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Rehabilitation For The Postsurgical Orthopedic ...



Participants: Patients (N=60) admitted to our department postorthopedic surgery were randomly assigned to either a case (n=30) or control (n=30) group. Exclusion criteria were age 18 years or younger and 90 years or older, Mini-Mental State Examination score of 21 of 30 or lower, no ambulating order, advanced vision impairment, malignancy, pneumonia, or heart failure.




Rehabilitation for the Postsurgical Orthopedic ...



Conclusions: In addition to conventional physiotherapy, AOT is effective in the rehabilitation of postsurgical orthopedic patients. The present results strongly support top-down effects of this treatment in motor recovery, even in nonneurologic patients.


Objective: The aim of this study was to quantify and characterize pain in patients undergoing lower limb postsurgical orthopedic rehabilitation and to investigate the impact of pain in slowing or interrupting their rehabilitation.


Conclusions: In light of the high occurrence and intensity of pain in the sample, and of the significant impact on the rehabilitation program, clinicians should pay more attention to pain, especially neuropathic pain, in postsurgical patients. Tailored pain pharmacological therapy could possibly improve patient compliance during the rehabilitation process and enhance long-term outcomes.


With detailed descriptions of orthopedic surgeries, Rehabilitation for the Postsurgical Orthopedic Patient, 3rd Edition provides current, evidence-based guidelines to designing effective rehabilitation strategies. Coverage of each condition includes an overview of the orthopedic patient's entire course of treatment from pre- to post-surgery. For each phase of rehabilitation, this book describes the postoperative timeline, the goals, potential complications and precautions, and appropriate therapeutic procedures. New to this edition are a full-color design and new chapters on disc replacement, cartilage replacement, hallux valgus, and transitioning the running athlete. Edited by Lisa Maxey and Jim Magnusson, and with chapters written by both surgeons and physical therapists, Rehabilitation for the Postsurgical Orthopedic Patient provides valuable insights into the use of physical therapy in the rehabilitation process.


"This book is awesome! It should really be called 'here is everything you need to know about rehabilitation and all the good stuff you have forgotten about'...This book gives you up to date information on the etiology of orthopaedic conditions, surgical procedures as well as surgical indications and considerations. However, its real strength lies in the guidelines and suggestions it has for the rehabilitation programs. The rehabilitation exercises are realistic, easy to implement and full of clinical nuggets which definitely makes the book come alive...This book will serve as a great reference point for any physiotherapists, or if you're like me it inspired a lot of new ideas for my clinic."


When you need orthopedic surgery to treat an injury or condition, physical therapy plays an important role both before and after your procedure. At Orion Physical Therapy in Lake Orion and Active Orthopedics Physical Therapy in Midland, Michigan, we offer comprehensive programs for pre-operative and post-operative rehabilitation.


After surgery, your orthopedic surgeon will recommend physical therapy to expedite your recovery and facilitate a successful outcome. Depending on your procedure, you may start physical therapy anywhere from a few hours to a few days after surgery. In some cases, the body part may first be immobilized for a period of time to help pain and swelling subside prior to starting rehab.


At Orion Physical Therapy in Lake Orion, Michigan and Active Orthopedics Physical Therapy in Midland and Lake Orion, Michigan, our licensed physical therapists have expertise in treating orthopedic, sports-related, and work-related conditions and injuries affecting the back, neck, shoulder, elbow, hand, wrist, hip, knee, foot, and ankle. Our therapists provide manual therapy, pre- and post-surgical rehabilitation, and treatment for balance disorders and gait training.


Physical therapy is many times indicated following any joint orthopedic surgeries such as on the hip, knee, shoulder, wrist, hand, neck, foot, ankle, and spine to help facilitate quicker recovery. Physical therapy may start anywhere from a few hours to a few weeks after surgery depending on extent of surgery, complications and physician recommendation.


Adam E. Cabalo, MD, is a fellowship-trained orthopedic surgeon board-certified by the American Academy of Orthopedic Surgeons. He specializes in spine surgery at Southern Oregon Orthopedics & Paragon Orthopedic Center in Medford, Oregon.


