General or Regional Anesthesia?

In regards to what type of anesthesia you use prior to your orthopedic procedure is something that will be discussed during your consultation with your orthopedic surgeon and the anesthesiologist.

I have had questions from prior patients during the pre-operative phase or classes regarding which type is best for a joint replacement. I of course do not make that decision and leave that up between you and your surgeon. Some surgeons prefer one or the other. There are cases where a regional anesthesia may work best and others a general anesthesia.

I know with a general, some patients will suffer from various side effects including nausea, vomiting, lethargy that remains for 24-48 hours that can effect their rehabilitation progression temporarily. In the elderly for instance you see lingering effects of general anesthesia demonstrated by a change in cognitive function. This can go on for a couple of days in the hospital. Getting this patient to participate effectively in physical rehabilitation can be rather challenging.

In a regional anesthesia the effects are not as acute, in fact other than a numbing of the lower extremities for instance you are put into a light sleep during the surgery and are able to rebound rather quickly. So from a physical therapy standpoint you are able to get right into the program with fewer side effects.

Talk with your doctor before the surgery and discuss what they prefer using.


Richard Haynes PTA/CPT
Total Joint Fitness LLC
Punta Gorda, Florida. 
http://ww.richardhaynes.com

Total Knee Replacement Revision With Home PT

Working with a total knee replacement and a total knee revision is not much different in regards to what we are trying to achieve in physical therapy. In fact right now I have a patient with a  total knee revision who is doing very well. His range of motion after three weeks from surgery  is 100 degrees of flexion and - 2 degrees of extension.

The important aspect of the therapy right now is to gain as much mobility in the knee as we can and to build on strengthening the entire leg.

My patient lost the original implant due to infection. The original knee replacement was approximately three years old before he received an infection from an unknown source in his right elbow. The infection then spread throughout the body and caused pain and noticeable swelling with his right TKR.

After going to the orthopedic surgeon, he found that the infection had settled in the knee and that IV antibiotic's and the removal of the knee hardware was required.

After having his original implant removed the surgeon simply sterilized it through an extensive process and replaced back into the knee and was sent home. I started PT with the patient in home health working on gentle strengthening exercises and range of motion activities to maintain some form of mobility in the knee.

After a run of six weeks of IV antibiotics, and  confirmation that the infection had cleared, he was taken back to the hospital for a another with a knee replacement using a new prosthesis.

The fact that he was not put into a immobilizer for six weeks or so allowed us to continue gentle range of motion activities. This helped from preventing the knee joint itself from locking up, developing adhesions and, the soft tissue around the knee area from contracting and weaken any further than it was.

He was also allowed to continue to walk with a rolling walker using weight bearing as tolerated on the right knee. This also allowed him from deconditioing any further and helped to maintain some strength in the right leg.

Right now in his recovery the knee flexion and extension are on track to allow him functional movement of the knee with walking, using stairs etc... the strength  however is running a little behind schedule which I contribute to the extensive procedure of having the prosthesis taken out again and replaced. A knee revision of course is more invasive than the original knee replacement surgery therefore, your recovery generally will be a little slower.

The strength will come back in his right leg however with persistence and in fact he is up using single point cane right now walking outdoors for limited distances.

I have roughly three more weeks with him to continue to progress toward our goals. At that time I am sure out patient physical therapy will be the next stop for him.

Pain has been been minimal as he uses the pain medication as needed and is monitoring his activity level around the house. This is key in maintaining adequate pain control.

If you have any questions or comments regarding knee revision and the rehabilitation process please do not hesitate to leave a comment. If you have had or are going through this rehabilitation right now, I would be interested to know how you are doing and what you have experienced.

Richard Haynes PTA/CPT

Total Joint Fitness LLC

Punta Gorda, Florida.

http://www.richardhaynes.com

Strength Training and Older Adults

For Years older adults including the geriatric population, have been advised by their well meaning doctors and caregivers that when working with weights or any type of resistance training that they should use light resistance.

In cases where you have not worked with strength training before that can be wise advice. It is important to get your nervous system accumstomed to handling resistance and, to make sure your technique is correct to avoid injury.

Today through research, its been discovered that working with heavier weight is more  efficient and it builds greater strength. With greater strength comes improved functinal mobility.


