The NBA is in denial. To claim that playing more games in fewer days without proper training camp to get up to speed is preposterous.
This year’s NBA season began less than 2 weeks after the lock-out doors opened. The players were then thrown into a whirlwind schedule, often playing 2 nights in a row, occasionally 3 in a row. Many criticized the quality of play at the beginning of the season. My impression was that the players were pacing themselves for the grueling sprint ahead of them. Injury rates were not astronomical, but the season’s not over, actually the intensity is about to rise, as the playoffs began on Saturday.
Derrick Rose of the Bulls and the Knicks’ Imam Shumpert both went down with ACL tears on Saturday. It’s probably a coincidence that they both happened on the same day, late in a game, without contact. Commissioner David Stern, backed by renowned orthopedist Dr. David Altchek, claims that the schedule had nothing to do with it.
I don’t buy it. My theory is that muscles fatigue and neuromuscular synapses don’t fire as quickly when fatigued or unaccustomed to particular conditions. Both Rose and Shumpert sat out portions of the season with injuries. They each had to expedite their returns as the playoffs approached. Recovery time between games was minimal. Rose was probably never at full strength all season and it’s likely that Shumpert broke down slightly from the grind of his first NBA season. I’m not saying that either of these players had a weaker ACL due to the wear and tear of a brutal schedule, but it’s definitely possible that the muscles supporting their knees and the nerves that stimulate those muscles to fire were fatigued or burnt out.
The key to high-level athletic performance is recovery between sessions or games and these guys did not get a chance to recover sufficiently.
It’s impossible to say that their injuries had nothing to do with the schedule. I hope I’m not right, but I won’t be surprised if injuries continue to play a large part in the remainder of the NBA playoffs.
On Saturday 2 NBA starters, including last year’s league-MVP, went down with ACL tears. The ACL is one of the 4 vital ligaments supporting the knee. For a professional athlete, an ACL tear usually means surgery to reconstruct the knee followed by 9-12 months of rehab in order to get back to playing shape. There’s no guarantee of returning to pre-injury levels, but minimally-invasive surgeries and improved rehab techniques have significantly increased athletes’ likelihood of continuing prosperous careers despite this brutal injury. Many factors determine success rates after an ACL injury, such as:
- Pre-injury conditioning
- Concomitant injuries, such as meniscus, bone or other ligamentous damage
- Surgical technique and graft source – using a portion of the patient’s patella tendon or a cadaver ligament to replace the torn ACL
- Rehab approach – aggressive vs. conservative
- The patient’s response to every step through the process
- Emotion and psychology play a huge part in recovery from this injury. A year of recovery requires consistent hard work and commitment to get back on the court.
From a PT perspective, we typically follow general guidelines or protocols that have been proven successful over the years. Still, every patient is different, and they each require attention to their particular response to surgery, PT and life. We work to assist, coach, guide and encourage the patient on this long road. We use manual techniques to reduce swelling and restore range of motion. We progressively teach the patient to recruit muscles that become dormant after surgery. We gradually add strengthening exercises, balance drills and eventually movements and activities that simulate game action.
Kevin Wilk, PT, DPT, along with Dr James Andrews, MD and others, published a paper in the March 2012 Journal of Sports PT, entitled “Recent Advances in the Rehabilitation of Anterior Cruciate Ligament Injuries.” The paper summarizes years of experience backed by scientific rationale for their ACL protocol. In the paper they outline some things they’ve found that improve recovery speed and increase the likelihood of a successful recovery:
- Achieving homeostasis prior to surgery – usually 21-day program
- Reducing swelling
- Restoring range of motion
- Achieving normal muscle strength in the knee and hip regions
- Following a program that emphasizes:
- Reducing inflammation
- Full knee extension or hyperextension in the first few days
- Full passive range of motion 4-6 weeks post-op
- Normal patella mobility
- Re-establish voluntary quadriceps control
- Restore neuromuscular control
- Gradually increase applied loads
- Sport-specific training
Some tools that can assist through this process are systems that can control weight-bearing, such as aquatic therapy or an Alter-G treadmill. Regular icing and self-care by the patient are vital throughout the rehab process. It is also absolutely necessary for the PT to listen to their patient. When the patient is sore or swollen, that should be addressed and the program intensity should be increased or decreased according to the patient’s pattern of response. When they report feeling great, they should be congratulated and empathy and encouragement help any patient through a bump on the road to recovery.
