Answers to Common Questions about Total Knee Replacement

 

Article found via http://www.healthline.com.

“1. When is the right time to undergo a knee replacement?

There’s no precise formula for determining when you should have a knee replacement. But if you’re having trouble getting up to answer the phone or walk to your car, you may be a candidate. A thorough examination by an orthopedic surgeon should yield a recommendation. It might also be beneficial to receive a second opinion.

2. Is there a way to avoid surgery?
For some, lifestyle modifications, physical therapy, medication, or alternative treatment methods such as acupuncture and prolotherapy (which involves injecting fluid to strengthen connective tissue) can help manage knee problems. Also, you may want to speak to your surgeon about other procedures that are commonly recommended before resorting to knee replacement surgery, including steroid or hyaluronic acid injections and arthroscopic surgery that addresses the damaged cartilage.However, delaying or declining a necessary knee replacement could result in a less favorable outcome. Ask yourself: Have I tried everything? Is my knee holding me back from doing the things I enjoy?

3. What will occur during surgery and how long will the knee replacement operation take?
The surgeon will make an incision on the top of your knee in order to expose the damaged area of your joint. The standard incision size can be as long as 10 inches, but a minimally invasive procedure can result in incisions as short as 4 inches. During the operation, the surgeon moves your kneecap aside and cuts away damaged bone and cartilage, which are then replaced with new metal and plastic components. The components combine to form a synthetic (but biologically compatible) joint that mimics the movement of your natural knee. Most knee replacement procedures take 1.5 to two hours to complete.

4. What pieces are used in a knee replacement and how are they kept in place?
Implants are comprised of metal and medical-grade plastic. To seal these components to your bone, two methods are used: bone cement, which typically takes about 15 minutes to set; and a cement-less approach that uses components with a porous coating that grows into tissue or attaches to bone. In some cases, a surgeon may use both techniques in the same surgery.

5. Should I be concerned about anesthesia during surgery?
Any surgery with anesthesia has risks. However, complication rates and mortality for general anesthesia are extremely low. An anesthesia team will determine whether general anesthesia or spinal, epidural, or regional nerve block anesthesia is best.

6. How much pain will I experience after surgery?
Although you will experience some pain after surgery, it should diminish quickly—within four or five days max. Your doctor will most likely prescribe medication to help you manage the pain, which will be administered through intravenously (IV) immediately after surgery. After you are released from the hospital, you will switch to painkillers taken in a pill or tablet form. After you have recovered from surgery, you should experience significantly less pain in your knee but there’s no way to predict exact results—some patients have knee pain for a full year after the surgery. Your willingness to engage in physical therapy and make lifestyle modifications can have a significant impact on your post-surgery level of pain and adjustment to the implant.

7. What should I expect immediately following surgery?
You will wake up with a bandage over your knee and, in most cases, a drain to remove fluid from the joint. It is likely that you will wake up with your knee elevated and cradled in a continuous passive motion (CPM) machine that gently extends and flexes your leg while you are lying down. A doctor might also insert a catheter so you don’t have to get out of bed to get to a toilet. In addition, you may wear a compression bandage or sock around your leg to improve blood circulation and reduce the odds of a clot. Your doctor will administer antibiotics intravenously and you may receive anticoagulants (blood thinners) to reduce the odds of a clot. Many patients experience an upset stomach during the immediate post-surgery period—this is normal, and your doctor or nurse can help provid medication to ease stomach pain.

8. What can I expect during recovery and rehabilitation from knee replacement?
Most patients are up and walking within a day or two—with the aid of a walker or crutches. A physical therapist will help you bend and straighten your knee a few hours after your surgery. After you return home, therapy will continue regularly for weeks and you will be asked to engage in specific exercises designed to improve the functionality of the knee. If your condition is more severe, or if you don’t have the needed support at home, the doctor may recommend you first stay at rehabilitation or nursing facility, though this is rare. During the weeks after surgery, your doctor will wean you from pain medication.

9. What do I need to do to prepare my home for recovery?

If you live in a multiple story house, prepare a bed and space on the ground floor so that you can avoid the stairs when you first return. Make sure the house is free of obstructions and hazards including power cords, area rugs, clutter, and furniture. Focus specially on pathways, hallways, and other places where you are likely to have to walk through. It’s wise to make sure that handrails are secure and a grab bar is available in the tub or shower you plan to use. You may want to add a bath/shower seat.

10. Will I require any special equipment?
Your doctor will likely recommend that you use a CPM machine at home, while lying on a flat surface or bed. You may be sent home from the hospital with this device, but if you aren’t, your doctor or therapist will arrange that one be delivered to you. A CPM machine helps to increase your knee motion during the first few weeks after surgery, and is usually prescribed to slow the development of scar tissue and to help you achieve the maximum range of motion from your implanted knee. It is crucial to use the device as prescribed by your doctor or PT.

