Both Knee Joint replacement rehabilitation :Full recovery in 5 weeks with Physiotherapy
It really feels great when your patients start living life independently doing all the activities of daily living and exercises by themselves.A true and real job satisfaction feeling for me as a physiotherapist. Thanks Aunty for sharing this message. message for kolhatkar mam
They say doctors are friends i dint believe it until now. I did this long planned surgery of knee replacement about a month ago and went thru pain.
But now as i stroll in the park or go to a restaurant to dine i believe that its a miracle. No more pain…The joy to walk again!
I found this newer me ! In this journey. Many loved ones helped me. U r one of it for sure.
Thanks for your help and support until now. As we complete this bond .. i promise to exercise and do all that u suggested me.
Ur alwaz invited for coffee and chats at my place! Thanks stay in touch..
Sunita Aunty had undergone total knee joint replacement surgery for both knees after suffering painful knee joint pain for more than a decade . I started her physiotherapy treatment after she got discharged from the hospital.Day 1 knee flexion was only 20 degree and she had flexion deformity.
Week One:Started with static knee exercises and passive exercises for both knees. Within a week knee flexion was 90 degree and Aunty could do assisted active knee exercises.
Week Two:By 2 weeks we started active exercises in sitting and standing position.Gait training was started to improve her walking style and eliminate the limp.
Week Three :After removal of stitches she was more comfortable in climbing staircase and walking around. In week three , I focused on quadriceps strengthening exercise and full range of motion (ROM) exercise for knee joint. Static Quadriceps and VMO exercises frequency and repetition was increased. Hamstring stretching was helpful to correct knee flexion deformity.
Week Four:After 4 weeks, Aunty was confident to do Quadriceps and hamstring strengthening exercises, hip, knee and ankle joint exercises , staircase climbing and gait without support.She could actively correct her flexion deformity and extend her knee with full range of motion.
Week Five:Sunita Aunty started walking without support. She was able to do daily activities of living and household chores on her own.
It was a pleasure to connect with a positive soul and such a cooperative person who followed physiotherapy treatment religiously. She is taking care of her 2 grandchildren now and enjoying her retired life and living pain free and independent life to the fullest.I am really glad to contribute my share as physiotherapist in her journey towards living pain free life and enjoy every moment of life to the fullest.
Now a days youngsters are crazy about trekking rappelling and all adventures Most important thing to remember is prepare yourself mentally and physically both for such adventures .
Nature is the best to be with It helps us to rejuvenate To find ourselves and most importantly gives us immense pleasure and peace
How to prepare for adventures? If you are interested in trekking then first start warm up exercises for hands and legs Start small walks and gradually increase the distance .Always prefer to walk at same pace as it is very helpful if you are consistent with your speed .Avoid taking long breaks or intervals during walk.
Walking along slopes or hills too is very beneficial.Practice climbing hills with small backpack.It increases your endurance and stamina .
Breathing exercises helps to increase your stamina and endurance.Deep breathing exercises play a vital role.
Stretching exercises helps to reduce stiffness and tightness in muscles .Strengthening exercises for hip knee ankle back abdominal muscles and Shoulders are very helpful as you can enjoy trekking without any discomfort or pain . Muscles which need to be strengthen are ◦ Quadriceps ◦ Hamstring ◦ Hip flexors ◦ Hip extensors ◦ Shoulder muscles ◦ Neck n back extensors ◦ Abdominal muscles Stretching exercises should be done before and after exercises Stretching exercises should be done pre and post trekking to release the tension and stiffness in muscles Stretching should be done for Quadriceps Stretching for following muscles are necessary ◦Hamstring ◦Back and neck extensors ◦Shoulder muscles ◦Biceps and triceps
Parag was waiting at the door and he was worried as his mother did not open the door for long time .He opened the door by using his own key and asked his mother “What happened? Why didn’t you open the door?”
Vrinda Aunty replied” I can’t walk fast .I take time to get up from the bed .My knees are hurting badly.I am really tired of this knee pain. I can’t do cooking as I can’t stand for a long time. I feel very sad as I am totally home bound now.” That is when Parag decided to take his mom to Orthopedic Surgeon to understand about Total Knee Joint Replacement surgery (TKR). Orthopedic Surgeon suggested to go for bilateral TKR and operated her both knees on the same day.
Post-surgery Parag called me to start her rehabilitation program.
Many times, patents are not given the clear idea about post-surgery pain and importance of Knee Joint replacement rehabilitation program, which plays a vital role in making the surgery successful.