The above outline is not the only means of rehabbing an ACL reconstruction, but it has been successful with the majority of patients treated this way. Considerations need to be made for concomitant injuries, other types of surgical techniques and females.
Posted by
Jeni P. on Mon, Mar 19, 2012 @ 07:25 AM
Going in for surgery on the knee comes with the expectancy of receiving physical therapy as part of rehabilitating and getting back to normal. But studies have shown that going for PT prior to surgery is beneficial.
Why?
Physical therapy can help strengthen the hamstring and maximize the quadriceps muscle before surgery; two important muscles that support the knee joint. Physical therapy can also assist in maximizing range of motion. PT pre-op can also lead to better surgical outcomes as well as faster recovery times. A physical therapist can teach his patient how to properly utilize swelling by Kinesio taping at home; taping helps improve circulation and prevents fluid build-up. A pre-op patient will benefit from learning and anti-swelling and anti-inflammatory exercises that he can do at home.
Reducing surgical anxiety is another major benefit of pre-op PT; it lets a patient know what to expect after surgery. It also helps to return to a PT who is familiar with a patient’s medical history.
Seeing a physical therapist two times a week for two weeks prior to surgery should be sufficient to see results. However, it is important to have a discussion with a primary care physical regarding yearly visits allowed per insurance policy.
A typical post-op plan of care might include:
- Reduce swelling with ice/elevation/re-education of quads
- Non-weight bearing exercises to help regain full extension and flexion of the knee
- Static exercises which strengthen muscles with little movement to the joint
In conclusion, pre-op physical therapy can benefit a patient by:
- Strengthening knee muscles to take the pressure off knee joints and ligaments as well as protect the joint
- Regular stretching allows normal muscle length
- Less swelling means less scarring: recover full range of motion more quickly and allow for proper firing of quads sooner
This is my response to a blog on stretching.............
http://toddhargrove.wordpress.com/2010/11/24/quite-a-stretch-guest-post-from-paul-ingraham/
Great blog - very specific info on the effects of stretching prior to performance. Most of the article is backed by quality evidence that has become accepted throughout the physical therapy and fitness community. What is not addressed here and in much of the literature is the long-term effects of stretching (or not).
The author suggests that most people do not need to be more flexible. According to a recent study by the CDC, the risk of having symptoms of osteoarthritis in at least one knee by age 85 was 45.5 percent. That's only in the knee, suggesting that more than 1/2 the population will live with arthritis in their lifetime.
There are several ways to prevent arthritis and stretching is one of them. Now I 
don't believe that stretching alone is the cure for arthritis, but increasing flexibility and relieving stress on the joints is one element of a joint preservation program. A stretching program can also improve exercise performance as indicated by this article from the ACSM
Stretching has gotten a bad rap lately. I've recently read several articles and blogs downplaying the value of stretching. The bottom line is that stretching is not a quick fix. Over the long haul it will increase muscle elasticity, overall flexibility, and performance.
This is my response to a blog on stretching.............
http://toddhargrove.wordpress.com/2010/11/24/quite-a-stretch-guest-post-from-paul-ingraham/
Great blog - very specific info on the effects of stretching prior to performance. Most of the article is backed by quality evidence that has become accepted throughout the physical therapy and fitness community. What is not addressed here and in much of the literature is the long-term effects of stretching (or not).
The author suggests that most people do not need to be more flexible. Stretching my have other value though. According to a recent study by the CDC (http://goo.gl/TsKrX), the risk of having symptoms of osteoarthritis in at least one knee by age 85 was 45.5 percent. That's only in the knee, suggesting that more than 1/2 the population will live with arthritis in their lifetime.
There are several ways to prevent arthritis and stretching is one of them. Now I don't believe that stretching alone is the cure for arthritis, but increasing flexibility and relieving stress on the joints is one element of a joint preservation program. A stretching program can also improve exercise performance as indicated by this article from the ACSM - http://goo.gl/Q9Rix
Stretching has gotten a bad rap lately. I've recently read several articles and blogs downplaying the value of stretching. The bottom line is that stretching is not a quick fix. Over the long haul it will increase muscle elasticity, overall flexibility, and performance.