If you have lifted a weight for 12 to 15 reps without muscle fatigue its time to increase the resistance for instance. Keeping your exercise repetitions between 8-12 will strengthen the type 2 muscle fibers we all have throughout our bodies.

It is the type 2 fibers where all of us begin to lose not only are strength as we age but, lose our muscle mass as well if they are not properly stimulated with resistance training. Heavier training also is good for pour endocrine system and helps promote anabolic hormone production as we age.

And of course with exercise as we all have heard by now comes a better nights sleep.
Your body was designed to work. The lack of exercise no matter what your age leads you down a path of deterioration and loss of mobility ultimately.

Preserving your muscle equates to more strength. More muscle means more strength and, more strength means less falls and injuries due to fraility.

With all my patients in home health I try to leave a lasting impression with them before discharge on the importance of physical exercise other than just walking around the block. I promote strength training as well for  improved balance, a better nights sleep, decrease in prescription drugs hopefully and, more confidence in their life.

Your muscles can be built when we are younger and preserved as we all age through a simple and basic strength training routine.

Before embarking on a strength training routine be sure to discuss it with your doctor for further direction and safety. This will depend on your previous medical history. If you are not sure where to start once medically cleared, Look into getting yourself to your local wellness center or gym.

Check to see if someone there that works there on staff can get you started in the right direction regarding exercise technique and what exercises to concentrate on.  Let them know what your strength training goals are and of course any physical limitations you might have.

There is literally no one that cannot improve with some sort of strength training program.

Remember, no one is going to take care of you like yourself. Accountability in your health and well being starts with the choices you make and the questions you ask.

Richard Haynes PTA/CPT
Total Joint Fitness LLC
Punta Gorda, Florida.
http://www.richardhaynes.com
http://www.totaljointfitness.com

Exercises For Balance In Home Health

Balance as we age can become a major problem for some. Most of the patients I see in the home health setting have a standing balance problem of one kind or another.

The causes are many of course everything from vestibular problems associated with the inner ear to postural alignment to muscle weakness.

And need I say more concerning the problem we have in our society with prescription drugs. Poly-pharmacy is a big problem in America. The use of multiple prescription drugs only compounds the other issues I am up against when treating patients for balance and strength training.

I promote of course strength training and neuromuscular re-education  exercise for balance to help my patient recover from previous injury and, to hopefully instill some confidence in their ability to become mobile again. Along with poor balance in many cases comes along poor safety awareness with it. This also compounds the problem for the patient and family as it leads to further injury.

 After assessing what the patient can do physically I than set them up on a home exercise program which may consist of both supine and standing or also known as closed chain exercises.

Depending on the patients prior level of function and injury or illness, there are times when starting with supine exercises are more approproitate for stabilization purposes and strength building to build a level of confidence to progress to standing eactivites.

Closed chain exercises however have more functional carry over and builds strength faster in the lower extremities and trunk muscles and joint proprioception which is required for balance.

Some of the exercises I promote depending on the patient are;
1. Heel raises
2. Abduction and adduction
3. Standing hip and knee flexion and extension.
4. Partial mini-squats.

These are just a handful  of exercises I use. Take a look at the video I provided for other ideas as well.
Most of the time I have to start will lower level exercises than build up to a higher more challenging exercise programs.

I also will  provide exercise programs  for those of you who request it.

Balance problems and the hazards of falling will continue as our society continues to grow older unless we become more proactive in our health and well-being.


Richard Haynes PTA/CPT
Total Joint Fitness LLC
Punta Gorda, Florida. 33950
http://www.richardhaynes.com

Hip Bursitis Pain

Hip bursitis can be a painful event. It is not uncommon for me to cross paths with one or two patients a month that are dealing with it. It can affect anyone however it is more prevalent with middle age and elderly patients.

I see it more as a post surgical problem with patients that have had either a hip fracture or a hip replacement. Some types of back surgery also can contribute to it as well just do to the different gait or walking mechanics involved.

Poor muscle strength and muscle imbalance around the hip and pelvic girdle will cause hip bursitis as well.

As most of my clients are elderly, I do not see overuse cases due to running or high activity levels, however this also contributes to hip bursitis for younger patients.

We all have bursae spread throughout our body to help tendons glide smoothly over muscle and in the case of your hip the bursae located there is very large compared to others. It can become inflamed easily.

