When we last left Sadie she had been evaluated by her new PT at a premier outpatient physical therapy office. The expert PT completed a thorough assessment, provided an initial treatment, created a treatment plan for Sadie and issued her an updated home exercise plan. Sadie was very pleased with the experience and she scheduled 12 appointments over the next 4-weeks.
Sadie attended all of her appointments and diligently complied with the home exercise program. During that 4-week period Sadie achieved her goals of:
- Eliminating any swelling
- Achieving full range of motion of her knee
- Strength has improved to 75% of normal
- Sadie can walk short distances safely without a cane and 1-2 blocks outside with a cane
- She can go up and down stairs with a cane (and railing), but can’t safely carry a laundry basket down to the washing machine in her basement
She’s had minor setbacks resulting in short periods of swelling and pain, due mostly to overworking. (Sadie’s a go-getter and can’t wait to get back to walking with her husband, tennis with the ladies and peaceful gardening.) Her attitude and approach have put her in position to be concentrating on functional activities with her PT today.
Together, Sadie and her PT have decided that today’s session will concentrate on gait training. Sadie can walk, but she still fatigues easily and would like to be able to walk 30-minutes or more on the boardwalk with her husband. Her PT explains that an efficient gait pattern will increase her endurance because she’ll expend less energy with each step.
They begin the session with a 10-minute warm-up on a stationary bike, soft tissue mobilization by the PT, stretching and TRX-assisted squats. Sadie is prepared to focus on walking technique. The expert PT watches Sadie do a few laps through the gym, assessing her progress and gait dysfunctions. Sadie tends to not straighten (extend) her surgical knee completely or push off of that leg at the end of her stride. The PT explains to Sadie how she can improve her walking and they launch into a few drills to emphasize knee extension and push-off. Sadie, being the star patient that she is, grasps the lesson and easily transfers that into her gait pattern, first with a cane and then without.
Once the PT feels Sadie can consistently maintain proper walking technique, she has Sadie go on a treadmill to lock-in the lesson. First Sadie practices on the treadmill for a few minutes with 2 hands holding on and then gradually progresses to normal walking without her hands. Sadie is an exceptional patient, but she has some difficulties and missteps as she fatigues during this exercise. She sticks to it and has significantly improved her walking from this session.
She’ll go home and practice the activities and techniques she learned today to make it her norm. Over the next 3-4 weeks Sadie and her expert PT will reinforce the lessons of today and work on increasing Sadie’s speed and endurance. In addition, they will work on:
- Ascending and descending stairs
- Functional balance and movements that apply to tennis
- Work on kneeling and rising from the ground as it applies to gardening
Follow this blog to read about Sadie’s eventual discharge from physical therapy, her return to all of her activities and her plan for maintaining the gains she’s made.
Sadie is a a 67 yo female patient with insignificant past medical history besides a 5 year history of R Knee osteoarthritis presents to WSPT 6 weeks post-op.
Sadie has minimal complaints of pain, but her knee will not extend fully (10 degrees shy of neutral) and she can flex (bend) it 95 degrees. She complains of limping when she walks, inability to rise from low surfaces and difficulty negotiating stairs (up and down). She lives with her husband in a 2-story private home with a laundry room in the basement.
Sadie completes her intake information and is taken into an assessment room by her physical therapist. Over the next 10-minutes, the PT takes a detailed history and documents the conversation in her computer software system.
The therapist then asks Sadie to roll her pants above her knees to observe for any swelling and examine the surgical site. It's noted that the sutures have healed well, the scar is a little adhered (tight) and the right surgical knee appears larger than the left. It is not warm or discolored. The PT measures both knees and finds that the girth of the right is 1.5cm larger than the left.
The PT quickly assesses lumbar range of motion (ROM) to clear any complications that may be arising from the spine. She proceeds to measure the ROM of both knees, hips, and ankles. She assesses sensation and tests both legs for strength. She then performs a Tinetti Balance and Gait Assessment to screen the patient for the risk of falling. This test involves standing balance activities and an assessment of Sadie's gait pattern and safety. Lastly, the PT observes Sadie performing several other functional activities like reaching for the ground, going up and down stairs, lifting a 5# object from a table overhead.
Once this assessment is complete, the PT explains her findings to Sadie, detailing her deficits in the areas of ROM, strength, balance, gait, and function. She explains her plan for how the Sadie can return to normal activity and makes sure this is in line with her goals and objectives. All of this is documented by the PT.
The session continues with Sadie warming-up further on a seated stepper.
The PT explains that the objectives when on the stepper are to:
- Increase knee ROM
- Increase B LE strength
- Get the blood flowing and increase cardiovascular circulation
- Increase endurance
Today the stepper is a 10-minute warm-up and then the patient returns to the PTs assessment room for soft tissue scar mobilization and ROM exercises of the right Knee. She tolerates this very well so the PT gives her 3 exercises to perform several times daily at home:
- Straight leg raises
- Bridging
- Prone knee flexion
The patient has good understanding so the PT documents the exercises on a computer print-out for Sadie to take home with her. The session ends with TENS and ice on Sadie's right Knee to prevent any swelling and minimize any residual pain from today's session. After 10-minutes, Sadie schedules 3 appointments per week for the next 4-weeks.
Over the next month, Sadie will be expected to be an active participant in her treatment program, performing home exercises, coming prepared to her PT sessions and focusing on her sessions with the PT each time. If any issues arise or symptoms are not improving, Sadie is expected to discuss this with the PT so the plan can be amended or Sadie's MD can be notified.
If the PT's guidance is followed and Sadie is compliant with her personalized rehab plan, the chances of a full recovery are very likely. It's the physical therapists responsibility and goal to make every effort to safely return every Total Knee Replacement patient back to normal life - less painful and more functional than before their surgery.