“Help!” Continues . . . So you’ve had ACL Reconstruction, Now What??

Hi! We are continuing our discussion on ACL tears and last post we talked about what to do if you think you have torn your ACL. Today we will discuss Rehabilitation and all the questions you should ask your Physical Therapist and Orthopaedic Surgeon and the answers they may give you . . .

If you missed the first part you can read it here Help! My daughter tore her ACL . . . We think??

So you’ve had surgery . . . 20150625__701135-s500-phHopefully you are feeling like you made a great choice ~ I don’t suspect you are necessarily happy with needing surgery and the coming rehabilitation but now that your joint is stable again proper healing can begin ~ its uphill from here baby!

I suspect you have the lots of questions tho . . .

  • How long do I have toimages-8
    • take meds
    • use the crutches
    • wear a brace
    • keep icing
  • When will it stop
    • hurting
    • being so swollen 
  • When can I get back to
    • sports
    • school/work
    • walking normally
  • Is this normal???

First lets talk about some common things you may be surprised by or concerned about that your  surgeon may not have mentioned . . .

  1. You may have a LOT of pain and swellingtherapeutic-drugs-monitoring-19-638
    1. STAY ON YOUR MEDS AS LONG AS YOU NEED TO!
      The pain and anti-inflammatory medication is needed to manage the pain and swelling along with frequent icing for the first days after surgery. If you do not take your medications regularly they will not build up in your system enough to control the pain and swelling.
    2. It is okay to use the ice machine that was sent home with you as much as you need. It doesn’t really freeze your knee just keeps it cool and comfortable.
    3. elevate your leg as much as you can during the day.
  2. You may bruise ~ tearing your ACL and Surgery are both internal injuries that can cause bruising.
  3. You may have trouble sleeping ~ Because of the pain and swelling, you may not be able to find a comfortable position.
  4. You may feel nauseous
    1. This should only last a day or two 
    2. if it lasts longer the pain medication may not be sitting well in your stomach. Speak to your physician about a different medication.
  5. You may feel more tired ~ everything you do may require more effort.
    1. Getting in/out of the car
    2. Walking with brace and crutches
    3. You may have trouble lifting your leg
      1. It will be heavy and your muscles may not be working well.

Lastly, you will (sometime in the rehabilitation process)images-6

be frustrated at the speed of recovery,

be concerned about your progress,

be anxious to get back playing your sport,

be sad that this is taking sooooo long,

be angry that this happened!

Allow yourself to have these feelings, sit with them, embrace them, accept them and move through them ~ it’s a part of the healing process.

A typical rehabilitation protocol looks like this:

Phase 1

  • Control pain and swelling with ice, medications and exercise to create optimal healing conditions.
  • Keep muscles working with exercise to avoid atrophy.
  • Introduce joint range of motion with exercise to prevent stiffening of tissues.
  • Continue wearing brace until you have adequate quad muscle control to protect ACL ~ usually 2-6 weeks depending on surgeon.
  • Use of crutches as needed when walking ~ usually only 1-2 weeks.

Phase 2 ~ continue with above and . . .

  • Introduce coordination exercises if haven’t already.
  • 6 weeks is a key healing time requiring protection of graft ~ at this point many people are feeling better and assume they can doing things that could put the graft at risk for tearing.
  • Toward the middle and end of this phase introduce balance, agility and coordination.

Phase 3 ~ continue with the above and . . .

  • Increasing speed with balance, agility and coordination
  • Remediate movement pattern dysfunction to prevent future injury.

Phase 4 ~ Return to Sport

  • Typically return to practice with a specialized knee brace at 8-9 months and playing in games at 9-12 months.
  • All making sure that you are using normal movement patterns and are cross training the opposite movements as well to reduce your risk of future injury

So there you have it  . . . The Nutshell Version of ALC rehabilitation!

Have I answered your questions? Created more? Post below and let me know . . .

Speak with you soon! Roxi

Help! My daughter tore her ACL . . . We think??

So I get a text from a friend of mine . . . and my heart sinks . . . she tells me her daughter may have torn her ACL during a soccer game his weekend! She writes “If you have time can you call me about Marie’s ACL and what questions we should ask the surgeon?”

Being a Physical Therapist, I get phone calls, texts and emails like this frequently. I also have personal experience with kids sports injuries. You see the moment they go down and pray its nothing serious, you cringe or gasp, your heart pounds as you calmly reassure yourself that everything is going to be fine. Most of the time they get up and keep playing, other times they walk off and rest, but the worst is when they are carried off or god forbid an ambulance is called!

Deep breath . . .     imgres-2

Once the adrenalin rush has subsided, your child is comfortable, and you’ve had a chance to process the injury then you reach out to people you know, who have experience, for advice . . . What’s next?

