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PHYSICIANS PHYSICAL THERAPY SERVICE
WWW.FREEDOMOFMOTION.COM
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Healthy Times Newsletter
| June 2010
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We'd like to take this opportunity to introduce, Lauren M. Bounds, PT, DPT. Lauren is the new Clinical Director at our Scottsdale Clinic and is a great new addition to the PPTS family. Welcome Lauren!!  |
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New Research Show Arthroscopic Knee Surgery No Better Than Physical Therapy, Medical Management:
New England Journal of Medicine Study Questions Value of Knee Surgery..
A new study questioning the usefulness of arthroscopic surgery for
osteoarthritis of the knee should encourage patients to consider physical
therapy as an effective non-surgical option, according to the American Physical
Therapy Association (APTA). The study was published in the September 11 issue
of the New England Journal of Medicine (NEJM).
The study found that knee surgery is no better than physical therapy,
combined with comprehensive medical management, at relieving the pain and
stiffness of moderate to severe osteoarthritis of the knee.
"This study offers hope and encouragement to persons with
osteoarthritis who would like to avoid the pain and emotional toll of
surgery," said APTA President R Scott Ward, PT, PhD. "Too often, the
first line of defense is surgery when it need not always be. Physical therapy
can be equally effective and should be considered by not only patients
themselves, but also the primary care doctors and orthopedists who are treating
them."
According to physical therapist Christopher M Powers, PhD, PT, director of
the Biokinesiology program and co-director of the Musculoskeletal Biomechanics
Research Lab at the University of Southern California Division of
Biokinesiology & Physical Therapy, "Many times knee pain is associated
with abnormal movement patterns that cause increased stress on the joint.
Arthroscopic surgery does little to correct the dynamic factors that may be
contributing to knee pain and pathology. These findings reinforce the need for
a comprehensive treatment approach for such patients."
The NEJM study adds to a growing body of evidence supporting physical
therapy for treatment of osteoarthritis of the knee, including:
- A report published in the January
2008 issue of the journal Physical Therapy that reviewed research
on osteoarthritis of the knee from 2000 to 2007 and found
"high-quality evidence that exercise and weight reduction reduce pain
and improve physical function."
- A study published in the Feb
1, 2000 issue of the Annals of Internal Medicine that concluded
"a combination of manual physical therapy and supervised exercise
yields functional benefits for patients with osteoarthritis of the knee
and may delay or prevent the need for surgical intervention."
A physical therapist will perform a thorough examination and design a plan
of care that may include:
- A series of exercises
designed to help improve motion. Activities in this phase might include
water walking, swimming, and flexibility exercises.
- An exercise sequence to
restore strength including a functional progression, that is, a gradual
return to normal activities using exercises that simulate the knee
stresses of your normal activities.
A knee's tolerance for stressful activities often decreases with age and
loss of conditioning. As a result, stresses that would not have caused pain or
injury to the knee last year could today. A decrease in levels of activity over
a period of time may also contribute to the vulnerability of knees.
But there are steps one can take to help prevent injury in order to continue
enjoying sports and exercise. Pursuing an exercise program designed by a
physical therapist can be one of the best protections from injury.
The first step in designing your exercise program is an evaluation by your
physical therapist. He or she can identify your predisposing factors, those
body traits that may make you more or less vulnerable to a knee injury. Based
on this evaluation, your physical therapist can design a program that will help
you gain your optimum levels of function, strength and conditioning.
Article Published on APTA.org May 4, 2009
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Warm-Up Programs Help Reduce Female Soccer ACL Injuries
Several years ago, the American Physical Therapy Association
(APTA) began urging female athletes - particularly soccer players - to consider
a new warm-up program to help lower their growing risk of anterior cruciate
ligament (ACL) injuries.
Concurring with a study published in the American Journal of
Medicine, APTA say specialized stretching, strengthening, agility, and jumping
exercises could lower the overall ACL injury rate among female athletes.
The study evaluated outcomes of NCAA Division 1 female
soccer players who performed the Prevent Injury, Enhance Performance (PEP)
program, designed by physical therapists at Santa Monica Orthopedic and Sports
Medicine Group. Those who performed the PEP program had an overall ACL injury
rate 41% lower than a group of female athletes who did their regular warm-up.
This was one of the largest studies conducted in the NCAA with 1,435 athletes
participating.
The PEP program, one example of the many physical
therapy-based programs that have demonstrated an equal ability to reduce ACL
injuries among female athletes, consists of sport-specific agility exercises
and addresses potential deficits in the strength and neuromuscular coordination
of the stabilizing muscles around the knee joint. Holly Silvers, PEP Program Developer,
explains, "The program was created to address the deficits that are seen in
female athletes, particularly weakness in the lateral hip muscles, gluteal and
core muscles." These deficits can contribute to ACL injuries, notes Silvers.
Mark Paterno, PT, MS MBA, SCS, ATC, coordinator of
orthopedic and sports physical therapy at Cincinnati Children's Hospital
Medical Center, said that recent research found that ACL tears occur 4 times
more frequently in females than in males involved in the same amount of sports
participation. He says the difference in neuromuscular control is one of 4
primary factors contributing to women's greater susceptibility to knee
injuries. Other discrepancies are anatomical (men and women are structurally
different), hormonal (women's hormonal make-up affects the integrity of the
ligament, making it more lax), and bio-mechanical (the positions of knees
during athletic activities).
"Women perform athletic tasks in a more upright position,
putting added stress on parts of the knee such as the ACL, resulting in less
controlled rotation of the joint," Paterno says. "While men use their hamstring
muscles more often, women rely more on their quadriceps which puts the knee at
constant risk. To combat these natural tendencies, physical therapists may
develop a treatment program to improve strength, flexibility, and coordination,
as well as to counteract incorrect existing patterns of movement that may be
damaging to joints," he adds.
Silvers notes that physical therapist-designed programs can
teach athletes how to avoid abnormal movement patterns and lessen stress on the
knee, which may include exercises to strengthen hamstring and core muscles,
"Whether patients are athletes or no, physical therapist expertise includes not
only rehabilitation and restoration of normal levels of function, but also
education regarding how to prevent further injury," says Silvers.
Source: APTA: PT in Motion Magazine, June 2010 pg. 34
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