healthy, well moving shoulder you should be including lower level drills that more specifically address scapular and RTC strength and control. –

I will always be a fan of traditional exercises like side like ERs, Prone Ys, Ts, etc.

Lately, I’ve thrown in more band work because it’s easy for me to do for higher volumes on a frequent basis and I enjoy the constant tension that the band provides. 

Give these two exercises a try:

✅ Band Front Raise Pull-Apart

✅ Band Overhead Y Raise

I find that these two do a great job of targeting my mid back and posterior shoulder without much compensation through a big range of motion.

Give them a try either in a warm-up for 1-3 sets of 10-15 reps or at the end of a training session for 2-4 sets of 10-25 reps depending on the difficulty of your band and your capacity. 

Should we Brace after an ACL Surgery?

  
 
 
 
 
 
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 [NEW BLOG POST]⠀ 💥Knee Bracing Immediately After an ACL Reconstruction 💥⠀ In this post, I review some recent Twitter, Facebook and Instagram discussions about the usage of a hinged knee brace after an ACL surgery.⠀ .⠀ You'd be surprised what I found in the literature and the differences that exist throughout the US and the world.⠀ .⠀ Go to my website <LINK in my BIO> and read/share with your friends/colleagues.⠀ .⠀ It was a bit eye-opening and I'm curious to hear what others have to say.⠀ .⠀ I still like to recommend a brace for my clients because it seems to give them an added security after a pretty painful surgery.⠀ .⠀ I typically keep them braced 4-6 weeks, depending on their quadriceps activity and if they can do an active straight leg raise without a lag.⠀ .⠀ Many others don't even bother bracing at anytime post-op, which was surprising.⠀ .⠀ What do you think? Read the blog post and let me know. Let's try to educate and come to a better consensus...thanks!⠀ .⠀ #kneerehab #knee #kneepain #kneesurgery #acl #aclsurgery #ROM #physio #physiotherapist #crossfit #exercise #deadlift #physiotherapy #physicaltherapy #physicaltherapist #athletictraining #athletictrainer #ATC #PT #teamchampion #dptstudent #lenmacpt #instagram
 
A post shared by  Lenny Macrina MSPT, SCS, CSCS (@lenmacpt) on

You can also get to the blog post by clicking this link

Let me know what you think about this new blog post or any of my social media posts…thanks!

Quadriceps Stretching after Knee Surgery: A tweak to the technique

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Obtaining full knee flexion after a knee surgery or knee injury can be difficult for some. The transition from passive knee flexion in seated (my preferred) or supine (not preferred!) can be a challenge for the physical therapist, once they are starting to work on quadriceps stretching. This blog post serves to help modify the prone quadriceps stretching technique after a knee surgery. The goal is to better localize the stretch to the muscle and not cause further pain and discomfort to the patient.

In the past, I’ve talked about restoring knee extension after surgery, particularly after an ACL reconstruction. If you missed that blog post, you can read it here here and here. You might say I have a slight obsession with talking about ROM after surgeries.

For a common surgery like an ACL reconstruction, I often see people present to me without full ROM. That’s why I continue to discuss techniques that can help other clinicians and patients restore their ROM before it’s too late.

Why is full ROM important after knee surgery?

Well, we think there’s a pretty close link between long-term issues and not restoring knee ROM.

In Shelbourne’s article in AJSM 2012, he states that “abnormal knee flexion at early follow-up, abnormal knee extension at final follow-up, abnormal knee flexion at final follow-up, partial medial meniscectomy, and articular cartilage damage were significant factors related to the presence of osteoarthritis on radiographs.”

He also went on to say that you had a 2x increased risk of knee arthritis if you don’t get full ROM. This was similar to having had a meniscectomy surgery or articular cartilage loss.

For such a simple concept, we PT’s can really affect the long-term outcomes for our patients if we don’t get full knee ROM. So why are people still struggling years after their knee surgery? I don’t know… but it’s troubling and definitely avoidable in most patients.

Check out this study from the Journal of Athletic Training in 2015. They discuss how a patient’s flexion ROM can help significantly improve their IKDC scores (functional score) during the 1st 2 months post-op.

Simple Modification to Prone Quadriceps Stretching

I began to think about this topic when I was reading a Facebook post in one of the PT groups and it made me think. We always talk about knee extension and there is some research that discusses the importance of safely obtaining knee extension ROM. I put this study in a recent Instagram post and got some pretty good response.

It seems that whenever I talk about knee ROM after a surgery, people’s ears perk up. Let’s go to the video and talk about a simple technique I use to improve knee flexion ROM after a surgery or injury.

As you can see, a small tweak to your technique can really make a big difference. Again, I’m not sure what exactly is going on. It seems like I’m adjusting the position of the tibia just slightly and that is influencing the location of the stretch toward the quads. If I take my hand away, then they feel the pain and pressure in the front of the knee and it does not feel good.

Slow and Steady Knee Flexion

For the record, I’m not one of those PT’s that likes to be super aggressive and push my patients to tears. I’ve inherited those patients from other PT’s and that technique often fails.

When I talk about improving prone knee flexion, I’m talking about improving quadriceps flexibility and length. Remember, if you have someone lie on their stomach and you try to flex their knee, you’re either limited by pain, joint capsule or the rectus femoris (2-joint muscle.)

It’s not until I think the knee has reached a period of calm that I begin pushing into prone flexion. I’m not using this to crank and get 5 more degrees for my documentation. I’m using this at an appropriate time to improve muscle flexibility and maybe get that end range of motion that is so important.

Remember, obtaining full knee ROM is a process, but a very important process. it’s not going to happen quickly, especially if you’re wicked aggressive (my Boston comes out when I get fired up!!)

Try it for yourself

So this week, try this technique out on one of your clients who may be struggling with regaining their knee flexion ROM. I’m curious to know what you think and if it works for you. As we’ve seen, it’s very important to get that full ROM back after a surgery and this is one modification that I think can help you immediately.

 

 

If you want to learn more about how I treat ACL’s and other knee injuries, then you can check out our all online knee seminar. If interested, check it out at www.onlinekneeseminar.com and let me know what you think. We cover the anatomy, rehab prescription, ACL, knee replacements and patellofemoral issues both non-operative treatment and post-operative treatment. This is an awesome course if you’re interested in learning more about rehabilitating the knee joint. And if you’re a PT, there’s a good chance you can get CEU’s as well.