Thursday, January 29, 2009

Physiotherapy Rehabilitation of Colles' Fractures

A fall on the outstretched hand (FOOSH) is a common occurrence and often results in a Colles' fracture, a fracture of the distal inch of the radius and ulna next to the wrist. Treatment is immobilisation in a splinting material such as Plaster of Paris for five to six weeks to allow healing of the bony fragments, followed by a variable period of rehabilitation depending on the severity of the fracture. The hand is extremely important functionally so the period in plaster is kept to a minimum to allow quick restoration of normal hand use, although a wrist splint can be used for a week or so, particularly in cases where there is significant pain on activity.

Once the Plaster of Paris has been removed the physiotherapist will examine the wrist for appropriate healing by firmly palpating the area over the fracture, which should not show much more than mild tenderness. The hand should look a natural colour, have no tightness or swelling in the fingers and muscle wasting should not be severe. Movements of the wrist will be restricted in a few planes but should not be affected in all planes of motion, neither should there be severe pain on movement nor pain on all movements. If many problems are present the physiotherapist will take urgent steps to rehabilitate the patient.

Range of movement exercises are the first line of treatment for a physiotherapist, teaching exercise performance every two hours. Many colles' fractures do very well simply with regular end range exercise practice and do not need more sophisticated treatments. The physiotherapist checks any restrictions in shoulder and elbow movement then records the forearm rotations, supination and pronation, which are important functionally. The physiotherapist will then assess wrist flexion and extension, finger flexion and extension and thumb movements. Most commonly restricted movements are supination and wrist extension.

Patients often report that the wrist feels at risk after the plaster has been removed and this may be due to the early removal of the plaster to prevent functional loss from immobilisation. A futura brace, a fabric support stiffened with a metal piece under the wrist, is applied with Velcro straps to give support during normal activities of daily living. The brace should be taken off during rests or light activity and for regular performance of the exercises. Too much further immobilisation at this stage could be harmful so patients should understand the limited use of the splint for comfort during activity.

If the ranges of motion do not improve as they should then the physiotherapist will consider using joint mobilisations to ease the movements. Accessory movements can be performed to the inferior radio-ulnar joint to help pronation and supination, and to the radiocarpal (wrist) and midcarpal joints, with the physiotherapist fixing one side of the joint as he or she moves the other side of the joint passively. This can be done gently or more vigorously at the end of range to push against the restrictions within the joint. Mobilisations can also be performed with the joint at the end of its available movement to give it the sliding and gliding movements it requires.

Strengthening the wrist occurs with a gradual increase in functional activities but joining a hand class can instruct the patient in practicing the large variety of small movements that the hand can perform and needs to strengthen for optimum hand function. Repetitive work at pieces of apparatus can strengthen and harden the hand to turning, twisting, pulling, grasping and fine work with the thumb and index finger. This can move on to work with weights or functional activities if the person needs to return to manual labour or another job requiring upper limb strength.

If the hand is very painful, swollen and restricted in motion then treatment may be urgently directed to preventing a pain syndrome developing, once the fracture has been reviewed by a doctor to make sure healing has progressed as it should. Hot and cold contrast bathing for the hand can be useful for the pain and swelling, with massage and sensory work to reduce the hypersensitivity which can be troublesome. Patients need to be very clear that they need to work hard through the pain in these cases to regain a normal hand.



Autor: Jonathan Blood-Smyth

Jonathan Blood Smyth is Superintendent of a large team of Physiotherapists at an NHS hospital in Devon. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for physiotherapists in Oxford or elsewhere in the UK.


Added: January 30, 2009
Source: http://ezinearticles.com/

Wednesday, January 28, 2009

Why Rehabilitation Programs Should Include Strength Core Training

Anybody who has had a physical injury has probably worked with a physical therapist in an attempt to ensure that it is possible to fully recover from the injury. If the injury was extreme, it is likely that the physical therapist implemented a system of rehabilitation that was centred on a core strength training system. Core strength training is a type of physical training in which a person works to strengthen the muscles of his physical "core": the muscles in his or her abdomen, back and shoulders. It is from these muscles that other muscles find strength, which is why the torso of the body is referred to as a person's "core."

Strength Core Training should be an important part of any physical therapy regimen because the core of a person usually from which the movement of the rest of the body happens. For example, a person cannot move his or her legs without also using the lower abdominal muscles to pull and stretch the thigh muscles. A person cannot swing his or her arms if the shoulders are not able to work together with the arms. If the core of a person is weak it is possible that he or she will not be capable of fully recovering from whatever injury affected the person to begin with.

