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PHYSICAL THERAPY
If you are contemplating having joint surgery and want to reduce your risk of developing a post operative infection
Two current measures previously shown to reduce infection:
New evidence has emerged that other practices are effective when added to the regimen:
Two current measures previously shown to reduce infection:
- giving antibiotics before surgery
- removing body hair with clippers instead of shaving to avoid nicks that could let bacteria into the bloodstream.
New evidence has emerged that other practices are effective when added to the regimen:
- prepping skin with an alcohol-based antiseptic before surgery,
- asking patients to bathe or shower for at least three days with a soap or wipes containing the antiseptic chlorhexidine
- testing patients for colonization with Staphylococcus aureus, including the most resistant strain known as MRSA. One study found that staph carriers who were treated with five days of the antibiotic mupirocin, administered as a nasal ointment, and who washed with chlorhexidine before surgery had a 60% lower rate of surgical site infections.
- advising patients about the importance of sleeping on clean sheets before surgery to avoid bacteria on the skin.
WHAT IS PHYSICAL THERAPY?
Physical therapy is a healthcare specialty that includes the evaluation, assessment, and treatment of individuals with limitations in functional mobility. Physical therapy services are provided by physical therapists, who are professionals licensed by the state in which they work. Physical therapists are required to have a master's degree or a clinical doctorate degree from an accredited institution and must sit for a licensing exam to practice.
Do I Need Physical Therapy?
If you have an injury or illness that results in physical impairment or loss of function, a physical therapist can help. Physical therapists treat people across the entire lifespan. Many specialize in treating a certain population, like children, the elderly, or athletes. Regardless of age, if you have impaired mobility, a physical therapy evaluation may be warranted to offer treatment and a strategy to improve function.
What Will Happen During Physical Therapy?
Physical therapists use many different techniques to help you decrease pain, decrease stiffness, improve motion and strength, and improve mobility. Physical agents, such as heat, ice, ultrasound, or electrical stimulation, may be used. Manual techniques are often used to help improve mobility. Therapeutic exercise is often used by physical therapists to help people gain range of motion, increase strength, and improve function. Patient education about a condition or illness is paramount to the practice of physical therapy, and therapists may use charts, models, and diagrams to help you understand your diagnosis and prognosis.
Where Will I Get My Physical Therapy?
Many people think of hospitals as the primary place where physical therapists practice, but therapists also work in a variety of other settings. If you are unable to leave your home due to illness or injury, a physical therapist can come to the house to provide home care. There, you can engage in specific exercises to help improve mobility and restore normal function.When an infant needs therapy, many state laws require that the child receive services in the setting that is most familiar to the child, either at home or in daycare. School-age children who have a movement impairment often receive physical therapy in school.
Physical therapists also practice in outpatient clinics, either privately owned, or owned and operated by large corporate entities, such as hospitals. Still other therapists work in nursing homes and long-term care facilities.
When an injury occurs that limits your ability to move about safely or normally, a referral to a physical therapist may be made. Physical therapists work closely with patients, doctors, and family members to ensure safe and rapid return to maximal function.
Physical Therapy and Rehabilitation:
Physical therapists are trained to identify deficiencies in the biomechanics of the body. Working with a physical therapist can target specific areas of weakness in the way our bodies work. They can relieve stress and help the body function without pain.Physical therapists are knowledgeable about surgical procedures and treatment goals, and can tailor their efforts to improve your well-being. After surgical procedures, it is important that therapy is guided by the surgical procedure. Physical therapists are knowledgeable about your body's limitations after surgery and can help ensure a successful outcome.
Stretching Tight Muscles and Joints:
Stretching is vital in maintaining good range of motion with joints and the flexibility of muscles. If you have stiff joints or tight muscles, normal activities, such as climbing stairs or reaching overhead, can be severely affected. With proper stretching, these functions can be preserved.After an injury or surgery, scar tissue forms and soft tissue contracts. It is important to regularly stretch in these situations to ensure that scar formation does not get in the way of your rehabilitation.
