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.