My patient already has had an x-ray to rule out calcification or a bone spur. He also has had cortisone shots in the past from looking at his medical history.

What  I have recommended to him at the present time is to slow down his activity level in the pool. Daily pool therapy and continual walking I suspect has initiated the problem. Taking an anti inflammatory will be helpful  along with using ice after exercise and some stretching exercise for the iliotibal band which runs down the outside of our legs.

There are times when the iliotibal band becomes inflammed and mistaken  for hip bursitis. This is what your local orthopedic doctor will call IT band syndrome.

Physical Therapy is not always recommended by doctors for this problem though some find it helpful. In PT we can apply either ultrasound, phonophoresis , or iontophoresis. The two latter treatments are ways in which medication can be applied to the bursae topically.

If the problem does not resolve soon than he will be referred to an outpatient physical therapy facility to continue with further treatment options.

It is important to be sure that you keep your body strong as a whole as I have stated in previous posts and after surgery the importance of working on the muscle groups that were involved. For instance after a hip replacement, This will help avoid hip bursitis and the problems associated with it due to muscle imbalance.

Look into stretching programs to keep your muscles and tendons flexible to hopefully prevent problems such as bursitis as you age.


Richard Haynes PTA/CPT
Total Joint Fitness LLC
Punta Gorda, Florida. 
http://www.richardhaynes.com

Knee Manipulation Causes During Home Health Physical Therapy

I have several knee replacement patients on my current caseload right now and, have started all of them on an aggressive home exercise program. Besides getting their legs stronger, the emphasis is on obtaining as much range of motion with their knees as possible. Working towards increasing their range of motion to allow for a functional gait or walking pattern and the ability to use their new replacements in their activities of daily living is crucial.

There are however cases you will hear about and may even know someone close that has had to undergo a knee manipulation several weeks to a month after the original knee replacement surgery due to lack of knee mobility.

There are a couple reasons why a patient will have to go through a manipulation process.

1. Poor pain control management once they are home. I advise my patients not to cut back too soon on their pain medication. Reducing the pain medicine during the acute stage is setting you up for chronic pain and sleepless nights. The first two-four weeks once you are home you should be medicating yourself as prescribed by the your surgeon, nurse, and physical therapist.

Poor pain control means you will not be as assertive as you need to be in regards to rehabilitation. Poor rehabilitation compliance means, you guessed it, a possible trip back to the hospital for a knee manipulation procedure. With inadequate pain control you will be hesitant to bend your knee as needed to promote further gains in flexibility.

2. Lack of knee flexibility to begin with. I have stated in previous posts that if you have been advised by several orthopedic surgeons while out getting second or even third opinions that you need a knee replacement, than by all means get it done. Postponing the surgery only complicates your rehabilitation process if you allow scar formation and muscle contractures to develop.

These two reasons are the most prevalent causes I see. There are others like knee infections after a replacement, total knee revisions or alignment problems with the original surgery and its components.

The  latter is now better controlled however with computer assisted surgeries as they are much more accurate.
The  knee manipulation process under anesthesia looks something like this,

After this procedure is done you are sent back home the same day to continue with aggresive physical therapy. In my case if I have a patient that has to undergo this procedure I follow with three items to maintain flexibilty.

1. I have my patients apply heat 30 minutes before my scheduled appointment to the quadriceps and hamstrings only.

2. Follow with manual manipulation using passive range of motion with my patient supine. This is a slow controlled process with very little discomfort to the patient.

3. I leave them with a peddlar to use twice daily for 10-15 minutes to help promote flexibility.


Overall hard work and being consistent with your physical therapy home exercise program as instructed should keep you out of the operating room for this procedure.

If you have any questions or comments please let me know.


Richard Haynes PTA
Total Joint Fitness LLC
Punta Gorda, Florida.
http://www.richardhaynes.com

Knee Replacement Pain Control

Pain control after your knee replacement is controlled rather well during your hospital stay. Once you get home that may be another matter. Between your higher level of activity once home and the fact the pain medications you have been prescribed may not be as effective as you received in the hospital, you can go through some miserable days if you do not get a handle on it quickly.

Below is some information that hopefully help you answer some of your questions regarding knee replacement recovery pain control.

