Posts

The Best and Easiest Way to Restore Knee Extension

One of the most common complications following a knee injury or surgery is not restoring full knee extension.  Losing knee extension causes a lot of issues, ranging from anterior knee pain, to altered movement patterns, to even difficulty when walking.

It’s super important to assure you restore full knee extension.

In this video below, Lenny Macrina, my co-owner of Champion and co-author of OnlineKneeSeminar.com, shares what he considers the best way to restore full knee extension.  Luckily, it’s not only the best in our minds but also the easiest to perform!  More importantly, he discusses why he doesn’t like one of the most common exercises that people tend to use.

 

 

Learn How We Evaluate and Treat the Knee

For those interested in learning more about how Lenny and I evaluate and treat the knee, we have an amazingly comprehensive course that covers everything you need to know to master the knee.  Our detailed examination process, all our treatment progressions, and detailed information on nonoperative and postoperative treatment of ACL, patellofemoral, meniscus, articular cartilage, osteoarthritis injuries, and so much more.

 

 

 

The One Thing You Must Do When Evaluating for an ACL Injury

Anterior cruciate ligament (ACL) injuries are common. When evaluating the ACL, special tests like a Lachman Test or Anterior Drawer have been shown to have great reliability and validity.

However, there is one main reason why you may get a false positive for an ACL injury of the knee that is often overlooked – you actually injured your posterior cruciate ligament (PCL)!

I know, it seems backwards, but watch this quick video for my explanation!

 

Learn How We Evaluate and Treat the Knee

For those interested in learning more about how Lenny and I evaluate and treat the knee, we have an amazingly comprehensive course that covers everything you need to know to master the knee.  Our detailed examination process, all our treatment progressions, and detailed information on nonoperative and postoperative treatment of ACL, patellofemoral, meniscus, articular cartilage, osteoarthritis injuries, and so much more.

 

 

 

Can PCL Injuries Be Successfully Treated Without Surgery?

Champion Physical Therapy and Performance

My latest article is now up on the new Champion Physical Therapy and Performance blog!  I discuss a recent research study that looked at the outcomes of subjects with PCL deficient knees that were followed for up to 21 years.

Pretty interesting stuff that shows the efficacy of our programs!  However, as you’ll read, we can do as much harm as good when designing exercises for people with PCL injuries.

Read the article here and be sure to sign up to receive all the updates from the Champion blog, there is plenty more coming from the Champion team!

 

I have also announced my latest Inner Circle webinar will overview my manual therapy system.  I’ve been really trying to create systems for all aspects of what I do as we build out Champion Physical Therapy and Performance.

Last month, I talked about how I design functional rehabilitation programs.  This month is devoted to manual therapy.  In this webinar I’ll discuss my system to performing manual therapy, including the specific order and techniques that I perform.  This system can be used for any issue depending on the needs of the patient.

I like to take a systematic approach for several reasons:

  1. Assures consistency between sessions
  2. Assures consistency between therapists
  3. Creates reliable and predictable results
Join me Wednesday August 27th at 8:00 PM EST for the live webinar or be sure to catch the recorded when it is posted.

How Soon Should You Have Surgery After a Multiple Ligament Knee Injury?

            knee dislocation mri      knee dislocation x-ray

Today’s post is another research update by Dan Lorenz on the effect of surgical timing in multiple ligament knee injuries.  There are pros and cons to both acute and chronic reconstruction.  My experience has always been to be about the middle of the road, get them early but let them settle down a bit first, then get rehab going fast.  Thanks again Dan!