11. What activities will I be able to engage in?
You should be able to resume normal daily activities—such as walking and bathing—within several days. Low impact exercise should also be doable after your rehabilitation period, typically six to 12 weeks. Consult with your physical therapist about introducing new activities during this rehabilitation period. You should avoid running, jumping, bicycling up and down hills and other high impact activities.

12. How long will the artificial knee joint last and will I ever require a revision (a second knee replacement)?
Studies show that upwards of 85 percent of patients still have a functioning artificial joint 20 years after receiving it. However, wear and tear on the joint can adversely affect its performance and lifespan. Younger patients are more likely to have the joint wear out and require a revision during their lifetime. Consult with a doctor about what’s right for you.”

Source: Greengard, S. (2012, April 30). Answers to common questions about total knee replacement. Retrieved from http://www.healthline.com/health/total-knee-replacement-surgery/common-questions

(2013, March ). Before and after rheumatoid arthritis [Web Photo]. Retrieved from http://www.coretherapy.com/health_news/articles_total_knee_replacement.html

Physical Therapy Benefits For Back Pain

After an episode of low back pain has lasted between two and six weeks, or if there are frequent recurrences of low back pain, it is reasonable to consider back pain exercises and physical therapy for back treatment. (Some spine specialists consider back exercise and physical therapy sooner, particularly if the pain is severe.) In general, the goals of back pain exercises and physical therapy are to decrease back pain, increase function, and provide education on a maintenance program to prevent further recurrences.

 

Passive Physical Therapy – Modalities

There are many different forms of physical therapy. Acutely, the therapist may focus on decreasing pain with passive physical therapy (modalities). These are considered passive therapies because they are done to the patient. Examples of modalities include:

  • Heat/ice packs
  • TENS units
  • Iontophoresis
  • Ultrasound

 

Active Physical Therapy – Back Pain Exercises

In addition to passive therapies, active physical therapy (exercise) is also necessary to rehabilitate the spine. Generally, a patient’s back exercise program should encompass a combination of the following:

  • Stretching for back pain exercise
  • Strengthening for back pain exercise
  • Low-impact aerobic conditioning

Even patients with a very busy schedule should be able to maintain a moderate back pain exercise regimen that encompasses stretching, strengthening, and aerobic conditioning. These exercises suffice as physical therapy for back pain relief.

  • Stretching for back pain exercises. Almost every individual who has suffered from low back pain should stretch their hamstring muscles once or twice daily. Simple hamstring stretching does not take much time, although it can be difficult to remember, especially if there is little or no pain. Therefore, hamstring stretching exercises are best done at the same time every day so it becomes part of a person’s daily routine.
  • Strengthening for back pain exercise. To strengthen the back muscles, 15-20 minutes of dynamic lumbar stabilization or other prescribed exercises should be done every other day.
  • Low-impact aerobic conditioning. Low impact aerobics (such as walking, bicycling or swimming) should be done for 30-40 minutes three times weekly, on alternate days from the strengthening exercises.

Source: Ullrich, P. F. (1999, 9 8). Physical therapy benefits for back pain. Retrieved from http://www.spine-health.com/treatment/physical-therapy/physical-therapy-benefits-back-pain

Physical Therapy FAQ’s Answered

Can I choose what physical therapist I go to?

Absolutely! The decision of where you receive treatment is yours. If you have a specific therapist or practice you would like to go to, you should let your doctor or insurance company know this. Not all physical therapists or practices are the same and the choice of your provider is yours. Sometimes your physician will recommend a specific therapist or practice to you; sometimes your insurance company will require you to go to specific therapists or practices. You always have the right to ask for a specific provider. If we are not “in network” with your specific insurance company, many have out of network options that still provide coverage.

What should I expect during my physical therapy treatments?

Your first visit will include the initial evaluation and then a treatment. You will be instructed on therapeutic exercises, learn how to manage and care for your symptoms, receive manual therapy if necessary, and may be treated with some type of therapeutic modalities. (As well as given a specific home program, ice, ultrasound, electrical stimulation, traction, etc.)

What type of treatment will I receive?

Treatment is based on the initial evaluation findings along with ongoing reassessment and evaluation. Treatment may consist of a variety of hands-on joint and soft tissue treatment techniques, exercise techniques and pain reducing modalities. Treatments are designed to increase motion and strength, reduce pain, and most importantly, restore function. Patients are typically involved in an active exercise program at home and are educated in ways to speed recovery and prevent recurrence of the problem.

What should I wear?

