Total Knee Arthroplasty (TKA), or knee replacement surgery as it is commonly referred to, can lead to prolonged reduction in physical function. We commonly tell patients that it may require up to one year to completely recover from the effects of this major procedure. It is well known that the sooner a patient recovers his or her range of movement and leg strength then the sooner they will begin to feel more normal in their daily activities.
In a recent study published in the February 2011 issue of the journal Physical Therapy, the importance of restoring the strength of the abductor muscles was identified as having greater influence over improving physical function following TKA than did measures having to do with the demographics of the patients, the size and proportions of the patients (anthropometrics), or the quadriceps (thigh muscle) strength. The abductor muscles are the hip muscles that lift the leg out to the side, technically known as the gluteus medius, gluteus minimus and the tensor fascia lata.
The study was done with 31 people, 71% of them female, having an average age of 68 years. Though the results suggest that abductor muscle strength is a significant influence, the study would more thoroughly and strongly be applied to targeting the gluteals (abductors) if the same findings can be replicated in a study with larger patient numbers.
Nonetheless, the evidence is strong enough to warrant that at least equal emphasis should be placed on strengthening this muscle group as is the quadriceps following joint replacement surgery. So, make sure you are getting those gluteals in shape as well as those quads after TKA!
By Rett Talbot, PT
Performance Orthopedics of the Palm Beaches
The further away from the heart, the less circulation; that’s why legs swell, and feel heavy or tired. Compression Stockings are designed to aid the lower legs in blood circulation by applying gradient pressure from the foot to knee/thigh. Compression Stockings are made of strong elastic which applies a significant amount of pressure to the veins, arteries, and muscles. When you increase arterial pressure in the legs, it causes more blood to return to the heart, and less to remain in the feet.
There are two types of stockings: Anti-Embolism and Gradient.
Anti-Emoblism stocking are generally wore by non ambulatory patient’s who are on bed rest and they aid in improving lymphatic fluid and circulating blood. These stocking are commonly known as a TED hose.
Gradient stockings are designed in such of way that the compression lessens at the top. When there is a mechanical insufficiency in the lymphatic system gradient stocking are beneficial for patients. Generally the stockings are worn during ambulation, but physicians will recommend them to patients who are prone to blood clots, swelling, and blood pooling from prolonged sitting or inactivity. There are a variety of brands, and most of the time you can purchase them at a pharmacy or medical supply store without a prescription. Commonly, anything over 20mmhg requires a written prescription from your physician. The reason for this is for some patient’s having too much compression could affect their arterial blood flow. This is why you should always consult your physician before purchasing compression stockings.
The sporting industry has also been using compression garments. It is believed that compression stockings aid with the removal of lactic acid, and improvement in circulation. Some of the other benefits from compression wear is reduced muscle soreness, and reducing the time a muscle takes to repair itself.
Compression stocking are now available in many colors, styles, and sizes which makes it much easier for the average consumer to purchase.
By Rita Zimmerman
Which One Should I Use?
Anyone who has sustained an injury has asked themselves at one point “should I use heat or ice for this problem?” The answer depends on the severity of the injury and the time frame the injury occurred. While both modalities are effective for pain relief, they will have different physiological effects on the body part they are applied to.
When an injury is first sustained, the tissues surrounding the injury will become inflamed and swollen. Application of cold to the area within the first 48-72 hours will act to constrict the blood vessels that contribute to the swelling. This will help to limit the amount of swelling and its duration. If heat is applied in this first 2-3 days, the blood vessels will dilate causing an increase in swelling and possibly more pain after the heat is removed. The more severe the injury is, the longer this initial “acute phase” will last and the use of heat should be delayed.
Once the swelling has begun to subside from the injury, improving blood flow to the region is encouraged and heat can be used. This will help to remove the waste products from the injured tissue and improve mobility of the region for function. Application of cold can still be used at this time for pain relief if desired. It is especially useful after increased activity to prevent a reoccurrence of swelling at this “subacute phase.”
For older injuries or chronic pain where swelling is no longer an issue, either heat or cold can be used for pain relief. Both should be attempted and the more effective treatment used as needed. A typical application of either modality is for 15-20 minutes, several times per day. The skin should be checked regularly for sensitivity, and to prevent burns. If you are still not certain as to weather heat or cold is the right choice, ask a healthcare professional.
By: Steve Bernstein
What is agility?
It is the ability to change the body’s position or direction efficiently. It requires the introduction of isolated movement skills in harmony (i.e. balance, coordination, speed, reflexes, strength, endurance and stamina).
Agility is associated mostly with athletes and fitness professionals, however, the average individual or senior can benefit from this form of training. The general public’s ADLs (activities of daily living), household activities and injury prevention can be greatly enhanced by the integration of agility training. For seniors, the first and foremost reason to have some form of agility training incorporated into an exercise program is for fall prevention.
This type of training does not require fancy machines or equipment. It can be as simplistic as a line on a tennis court or two cones. Seniors can incorporate agility training into an exercise program or daily routine simply by side-stepping across the room (with or without an assisted device).
In conclusion, agility training can help any individual, elite athlete to senior citizen, prepare for the sport of life.
by: Rocco Ferraiolo PTA, NASM-CPT, Sparq certified