Many of my patients have told me that “when you have arthritis you often just don’t want to move.” Besides the pain of movement, the impact of contact with the ground causes severe pain with every step. Walking accentuates this force because the entire body weight is repeatedly shifted entirely onto the affected side. Someone with an arthritic joint will often compensate or limp in order to minimize the weight on that injured limb or side of the body. Compensations often lead to other asymmetries and then 1 dysfunctional body part evolves into multiple problems.
The pain of arthritis will also cause many people to limit their activity level. The results are increased swelling/edema, stiffness, weakness, and weight gain. These symptoms lead to more pain and the cycle continues and progresses.
When a patient with arthritis presents to physical therapy, the primary objective of the PT is to maximize the patient’s overall function with minimal compensation over the long-term. In layman’s terms, we want them to be able to do as much as possible without injuring something else. For example, if a patient has osteoarthritis (OA) of their right knee, they will commonly walk on a partially bent knee to avoid further injuring or causing more pain to the joint. The common effect is hip or back pain, particularly with excessive use.
If we can help them move and walk more normally, we can significantly reduce the effects on their entire body. Practicing normal movement in a painfree environment enables progression to everyday painfree movement during regular daily activities. Water offers that painfree environment. Aquatic therapy is an invaluable tool for patients with OA, particularly in the latter stages of the disease. The hydrostatic pressure of a pool provides an effective means of reducing swelling; the 93-degree waters of our Hydroworx pool ease pain and facilitate movement; and the buoyancy of water reduces the effects of gravity. These natural qualities combined with the unique features of the Hydroworx pool - the treadmill, parallel bars, resistance jets, steps, exercise platform, and massage hose - make it the ultimate rehab tool for patients with arthritis.
A warm pool allows arthritic joints to move as if they’ve been lubricated like the Tin Man from the Wizard of Oz. Warm water feels great on sore joints and the buoyant properties assist with movement. The beauty of the Hydroworx pool is the ability to walk or jog on a treadmill in this buoyant environment. Instead of experiencing pain every time an arthritic limb makes contact with the ground, the user feels as if they are floating with every step. Chest-deep water unweights the body 80%. That means that a 200 lb individual feels as if they weight 40 lbs.
Decreased pain and increased mobility allow a patient, even with severe arthritis, to endure a vigorous workout without the normal side-effects. Think of the long-term benefits: increased mobility, increased strength, improved cardiovascular endurance, weight loss, and related decreased pain, in addition to improved gait and decreased risk of falls.
Our patients and clients with arthritis can’t live without their regular sessions on the Hydroworx treadmill. For many of them, it’s become a part of their regular routine and they continue with us as cash clients long after their insurance PT benefits are used up. In the current healthcare environment, the Hydroworx pool is an ideal tool for individuals with arthritis.
Take a look at some great exercises for people with Arthritis below...
...and try them out today! Right here at WSPT
WSPT uses a variety of treatments and techniques to treat our patients. In an effort to increase understanding and raise awareness, we’ve chosen to spotlight one of our latest treatment techniques: Kinesio Taping.
What is Kinesio Taping? The Kinesio Taping Method is designed to facilitate the body’s natural healing process while providing support and stability to muscles and joints without restricting the body’s range of motion. It also provides extended soft tissue manipulation to prolong the benefits of manual therapy. Latex-free and wearable for days at a time, Kinesio Tex Tape is safe for populations ranging from pediatric to geriatric, and successfully treats a variety of orthopedic, neuromuscular, neurological and other medical conditions.
It’s important to note that Kinesio Tape is different than standard athletic tape. Athletic strapping tape is used mostly to limit ranges of motion and to constrict muscle movement. The effect of this method is to create a bridge over the areas that are injured so that athletes can perform sport movements and have either prophylactic support or support to an injured part of the body. Athletic tape is typically removed after the end of an athletic event.
Kinesio Taping is used by therapists to change muscle tone, move lymphatic fluids, correct movement patterns, and improve posture. The Kinesio Taping Method has been developed specifically to be used in conjunction with Kinesio Tape. The Kinesio Taping Association certifies practitioners of the Kinesio Taping Method. Kinesio Tape can be identified by the words "Kinesio Tex" printed on the back of the tape. All of WSPT’s therapists are familiar with the application of Kinesio Taping, and several are on their way to being certified practioners.
For more on Kinesio Taping read Stephanie Gannello’s blog here.
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.