Medical News Today
Orthogate.org
orthosupersite
washingtonedu

The most important piece of advice I give all my patients is to control and monitor their activity level once they are home. Household activity and getting involved in things you should be avoiding for the first three weeks is the most important aspect of pain control.

Icing elevating your leg and, taking your pain medication as prescribed will work wonders in maintaining the pain at a reasonable level.


Richard Haynes PTA
Total Joint Fitness LLC
Punta Gorda, Florida.
http://www.richardhaynes.com

Makoplasty Rehabilitation and Activity After Surgery

Back Pain And Exercise

Many Americans and for that fact millions of  people around the world deal with back pain every day. We all have heard the figure's on the costs to businesses due to workers not able to perform their job or, are absent from work due to back pain.

Though back pain has many causes, the biggest problem is the fact that most of us are either too heavy and our backs are not able to carry the added load and on top of that are bodies are weak and deconditioned.

The fact that I plan on working in my field until at least 65 gives me a strong incentive to keep my back strong and if you plan on working longer or, having some sort of quality of life as you age than keeping your back strong is a necessity.

Keeping your body weight in check is a good start to prevent low back pain. Building strength and endurance in your low back is the key to living a pain free and productive life as you age.

When it comes to low back exercise I personally have two exercises I use regulary hyperextensions and deadlifts.

One of my favorite exercises that I perform in the gym two to three times a week is the hyperextension.
I perform a warm-up without weight than add a 45 pound plate to the exercise holding it out in front of me and completing three to four sets of 12 repetitions. Though just using your body weight to start is sufficient and recommended until you get the proper technique down and get strong enough to add further resistance.

Another exercise that I like for low back strengthening is the deadlift. I do not use large amount of weight here as there is no need as you get older to risk injury. The deadlift is a great exercise to work not only your low back but, it works literally every muscle in your body. Your legs and hips are used in this exercise tremendously which is great for older adults to maintain leg and pelvic girdle strength to prevent further injury and falls.

This exercise can be used with either a barbell, dumbbells, or kettlebells.

The deadlift also for you men is a great testosterone booster at any age. For men and women both, it is an exercise that boosts growth hormone as well.

These are two exercises that can be modified to help you work around your injury or if you are just starting out, practice until you get strong enough to add resistance.

Give these exercises a try. If you need some assistance ask one of the trainers at your gym or fitness center to give you further insight and to make sure your technique is correct. Poor technique with any exercise not only prevents you from working the targeted muscles properly but, can cause injury due to using a poor technique.

These exercises are recommended if you do not currently have back pain. They are prevention exercises only.



Richard Haynes PTA
Total joint Fitness LLC
Punta Gorda, Florida.
http://www.richardhaynes.com
http://www.totaljointfitness.com
http://www.orthopedicweightloss.com

