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Physical therapy for orthopedic and joint problems

The goal of physical therapy can be to see if you can recover from your symptoms WITHOUT SURGERY, or if surgery is unavoidable, help you return to activity AFTER SURGERY. Your physical therapist is you key asset to help you accomplish both goals. If you have a knee, hip, foot, shoulder or hand problem, Orthopedic Institute has a therapist experienced in that specialty.

Consider that for a knee injury, typically 80 percent will not need surgery and that’s an encouraging fact. However, you’ll need specialized help, and perhaps special braces to help your knee recover.

With that said, if you heard a loud pop when your anterior cruciate ligament snapped last week while playing basketball, or if you have a fracture as a result of a car accident, you’ll probably need surgery to repair the damage. Anytime there is a severe structural break, tear, or deterioration of the joint, you will likely need the help of a surgeon to repair the damage. But the good news is that — with the exception of joint replacement — most general orthopedic problems can be repaired in outpatient surgery, so you’ll be home the same day to recover in your own home, and then begin rehab soon after with your designated physical therapist.

In your battle back to activity, your determination, fitness and your therapist will be your allies. For example, it can be tough to do knee exercises and stay fit when you have sore knees.

Also keep in mind that unlike professional athletes like Tiger Woods who won the U.S. Open in 2008 with a fractured leg, and then returned in 2009 after knee surgery to stay the Number 1 golfer in the world, your objective may not be to get back to professional competition. If you have knee pain or a serious knee problem, adjust your expectations so you can focus on how far you are getting instead of how far you still need to go. Set realistic and practical goals.

Click here to learn about the athletic trainers at Orthopedic Institute Sioux Falls.

How certain ligament tears can heal on their own with physical therapy

Your physician at Orthopedic Institute may categorize your ligament tear as a grade one tear, grade two tear, or grade three tear, with grade three being the worst kind of tear. Grade one tears of a ligament can be painful, but there is no instability. Grade two tears include some instability. Grade three tears have instability of five to ten millimeters in the joint. But the ligament involved can also be key to determine if you need surgery or not.

Remember the RICE formula for treatment of acute knee pain from activity: Rest, Ice, Compression, Elevation.

Ice can control swelling and inflammation initially. Be careful you don’t overdo the contact of ice with the skin as you don’t want to cause skin damage. An ice bag in a towel place around the knee is a suitable way to apply cold to the knee. Another trick is to get some Dixie cups, fill several with water, place them into the freezer. After activity, take one of the Dixie cups out, peel back its edge, and you have a nice ice applicator for your knee.

Generally speaking, most physical therapists who specialize in knee treatment spend little time in “passive modalities” like ice, heat, electrical stimulation, or ultrasound treatments. They know that the most success is gained from getting the person moving with special exercises.

Because of the significance of this area, we’ve dedicated an entire chapter to exercise therapy for knee problems. But first, let’s continue on with other mainstream and alternative treatments for you to consider.

Why your therapist will use orthotics and braces

In some cases, joint pain can be relieved by something as simple as using an orthotic or brace. Foot orthotics are orthopedic devices like insoles or supports that are usually custom fit to control the foot and correct imbalances.  An orthotic foot support can raise the arch of the foot and realign the bones of the foot to prevent excess motion when you bear weight.  Foot problems can sometimes cause ankle, knee, hip, and back problems.

If you are an avid runner, and you are suffering from knee problems, your physical therapist may provide you with an orthotic foot device.  The device could position your foot in such a way that knee pain could be alleviated.  Many times, improper foot mechanics lead to improper running or other physical motion, and this can damage the knee.  If you are suffering from arthritis, or you are overweight, the foot orthotic could help by repositioning your foot and counteracting stress on your knee to allow greater comfort and mobility for greater lengths of time.

Orthotics come in rigid, semi-rigid, and soft materials.  The rigid materials are generally prescribed when entire control and support is needed.  The semi-rigid materials offer support, but they also allow for shock absorption. 

About knee braces and wraps and why you shouldn’t be a do-it-yourself therapist

Knee braces can be used to help an existing knee injury, or to protect the knee from future injury.  Before you treat yourself with a brace or wrap, you should consult with one of our specialists.  If worn improperly, the brace could do damage, and wearing it for a long period of time would not allow the muscles around your knee to grow stronger.

Said another way, using a brace is like using a crutch. While it can help you become active after an injury, depending upon it excessively doesn’t encourage the supporting muscles to strengthen. And in a sense, you become dependent upon that crutch, so when it isn’t there, you can have problems. With that said, a subliminal function of a knee brace is that it can act like a string around your finger—to remind you to be careful during activity, and not be overly aggressive with the knee joint.