So after sympathizing greatly with her, I asked my friend:

  1. What happened? Was it a contact or non contact injury?
  2. Did Marie hear or feel a pop? Is her knee swollen? Can she put weight on it? Does she have full range of motion? How much does it hurt? Does it buckle?
  3. Has she had any imaging ~ X-ray, MRI?
  4. How is she feeling emotionally? How are mom and dad doing?
  5. How can I help? What do you need or want from me?

And I listen . . . Any healthcare provider you choose should ask similar questions and then listen.

Then she asked me:

  1. What could be wrong in the knee? Is it the ACL?
  2. Does she need surgery? Could she get away without it?
  3. What should I ask the orthopedic surgeon?
  4. How soon could she play? Is this going to affect her permanently/forever? Will it limit her ability to play soccer going forward? And as an adult?

As you can imagine this conversation is a little different for everyone . . .

The Nutshell Version: What You Need to Know About ACL Injury.

The Mechanism by which an ACL tearhqdefault

  1. Cutting and planting moves (with rotation) or quick change in direction ~ non contact injury.
  2. Getting hit in a manner that pushes your femur backward or your tibia forward past the point at which the ligament can hold ~ contact injury.

You may hear or feel a pop, and the knee joint will probably swell up, it may or may not hurt much past the initial injury.  In order to confirm it is actually a tear in your ACL and not injury to muscle, knee cap or meniscus instead, you need a clinical evaluation by a Physical Therapist or an Orthopaedic Surgeon and an MRI.

The ACL or Anterior Cruciate Ligament is a ligament which connect the femur to the tibia. If it tears completely it makes the knee joint unstable to correct this there are two options:

  1. Surgery to reconstruct the ligament and restore joint stability.
  2. Physical Therapy to train the muscles to maintain joint stability in any and all activities in which a person wants to engage ~ from standing and walking to sports performance.

The general recommendation is surgery IF . . .

  1. You have a complete tear and it impacts other structures like other ligaments or the meniscus.
  2. You want to return to a high level of athletic play.

Surgical options include:

  1. Allograft ~ a cadaver tendon is used to reconstruct the ACL
    • PROS:  Only one location in the knee to heal, better motion, less time in operating room
    • CONS: chance of rejection of graft since it is not your own tissue. Higher failure rates, slower to adapt to person body.
    • Recommended for: older patients
  2. Autograft ~ your own patellar or hamstring tendon is used to reconstruct the ACL
    • PROS: no chance of issue rejection, its your own tissue so it doesn’t have to adapt, its stronger and lower failure rates
    • CONS: have two sites to heal the ACL and patellar or hamstring tendon. This may slow the recovery time as it can create tissue irritation at the graft harvest tendon location.
    • Recommended for: younger patients, athletes

When you see the Orthopedic Surgeon you should ask the same questions my friend asked me . . . once you know the diagnosis ask these questions:

  1. Is surgery needed? What are the options?20150625__701135-s500-ph
  2. What kind of surgery do you recommend or what kind of graft will you use?
  3. Can I have Physical Therapy before surgery?
  4. What happens after surgery? How long do I have to wear the brace? Use crutches? When can I start physical therapy? Sleep or walk without the brace? Return to sports?

For answer to those last questions see my next post coming this weekend . . .

. . . The Nutshell Version: What You Need to Know About ACL Rehabilitation!

Until next time . . . CiA13cRXEAQaiLr

Roxi

Patellar dislocation VLOG?!?!?

Hello! I am trying my hand at video blogs because . . . why not! I spend time talking to people all the time about questions they have, why not answer some in a more personable fashion than on the phone or via text!

So here is my first . . . Click this link!

This Vlog is about knee cap dislocation ~ the who, what, where, when and why (although not entirely in that order) 🙂

Hope you enjoy . . .

Click here to see the video 

 

Return to Reality ~ Remember Who You Are

f65f1cc99b863ca37484061c3c05283bIts September 1st and here is my update . . . . 

Well, actually it is September 12th because  ~ Life Gets In The Way 😛  but . . . Here’s my update 🙂

The Life that got in the way included:

  1. My son had his wisdom teeth removed!
  2. We tented the house which required bagging things, moving out and then cleaning up.
  3. The start of school while we were moved out! I earned my “master schedule juggler” award that week!
  4. I continued to see patients at various locations (because my clinic is in my home ~ which was tented).
  5. My volunteer commitments resumed ~ I coordinate the Snack Shack for my son’s high school and we had opening days for AYSO and FRAM soccer!

My Successes included:

  1. I resumed cooking delicious and healthy dinners for my family (once we were back home and the kitchen cleaned).
  2. I relaxed over this weekend after the chaos of the last few weeks. Relaxation is so important to allow us recharge our physical and emotional energy banks.
  3. I reconnected with people I had missed over the summer!
  4. I began a health journal which I will continue sharing as the weeks go by!
  5. I played fetch with the dog and did some yoga flow today 🙂

My Stagnations included:

  1. Forgetting who I am

It all comes down to this! For me when I let life gets in the way it is because I have forgotten who I am and therefore I no longer make the choices that I want to make but allow my circumstances dictate how I spend my time. I lose myself in my circumstances.

