Research shows physical therapy as effective as arthroscopic knee surgery ALEXANDRIA: A new study questioning the usefulness of arthroscopic surgery

ALEXANDRIA: A new study questioning the usefulness of arthroscopic surgery for osteoarthritis of the knee should encourage patients to consider physical therapy as an effective non-surgical option, according to the American Physical Therapy Association (APTA). The study was published in the September 11 issue of the New England Journal of Medicine (NEJM).

According to Eurekalert, the news service of the American Association for the Advancement of Science, the study found that physical therapy, combined with comprehensive medical management, is just as effective at relieving the pain and stiffness of moderate to severe osteoarthritis of the knee as surgery.

"This study offers hope and encouragement to persons with osteoarthritis who would like to avoid the pain and emotional toll of surgery," said APTA President R. Scott Ward, PT, PhD. "Too often, the first line of defense is surgery when it need not always be. Physical therapy can be equally effective and should be considered by not only patients themselves, but also the primary care doctors and orthopedists who are treating them."

According to physical therapist Christopher M Powers, PhD, PT, director of the Biokinesiology program and co-director of the Musculoskeletal Biomechanics Research Lab at the University of Southern California Division of Biokinesiology & Physical Therapy, "Many times knee pain is associated with abnormal movement patterns that cause increased stress on the joint. Arthroscopic surgery does little to correct the dynamic factors that may be contributing to knee pain and pathology. These findings reinforce the need for a comprehensive treatment approach for such patients."

The NEJM study adds to a growing body of evidence supporting physical therapy for treatment of osteoarthritis of the knee, including:

A report published in the January 2008 issue of the journal Physical Therapy that reviewed research on osteoarthritis of the knee from 2000 to 2007 and found "high-quality evidence that exercise and weight reduction reduce pain and improve physical function."

A study published in the Feb 1, 2000 issue of the Annals of Internal Medicine that concluded "a combination of manual physical therapy and supervised exercise yields functional benefits for patients with osteoarthritis of the knee and may delay or prevent the need for surgical intervention."

A physical therapist will perform a thorough examination and design a plan of care that may include:

A series of exercises designed to help improve motion. Activities in this phase might include water walking, swimming, and flexibility exercises.

An exercise sequence to restore strength including a functional progression, that is, a gradual return to normal activities using exercises that simulate the knee stresses of your normal activities.

A knee's tolerance for stressful activities often decreases with age and loss of conditioning. As a result, stresses that would not have caused pain or injury to the knee last year could today. A decrease in levels of activity over a period of time may also contribute to the vulnerability of knees.

But there are steps one can take to help prevent injury in order to continue enjoying sports and exercise. Pursuing an exercise program designed by a physical therapist can be one of the best protections from injury.

The first step in designing your exercise program is an evaluation by your physical therapist. He or she can identify your predisposing factors, those body traits that may make you more or less vulnerable to a knee injury. Based on this evaluation, your physical therapist can design a program that will help you gain your optimum levels of function, strength and conditioning.


Source: http://www.hindu.com/thehindu/holnus/099200809140921.htm

Therapy program draws Olympic inspiration

By MARCELLA PEYRE-FERRY, Special to the Local News

08/17/2008

WEST BRADFORD — The Olympic games have inspired some young riders with disabilities to strive for extra accomplishments last week during their therapy sessions at Quest Therapeutic Services.

Quest uses horseback riding as a tool for physical therapy and therapeutic riding for young people ages 2 to 21. This week, the center has adapted its hippotherapy program to include exercises that the children can compare to what they see at the Olympics.

The therapy sessions have adapted to include mounted and unmounted games kicking off with a torch relay, using a simulated torch with tissue paper flames. Gold medals are given out daily to riders for executing swimming strokes with their arms while mounted, playing equestrian games and doing gymnastics.

Other mounted games on the horses include relays, basketball toss and jumps. There are also children's games on the ground, including softball, soccer, tennis, and track-and-field activities.

The addition of the games is intended to encourage children with special needs to meet goals on their individual treatment plans and bring excitement to their therapy.

"We use the horse as a tool as part of the therapy program," said founder and President Sandra McCloskey.

