Early Physical Therapy For Joint Replacements

By: Dr. James DiGregorio, PT, DPT

With the advancements in surgical procedures and technologies, many surgeons are opting for patient’s to not perform “pre-hab” (physical therapy prior to surgery) and physical therapy following a partial joint replacement or a total joint replacement surgery, most commonly done at the hips or knees. Although this is an option that might work for some, it has been proven to not be the best option for the following reasons. 

PRE-HABILITATION

  1. Stretching and Range of Motion: Focusing on achieving knee flexion and extension motion and most importantly hamstring and quadriceps length/flexibility. A total joint replacement will fix the bony deformities by removing the damaged bones around the knee; but it does not address the muscular issues. If someone has limited knee/hip range of motion leading up to surgery, then likely the muscles around the joint are tight. Following the surgical procedure, this will make it tougher for the first stage of recovery, to regain the range of motion, since you need to fight the muscles. 
  2. Walking: A normal walking pattern is controlled by something called a CPG or central pattern generator in the brain. This is why a person is able to walk without thinking about it. Typically prior to a total joint replacement, a person will develop a limp on one side due to pain in the knee or hip. Developing a normal walking pattern in the brain prior to the surgery will strengthen this CPG; making recovery quicker following surgery.
  3. Strength: One of the most important reasons for pre-habilitation is gaining strength prior to a total joint replacement. Improving strength prior to surgery not only reduces the pain following surgery, but also reduces recovery time. Strength gained prior to surgery is maintained and carried through after the total joint replacement. 

POST-SURGICAL

  1. Following Surgery: The first thing to work on is the knee bending and straightening range of motion. The first few weeks and up to a month after a total joint replacement is crucial for range of motion; if it is not achieved, muscles can be shortened and make it harder for range of motion to return and then more pain is caused. A range of motion of at least 115 degrees is important for normal daily function. Joint mobilization techniques and stretching are very important after a total joint replacement for a reduction of pain during recovery.  
  2. Walking, Stairs, and Transfers: Some of the most simple mobility tasks such as standing up from a chair, rolling over in bed, or going up and down stairs can become difficult or painful following a total joint replacement. Targeted strengthening, neuromuscular re-education, and functional mobility tasks are put in place to make these tasks easier and with less pain. Repetition with these tasks will make them easier, but building proper muscle activation and proper techniques with each movement is important for proper recovery. 
  3. Pain Management: A total joint replacement can be accompanied with pain, as this is normal and common with any surgery. Manual treatments and modalities performed by a physical therapist are techniques to reduce pain and make recovery more enjoyable for the patient. 

Physical Therapy is a Necessary Part of Healing for Returning to a Pain Free Life Following a Total Joint Replacement. 

If you still have additional questions regarding physical therapy, you can call any one of our offices to schedule your appointment today. 

Montvale:(201) – 746 – 6577

Closter:(201) – 784 – 2700

Oradell:(201) – 254 – 7240

5 Things You Probably Didn’t Know About Physical Therapy

By: Dr James Gamrat, PT, DPT

So you’ve been referred to physical therapy but don’t know what to expect. Here are 5 tidbits of information to help you understand more about physical therapy and your upcoming visit.

1. “No Pain No Gain” Does Not Apply

Contrary to popular belief, Physical Therapy, “PT” does not also stand for “Pain and Torture”.  For the majority of patients who are referred to physical therapy, our goal as a physical therapist is to alleviate your pain, which should not cause ADDITIONAL pain when you are at physical therapy. Part of a physical therapist job is to help the individual receiving treatment differentiate between “pain” and “soreness”. PT may make the individual experience temporary soreness. Through multiple treatment sessions, pain and soreness will gradually decrease leading to improvements in performance of muscles, available motion, strength, and to decrease difficulty with everyday tasks. 

2. “Location of Pain Does Not Mean Origin of Pain”

Through your evaluation, your physical therapist will identify the cause of your pain and not just the location of your pain. The human body can perceive three specific types of pain: localized pain, referred pain and radicular pain. Localized pain is “local” or close to the area of injury. However, referred and radicular pain cause the individual to experience pain and discomfort in a different area of the body. Your physical therapist will be able to tell you based on several tests, on how you move and through the exam if your pain is the direct cause of your injury or as a result of referred pain from a muscle or radicular pain from a nerve.  