It is probably a lack of core strength that contributed to your injury in the first place. So many people focus on having a good cardiovascular system or a high level of endurance. The core's strength training is often put on a back burner. This is unfortunate because with a strong core, everything else becomes easier to do. When you work with your physical therapist, you will probably be taught to the following exercises (or modifications thereof) of the following exercises:

Ball crunches: crunches done while sitting on an exercise ball. This way the lower back muscles are worked as well as the muscles of a person's frontal abdominal region and shoulders.

Push-ups. Push ups teach the body how to bear the weight of a person through the trunk while balancing that trunk's weight upon the arms and toes. It takes the work out of the back and the legs. Planks are a type of push up that work the same muscles but can be done by people not yet strong enough in the upper regions to do regular push ups.

When the core of a person is strong, there is no need to worry about muscular or skeletal alignment. A strong core naturally keeps the rest of the body in line. Successful rehabilitation depends upon whether or not a person's core is strong enough to carry him/her throughout the recovery process.



Autor: Andrew Mitchell

Andrew Mitchell, clinical editor at the Osteopaths Network, writes papers about musculo-skeletal conditions, drug-free treatment, pain management and how to find a Wimbledon osteopaths. He is interested in the treatment of back pain, neck pain and injury and pain management.


Added: January 29, 2009
Source: http://ezinearticles.com/

Tuesday, January 27, 2009

Physiotherapy Management of Respiratory Conditions

Respiratory conditions are a very common presentation in community and hospital settings, with a wide variety of diagnoses being assessed and treated by physiotherapy. Conditions which can present include pneumonia, chronic bronchitis, asthma, bronchiectasis, cystic fibrosis, hyperventilation and chronic obstructive pulmonary disease. Physiotherapists are trained to assess respiratory conditions and manage, treat and advise on them. Respiratory skills are an important part of every physiotherapist's training and early work, if they have a job in an acute area of practice. It is a difficult skill to learn and physiotherapists have a lot of responsibility for managing acutely unwell patients in hospitals.

The patient's notes and observation charts are first reviewed by the physiotherapist before going to see the patient, so as to be clear about the medical diagnosis, opinion and treatment. The blood test results will be important and the physiotherapist should have a good understanding of these. The physiotherapist will introduce themselves to the patient and whilst questioning the patient about their illness will be observing their condition at the same time, looking for the rate of respiration, hand, nose and lip colour, oxygen or nebuliser treatments, the overall wellness of the patient, their weight, the effort of breathing they are making and if they are using arm and neck muscles to help breathing.

The observation gives the physiotherapist a lot of information very quickly about the patient's condition and what they need to concentrate on in the examination. They can then move on to the objective examination, starting with assessing the lung expansion and air entry. By holding the chest on both sides, the physiotherapist can assess how well the expansion is occurring and whether it is symmetrical. Auscultation, listening to the chest with a stethoscope, tells the examiner about how well the air is entering the lungs, whether there is a blockage, collapse, consolidation or wheeze. The results of this will determine any further examination and the type of treatments suggested.

The physiotherapist initially looks at the patient's oxygen concentration as the correct level is critical for the patient's respiratory and overall status. If the blood oxygen saturations are below normal then the doctors will prescribe oxygen at a specific percentage such as 24 percent or 28 percent via a venturi type administration device which maintains a constant oxygen concentration as variations in concentration would be damaging. Continuous gas delivery can dry the airways and the secretions, making treatments more difficult, so oxygen should always be administered humidified and heated to body temperature by the appropriate gas delivery circuit.

The next clinical aspect for the physiotherapist to address is the air entry to the peripheral airways of the lungs. The airways can collapse or become occluded by swelling or sputum, blocking air entry and reducing the lungs' ability to maintain oxygen concentrations. Physiotherapists initially use breathing exercises to attempt to re-inflate the collapsed areas, instructing the patient to attempt to breathe deeply every hour or so. If this is not sufficient then intermittent positive pressure breathing may be attempted, using a pressure device to deliver gas at varying pressures into the lungs to re-inflate the desired areas passively.

Sputum retention in the lungs occurs when the patient is unable to expectorate the secretions which are formed by infections and worsened by lying in bed in hospital. Active cycle of breathing is a typical physiotherapy technique taught to patients, allowing them to move secretions from peripheral airways to the central airways where they can be removed by huffing or coughing. The technique involves steadily increasing depth of inspiration with longer expirations under slight pressure, avoiding the tendency to increase the bronchospasm of the airways. Patients can become very good at practicing this technique, allowing them to self treat effectively.