The program anticipates 160 young people will participate in the special events over two weeks.

"It helps to motivate them to reach their goals," McCloskey said. "They're getting really into the spirit of this. This is their day to be in the Olympics."

Hippotherapy at Quest Therapeutic Services is designed to enhance the development of children with special needs. Licensed pediatric physical, occupational and speech therapists serve children with diagnoses such as cerebral palsy, spina bifida, autism and developmental delays. Many volunteers also work to make the program possible, because it takes three people on the ground to assist every student on horseback.

Parents were enthusiastic about the program and how Quest has helped their children. "After less than six months, he's doing much better. He's very happy," said Seema Nayak of Malvern, whose son, Aashay, is benefiting from his sessions at Quest.

Aashay is weaker on one side of his body. But since he started the hippotherapy, he has begun to use his weaker arm and leg more.

"It's a big change for him," said Seema Nayak.

Lee Law of West Chester is a pediatric physical therapist who brings her 10-year-old son, Ryan, to Quest. "It's made a tremendous difference in his head control and support in his trunk," she said. "He gets excited about this as opposed to other therapies."

Parents Lee and Steve Law, along with Ryan's sister and aunt, watched from the lounge area while Ryan turned in different directions in the saddle, road over rails on the ground that simulates jumps and tossed nerf balls and bean bags at targets from the back of the patient pony.

One of the big benefits of hippotherapy is that the motion of the horse helps work muscles that do not otherwise get any stimulation.

"I think you get a lot out of a session because it works him all over," Law said. "It's something different from conventional therapy that you can work on all the things at the same time."

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Physical therapist identifies future pain with new exam

COURTNEY CRAUTHERS
The Edmond Sun

EDMOND — People looking to prevent weakness and pain later on in life don’t really have a way to educate themselves on how to do it. Until now.

Eric Browning, physical therapist at Keith Physical Therapy, 13301 N. Meridian, created the Musculoskeletal Exam to predict the likely places an individual might develop pain and identify muscles that already might be causing episodic pain.

“Nobody else has done anything like this as far as I know,” Browning said. “It’s just using the knowledge we already have in a systematic way.”

Browning does an assessment of strength and flexibility of the main muscles through 140 to 160 tests during the exam, which costs $120. He said he takes patients through at least six tests per every area of the body and so feels confident in his predictions. Tested muscle areas include wrist, biceps, triceps and feet. He then enters the data into an Excel program, which graphs the strength of each muscle, identifying low- to high-risk areas.

His exams are unique in that he uses a manual muscle tester to measure strength, Browning said. He then compares that to what studies have shown an individual’s strength should be based on their age and body weight. Most doctors and physical therapists measure strength on a one to five scale. Browning said typically when people go to the doctor strength analysis is determined by squeezing the doctor’s hand.

After the MSE exam, Browning gives the individual a report of their exam and educates them on exercises they can complete for muscles that have been determined to be at high risk for pain. He said he also can refer an individual to the appropriate doctor if any problems are found.

“It allows me to help them learn how to fix something before it’s broken,” Browning said. “Most of what we do is empower people to do therapy with minimal equipment.”

He said people can come in for an MSE, work on strengthening their weak muscles and then come back for another exam.

“It’s a tracking system,” Browning said.

Browning said the exam also is good to help people identify what muscle is causing the episodic pain.

For example, a baseball player kept coming in for therapy because of pain in the middle of his back. However, the pain actually was coming from a weakness in his hip and was being absorbed in his back.

People who are planning to train with a personal trainer or people with hypermobility or flexibility are good candidates for an MSE, Browning said.

“People that train at extremely high levels are likely to have pain at some point,” he said.

Browning created the exam about a year ago and began implementing it about five months ago.

“Everyone that has come has been extremely pleased with the information I’ve given them,” he said.

All patients have been motivated to reverse effects, Browning said.

“The response he got is excellent and his predictability is excellent,” said Thomas Keith, Browning’s partner. “I think it’s an outstanding idea.”

Browning earned a bachelor’s degree in biology at Oklahoma State University and a master’s degree in physical therapy at the University of Oklahoma Health Sciences Center.



FOR MORE information about MSE, visit www.keithpt.com.

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