Importance of Knee joint Replacement Rehabilitation Program:
Knee replacement rehabilitation is important for the patient, as it ensures complete recovery of the patient. Performing selected sets of exercises after total knee replacement surgery make the patients more flexible, increasing their muscle strength with mobility. With a physiotherapist providing guidance for an exercise program, recovery will be faster ensuring mobility. Strengthening exercises strengthen lower limbs and averts muscle mass loss. This helps patients to regain strength required for toileting, walking and for other activities.
When I met Vrinda aunty on 7th day after operation, her knees were bending only 30 degrees.I designed following program for her by considering her age, health, knee conditions and overall fitness.
Post operation Week Two :I started with following exercises
Active ankle exercises
Active knee range of motion exercises
Passive knee bending
Assisted straight leg raising
Exercises in sitting
Results:Knees were bending 90 degrees. Walking pattern (Gait) was improved .She could go down from staircase by support and sit in the car to go for suture (stiches) removal.
Post operation Week three:Next week we focused on strengthening exercises
Knee hip strengthening exercises
Range of motion exercises for knee in prone , supine, lying and sitting position
Backward knee bending in standing positions
Hip and knee exercises in standing
Gait training without support
Results: Knees were bending in 120 degrees and Vrinda Aunty could walk without support.
Post operation Week Four:In addition to variations in the exercises designed for week two and week three , following exercise were added
Stair case Up and Down
Results:Knee flexion was more than 120 degrees. She was able to walk without walker confidently. She could climb staircase independently .Muscle strength was improved. She was able to do her day to day activities.
After 4 weeks:After 4th weeks, home exercise program was given to her to maintain the flexibility and mobility of knee and strengthen lower limb muscles.
Vrinda Aunty returned to her native place –Nasik. She called me from Nasik to thank me when she started enjoying her evening walks with her friends. She was glad that she could offer her prayers to god by going to the temple .She was able to do her household chores on her own.
Vrinda Aunty was living her life to the fullest and that was the most rewarding feeling for me.
Review from Vrinda Aunty’s daughter in Law: Poorva Gosavi:
“Dr Mugdha is excellent physiotherapist. My mother in law had surgery of both knees. Within a month, she is able to do all her work by her own .All credit goes to Dr Mugdha. She gave her tremendous confidence. She is friendly. I am really thankful to her n her team as well. Wish them all the best for future. Best physiotherapist I have ever seen. Thank you !!”
They are the primary tools which we use to express our emotions. But what if we lost that ability?
For that is exactly what happen when a person suffers from facial palsy (Bell’s palsy) ,he or she cannot express themselves using their facial muscles
Pihu ,a budding dancer ,age 12 went to her class as usual .While dancing, she realized that she was not able to give the proper facial expressions required and had slight watering from her eyes. She informed her mother about this after coming home but, her mom thought it was probably due to her studies and over exertion. The next day, Pihu was struggling to gargle while brushing as water was leaking through a corner of her mouth .Immediately her mother met their family physician, who gave her medicines and recommended her to go for physiotherapy treatment.
When Pihu came to our clinic she was looking severely depressed. I assured her mom and her that “ All is well “ and soon she will be able to regain control of her facial muscles .
The journey of turning her frown upside down started from that day!!
I recommended her to do hot fomentation.
Not able to raise her left eye brow
Not able to smile .
Not able to blink/close her left eye.
Not able to blow the balloon
Following treatment was recommended.
Electrical Muscles stimulation for facial muscle
Kinesio taping to correct the deviation of mouth
Progress: End of first week
By end of the first week her facial muscle tone improved. Pihu was able to do few facial exercises with assistance. Kinesiotaping gave her confidence to speak without mouth deviation
Progress: End of second week
Pihu was able to raise her left eyebrow and blink her eyes .She was able to gargle while brushing.
Progress: End of third week
Pihu could whistle, blow balloons and smile without mouth deviation.
Progress: End of fourth week
Pihu danced again gracefully with outstanding facial expressions and got a standing ovation for her performance from her dancing class.
Pihu’s father had been out of India for that month for business reasons and he had been worried about his beloved daughter but when he came home, he was welcomed and greeted by his darling daughter with big smile. He was astounded. He asked his wife if she had been joking or playing a prank when she had told him that Pihu had facial palsy to get him back home early. He couldn’t find a single change in his daughter’s facial expressions.Thus journey from frown to smile was completed successfully at our clinic.
Complete recovery from Lower limb Paralysis (Paraplegia)
Kavita, a healthy thirty two year old was living happily with her husband and her young daughter when she suddenly felt severe weakness and pain in her back and lower limbs. She consulted a spinal surgeon for her back pain. After investigation, it turned out to be a spinal tumor which needed immediate surgery .Kavita was relieved as luckily, the tumor turned out to be benign. But after surgery, she developed (post operation) paraplegia. She was not able to move her legs by herself i.e. voluntarily .She was advised rehabilitation physiotherapy, that’s when she approached me .She was not able to move on her own and not able to take care of her child, husband and household work. She was very eager to get back on her feet.