Developing The Winning Edge in Fitness and  Rehabilitation

Exercise After Knee Replacement Is Critical

Exercise After Knee Replacement Critical

Knee Replacements Continue On The Rise

Nearly 1 in 20 US adults over 50 have fake knees

By LINDSEY TANNER
AP Medical Writer

By LINDSEY TANNER

Published Friday, February 10, 2012

Updated Friday, February 10, 2012

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CHICAGO —

Nearly 1 in 20 Americans older than 50 have artificial knees, or more than 4 million people, according to the first national estimate showing how common these replacement joints have become in an aging population.
Doctors know the number of knee replacement operations has surged in the past decade, especially in baby boomers. But until now, there was no good fix on the total number of people living with them.
The estimate is important because it shows that a big segment of the population might need future knee-related care, said Dr. Daniel Berry, president of the American Academy of Orthopedic Surgeons and chairman of orthopedic surgery at the Mayo Clinic in Rochester, Minn. He was not involved in the research.
People with knee replacements sometimes develop knee infections or scar tissue that require additional treatment. But also, even artificial knees wear out, so as the operations are increasingly done on younger people, many will live long enough to almost certainly need a second or even third knee replacement.
The new estimate comes in an analysis being presented Friday at the academy's annual meeting in San Francisco.
"These data are sobering because we didn't know what an army of people we've created over the last decade," said Elena Losina, lead author of the analysis and co-director of the Orthopedics and Arthritis Center for Outcomes Research at Harvard's Brigham and Women's Hospital. "The numbers will only increase, based on current trends."
Replacement joints can greatly improve quality of life for people with worn-out knees, but they're not risk-free and it's a major operation that people should not take lightly, she said.
Modern knee replacements in the United States date back to the 1970s. Since then, advances in materials and techniques, including imaging scans to create better-fitting joints, have made the implants more durable and lifelike, surgeons say.
Losina and colleagues came up with their estimate by analyzing national data on the number of knee replacements done from 1998-2009, U.S. census data, death statistics and national health surveys.
For example, in 2009, more than 600,000 knee replacement operations were done nationwide. The study estimate includes people who had knee replacement operations that year and in previous years who are still living.
Overall, 4.5 million Americans are living with artificial knees. That includes an estimated 500,000 who have had at least two replacement operations on the same knee.
Knee replacements are most common in people older than 80 - 1 in 10 people in this age range have them, the study found. Though they're less prevalent in people younger than that, there are still more than half a million Americans in their 50s with the artificial joints, and based on current trends, operations in that age group are expected to increase.
According to the federal Agency for Healthcare Research and Quality, knee replacements tripled in people ages 45 to 64 between 1997 and 2009.
Doctors think two trends have contributed to that increase: the nation's obesity epidemic and amateur athletes who don't adjust workouts to spare aging or even injured joints. Both can lead to or worsen arthritis, the main reason for replacing knees.
Donna Brent, 63, is in the latter category. The Deerfield, Ill., administrative assistant says decades of racket ball, tennis, softball and other sports took a toll on her knees, but she got used to living with the pain, even when she became bowlegged and developed a limp. When pain "started getting in the way of some of my sports," she gave in to her doctor's advice and had the operation last June on her right knee. She said she feels better than ever, is back to exercising and plans to resume tennis and softball when the weather warms up.
During knee replacement operations, surgeons slice off a small portion of the worn-out surface on the ends of both leg bones that meet at the knee, then implant an artificial joint usually made of plastic or metal. Typical operations last about two hours, require a few days in the hospital, and cost roughly $40,000.
Artificial knees generally last 15 to 20 years. While some are promoted as lasting 30 years, these estimates are generally based on use among older people more sedentary than baby boomers who expect new knees to let them be as active as they were before surgery. Sometimes that's possible, though doctors often discourage knee replacement patients from engaging in high-impact sports including jogging.
The National Institute of Arthritis, Musculoskeletal and Skin Diseases paid for the study.
---
Online:
Knee problems and replacements: http://1.usa.gov/xeWHqG
American Academy of Orthopedic Surgeons: http://www.aaos.org

Copyright 2012 . All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Read more here: http://www.islandpacket.com/2012/02/10/1959176/nearly-1-in-20-us-adults-over.html#storylink=cpy

Rotator Cuff Injuries and Rehabilitation

As we age our rotator cuffs become more susceptible to injury. Generally it is a case where our rotator cuff tendons become frayed and weaker due to cumulative effects of age, injury or repetitive use with some type of movement.

Rotator cuff injury can also take place with work related injuries or sporting activities as well.

Once injured you can either treat them conservatively with physical therapy, using exercise, pain relief modalities such as heat and ice, or your orthopedic doctor may after proper testing  decide to surgically repair your rotator cuff.

Either way, it can be a long tedious process if not taken care of once the symptoms arise. Difficulty sleeping at night due to pain in the affected shoulder, inability to lift your shoulder over your head, difficulty just doing basic activites of daily living due to pain and immobility for instance, is a sign to call your orthopedic doctor as soon as possible and get it checked out.

I myself make sure I complete my rotator cuff exercise at least twice a week in the gym. Since rupturing the long head of the biceps tendon in my shoulder I have been aware how important it is now to keep the rotator cuff stronger than ever. Years of working out in the gym with the bench press and shoulder presses can contribute to shoulder problems and the rotator cuff usually takes the brunt of the storm.

Proper strengthening of your rotator cuff is good preventative medicine. It takes just a few minutes and is a good idea to  add to your workout routine, in fact you can do them at home following a simple exercise program.

Rotator cuff training and injury prevention becomes more important as we age. The physical rehabilitation can take anywhere from 8-12 weeks of course depending severity, age, and what type of measures have to be taken to repair the injury or reduce the pain.