Physiotherapists can also apply manual techniques directly to the chest, using vibration or clapping to mechanically disturb the secretions and make coughing and expectoration more likely. Flutter devices are useful to mechanically disturb the sputum as the patient breathes in the vibrating air, again promoting coughing. Surgery to the thorax or abdomen or fractured ribs can inhibit deep breathing and coughing and physiotherapists will encourage patients to take regular pain control medication and to support the wound or painful part whilst practicing their inspiration and huffing.



Autor: Jonathan Blood-Smyth

Jonathan Blood Smyth is a Superintendent of Physiotherapy at an NHS hospital in the South-West of the UK. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for physiothrapists in Southampton.


Added: January 27, 2009
Source: http://ezinearticles.com/

Monday, January 26, 2009

Brachial Plexus Lesions - Pain and Therapy

The most difficult injuries to manage are those caused by severe stretch or traction as there is no obvious guide to what has occurred inside. Doing surgery early might interfere with normal recovery while leaving surgery for too long can allow important parts of the nervous system to degenerate without connections. Nerve avulsion can be surgically approached after three to six weeks or if natural recovery does not occur as expected then surgery can be approached at 3 to 6 months. If the nerve has been cut then repair can be attempted, whilst if it has been avulsed then grafting can be performed. To speed up recovery a nerve transfer may be used.

A very difficult part of brachial plexus lesions is the unexpected pain which can develop with time. Even though the nerves have been pulled out from the spinal cord connections, a chronic pain problem can develop in the area the nerves supply normally, which is the arm. As the nerves transmitting impulses to and from the spinal cord have been severed by being forcibly disconnected, the spinal cord nerves which normally receive their inputs are deprived of this. These nerves change and start transmitting signals spontaneously, generating an abnormal pain problem which can be unpleasant and persistent.

The pain is often described by the patients as burning, crushing or shooting, can be very severe and be accompanied by agonising spasms. Deafferentation pain is the name given to the type of pain which is caused by a lack of incoming (afferent) input to the nerves of the spinal cord. Conservative measures are most common in treatment and it is useful to involve a pain management team early on in management. Patients can usefully be admitted with this complex pain problem to sort out their medication and adopt a multidisciplinary approach.

TENS, transcutaneous nerve stimulation, is a physical modality for pain control which sends signals into the spinal cord to affect the pain gating system and may be useful in some cases. It can take a long time for an effect to be forthcoming and for the best outcome to be clear. There are a list of other treatments for brachial plexus lesions, none of them with much demonstrable success, including CBT (cognitive behavioural therapy), biofeedback, acupuncture, desensitisation and hypnosis. Due to the varied nature of the presenting symptoms a multidisciplinary team is vital to manage the patient over time.

An experienced multidisciplinary team is necessary to manage the non-surgical care of these patients, including an occupational therapist, orthotist, physician and physiotherapist. Orthotists provide long term bracing to prevent contractures and to protect healing structures, occupational therapists work at the functional abilities of the person, physiotherapists maintain joint ranges and monitor muscle work and the physician diagnoses and sets the treatment goals. Designated specialist centres are most appropriate for surgical care as only specialists can decide on the relevance of a hugely variable condition and choose from the very large number of operative options.

The outcome of a brachial plexus lesion is extremely variable as the mechanism of injury is so unpredictable and the results uncertain. The type of injury, the patient's age and the surgical treatment all affect the outcome. Muscle transfers, transferring a working muscle to do the work of paralysed ones, can be useful as can sural nerve (a nerve in the leg we can manage without) grafting, with many surgeons settling on surgery between three and six months after injury. Some surgeons have attempted to replace the nerve roots into the spinal cord but the results are not yet predictable, although success would dramatically change attitudes as healing in the central nervous system has not been usefully demonstrated.

Nerves heal at an average speed of about an inch a month, or one millimetre a day, which means that if the nerve injury is a long way from the muscle it needs to supply it will take a very long time to get there. The connecting endplates on the muscles may degenerate before the nerves have a chance to grow down to them. Nerve growth factors are the subject of much research to increase the rate of recovery of nerve repairs and grafting.



Autor: Jonathan Blood-Smyth

Jonathan Blood Smyth is a Superintendent of Physiotherapy at an NHS hospital in the South-West of the UK. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for physiotherapists in Dorset.