3. “Quality is Better than Quantity of Movement”

 When your body is in pain, your body will adapt to find a new way to move to avoid pain. This may be good in the short term but long term, body compensation can place an increase in forces through different joints in your body which are not designed to take these new demands. This can lead to break down of cartilage in addition to overloading of muscles & tendons which are not well at absorbing force. Despite removing pain, your body may still retain and remember this new compensating movement pattern. If this is not corrected, compensation can lead to secondary areas of pain as a result. To correct these compensations, your therapist will identify these compensations, and help improve your quality of movement so you can do the quantity of daily tasks pain free away from the clinic. 

4. “You Never Finish Physical Therapy” 

Typically most therapy sessions can last between forty five minutes to an hour depending on what treatment you are receiving. If your frequency of treatment is three times a week, this can average between 2-3 hours out of 112 awake hours per week to correct your injury (based on 8 hour sleep schedule). Your therapist may give you two or three important exercises or techniques to continue with at home to help in between therapy sessions. To improve movements learned at physical therapy, one must practice and incorporate these concepts through everyday life.The more time implemented outside of therapy, it will reinforce the correct movement compared to the old painful way. Even after your last therapy treatment, successful therapy is lifelong integration of new habits, exercises and movement patterns that will keep you healthy and pain free for years to come. 

5. “Each Physical Therapist is Different” 

Just like in any profession, each physical therapist is different. Some of my patients that I evaluate say “I have been to another physical therapy clinic before and my other therapist told me that I failed”. In my opinion, the other therapist is the one who has failed that patient. I end up finding that there could have been multiple different physical therapy techniques that could have been added whether it be joint mobilizations, myofascial stretching, cupping, Class IV laser or instrument assisted tissue mobilization. If appropriate, to optimize and expedite recovery collaborative treatment such as chiropractic or acupuncture treatments with physical therapy can assist in speeding up recovery. 

If you still have additional questions regarding physical therapy you can call any one of our offices to schedule your appointment today. 

Montvale:(201) – 746 – 6577

Closter:(201) – 784 – 2700

Oradell:(201) – 254 – 7240

Chiropractic Certification & Training

An Article By Healthline

Chiropractors must earn a postgraduate degree called a Doctor of Chiropractic (DC). It usually takes 4 years to complete. Admission to the program requires at least 90 Semester Hours of undergraduate coursework, and some programs require a bachelor’s degree.

All states also require chiropractors to be licensed. The licensing requirements vary from state to state, but all states require a chiropractor to pass the National Board of Chiropractic Examiners exams.

Some chiropractors specialize in a particular area of chiropractic treatment and go on to do a residency for several more years.

According to the American Chiropractic Association, there are more than 70,000 chiropractors in the United States.

Here are some suggestions for finding a qualified chiropractor in your area:

  • Ask for recommendations from your doctor, physical therapist, or other healthcare providers.
  • Ask your friends, coworkers, or family members if they have any recommendations.
  • Make sure your chiropractor is licensed by your state chiropractic board.
  • Try using the American Chiropractic Association’s Find a Doctor Tool
  • Schedule a consultation with a chiropractor to see if they’re a good fit before starting treatment. Don’t feel obligated to stick with a chiropractor if you feel they aren’t right for you. It’s OK to consider several chiropractors before you decide on the best one for your needs.

The Bottom Line

Chiropractors use hands-on adjustments to reduce pain and help your body heal itself. They often focus on issues dealing with the spine.

Research has found that chiropractic adjustments may be an effective treatment for various forms of neck or back pain. Seeing a chiropractor may also lower your need to take pain relievers or undergo more invasive treatments like surgery.

The Last Profession Standing for Low Back Pain: Chiropractic

Article Written By: Donald M. Petersen Jr., BS, HCD(hc),FICC(h)

In the research world, low back pain has become the benchmark for effectiveness, as there are significantly more studies on LBP than any other musculoskeletal ailment. The studies we have seen over the past several years read like the makings of a great detective novel.