I used to go to her mother’s place to treat her. I started with MFR to get rid of muscle stiffness .Full passive range of movement (ROM ) was given to ankle, knee and hip(right and left leg ). NDT worked really well with Kavita .
Exercises on ball and mat , co-activation , rolling ,gait training , strengthening exercises, joint approximation , theraband exercises , faradic stimulation and SI has helped to improve her condition considerably .One of the most important aspect was Kavita’s will power and positive attitude.
Kavita was able to walk with help of walker within one month. After two and half months, she was able to walk independently. I still remember tears in her mother’s eyes when Kavita went back to her home walking proudly on her feet. This was the second time that she was crying while her daughter was leaving home, only this time they were tears of joy and not sadness. Her daughter was back on her feet to take care of her own daughter and family.
Above exercises should be done as preventive exercises and not when you are experiencing pain in the knee.
Knee Joint :
The knee joint’s main function is to bend and straighten for moving the body. The knee is more than just a simple hinge. It also twists and rotates. In order to perform all of these actions and to support the entire body while doing so, the knee relies on a number of structures, including bones, ligaments, tendons, and cartilage.
Possible causes of knee pain:
Overuse in or around the knee due to wiping the floors in kneeling position, vigorous cycling, extensive walking etc. causes knee pain, stiffness in the knee.
Ligament sprain or tear
Arthritis :Osteoarthritis , Rheumatoid Arthritis
Type of knee pain and Treatment
What causes Acute knee pain ?
Fractures: Fractures of any of the bones of the knee are traumatic injuries typically caused by moderate to high forces due to sports injury or accidents.
Sprained and torn collateral ligaments . Medial collateral ligament (MCL) is the most commonly injured ligament in the knee. Like all ligaments, this ligament may be sprained or torn. A sprained ligament may be partially ruptured. A torn ligament is completely ruptured.
Severe MCL sprains or tears often produce a tearing or ripping sensation along the inner joint line of the knee. You may also notice knee instability and swelling may be observed at knee.
ACL partial /complete tear.
Rest: Sufficient Rest should be given to the knee joint to reduce the pain and swelling. Weight bearing on the affected knee should be avoided.
Anti-inflammatory medicines should be given to reduce the inflammation.
Icing :Icing should be done three to five minutes every two hours.
Compression: Crepe bandage should be tied in the figure of eight manner around the knee joint or hinge knee cap should be used.
elevation: The leg should be kept elevated to reduce swelling and support the knee.
Physiotherapy Treatment :IFT or ultrasound or TNS can be used to get instant relief .
Manual Therapy : Manual Therapy can be given once the swelling is reduced .
After the pain relief , relaxation exercises ,range of motion exercises ,quadriceps strengthening exercises should be done to avoid relapse of acute knee pain.
What causes Chronic Knee pain ?
Arthritis: Arthritis of the knee is an inflammation of the knee joint that is often painful along with stiffness and loss of range of motion in the knee. Osteoarthritis is caused by degeneration of cartilage in the knee. In its extreme form, the menisci (cartilage) will be completely eroded, and the femur will rub on the tibia, bone on bone.
Rheumatoid arthritis (RA) is a disease of the whole body that affects many joints, often including the knee. The knee can be warm to the touch and swollen. Rheumatoid arthritis may produce morning stiffness and pain
Gout arthritis : These severely painful forms of arthritis are caused by crystals that form in the knee and other joints. Defects in the absorption or metabolism of various natural substances such as uric acid and calcium pyrophosphate results in the formation of crystals. Gout and pseudo gout cause a rapid-onset, markedly inflamed knee joint. The knee can be exquisitely painful, swollen, and warm with loss of range of motion.
Bursitis: As a result of trauma, infection, or crystalline deposits, the various bursae of the knee may become inflamed. Acute or chronic trauma causes a painful and often swollen knee from the inflammation of the bursae. A particularly common bursitis occurs in people who work on their knees. It is often referred to as housemaid’s knee.
If there is an excessive swelling on the knee , anti-inflammatory medicines and ICING are highly recommended .
Analgesics should be given for extreme pain for initial pain relief.
Physiotherapy Treatment :Shortwave Diathermy/ IFT/Ultrasound or Paraffin wax bath is recommended depending upon the need and patient’s condition.
Exercises : Static quadricep , quadriceps drill , progressive resisted exercises , straight leg raising ,cycling ,gait training , knee range of motion exercises and squatting.
Preventive measures to avoid knee pain
Stay slim and stay fit as weight gain causes knee pain .
Thirty minutes walk for five /six days in a week .