 

RESEARCH UPDATE: SYSTEMATIC REVIEW OF THE TIMING OF OPERATIVE INTERVENTION AND POSTOPERATIVE REHABILITATION IN MULTIPLE LIGAMENT INJURED KNEES

Dan Lorenz, PT, DPT, ATC/L, CSCS

Mook et al recently did an interesting systematic review of studies to compare outcomes in early, delayed, and staged procedures as well as the subsequent rehabilitation protocols. Twenty-four retrospective studies were analyzed involving 396 knees dealing with multiple ligament knee injuries involving both cruciates and either or both collaterals. Data were compared as follows: 1) acute (time to surgery <3 weeks), 2) chronic (time to surgery >3 weeks), and 3) staged treatment (combination of repair and reconstruction in the acute and chronic periods). Findings were as follows:

  • Anterior instability – Acute treatment lead to greater instability compared to chronic treatment. No differences were found between acute and staged or staged and chronic. No differences in anterior instability were garnered from postoperative rehabilitation.
  • Posterior instability – Posterior instability was found in 28% who were managed with immobilization compared to 12% of those managed with early mobilization.
  • Varus laxity – Acute treatment resulted in 21% of patients having laxity in the immobilized group compared to only 1.6% managed with early mobilization. In the chronic treatment group, varus laxity was found in 1% managed with immobilization compared to 20% managed with early mobilization.
  • Valgus laxity – Acute treatment resulted in 26% of patients having laxity managed with immobilization compared to 2% of those managed with mobilization.
  • Flexion loss >10° – Significantly more patients (31%) had flexion loss of >10° in the acute group compared to patients in the chronic group. Significantly fewer patients were found to have flexion loss when managed in stages compared to those managed acutely. Flexion loss >10° was reported in 48% of those who were immobilized compared to 28% of those who were allowed early immobilization.
  • Extension loss of >5° – no differences were found based on surgical timing, but 15% of patients immobilized compared to 5% who were allowed early mobilization showed extension losses.
  • Good or excellent subjective outcome scores – Significantly greater outcomes were found in the staged group compared to the chronic group and the acute groups.
  • Abnormal/poor subjective outcomes – Significantly more poor outcomes were found in those managed with immobilization compared to those who were allowed early mobilization.
  • Lysholm Score – no differences in timing or rehab
  • Return to work – acutely managed patients who were immobilized early were significantly less likely to return to work than those who were mobilized early. No differences were found on basis of surgical timing
  • Return to athletics – patients who were managed acutely were significantly less likely to return to athletics than those who were managed in stages.
  • Operative arthrolysis – significantly fewer patients in the chronic treatment group underwent manipulation when compared to both the acute and staged treatment groups.

 

Clinical Implications

From a rehab standpoint, researchers found that those managed acutely with early mobilization had better outcomes as well as less range of motion losses. Observations from the researchers include a few important points. Reconstruction within three weeks after injury results in more anterior instability, more severe ROM complications, and more need for MUA. Secondly, they found patients that are managed in stages had the highest percentage of excellent/good subjective outcomes and the least ROM deficits. Third, although final ROM was preserved best in patients undergoing staged treatment, a high percentage needed follow-up surgery due to arthrofibrosis. This finding suggests that simultaneous repair and reconstruction of the cruciates acutely may lead to substantial ROM deficits and are unresponsive to follow-up surgery. Next, aggressive rehabilitation with early mobilization is associated with less ROM complications and earlier return to work, particularly in those who are acutely managed.

In conclusion, researchers stated:

  • Delayed surgery potentially results in equivalent stability measures compared to acute surgery.
  • Staged procedures produce a better subjective outcome and lower number of ROM deficits, but still needed additional treatment due to joint stiffness.
  • Patient managed acutely are as likely as those who are managed in stages to require additional treatment due to ROM deficits.
  • For the acutely managed patient, early mobilization results in better outcomes.
  • The type of rehab for delayed procedures isn’t as important as those who are managed acutely (mobilize acute early).

Does anyone have any thoughts on this study that they would like to share?  Any experiences?

 

 

Mook WR, Miller MD, Diduch DR, Hertel J, Boachie-Adjei Y, & Hart JM (2009). Multiple-ligament knee injuries: a systematic review of the timing of operative intervention and postoperative rehabilitation. The Journal of bone and joint surgery. American volume, 91 (12), 2946-57 PMID: 19952260