If your are experiencing shoulder or upper arm pain get it checked out to determine the exact cause. other than simple manual tests, your orthopedic surgeon will do an MRI to evaluate the rotator cuff itself. Simple x-rays will not show a rotor cuff problems.

Leave me comment or a question if you have questions regarding rotator cuff pain.

Richard Haynes PTA

Total Joint Fitness LLC

Punta Gorda, Florida.

http://www.richardhaynes.com

http://www.totaljointfitness.com

http://www.orthopedicweightloss.com

Exercise After Physical Therapy Program

I am a big proponent with all my patients for them to start some sort of physical exercise program once they leave the confines of home health rehabilitation. Of course not everyone is interested in doing so or they do not have the ability to complete anything aggressive due to their medical conditions.

Everyone is advised to seek medical clearance from their doctor before starting an exercise program so that one can be safely implemented. Once cleared, the benefits of continuing to build on what you as a patient have accomplished in physical therapy is the perfect springboard to further your strength and ultimate independence.

Your exercise program depending on your injuries can be something as simple as working on aquatic therapy exercises to getting into your local gym or fitness center and working on developing more strength and cardiovascular endurance. This of course will depend on your prior level of function, age, goals, and ability to commute.

I develop not only home exercises for my clients as a part of the rehabilitation process, but offer general advice on how to strengthen your body and improve things like balance, toning up muscle, and basic weight loss ideas.

For patients of mine that are in my age group the 50+ crowd who have had either a knee or hip replaced or, a medical problem due to inactivity or obesity related, than I promote something more aggressive that they can consider.

No matter what direction you head after physical rehabilitation, the important thing is to work on improving yourself and becoming better than you have been not only physically but mentally as well.

Getting yourself stronger physically helps your self esteem, improves your sleep dramatically, and improves your energy levels as well. This is all common knowledge in today's world but many of us still do not take the advice.

As I always say  your body was designed to work. You feel much better moving than sitting around in life.

No matter what your age is, consider developing a plan to springboard your way to a successful life in your latter years through exercise and proper nutrition.

Besides, who whats to spend our lives sitting in doctors offices due to ailments that can be prevented through physical exercise.

Get serious and take your physical destiny back into your own hands. 

Richard Haynes PTA

Total Joint Fitness LLC

Punta Gorda, Florida.

http://www.richardhaynes.com

http://www.totaljointfitness.com

Exercise Routines With In Home Patients

One of the biggest challenges after working with a patient in their home during the rehabilitation process is convincing the patient to keep up with heir exercise program to avoid losing the strength and progress they have made.

There is no doubt that many will lose the desire to continue unless someone is there to help motivate them to push beyond their pre-conceived physical and mental limitations.

Sometimes exercise and the older generation clash. I have heard numerous times," Richard, I worked hard enough when I was younger". Of course that does not have any bearing on what they are dealing with today in regards to their physical limitations or injuries.

Our bodies are a machine. You cannot let the human body sit and do nothing. To make it efficient and allow you to live some sort of quality of life as you age, physical exercise has to be in the equation.

I will always leave the patient or family member's with a copy of a program for the patient to follow but also warn them that both physical and mental boredom will set in unless they find ways to change the exercise program around to add variety.

 It is at this point unless you are highly motivated that you hit a brick wall. This of course is true of everyone at all ages and at all fitness levels. Our bodies are masters at getting accustomed to a movement than finding ways to make it easier and less taxing on our nervous system. There is where growth and progress stop!

To keep active and inspired with an exercise program get involved in a  membership at a local fitness center or wellness center at one of your local hospitals. Having others around to inspire you allows you to enjoy your activity. Also getting in a atmosphere where you can get further education on exercise and fitness is well worth the drive.

Consistency, and dedication is the only way to achieve success in anything you are doing. Exercise is no different.

You can either pay the price today or you will pay it tomorrow in physical decline and loss of independence.

Start today with a sound and functional exercise program. Better sleep, less pain, and a greater enthusiasm for life than begins to take shape for you. After all isn't that we all live for?



Richard Haynes PTA
Total Joint Fitness LLC
Punta Gorda, Florida
http://www.richardhaynes.com
http://www.richardhaynespta.com