Added: January 26, 2009
Source: http://ezinearticles.com/

Sunday, January 25, 2009

Ice Therapy RICE For Injury Management

Have you ever been the victim of an unforeseen injury? Whether it is that a hidden curb that took out your ankle on a grocery shopping trip, an accidental slip down the stairs that leaves your knee twisted underneath you, or an athletic injury from your weekend basketball game, proper injury management, that includes rest, ice therapy, compression, and elevation may be essential for a full recovery.

These injuries have rabid onset and occur almost immediately. You may feel pain, discomfort, loss of function and are unable to perform your task at hand. These acute injuries call for treatment and the most common treatment is called "RICE". This acronym stands for Rest, Ice Therapy, Compression, and Elevation. They are the four steps used in first aid injury management to address these types of injuries.

A major part of injury is swelling, and although swelling is part of the healing process, too much swelling can impede the healing process and decrease one's ability to return to activity. If swelling can be controlled initially, the amount of time for injury rehabilitation will be reduced. Initial injury management should include rest, ice, compression and elevation- RICE.

The guidelines for RICE are as follows:

  • Rest- stop the activity that has caused the injury or will make it worse. Rest will vary depending on the severity of the injury
  • Ice- an ice wrap should be applied for 20 minutes- this will help with initial swelling. A good rule of thumb is to apply a cold pack treatment to a recent injury for 20 minutes, and repeat every 1 to 1.5 hour throughout the waking day.
  • Compression- applying compression wraps/elastic bandages can reduce and prevent excessive swelling. Bandage should always reach the largest muscle area below the injury to the largest muscle group above the injury.
  • Elevation- Raise the injured area at least, or slightly above heart level. The force of gravity can reduce swelling. Support the affected area in the most comfortable position afforded.

If an unforeseen injury jumps out and bites you in the ankle, knee, lower back or other body part apply first aid immediately using the RICE method. Rest your affected body part, provide ice therapy to your injury site, put something on it that slightly restricts the blood flow and elevate your injury above your heart to reduce the secondary swelling. Manage your injury with RICE and you'll be back before you know it. If you experience extreme swelling, intense pain, deformity, or simply because you are not sure, you should visit your physician as well as performing these initial injury management procedures. Don't forget the RICE principle for your trip there.



Autor: Tom Bomar Tom Bomar
Level: Platinum
Tom is a health and wellness professional, certified as a strength and conditioning specialist and member of the National Strength and Conditioning Association. He provides ... ...

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Tom Bomar is a health and wellness professional, certified as a strength and conditioning specialist and member of the National Strength and Conditioning Association. He provides Fitness Professional business, education, and travel opportunities through Fit Pro Biz

Quality re-usable ice wrap products that provide cold therapy benefits as well as compression benefits can be found at http://ultimateicewraps.com


Added: January 25, 2009
Source: http://ezinearticles.com/

Thursday, January 22, 2009

How to Have a Successful Total Knee Replacement Recovery

One of the most common joint replacement surgeries is the total knee replacement (TKR) or total knee arthroplasty (TKA). Despite the numerous surgeries performed each year many individuals are ill prepared regarding the total knee replacement recovery process. Below we will discuss some of the issues involved in recovering and rehabilitating from this orthopedic surgery.

1. Preoperative Physical Conditioning

Knee replacement recovery actually begins well before the surgery takes place. Here's why. Successful knee replacement recovery will depend on many different factors but some include the age of the patient, the number of commodities and the general condition of the individual prior to surgery. Patients who are in better physical shape and overall condition tend to have an easier time with the rehab program.

Many orthopedic doctors will recommend a patient lose weight and/or strengthen the muscles of the involved leg to better prepare the knee joint for surgery and postoperative rehab.

2. Pain

I won't sugar coat this one. Other than shoulder replacement, the total knee replacements are among the most painful orthopedic surgeries that are done. I have rehabilitated many joints in my career and this one gets frequent complaints regarding the level and duration of pain through the rehab phase. The good news is that your doctor will prescribe pain medications if indicated and there are special therapy treatments to help reduce pain as well. Once you can get through the initial week or two of total knee replacement recovery it gets significantly better.

3. Early Postoperative Rehabilitation

It is crucial to start the total knee replacement recovery as soon as the physician indicates. Early rehabilitation will reduce joint stiffness, swelling, improve overall circulation in the extremity, speed up weight bearing activities and reduce pain. Most patients will have a continuous passive motion (CPM) device placed on the surgical knee within hours of the operation. This mechanical device will provide automatic passive range of motion to the knee while the patient is lying in bed.

