Event 4: Alternative Therapies

Joyce Meets with Physical Therapist

Components of a Physical Therapy Evaluation

Detailed History
Imaging Results
- Post Traumatic Arthritis (Joyce)
Pain Questionnaire
- Knee Injury and Osteoarthritic Outcome Score (KOOS)
Physical Examination:
Hip & Knee Motion
- Thomas Test
Patellofemoral Mobility
Hip & Knee Strength
- Hamstrings, quadriceps, gluteus maximus and medius
Ligament and Meniscus Testing
- Lachmann, McMurray, Valgus & Varus Stress Test
Foot and Ankle Motion
- Foot Posture Index
Core Strength
Functional Testing:
- Barefoot gait/running
- Single leg balance
- Bilateral squat
- Single leg squat
- Walk up/down a step
- 3-hop-test
Patient Goals according to Joyce:
- I would like to be able to go up and down the stairs without pain and squat down to feed the cat
- I would like to be able to have less stiffness after riding in the car or at the computer
- I would like to start jogging again without pain
Results from Patient Case (Joyce):
- All tests within normal limits, but feels “stiff” at the end ranges of flexion on the involved side
- Joyce describes stiffness and popping/grinding when moving knee. Some tenderness along the medial joint line
- The PT confirms symptoms that are consistent with diagnosis of post-traumatic knee OA. This diagnosis is in line with extensive knee injury in college resulting in knee OA at a “younger” age. The periodic increases in demand on her knee joint contribute to the flare-ups

Knee Injury and Osteoarthritic Outcome Score (KOOS)

The KOOS was developed as an extension of the WOMAC Osteoarthritis Index with the overall purpose of evaluating short- and long-term symptoms and function after knee injury and OA
KOOS consists of 5 subscales; Pain, Other Symptoms, Activities of Daily Living (ADL), Sport and Recreation Function (Sport/Rec) and knee-related Quality of Life (QOL)
KOOS is in the public domain and is free of charge. No licensing or permission are required to use KOOS or the other questionnaires¹

References

KOOS
Roos EM, Lohmander LS. Knee injury and Osteoarthritis Outcome Score (KOOS): From joint injury to osteoarthritis. Health Qual Life Outcomes 2003;1:64.

Interventions for Posttraumatic Knee Osteoarthritis (OA)

Exercise is the cornerstone to treatment for posttraumatic knee OA!

Exercise without pain using proper mechanics
Whole body approach to movement
- Ankle/foot, hip, spine can all affect knee
- Common interventions may include: Hip abductor/extensor strengthening, core strengthening, functional training, manual therapy
Typical Plan:
- 6 weeks, 2x/week outpatient sessions, daily home exercise program (based on equipment available at apartment/work)

How Do I Find a Physical Therapist in My Area?

Find a PT allows you to search a national database of physical therapist members of the American Physical Therapy Association (APTA) for the exclusive purpose of seeking physical therapist services.

American Physical Therapy Association (APTA). Move Forward.

APTA. Choose PT: Popular resources.

CDC Recommendation

Centers for Disease Control and Prevention (CDC) guidelines recommend nondrug approaches such as physical therapy over long-term or high-dosage use of addictive prescription painkillers.

"The contextual evidence review found that many nonpharmacologic therapies, including physical therapy, weight loss for knee osteoarthritis, psychological therapies such as CBT (cognitive behavioral therapy), and certain interventional procedures can ameliorate chronic pain," the guidelines state. "There is high-quality evidence that exercise therapy (a prominent modality in physical therapy) for hip or knee osteoarthritis reduces pain and improves function immediately after treatment and that the improvements are sustained for at least 2-6 months. Previous guidelines have strongly recommended aerobic, aquatic, and/or resistance exercises for patients with osteoarthritis of the knee or hip.”

Reference

Center for Disease Control and Prevention (CDC). Morbidity and Mortality Weekly Report. Opioids for Chronic Pain. March 15, 2016

Joyce Meets with Chiropractor

What is Chiropractic Care?

A system of integrative medicine based on the diagnosis and manipulative treatment of misalignments of the joints, especially those of the spinal column, which are held to cause other disorders by affecting the nerves, muscles, and organs*

*Via Oxford Dictionary

Chiropractic Care and Sacroiliac Joint Dysfunction

Yeoman’s Test is used to determine if sacroiliac joint pathology is present.
The exam can also indicate Iliopsoas or quadricep muscle contracture.
Lumbar Range of Motion

Global ROMs for the Lumbar Spine

Flexion
- 40-60 degrees
Extension
- 20-35 degrees
One-side lateral flexion
- 15-25 degrees
One-side axial rotation
- 5-18 degrees

Yeoman's Test

Test Positioning

The subject lies prone on the table.

Action

The examiner passively flexes the subject's knee to 90 degree while simultaneously extending the ipsilateral hip.

Positive Finding

A reporting of pain during this test is considered to be a positive sign. Pain in the sacroiliac joint may be related to anterior sacroiliac ligament pathology. Pain in the anterior thigh region may be related to hip flex or musculature tightness or femoral nerve tension.

Special Considerations/Comments

The examiner should pay attention to the position of the subject's trunk, as trunk rotation may be used to compensate for positions of discomfort. Compensatory movement such as trunk rotation may result in a false negative finding.