But instead of trying to discover “who done it,” science has been eliminating the usual suspects in an effort to unveil “who should do it.”

Ruling Out PTs or DOs

A study published last August eliminated two professions from the lineup. The randomized, controlled trial revealed that “[neither] spinal manipulation nor mobilization appeared to be an effective intervention for young adults with mild to moderate chronic low back pain.” While this may be unsettling on its face, it should be noted that “all treatments” were provided by “either a doctor of osteopathic medicine or physical therapist.”1

It’s Not MDs, Either

The most recent study narrows down the virtual last profession standing. In their efforts to better understand the risks associated with patients’ transition from acute to chronic LBP, a research team at the University of Pittsburgh discovered that almost half (48 percent) of medical patients received “nonconcordant care” or care not consistent with established guidelines. The researchers’ work demonstrated that “exposure to nonconcordant care was associated with increased odds of developing chronic LBP.”2

In essence, the nonconcordant care provided by the medical physicians during the first 21 days of care increased the patient’s chances of transitioning from acute to chronic. Not surprisingly, the most common form of nonconcordant care involved drugs. Almost a third, (30 percent) “received prescriptions for nonrecommended medications,” of which almost two-thirds (65 percent) received opioids.

Health Payers Are Noticing

The above is not lost on health payers, who enjoy the ability to analyze large data to better understand what works. Two years ago, David Elton, DC, senior VP of clinical programs at OptumHealth, gave a powerful presentation in which he outlined the most effective care for their insureds. Dr. Elton noted, “The pathway that’s most aligned with all prevailing guidelines [is] when patients start with chiro / PT / acupuncture. … You receive the services you should, you avoid the services you shouldn’t, imaging is aligned, total episode cost is lowest. … The actuaries have done the work, it’s presented at the actuarial conference, the net of the increased conservative care will take out about 230 million in annual medical expenditures and reduce opiate prescribing for back pain by 25-26 percent.”3

The Last Profession Standing: Chiropractic

So, what’s the problem? Why aren’t almost all acute spine cases seen by doctors of chiropractic? (Not that this is the only benefit to chiropractic care.)

More than 30 years ago, United States District Judge Susan Getzendanner held that “the conduct of the [American Medical Association] and its members constituted a conspiracy in restraint of trade based on the following facts: the purpose of the boycott was to eliminate chiropractic; chiropractors are in competition with some medical physicians; the boycott had substantial anti-competitive effects; there were no pro-competitive effects of the boycott; and the plaintiffs (chiropractors) were injured as a result of the conduct.” Old prejudices die hard. I believe the impact of this effort is still influencing referral decisions today.

Based on these and multiple earlier studies, chiropractic is the only profession left standing for effective LBP care, both acute and chronic. And while this distinction minimizes the impact chiropractic care has on the rest of the spine, the entire musculoskeletal system and ultimately, total wellness, it does present providers and payers with a clear choice.

But as this most recent study demonstrates, many providers, particularly medical doctors, are still choosing nonconcordant care in place of guideline-directed chiropractic care. You can change all that – by visiting your doctor of chiropractic regularly for low back pain; and always requesting you see a chiropractor if your medical doctor suggests otherwise.

References

  1. Thomas JS, Clark BC, Russ DW, et al. Effect of spinal manipulative and mobilization therapies in young adults with mild to moderate chronic low back pain: a randomized clinical trial. JAMA Netw Open, 2020;3(8):e2012589.
  2. Stevans JM, Delitto A, Khoja SS, et al. Risk factors associated with transition from acute to chronic low back pain in US patients seeking primary care. JAMA Netw Open, 2021;4(2):e2037371.
  3. The Role of Nonpharmacological Approaches to Pain Management: Proceedings of a Workshop. National Academies of Sciences, Engineering and Medicine, 2019.

Donald Petersen Jr. is the president and publisher of MPA Media, which produces To Your Health and a variety of other media resources on natural health and wellness, including trade publications for the chiropractic and acupuncture professions.