4. Progressive and Continuous Rehab

Some of the goals for total knee replacement recovery is to walk down the hallway with a crutch or walker, climb a short set of stairs, fully straighten their knees, bend the knee to approximately 90 or greater, and perform home exercises independently. If the patient is unable to reach these goals within three to six days, further aggressive rehab is needed and they may be sent to a rehabilitation center for a week or two or longer depending on their medical and social needs.

Ultimately the goal of replacement recovery is to return the patient to their prior level of function and living environment. Most total knee replacement surgeries have a high success rate when combined with early, progressive rehab intervention.



Autor: Richard Syner Richard Syner
Level: Basic PLUS
Richard is a physical therapist and health promoter....

About the author: Richard is a clinical physical therapist and fitness promoter. You can learn more about exercise by visiting Ways To Workout At Home today!

This article may be reprinted only if the entire article remains intact and unchanged, including the author resource box.


Added: January 22, 2009
Source: http://ezinearticles.com/

Wednesday, January 21, 2009

Treating Carpal Tunnel Symptoms Will Prevent Nerve Damage in the Hand

Perhaps one of the most encouraging facts about being diagnosed with carpal tunnel syndrome (CTS) is that it is a highly treatable condition. However, it's extremely important to take active measures to treat symptoms as soon as possible in order to avoid permanent nerve damage in the hands and fingers from this rather common problem, and most especially if your occupation requires repetitive movements and repeated use of the hands and wrists.

Understanding Carpal Tunnel Syndrome

The opening of space on the underside of the wrist known as the carpal tunnel is comprised of the wrist bone and a ligament, which connect to bones, called the transverse carpal ligament. Running through this opening, approximately the width of your thumb, is the median nerve, a sensory nerve that provides sensation to the muscles within the thumb, index and middle fingers, and half of the third or ring finger.

The smallest finger receives its sensation from another nerve branch.

Carpal tunnel syndrome is also known as nerve entrapment, as injury to the area causes the tunnel to become narrower from the swelling and pressure on the nerve. The longer the nerve is entrapped, the greater the chances are for nerve damage, making it imperative to being treatment immediately.

Treating Carpal Tunnel Syndrome

Treating CTS may begin conservatively at first, provided the symptoms have just started, and include stopping or changing the activities or repetitive motions that may be causing the condition.

Smokers are strongly encouraged to quit and patients should reduce their caffeine intake and lose weight if needed as both of these have been known to contribute to one's risk of developing carpal tunnel syndrome which is also more prevalent in women than men.

To reduce the internal swelling and pressure on the median nerve, anti-inflammatory medication, including oral non-steroidal anti-inflammatory drugs, or NSAIDs, including ibuprofen are usually recommended.

Wearing a wrist brace in the very early stages of carpal tunnel syndrome is also effective for reducing symptoms as well as the risk of nerve damage. Wrist braces offer support and keep the joint in the proper position during activity and when worn at night, they help to prevent injury to the area and ease the pain and numbness that often worsens during the nighttime hours.

Physical therapy in the form of gentle exercises outlined by an occupational or physical therapist that improve range of motion and strengthen the muscles can also help to keep CTS at bay. Your doctor may also prescribe cortisone shots administered into the carpal tunnel which will temporarily help to reduce swelling and inflammation.

If all else fails, there are different types of surgical procedures done for treating carpal tunnel syndrome and providing relief from symptoms. While the methods of surgery may vary, the end goal is the same, to relieve the pressure on the carpal tunnel and allow for the optimal level of blood circulation to all of the nerves in the area.

Some surgical procedures will require full anesthesia, while others can be performed using a regional type of anesthesia, and both will require several weeks of recovery time, but surgery for carpal tunnel syndrome offers a rather favorable success rate provided care is taken afterward to prevent reinjuring this most delicate area.



Autor: Frank Barnett

Of course, the best treatment is always prevention. Avoiding the pain and long-term recovery of carpal tunnel syndrome may be as simple as modifying your workspace. The right combination of keyboard, mouse, and desk can help you be more productive with less pain.

You can find out more from Ergonomic Resources.


Added: January 21, 2009
Source: http://ezinearticles.com/

Tuesday, January 20, 2009

Knee Replacement How to Determine If You Need One

When it comes to determining whether its time to have a knee replaced, only you can determine it.
If you ask the your orthopedic surgeon they will tell you " you will know when its time" in other words when the pain becomes so un-bearable that you cannot walk effectively or, you cannot get a good nights sleep then its time. When day to day living becomes a chore due to the pain, its time to get to the operating room.