It is best to wear clothing and shoes that are appropriate for exercise. The clothing should either expose the area (i.e. wear shorts if you are being seen for a knee problem) or be loose fitting to easily expose the area that is being treated. You may be asked to put on a gown depending on where your pain or problem is located.

How many treatments will I need?

Our average number of treatments is 6, but this can vary depending on the extent and type of injury that is being treated.

What is Physical Therapy? Is it like Massage Therapy or Chiropractic Care?

In reference to massage therapy, a PT can and will often administer massage-like techniques called soft tissue mobilization, but massage therapists cannot administer PT. The PT you receive therefore may include soft tissue mobilization but will include much more education, exercise and the use of other modalities.

Chiropractic care differs quite a bit in the sense that a Chiropractor relies heavily on performing joint manipulations. Chiropractors typically will see a patient for much longer than a physical therapist for continued joint manipulations or “adjustments” whereas a physical therapist will rehab the injury or painful area and then instruct the patient in a Home Exercise Program for continued care. A physical therapist with specialized training can effectively perform many of the physical adjustments that a Chiropractor utilizes.

How can Physical Therapy help back pain?

Physical Therapy helps control back pain by reducing pain, controlling swelling and through therapeutic exercises. Patient education such as home exercises and lifting techniques also play a large role is assisting the patient in controlling low back pain.

I just had orthopedic surgery; will physical therapy help me heal faster?

Of Course! Physical Therapy can help reduce swelling, increase active and passive range of motion and increase strength and endurance after orthopedic surgery. Most importantly, attending physical therapy increases the functioning of the involved muscles, bones and other soft tissues much more quickly and effectively than just “staying at home” after surgery.

How do I know that physical therapy can help me?

Physical therapy can help anyone who is suffering from musculoskeletal injuries, recovering from surgeries or other difficulties such as balance/walking problems, or neurological problems such as stroke and acquired brain injuries. Even people recovering from non-orthopedic surgeries (internal problems, cancer) can benefit from PT by regaining strength and endurance. The realm of physical therapy is huge and encompasses the whole body and its functioning. To learn how PT can specifically help your condition, make an appointment with any of our locations for a Free Assessment.

Do I need a referral to come to physical therapy?

In the state of Iowa, a referral from a physician is not required to receive a physical therapy evaluation or treatment. Some exceptions do occur. Medicare always requires a referral to obtain physical therapy services. This referral may come from a physician, a physician assistant, a nurse practitioner, a dentist or a podiatrist. In addition, some insurance companies require a referral to provide insurance coverage. You should call your insurance company to determine whether or not you are required to have a referral for coverage.

What does a physical therapist do?

Physical therapists are experts trained in the evaluation and treatment of musculoskeletal dysfunction. They are trained specifically to improve movement and function, relieve pain, and expand movement potential. Physical therapy is often the treatment of choice in situations where pain impairs function, in recovering from an injury or surgery, and in recovering from a disease process or illness. Physical therapists also teach adaptive and physical coping skills in dealing with impaired function from a disease, injury or illness.

Will my insurance cover physical therapy?

Most insurance companies do cover physical therapy services. The amount and type of coverage varies. It is always best to check with your insurance company regarding specific coverage guidelines. The staff at each location will also verify your specific coverage guidelines at your first visit. If you do not wish to utilize your insurance, you may choose our private pay plan. We accept checks, VISA and MasterCard.

As a patient, what can I do to assure the best possible outcome?

First, recognize that you play the most important role in your own recovery. We encourage patients to act as full partners with their therapist in the treatment process. Comply with your in-clinic therapy schedule; follow through on your home exercise programs; and communicate often and completely with your therapist regarding any problems or concerns you may experience. Physical therapy is an active process that requires your full commitment and interaction with your therapist. Ask questions and be receptive to suggestions regarding exercise, lifestyle changes and adjustments or modifications of your daily activities.

Why should I go to physical therapy, can’t I get better on my own?

1. Physical therapists are trained to identify the movement dysfunction and compensation changes related to your diagnosis.
2. We rehabilitate an injury with the correct movement patterns in place of faulty habits.
3. We educate you about what your injury does to your body and how to correct it
4. We teach you how to prevent further injuries

 

Source: 

21 Century Rehab. (2014, March 18). Faq’s – what is physical therapy?                                                                                       Retrieved from http://21stcenturyrehab.com/faq/.

Credit to Encore’s PT staff!

This is an email we received from a student who shadowed a few of our PT’s in the North Alabama area. Congratulations Kristin and good luck!

“I received word yesterday that I have been accepted into UAB’s DPT program!  I will be graduating from undergrad in December and starting the DPT program this coming January.