You should be aware that a brace is only an additional aid to medical treatment.  We recommend that you first visit with a knee specialist before going out and buying a brace to wear for your knee pain.  You need the source of your knee pain, and only an orthopedic surgeon can make such a diagnosis.

If you are professional baseball player with a limited number of productive years, you may not have the luxury of taking it slow for a couple seasons to see if your knee can recuperate and heal on its own without surgery. That’s why it’s common to read in the daily newspaper about athletes who have arthroscopic surgery for knee problems. They simply can’t wait, because they depend on their knees for their earning power.

Wrapping your knee with an Ace bandage or other tight brace intended to hold the joint or kneecap tightly in position, can also lead to problems.  If the joint is wrapped or compressed tightly, blood clots could occur because the large vein behind the joint becomes blocked.  But when knees develop mechanical problems, your doctor may recommend that you use a brace to support an injured ligament, control instability, or relieve pressure on a damaged component of the knee.

Dieting down to reduce pain symptoms

What does dieting have to do with sore knees? A ton–literally. Around 1990, about 25 percent of Americans were overweight. At the time that had medical researchers alarmed, and they set out to reduce that number by the millennium.  Unfortunately, instead of people becoming less overweight,  the percentage of overweight Americans has grown.  Now, more than half of Americans are overweight. Worse, as of last year, more than one in four Americans are classified as obese. Obese is defined as a body mass index of greater than thirty. This isn’t thirty pounds, but a BMI of 30, which are two different things. For example, a person five-foot-nine would have to weigh more than 200 pounds to be obese.

If you are obese, the first step toward reducing your knee pain, has to be in the area of reducing the weight you place on your knees. Mother Nature did not design the knee mechanism to take the excessive pounding of bone on bone.  Denial can be a big problem for many people. Their weight problem catches up with them over a few years, and they refuse to confront the reality that they are now clinically obese. If your sore knees are the first signal from your body that you are overweight, act now to save your knees and improve your overall health.

Hydrotherapy: Using water to create artificial weightlessness

Hydrotherapy came to the United States from Germany. Research has shown that aerated baths or spas have had positive effects on the body.  Spas and whirlpools have been used as therapy to improve circulation and relieve chronic pain from the back and joints.  Hydrotherapy relies on cold, warm, or hot water depending on the treatment.  The use of cold water reduces inflammation, but the use of cold and warm water together can improve circulation. 

The second function of water therapy is that water creates an artificial weightlessness, especially for the overweight person recovering from knee or hip pain. The water can also be used to create gentle resistance for arm and leg exercises.

Exercise therapy

For someone suffering arm or leg pain the mere thought of exercise and movement can be painful. But for you to return to activity, and to relieve symptoms, your therapist will rely heavily on moving the sore joint or limb to restore essential flexibility and range of motion in the joint.

However, those people dealing with traumatic injury, such as a fall that has torn a ligament or banged the kneecap, should not embark on any knee exercise program until they have been examined by a specialist. A fall on the knee or a blow to it could have caused a bone fracture, and exercise could worsen the situation.   

The goal of exercise is to strengthen the muscles outside the “pain zone.” Many people with leg or arm problems can still move the limb through a certain range of motion without pain, or with only mild discomfort. Your therapist will begin your exercise program by working in those zones, which are relatively comfortable, and through these exercises, expand those zones to a wider range.

Aerobic exercise for the overweight patient

Body weight is a key factor in knee pain. This is problematic for people who find themselves overweight and with knee pain. That’s because to lose weight, you need to exercise to speed up your metabolism.  But most aerobic exercises, like running, biking, aerobic classes, jazzercise, etc., all involve the knees. Consequently, a knee pain sufferer who is overweight may feel they are stuck. They can’t exercise, so weight can pile on, and more weight places more pressure on sore knees.

There is a way out. Your therapist may have you use a special stationary bike as an aerobic exercise that doesn’t put too much of a load on the knee joint. This stationary bike has pedals for the hands and arms. This machine gets the heart rate up just like a stationary bike, only the legs do nothing. Another alternative is to swim. There is no impact, and even if you choose to kick, the range of motion is slight. pain, as well.

In summary, your physical therapist at Orthopedic Institute is your partner, and personal trainer, focused on getting you back to activity.  

NO PHYSICIAN REFERRAL IS NEEDED UNLESS REQUIRED BY YOUR INSURANCE

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