By postponing the surgery you are inviting other problems that will contribute to a delayed rehabilitation outcome. For instance, your surrounding musculature will undergo a shortening process which leads to contractures with the hamstrings or quadriceps which will prevent you from obtaining the knees full range of motion.

The longer the surgery is postponed you also develop faulty mechanics in your walking pattern which can lead to back pain and balance problems. Muscle atrophy and weakness begin to develop so you begin to witness a cascade of problems that can be tracked back to the knee itself.

If you have gone and obtained a minimum of two opinions from local orthopedic surgeons and both have determined the knee has to be replaced, then you can feel assured that setting a date to get it done is the next move to make.

Listening to advice on the streets on how its best to wait until you can't walk anymore and have to be pushed to the surgeon in a wheelchair is no longer valid or, recommended.

Many surgeons today will operate on patients in their 40s and 50s when it comes to joint replacement since the replacements have become more minimally invasive and, the prosthesis have become more durable.

Today there are knee prosthesis developed that have more of a rotational component and mimic the true anatomical knee which gives them a longer shelf life.

Dealing with chronic pain form a knee that is considered to be bone on bone in other words the cartilage is no longer effective in cushioning the joint, is just another day being spent in pain and creating a life changing event that is not acceptable to most.

I can tell you first hand having a knee replaced myself at 44 years of age was the best thing that I did.

Once you decide to have the knee replaced and, you go through rehabilitation the next words out of your mouth will most likely be " why did I wait so long"

Richard Haynes



Autor: Richard A Haynes Richard A Haynes
Level: Basic PLUS
I live in Punta Gorda Florida and have worked in the field of Physical Therapy since 1995. I have been a fitness consultant since 2000 ... ...

http://www.totaljointfitness.com


Added: January 20, 2009
Source: http://ezinearticles.com/

Monday, January 19, 2009

Total Knee Replacements - How Long Does it Take to Heal

When you finally decide to go ahead with a knee replacement, you can get bombarded with a lot of information from friends, family, and hopefully the surgeon. When it comes to friends and family, most of the information you will get are opinions though they mean well you get very little fact. The time it took for their knee to heal can vary and unless they had the knee operated on within the last 4-6 months the information you get may be inaccurate.

Your surgeon may or may have not discussed with you some of the experiences you will encounter when, it comes to the actual amount of time it will take for the knee itself to be completely healed.

During the healing process your knee will go through what I consider three phases from a rehabilitation standpoint. The phases are the acute phase, the post-acute phase, and the long term healing phase.

These are phases that I have discovered are important for a patient to understand. The time I feel to discuss them with the patient is not only prior to surgery but, again after surgery as there will be information during the pre-operative briefing that will not be retained.

In general the phases mentioned above tend to play out for the patient in the following way:

1. Acute Phase: This is without question the most painful. It lasts from the day of surgery out to week six.. This time can vary from patient to patient but by week five there is a noticeable decrease in pain. The knee will go through the swelling phase and "throbbing phase" when it comes to pain. It is vital that your understanding and compliance with pain control measures are followed. The use of ice before and after rehabilitation are recommended along with foot elevation to keep the swelling to a minimum. Sleepless nights are generally in store in not un-heard of due to pain. The best measure found to relieve the pain you will encounter during sleep is to move or pump the knee back and forth five to ten times as the knee gets stiff and the spasms occur.

2. Post-Acute Phase: This phase kicks in from roughly week seven to week twelve. Here is where you begin to get a better handle on how to control the swelling and you also have learned as well how temperamental the knee can be. In other words as you become more active the knee will fool you. You will be tempted to do more then the knee is ready to handle physically. if you take on more then the knee is prepared for, the next day you will pay the price in increased pain and swelling. The use of pain medication though not as frequent is still advised. You should at this point be up on a single point cane and away from the walker which with the new found freedom add to the subtle ability to overwork the leg.

3. Long Term Healing Phase: This is the phase that most orthopedic surgeons will tell you will take close to a year for the knee to be totally healed. You will be able to however to do most anything within reason at this point unless it involves a high-impact activity like constant running and jumping. Pain, swelling, and muscle spasms at this point have completely subsided. You will have obtained all the range of motion of the knee that you will get. Your strength gains however can always be improved in the muscles surrounding the knee. Your walking pattern has now been established and the knee can and will endure most anything you ask it too.