Exercises to Strengthen Your Body:
Strengthening exercises are performed to help you improve the function of your muscles. The goal is to improve strength, increase endurance and maintain or improve range of motion.Post-operative exercises should always be guided by your doctor and physical therapist, as there may be specific restrictions for your injury. The following guidelines can help you along your way:
Core Strengthening and Stability:
One of the most recent developments in physical therapy is the emphasis on core strengthening and stability. The core of your body is like the foundation of your house. If you were to build your house on a weak foundation, you could risk damage and collapse. Similarly, bodies with a weak core are susceptible to acute injury and chronic overuse syndromes. Core strengthening emphasizes the muscles of the back and pelvis. Some exercise programs, especially pilates, are fantastic at increasing the bodies core stability. That is the reason many professional athletes do regular pilates workouts.
Ice and Heat Application:
Ice and heat are useful in warming up and cooling off muscles. In addition, these methods can stimulate blood flow and decrease swelling. These can be important aspects of the therapeutic process. The key to proper ice and heat treatment is knowing when to ice and heat an injury.
Ultrasound:
Ultrasound uses high frequency sound waves (not within the range we can hear) to stimulate the deep tissues within the body. By passing an ultrasound probe over your body, deep tissues are stimulated by the vibration of the sound wave. This leads to warming and increased blood flow to these tissues.
Electrical Stimulation:
Electrical stimulation is a therapy that passes an electrical current to an affected area. Nerve conduction within the region is altered, which can in turn alter muscle contractility. Blood flow to these tissues is also increased with electrical stimulation. Patients often experience diminished pain after this electrical stimulation of treatment.
Do I Need Physical Therapy?
If you have an injury or illness that results in physical impairment or loss of function, a physical therapist can help. Physical therapists treat people across the entire lifespan. Many specialize in treating a certain population, like children, the elderly, or athletes. Regardless of age, if you have impaired mobility, a physical therapy evaluation may be warranted to offer treatment and a strategy to improve function.
What Will Happen During Physical Therapy?
Physical therapists use many different techniques to help you decrease pain, decrease stiffness, improve motion and strength, and improve mobility. Physical agents, such as heat, ice, ultrasound, or electrical stimulation, may be used. Manual techniques are often used to help improve mobility. Therapeutic exercise is often used by physical therapists to help people gain range of motion, increase strength, and improve function. Patient education about a condition or illness is paramount to the practice of physical therapy, and therapists may use charts, models, and diagrams to help you understand your diagnosis and prognosis.
Where Will I Get My Physical Therapy?
Many people think of hospitals as the primary place where physical therapists practice, but therapists also work in a variety of other settings. If you are unable to leave your home due to illness or injury, a physical therapist can come to the house to provide home care. There, you can engage in specific exercises to help improve mobility and restore normal function.When an infant needs therapy, many state laws require that the child receive services in the setting that is most familiar to the child, either at home or in daycare. School-age children who have a movement impairment often receive physical therapy in school.
Physical therapists also practice in outpatient clinics, either privately owned, or owned and operated by large corporate entities, such as hospitals. Still other therapists work in nursing homes and long-term care facilities.
When an injury occurs that limits your ability to move about safely or normally, a referral to a physical therapist may be made. Physical therapists work closely with patients, doctors, and family members to ensure safe and rapid return to maximal function.
Physical Therapy and Rehabilitation:
Physical therapists are trained to identify deficiencies in the biomechanics of the body. Working with a physical therapist can target specific areas of weakness in the way our bodies work. They can relieve stress and help the body function without pain.Physical therapists are knowledgeable about surgical procedures and treatment goals, and can tailor their efforts to improve your well-being. After surgical procedures, it is important that therapy is guided by the surgical procedure. Physical therapists are knowledgeable about your body's limitations after surgery and can help ensure a successful outcome.
Stretching Tight Muscles and Joints:
Stretching is vital in maintaining good range of motion with joints and the flexibility of muscles. If you have stiff joints or tight muscles, normal activities, such as climbing stairs or reaching overhead, can be severely affected. With proper stretching, these functions can be preserved.After an injury or surgery, scar tissue forms and soft tissue contracts. It is important to regularly stretch in these situations to ensure that scar formation does not get in the way of your rehabilitation.