I just wanted to thank you again for the part you played in helping me identify my future career path by setting up times for me to observe in different PT settings.  Physical therapy wasn’t really on my radar, but after shadowing the therapists at the Encore facilities, there was no doubt in my mind as to the direction my education and career should take.  Your therapists are truly spectacular, and my experiences with them were pivotal in helping me decide to pursue physical therapy.  I am so excited and cannot wait for January to come!

Thank you again!

Kristin Ford”

A Special Thank You Letter

“I am a 67 year old grandmother and have had my fair share of orthopedic rehab. I have never, throughout all my injuries, experienced anything to touch the care of Encore Rehab in Spanish Fort, AL. My two therapists, Rachel Hartman and Jessica Jones, are the best you can get! Peggy Alexander, the receptionist, facilitates everything so quickly that you are immediately cared for the minute you walk in the door. These three women are an asset to Encore’s company and are responsible for the incredible recovery of my new knee. With their help, I am now in my 5th week of therapy and can say they have given me exactly what I want, a wonderful new knee with full range of motion. It can be done at Encore with Rachel and Jessica.”

– Susan Dube, Daphne, AL.

2014 Final 48 at the BJCC

1A Falkville High School Girls game vs. BrantleyImage

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2A Tanner High School Boys vs. Elba

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3A Holly Pond High School Girls vs. Trinity

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3A State Runner up: Holly Pond High School vs. Lauderdale Co. 

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5A Brewer High School Girls vs. Sylacauga

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5A Faith Academy High School Boys vs. Parker

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Six Foods that Fight Depression

by Michelle Blessing “Special Needs Mommy” | January 7, 2014

Many women suffer from seasonal disorders, depression, or anxiety. Seasonal Affective Disorders (SAD) is a form of depression that occurs around the same time every year, and for most, it is around the fall and winter months. SAD saps your energy, causes mood swings and diminishes levels of excitement, happiness and overall motivation. If this sounds familiar, you may be wondering what you can do to help the problem without relying solely on medication. Truth be told, diet can be a powerful tool in changing your mood and overall mental health. Here are 6 feel better foods to help you fight that seasonal slump.

1. Vitamin B-12 and Folic Acid: Although not foods, per say, vitamin B-12 and folic acid are essential vitamins in fighting depression symptoms.  Studies have shown that foods or meals high in these two compounds prevent central nervous system disorders and mood problems. Folic acid can be found in leafy greens and beans; vitamin B-12 in meats, fish and dairy products. Eggs, spinach, and salmon are all great sources of folic acid and vitamin B-12.

2. Selenium: Selenium is a mineral with antioxidant-type properties.  Research has shown that 200 micrograms of selenium per day can decrease symptoms of depression.  Selenium is found naturally in whole grains, such as oatmeal and brown rice.  You can also find selenium in Brazil nuts and seafood, such as clams and oysters.

3. Fish: We’ve heard it for years, but recent studies have further shown the effect of omega-3 fatty acids and lower levels of depression.  This is especially true of women suffering from postpartum depression. Some excellent sources of omega-3 fatty acids include salmon,tuna, and herring.

4. Fruits and Vegetables: Depression can be linked to damage in the brain caused by free radicals.  Beta-carotene, vitamin C and vitamin E can all combat damage done by free radicals. Fruit such as strawberries and blueberries are excellent sources of vitamin C, and carrots are a great way to get beta-carotene.  Nuts, seeds and wheat germ are sources of vitamin E.  One way to pack a punch is to whip up a fruit and veggie smoothie with some added wheat germ for breakfast – a great start for a happy day.

5. Vitamin D: Vitamin D deficiency has been directly linked to depression, so getting adequate amounts of this nutrient is essential.  The most obvious source of vitamin D is the sun, but many women worry about sun protection, and therefore cover up, leading to vitamin D deficiencies.  Some other sources of vitamin D include cheese and egg yolks, so make yourself a yummy cheese omelet for breakfast and get your daily dose of this necessary nutrient.

 6. Chocolate: Of course we saved the best for last – chocolate!  Dark chocolate affects your body’s endorphins, releasing feel-good chemicals within your brain.  A small piece of chocolate can be mood boosting and it has been shown to lower blood pressure.  So, go ahead and splurge with a bit of dark chocolate for dessert!

Source: http://www.skinnymom.com/2014/01/07/6-feel-better-foods-to-help-combat-seasonal-disorders/

Encore’s Athlete of the Month

Congratulations to Brooks Bennett, Encore’s Athlete of the Month!
“Brooks played safety for the Bucs defense the past two season. He earn the starting position as safety entering his senior season.  Through determination, persistence & toughness, Brooks completed the season and lead the Bucs to their 2nd consecutive undefeated State Championship season!”

*Chosen by Head Athletic Trainer for Hoover High School: Brandon Sheppard, MEd, ATC