There will always be some differences among patients when it comes to set time frames with pain
and recovery. Having a total knee replacement is considered a major surgery and the advances
made in surgery have shorten the time frame by weeks if not by months with some.

The key to joint replacement recovery is patience. By having some patience you develop a stronger more pain free recovery instead of pushing yourself to the edge of suffering from chronic pain and overall physical breakdown.



Autor: Richard A Haynes Richard A Haynes
Level: Basic PLUS
I live in Punta Gorda Florida and have worked in the field of Physical Therapy since 1995. I have been a fitness consultant since 2000 ... ...

Richard Haynes
Punta Gorda, Florida

http://www.richardhaynes.com


Added: January 19, 2009
Source: http://ezinearticles.com/

Sunday, January 18, 2009

Joint Examination by Physiotherapists

Our joints are extremely important for our functional activities, from the temporomandibular joint for eating and talking to the major weight bearing joints such as the hips and knees. Our joints are designed to allow us to move about, to accomplish tasks and to bear weight, a job they do superbly well. However, with injury, illness or disease our joints can be affected in various ways, limiting our abilities and causing stiffness and pain. Physiotherapists are trained to examine joints logically, determine the limiting factors and construct a treatment plan accordingly, with many techniques at their disposal.

In the human body the junction between two bones is called a joint and they can function as movement, weight bearing or force transmission joints according to their structure. The shoulder is a movement joint, the symphysis pubis a force transmission joint and the hip a weight bearing and movement joint. Synovial joints are the most common type, making up all of our major obviously useful joints. Articular cartilage lines the bone ends to reduce friction and allow effortless movement, the synovial membrane lining the joint secretes synovial fluid and the joint capsule, a ligamentous bag, supports the joint against stresses.

Observing the patient as they walk into the examination room and sit down can give the physiotherapist valuable information about the state of their joint. Slow and guarded movement is common, along with splinting of the joint and carrying it in a close and protected position to minimise joint stresses. Once the physio has taken a history they will check out the joint visually, looking for swelling, effusion, warmth or a joint deformity. If there is no obvious problem in a cool, settled joint the physiotherapist will need to stress the joint more thoroughly to find the restriction. However, a swollen, inflamed joint should be treated acutely as soon as possible.

Moving on from the relatively quick visual joint assessment the physiotherapist will start to palpate round the joint structures. This systematic manual examination allows the physiotherapist to clarify which parts of the anatomy are involved in the problem. The typical areas tested will be the ligaments, the areas where the tendons and ligaments insert to the bone, the joint line itself and around the margins of the joint. Any fluid in the knee, called an effusion, can be identified as it moves about if it is thin, it is very firm if the swelling is tight and it is thick and deformable if the swelling is older and stickier.

Active joint range of motion is then assessed and this is the joint movement the patient can do for themselves. Depending on the joint, this is expressed in degrees or as a proportion of the tested normal range on the other side, with limitation of range noted and the reason. Passive range is then tested and the physiotherapist moves the joint for the patient to see if any more movement is possible within the limits of discomfort. If the active range is poor and the passive range full, i.e. the joint can move where it should, then weakness or pain may be the limiting factors. If the passive and active ranges are both restricted then joint stiffness may be the problem.

The physiotherapist will assess the active range of the joint movement which is what the patient can manage independently, noting the ranges as a proportion of normal and why the joint could not achieve full range, e.g. pain or muscle weakness. The physio will then move the patients joint passively without the patients effort to see if the joint ranges are different. If the physio can move the joint through its full normal range but the patient cannot do this, then either pain or muscle weakness is the likely cause. If neither the physio nor the patient can get the joint to full range, pain or joint stiffness may be the problem.

Ligaments are very important for normal function of a joint and the physiotherapist will routinely test their integrity, stressing them strongly by manual testing. The ligaments of major joints are very strong and testing a normal ligament should show no effect but it can uncover an absent, painful or stretched ligament by its effect on joint stability. Physios use the Oxford 0-5 scale to grade muscle strength, allowing for anxiety or pain which might interfere with a patients effort. Proprioception and joint sensibility may also be tested to ascertain if good feedback from the joint to the brain is present, this being important in normal movement planning.



Autor: Jonathan Blood-Smyth

Jonathan Blood Smyth is a Superintendent of Physiotherapy at an NHS hospital in the South-West of the UK. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for physiothrapists in Southampton.