Have you ever looked in the mirror and thought or said:

  • “What the . . . ?”
  • “Who is that?”
  • “That’s not me!”
  • “When did I get ____________ (old/fat/crows feet/dark circles/bags/jowels/chin hair)?” 😀

I am shocked when I look in the mirror because what I see reflected back is not how I actually see myself! In my minds eye, I see a timeless beauty; an intelligent, vivacious, woman; someone who loves yoga, hiking, taking care of her mind, body and soul. What is reflected in the mirror is not that person. So how did I get off track? Life got in the way 🙂

More importantly how do I get back on track?

I have been asking this question for years and have never found an answer until . . . a recent conversation I had with someone with whom I am working on my branding. She asked me a series of questions about the future ~ goals, desires, plans. But she asked it in a way that made me see who I am 6 months from now. AND THEN . . . she told me to act the way that person acts.

Eureka! See what you are 6 months, a year, 5 years from now. Act the way your future self acts. It’s so simple. If I see myself as an athletic, intelligent, compassionate wonder woman then all I have to do is consistently act like an athletic, intelligent, compassionate wonder woman and that is what I will see in the mirror!

So . . . now I finally have a cairn to mark my path, a guide to show me the trail, a way tostay on track and stop life from getting in the way!

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~ My Cairn ~

Join me on this journey as I post more personal and professional stories. And stay tuned for continued PT education!

Follow me on facebook, twitter and this blog!

Blessed to share the journey~  Roxi

Life Gets in the Way!

If I had a dime for every time I made this excuse . . .

images
I’d be rollin’ in dough!

A perfect example is vacation right?

We have a routine that keeps us doing t
he things
that keep us healthy ~ eating right, exercising, taking our vitamins, etc. Then we go on vacation! We relax, indulge, pamper, overdo (or under-do), and return home feeling like we need a vacation from our vacation before we return to work. Because we are tired and have lots of laundry or yard work to catch up on we skip returning to our regular routine until we realize we have been back for a month and still haven’t gotten to the gym or studio . . .

This can happen with the holidays, projects at work, illness, renovations or any number of other things that make it easy for the majority of us to set aside our commitments to our heath and wellbeing and focus on outside things.

Do you find yourself in these examples?

(I hope I am not alone~heeheehee)

I think of this because our family is currently on a college touring road trip. And I have 8 hours in the car . . . We have toured 5 campuses in 5 days, from Iowa to Pennsylvania! Driven 1,288 miles (not including the 1700+ it to get to the first campus ~ #roadtrip) and walked 21.8 miles!

It was good exercise but not complete exercise. We were all missing the flexibility component of our routine, as evidenced by our taking every opportunity to stretch ~ in line at the gas station, during the standing portions of the tours, and while in bed!  We are now done with the college tours and starting the family vacation portion of our road trip . . . so what did we do when we got to Mackinac Island?? Walked around a lot the first afternoon and rested from our college touring ~ its actually quite tiring! Yesterday we slept in and then rented bikes! We were so excited to not be walking that we road the entire island and then some! The circumference of the island is 8.2 miles, but we also wanted to see the interior and only had yesterday left (as I write we are traveling to Two Harbors, Minnesota to spend five days with family).  So . . . we biked around the island sightseeing, returned to the hotel to get our swim suits, biked to a place to swim in Lake Huron and back to the hotel again ~ A total of 20 miles (gasp). Needless to say the legs were jello, the joints were achy, the spirit was blessed and the mind was clear!

IMG_8417I know the rest of the week holds hiking and water activities, shopping and more. Of course there is the long drive home as well (sigh). So what will happen when I get home?

Back to the same routine of 3 day a week strength training, 3 days a week walking the dog, 10-15 minute of yoga and foam rolling, cooking healthy meals, taking my vitamins?

Or will I let life get in the way?

Stay tuned . . . I’ll give an update September 1st!

Olympics 2016 ~ #TeamUSA!

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Have you been watching the Olympics this year? 

We are college touring (my son is a senior) and vacationing for the entire two weeks so I have only been catching the sports I love at the end of the day or via Sirius XM!

What are your favorite events?

Mine are gymnastics, beach volleyball and soccer. This year I did get into the swimming a bit too! Wow, we have some phenomenal athletes! #TeamUSA.

Another sport I have been following is mixed doubles Badminton!?! I know kinda random but . . . a former PT Aide that I worked with is an Olympian in this sport! I am so proud of her just being an Olympian and Athlete. She posted a picture of herself on Instagram using gradient compression pumps on her legs for recovery 🙂

In addition, Kerri Walsh Jennings and April Ross are sporting their kinesiotape and Michael Phelps has had cupping. What’s that you ask?? Stay tuned below for a link to my colleague’s blog post!