He returned to Maui as an orthopedist and had the experience of helping a diverse patient population with varying orthopedic needs. Since then, Dr. Cabalo has returned to his passion for specialization in spine surgery and trauma. He enjoys the art and skill that goes into fixing the human body. Regarding his work, Dr. Cabalo says, "It has been so fulfilling to know that I may have helped improve the quality of one's life."


Post-operative rehabilitation following pectoralis major tendon repair is dependent on several surgical considerations. Direct repairs of pectoralis major muscle to tendon is difficult because the ability to obtain a firm anchorage for suture in soft muscle tissue is limited.12 For this reason, speculation is that direct repairs of muscle to tendon or those from tendon to tendon may require greater soft tissue time constraints. This repair may be so tenuous that some authors even suggest conservative treatment following a tear in the musculotendinous region.36,37 Post surgical rehabilitation requires a balancing act of maintaining enough restriction of range of motion to allow adequate soft tissue healing, yet still allowing enough activity and motion to restore shoulder mobility, all the while gradually returning functional strength to allow a return of full unrestricted functional activities. In numerous instances these functional activities are to return the athlete to very high levels of strength since a large majority of these injuries occur in competitive or recreational weightlifters. Because damaging the healing tendon immediately following surgery is contraindicated, the patient's shoulder is generally placed in an immobilizer or a sling for the first 3-4 weeks, depending on the type of surgery required (Table 1).


With isolated MPFL reconstruction, ambulation is weight bearing as tolerated and range of motion is progressed as tolerated immediately. Strict immobilization of the knee can result in loss of ground substance and dehydration and approximation of embedded fibers in the extracellular matrix of soft tissues.57 Because the surgical reconstruction of the MPFL requires operating at or near the medial epicondyle of the knee, early motion is indicated. During flexion and extension motion at the knee there is substantial movement of soft tissues around the medial epicondyle and therefore stiffness and loss of motion is common.58 Although some report a restriction of motion and weight bearing are required to protect against additional soft tissue injury following MPFL surgery,59,60 the authors of this manuscript suggest that immobilization is not worth the risk of post-operative stiffness. To decrease this risk of stiffness, range of motion is initiated progressively and early. Immediate range of motion as tolerated is allowed because the MPFL experiences maximal loads near full knee extension and during early knee flexion range of motion.28 As long as the graft is placed isometrically, increases in knee flexion range of motion should not place undue strain on the substitute tissue. Controlled mobilization reverses the effects of immobilization by stimulating collagen synthesis and optimizing alignment of healing tissues.61,62 This is of particular concern in ligaments as studies in animals have clearly shown that following even a few weeks of immobilization results in marked decreases in structural properties.63,64 These decreased properties occur due to subperiosteal bone resorption within the insertion sites as well as microstructural changes within the ligament substance. Remobilization was found to reverse the changes, however it took up to one year to return the properties to normal levels following only nine weeks of immobilization. A systematic review of eight papers of investigations following rehabilitation for MPFL reports that there is little differences in radiological or clinical outcomes between patients who were initially full weight bearing, began immediate active exercises, and were not immobilized in a knee brace, compared to those who were initially non-weight bearing, instructed not to exercise their knee, and were immobilized in a knee brace during the initial postoperative weeks.65


Early exercises include quadriceps sets, heel slides, hamstring sets and gluteal sets until the patient is full weight bearing without symptoms. Because the hip and trunk are so important in maintaining proximal control for the knee and the patellofemoral joint, total leg strengthening (TLS) is initiated early. A phased approach is used to progressively strengthen the hip. The exercises used are based on electromyographic (EMG) studies demonstrating the hierarchy of maximal volitional contraction of the surrounding hip musculature.77-80 Bolgla and Boling81 performed a systematic review showing that both quadriceps and hip strengthening exercises are helpful to reduce pain in those with patellofemoral pain syndrome. They are also the mainstay during MPFL rehabilitation. Please see Table 1 for list of exercise in rank order based on percentage EMG activity. 041b061a72


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