Exercises to Strengthen Your Body:
Strengthening exercises are performed to help you improve the function of your muscles. The goal is to improve strength, increase endurance and maintain or improve range of motion.Post-operative exercises should always be guided by your doctor and physical therapist, as there may be specific restrictions for your injury. The following guidelines can help you along your way:
- Exercises for Knee Injuries
- Exercises for Shoulder Injuries
- Exercises for Back Injuries
- Exercises for Neck Injuries
Core Strengthening and Stability:
One of the most recent developments in physical therapy is the emphasis on core strengthening and stability. The core of your body is like the foundation of your house. If you were to build your house on a weak foundation, you could risk damage and collapse. Similarly, bodies with a weak core are susceptible to acute injury and chronic overuse syndromes. Core strengthening emphasizes the muscles of the back and pelvis. Some exercise programs, especially pilates, are fantastic at increasing the bodies core stability. That is the reason many professional athletes do regular pilates workouts.
Ice and Heat Application:
Ice and heat are useful in warming up and cooling off muscles. In addition, these methods can stimulate blood flow and decrease swelling. These can be important aspects of the therapeutic process. The key to proper ice and heat treatment is knowing when to ice and heat an injury.
Ultrasound:
Ultrasound uses high frequency sound waves (not within the range we can hear) to stimulate the deep tissues within the body. By passing an ultrasound probe over your body, deep tissues are stimulated by the vibration of the sound wave. This leads to warming and increased blood flow to these tissues.
Electrical Stimulation:
Electrical stimulation is a therapy that passes an electrical current to an affected area. Nerve conduction within the region is altered, which can in turn alter muscle contractility. Blood flow to these tissues is also increased with electrical stimulation. Patients often experience diminished pain after this electrical stimulation of treatment.
Surgery, therapy both prove good for knee repair
By Marlynn Marchione : AP : March 19, 2013
You might not want to rush into knee surgery.
Physical therapy can be just as good for a common injury and at far less cost and risk, the most rigorous study to compare these treatments concludes.
Therapy didn't always help and some people wound up having surgery for the problem, called a torn meniscus. But those who stuck with therapy had improved as much six months and one year later as those who were given arthroscopic surgery right away, researchers found.
"Both are very good choices. It would be quite reasonable to try physical therapy first because the chances are quite good that you'll do quite well," said one study leader, Dr. Jeffrey Katz, a joint specialist at Brigham and Women's Hospital and Harvard Medical School.
He was to discuss the study Tuesday at an American Academy of Orthopaedic Surgeons conference in Chicago. Results were published online by the New England Journal of Medicine.
A meniscus is one of the crescent-shaped cartilage discs that cushion the knee. About one-third of people over 50 have a tear in one, and arthritis makes this more likely. Usually the tear doesn't cause symptoms but it can be painful.
When that happens, it's tough to tell if the pain is from the tear or the arthritis — or whether surgery is needed or will help. Nearly half a million knee surgeries for a torn meniscus are done each year in the U.S.
The new federally funded study compared surgery with a less drastic option. Researchers at seven major universities and orthopedic surgery centers around the U.S. assigned 351 people with arthritis and meniscus tears to get either surgery or physical therapy. The therapy was nine sessions on average plus exercises to do at home, which experts say is key to success.
After six months, both groups had similar rates of functional improvement. Pain scores also were similar.
Thirty percent of patients assigned to physical therapy wound up having surgery before the six months was up, often because they felt therapy wasn't helping them. Yet they ended up the same as those who got surgery right away, as well as the rest of the physical therapy group who stuck with it and avoided having an operation.
"There are patients who would like to get better in a 'fix me' approach" and surgery may be best for them, said Elena Losina, another study leader from Brigham and Women's Hospital.
However, an Australian preventive medicine expert contends that the study's results should change practice. Therapy "is a reasonable first strategy, with surgery reserved for the minority who don't have improvement," Rachelle Buchbinder of Monash University in Melbourne wrote in a commentary in the medical journal.
As it is now, "millions of people are being exposed to potential risks associated with a treatment that may or may not offer specific benefit, and the costs are substantial," she wrote.
Surgery costs about $5,000, compared with $1,000 to $2,000 for a typical course of physical therapy, Katz said.
One study participant — Bob O'Keefe, 68, of suburban Boston — was glad to avoid surgery for his meniscus injury three years ago.
"I felt better within two weeks" on physical therapy, he said. "My knee is virtually normal today" and he still does the recommended exercises several times a week.