All of this had me thinking . . . I kinesiotape a few of my athletes for competition and many people come to ask me on the sideline “Does that stuff really work? What does it do??”

So here’s the scoop . . .

What is kinesiotaping?

Kinesiotaping is a technique used by Physical Therapist, Athletic Trainers, and Athletes to improve muscle performance or decrease pain during sport. It can also be used to decrease swelling in certain circumstances. It is a light elastic tape that is applied to the body to facilitate or inhibit muscles or move swelling. It is not rigid and therefore allows the body to move through its full range of motion during sport.

Does it really work?

Most medical research says there is no significant difference between use of tape and other treatments BUT . . . Athletes say YES it totally works!  Ultimately, you need to decide for yourself. Ask your Physical Therapist if kinesiotaping is appropriate for your problem and if so have him/her tape that area to see if it helps ~ reduce pain, swelling, make moving easier.

What does kinesiotaping do?

  • For use on muscles, the tape gives your body signals to either use a muscle more or less.
  • For reduction of swelling the tape lifts the skin and fascia to create movement of the fluid so it drains away from the swollen area.
  • For pain it lifts the skin and fascia to decrease the pressure on a muscle that is in spasm.

How do I know what kind of tape to buy?

Your Physical Therapist may be able to recommend the tape that is best for you. The major differences between the brands are patterns of wave forms, color options, and adhesive none of which affects the function of the tape but each person will have different preferences in brand of tape so use which every you like best!

Are they side effects?

  • You can have skin sensitivity reactions such as itching, redness, and the like.
  • If worn for many hours after sweating it can cause a rash from trapped sweat under the tape.
  • If you have latex allergies the tape may irritate your skin.
  • If the tape is close to the neck, head, armpit or back of the knee you can have dizziness, nausea and a general feeling of not being right ~ if this happens it will happen within 5 minutes of applying the tape, REMOVE THE TAPE IMMEDIATELY and the symptoms should be reduced greatly if not gone within 5 minutes. Kinesiotape should never be applied in the armpit or back of the knee.

Can I tape myself?

Yes . . . But, you will want to know what to tape and how to tape it. Speak to your Physical Therapist about your specific issue.  There are lots of YouTube videos available to teach you how to tape yourself but to avoid injury, and understand the purpose of taping, make sure they are done by reliable sources. Better yet check with your PT.

Do you have any Kinesiotaping stories to share? Comment below!

Did I answer all your questions? If not comment below or email me . . . drroxi@zptforinjury.com

Look forward to hearing from you! Be well, Roxi

P.S. here’s the cupping blog my colleague wrote!

The Active Play A.T.H.L.E.T.E.

The forth and final in the series: The Athlete and the Injury . . .

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Active Play Athlete

Here are some guidelines for the Active Play Athlete:

Accommodate your body

You are already doing this by participating in a variety of activities! This is what our bodies crave and what limits our injury risk

Continue this habit!

Take time to  . . . do what you dislike 🙂

There is something you don’t like to do ~ admit it! And then do it anyway!

Even though your performance is already a mixture of sports and activities you still need to strengthen, stretch and get in some cardio work to decrease your risk of injury.

Have goals

Is there a fitness goal you are working toward? If not make one. This will keep you motivated and engaged in your physical health.

Lift Weights

So many people forget to do strength training – you don’t need dumbbells or machinery, you can simply use your body weight.

Girls between the ages of 12-25 can lose bone mass and set themselves up for osteoporosis later in life if they are not getting stronger in their teens!

Environment will enhance your athleticism

If you prefer one type of activity over another then vary the environment in which you perform it! If you like  to hike or bike then do it in the mountains, the beach, trails and asphalt. The varying terrains will force your muscles to work differently reducing your overall risk of injury.

Take a class

Classes can offer flexibility, strengthening, cardio, agility all in one hour or less!

Sometimes it is easier to be motivated when you are with your friends!

Also, since variety is your spice of life you can take a different class each day and stay a well rounded athlete!

Exercise your judgement

If your body is telling you something isn’t right, listen to it. Sometimes the “No Pain No Gain” adage is not correct! (sometimes it is!)

Take rest/recovery days

Eat right to fuel your body for the activity you do

If you have an injury, or are not sure how to round out your routine . . . see a PT, the human movement specialist, who can provide you will information to make educated decisions.

So there you have it . . .  tips for all types of athletes . . .Have you decided who you are? How about your child?

Leave a comment and tell me how you are going to prevent injury now that you know?

No matter the type of athlete you are, risk of injury is part of living. Use the tips above to mitigate your risk and see your PT for more help!

Be Well, Roxi