Added: January 18, 2009
Source: http://ezinearticles.com/

Wednesday, January 7, 2009

How to Have a Successful Total Knee Replacement Recovery

One of the most common joint replacement surgery is the total knee replacement (TKR) or total knee Arthroplasty (TKA). Despite numerous operations, every year many people are ill prepared in terms of total knee replacement recovery process. Below we discuss some of the issues relating to the restoration and rehabilitation of these orthopedic surgery.

1. Preoperative Physical Conditioning

knee replacement and recovery actually starts before the operation takes place. Here's why. Successful knee replacement recovery depends on many different factors, but also some of the age of the patients, the number of goods and the general condition of the natural person who, before the surgery. Patients who are in a better condition and the general condition of the rule easier, with the rehab program.

Many orthopedic surgeons recommend patients lose weight and /or strengthen the muscles of the legs, leading to a better preparation for the knee surgery and postoperative rehabilitation.

2. Pain

I will not sugar coat this one. Other than shoulder replacements, knee replacements are among the most painful orthopedic operations, which are finished. I have rehabilitated many joints in my career, and this often gets complaints about the amount and duration of pain through the rehab phase. The good news is that your doctor is in pain medication, if specified, and there are special treatments to reduce the pain and. Once through the first week or two of a total knee replacement recovery will be significantly better.

3. Early Post-operative rehabilitation

It is of crucial importance to the entire knee replacement recovery, when the doctor there. Early rehabilitation is joint stiffness, swelling, improvement of general circulation in the extremities, speed and weight of pain relief. Most patients have a Continuous Passive Motion (CPM)-device on the knee surgery within a few hours after the operation. This mechanical device is automatically passive field of application to their knees, while the patient lies in bed.

4. Progressive and continuous Rehab

Some of the targets for the whole knee replacement recovery to walk down the hallway with a crutch or walker, climb a short set of stairs, in full the knees straight, bend the knee to about 90? or higher, and perform exercises independently at home. If the patient is unable to achieve these goals, within three to six days, more aggressive rehabilitation is necessary, and they can be sent to a rehabilitation center for a week or two or more depending on their medical and social needs.

ultimate goal of knee replacement recovery is to the patient to their prior level of function and living environment. Most total knee replacement surgery have a high success rate in conjunction with early, progressive Rehab intervention.

 

About the author: Richard is a clinical physical therapist. You can learn more about joint replacements by visiting his blog at http://fix-my-health.blogspot.com today!

This article may be reprinted only if the entire article remains intact and unchanged, including the author resource box.

Article Source: http://EzineArticles.com/?expert=Richard_Syner

Saturday, January 3, 2009

For Best Results Rehab Your Twisted Ankle the Way it Moves

your ankle moves in an unlimited number of possibilities, but a lot of rehab programs only to the actual ligaments and tendons were injured, and not the entire ankle.

The problem with the concept of most programs is that they only damaged tendons /ligaments and neglecting the other parts of the ankle. This approach allows the ankle in an unbalanced strength and flexibility, the state to more frequent and severe ankle sprains.

It is my opinion that the ankle rehab should be a whole ankle approach. What I mean is that a rehab program, the entire ankle ankle - the victim unharmed and parts at the same time, so everything in the ankle is the same strength and flexibility required.

With the help of a 3D approach is a challenge for the programs, with belts and such, because it is really hard to make the injured ankle to contribute effectively in the field of movement, where the violation occurred, so that the other parts unharmed a greater role in the movement, so that an unbalanced situation.

The unbalanced situation can cause the ankle to be withdrawn or to move more freely, so that a further ankle injury is almost guaranteed to happen.

Sun, the most important thing you can do is to rehab your ankle with a 3D approach, namely, strengthening and stretching of the entire ankle joint, that you walk on uneven ground, to ensure that your ankle during his entire width of the movement. They should pay special attention to the positions of the stiff, because that is the area where the damage was done, if you hurt your ankle.

If you are not your Rehab ankles, as she moves you will notice that, as you have your normal activities or sports, you have certain movements that cause you pain. Gradually, the number of ways that you can create your ankle without pain, reduce stiffness and to significant potential arthritis sets in.

Whatever rehab program you're after, make sure that both the rehab injured ankle that you and the other ankle so both are equally strong and flexible.

You will be back in action before you know it.

 

Bret Mundt has helped more than 2,500 people with sprained ankles get healed fast. With more than 50 sprained ankles over his basketball career he learned the tricks and secrets about how to rehab a injured ankle in less than 7 days so he would not lose playing time. Even if you can't walk and chew gum at the same time, you can get head shaking results with the step by step ankle rehab program.

Article Source: http://EzineArticles.com/?expert=Bret_Mundt

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