Robert Dvorkin had both treatments for injuries on each knee several years apart. Dvorkin, 56, director of operations at the Coalition for the Homeless in New York City, had surgery followed by physical therapy for a tear in his right knee and said it was months before he felt no pain.
Then several years ago he hurt his left knee while exercising. "I had been doing some stretching and doing some push-ups and I just felt it go 'pop.'" he recalls. "I was limping, it was extremely painful."
An imaging test showed a less severe tear and a different surgeon recommended physical therapy. Dvorkin said it worked like a charm — he avoided surgery and recovered faster than from his first injury. The treatment involved two to three hour-long sessions a week, including strengthening exercises, balancing and massage. He said the sessions weren't that painful and his knee felt better after each one.
"Within a month I was healed," Dvorkin said. "I was completely back to normal."
By Marlynn Marchione : AP : March 19, 2013
You might not want to rush into knee surgery.
Physical therapy can be just as good for a common injury and at far less cost and risk, the most rigorous study to compare these treatments concludes.
Therapy didn't always help and some people wound up having surgery for the problem, called a torn meniscus. But those who stuck with therapy had improved as much six months and one year later as those who were given arthroscopic surgery right away, researchers found.
"Both are very good choices. It would be quite reasonable to try physical therapy first because the chances are quite good that you'll do quite well," said one study leader, Dr. Jeffrey Katz, a joint specialist at Brigham and Women's Hospital and Harvard Medical School.
He was to discuss the study Tuesday at an American Academy of Orthopaedic Surgeons conference in Chicago. Results were published online by the New England Journal of Medicine.
A meniscus is one of the crescent-shaped cartilage discs that cushion the knee. About one-third of people over 50 have a tear in one, and arthritis makes this more likely. Usually the tear doesn't cause symptoms but it can be painful.
When that happens, it's tough to tell if the pain is from the tear or the arthritis — or whether surgery is needed or will help. Nearly half a million knee surgeries for a torn meniscus are done each year in the U.S.
The new federally funded study compared surgery with a less drastic option. Researchers at seven major universities and orthopedic surgery centers around the U.S. assigned 351 people with arthritis and meniscus tears to get either surgery or physical therapy. The therapy was nine sessions on average plus exercises to do at home, which experts say is key to success.
After six months, both groups had similar rates of functional improvement. Pain scores also were similar.
Thirty percent of patients assigned to physical therapy wound up having surgery before the six months was up, often because they felt therapy wasn't helping them. Yet they ended up the same as those who got surgery right away, as well as the rest of the physical therapy group who stuck with it and avoided having an operation.
"There are patients who would like to get better in a 'fix me' approach" and surgery may be best for them, said Elena Losina, another study leader from Brigham and Women's Hospital.
However, an Australian preventive medicine expert contends that the study's results should change practice. Therapy "is a reasonable first strategy, with surgery reserved for the minority who don't have improvement," Rachelle Buchbinder of Monash University in Melbourne wrote in a commentary in the medical journal.
As it is now, "millions of people are being exposed to potential risks associated with a treatment that may or may not offer specific benefit, and the costs are substantial," she wrote.
Surgery costs about $5,000, compared with $1,000 to $2,000 for a typical course of physical therapy, Katz said.
One study participant — Bob O'Keefe, 68, of suburban Boston — was glad to avoid surgery for his meniscus injury three years ago.
"I felt better within two weeks" on physical therapy, he said. "My knee is virtually normal today" and he still does the recommended exercises several times a week.
Robert Dvorkin had both treatments for injuries on each knee several years apart. Dvorkin, 56, director of operations at the Coalition for the Homeless in New York City, had surgery followed by physical therapy for a tear in his right knee and said it was months before he felt no pain.
Then several years ago he hurt his left knee while exercising. "I had been doing some stretching and doing some push-ups and I just felt it go 'pop.'" he recalls. "I was limping, it was extremely painful."
An imaging test showed a less severe tear and a different surgeon recommended physical therapy. Dvorkin said it worked like a charm — he avoided surgery and recovered faster than from his first injury. The treatment involved two to three hour-long sessions a week, including strengthening exercises, balancing and massage. He said the sessions weren't that painful and his knee felt better after each one.
"Within a month I was healed," Dvorkin said. "I was completely back to normal."