By Stacey Knowles, PT,MS,CFMT,FAAOMPT| Knee Pain | Arthritis| Physical Therapy| Medical Management of Knee OA | Return to Sport
According to the CDC, Knee Osteoarthritis (OA) afflicts approximately 15 million Americans with arthritis related medical bills and lost wages totaling $303 billion. Dr. Scott Kelly reports in the December 2019 issue of the United States Bone and Joint Initiative that despite lifestyle changes that include exercise and weight management, knee arthritis continues to become more prevalent and is affecting a younger population. Hence it is important to address your knee pain early and effectively to improve the longevity of your knees.
Medical Management for Knee Arthritis
Typically medical management addresses your pain via medications and/or surgery. Many people utilize over the counter medications to control their joint pain. There are a plethora of non-steroidal anti-inflammatory drugs as well as steroids that can prescribed by your physician for pain management. Although many of these medications may manage your symptoms, they may also cause such adverse side effects as stomach upset, allergic reactions, nausea, anxiety, bleeding or negative interactions with other medications that you may be currently taking. Other options include topical creams which can be prescribed by your physician or obtained over the counter. The benefit of these creams is the fact that they may offer temporary relief however the cons of this treatment approach is that the creams simply do not reduce acute pain.
Over the Counter Medications
· Tylenol – non-inflamed joint pain
· Ibuprofen – inflamed joint pain
· Aleve – inflamed joint pain
· Biofreeze-topical analgesic cream
· Corticosteroid injection
· Tiger Balm – topical analgesic cream
· Methylprednisone – oral steroid
· Icy Hot – topical analgesic cream
· Voltaren – topical analgesic cream
Many people believe that surgery may be the only option they have to manage their pain. In many cases of severe osteoarthritis surgery offers the best pain relief. However in many cases physical therapy can be very beneficial for most patients even those with severely arthritic knees. What many people do not realize is that surgery does not always completely alleviate the pain as there can be significant increases in pain post-operative as well as reduced range of motion due to joint stiffness, swelling, scar tissue formation, and muscle weakness that can affect your overall mobility. All of the aforementioned would best be addressed in physical therapy. Hence in many cases pre-operative physical therapy can be very beneficial to improve upon your strength, flexibility as well as education regarding walking with crutches, a cane or walker, transitioning between surfaces and navigating stairs to maximize your post-operative recovery. In some cases physical therapy as reduced the necessity for immediate surgical intervention.
Physical Therapy Management for Knee Arthritis
Physical therapy can be quite beneficial for knee pain because the therapist can evaluate your strength, flexibility and function of your entire leg in order to identify a potential cause of your pain. It’s like a bicycle chain that has rusted, is worn, or simply is not on the spokes. When a bicycle chain has any of these issues it simply means you will have difficulty propelling the bike easily.
A physical therapist will evaluate your spine, hip, ankle and foot to determine if the joints and soft tissues above or below are contributing to you pain or in the bike analogy are making it harder to propel your bike. A PT would treat any stiff joints and muscles with various hands-on techniques to improve the overall movement. Also the physical therapist will address any strength deficits via specific exercise prescription to ensure that the hip, knee and foot are strong enough to maintain the stability of the leg when performing the painful activity: walking, running, biking, climbing stairs, lifting or participation in a sport. In essence our muscles help absorb the shocks the knee joint may sustain during an activity.
Physical Therapy Treatments may include:
Joint Mobilization – improving joint movement with hands-on techniques
This is not to say that the knee itself is not the cause of your knee pain, or that the knee itself does not need to be treated, but more to make you aware the impact of other joints, other than your knee, may have contributed to the arthritic changes in that joint. Obvious incidents to the knee joint are age, repetitive injury such as sport or work related strains and awkward sustained postures and trauma all have an impact on your knees. This is what makes your physical therapist so important as a part of your healthcare team is the fact that they will address your entire system to determine the best treatment approach to address your individual goals. This is also not to say that medical management does not have a role in managing your pain and in many cases you may need a combination of both medical management and physical therapy to optimize your function.
By Stacey Knowles, PT,MS, CFMT, FAAOMPT | January 26, 2020 | Frequent Urination | Urinary Incontinence| Pelvic Pain
Your bladder is an organ but more importantly a sack that is surrounded with muscles with several sensors to alert you when you have to go to the bathroom. When you are going to the bathroom before your bladder completely fills you may be training your bladder to only hold that small volume that was in it instead of waiting until your bladder was completely full. Just like any other muscles in the body we have to train our bladders. Granted if you have an infection, are taking medications or have some other underlying pathology there are exceptions to this rule. But ask yourself before you go running to the bathroom to “JIC” or “Just In Case” pee if you truly have to go to the bathroom or can you hold it a bit longer before you go? However it is important that you know where the bathrooms are, do not wait until you have pain or you simply cannot hold it any longer.
Drinking Less Water Is Not the Solution
It is important to drink water as our bodies composed of 50-75% water. Our blood, muscles, bones and fatty tissues are comprised of water. Hence not drinking water will not only deplete these tissues but also may irritate your bladder resulting in an increase your urgency (feeling you need to urinate) and frequency (actual urine production). Dark urine or strong smelling urine are typical signs of dehydration.
Drinking When Your Thirsty
Typically when you are thirsty, your body is signaling that you are dehydrated. Thirst is your body’s way of signaling you to increase your fluid intake. When we guzzle down an entire glass of water when we are thirsty, your body cannot absorb the water. Too much fluid all at once can make you urinate more often. In fact you should drink smaller amounts throughout the day at each meal and between meals allows the body to stay hydrated.
Getting Up At Night To Urinate
Many people report they tend to shy away from drinking fluids because their sleep is often interrupted by having to urinate. Slow down your drinking a couple of hours before bedtime so that you can have a chance to empty your bladder before bedtime naturally. Avoid caffeinated, sparkling and sugary beverages as well as acidic and spicy foods if your bladder is more sensitive and highly reactive to food or drink. If you do not know what may be the trigger of your bladder symptoms try writing down the time of day, volume of fluid urinated (in seconds or small, medium large amount) and type of fluids and foods you are drinking and eating for 3 days. And for all you men who stand and ladies who squat when you urinate try sitting! Yeah I said it, sit with your feet on the floor or propped up on a step stool (we discuss this one in more detail in a later blog). This will optimize the position of your urethra (duct that urine exits your body) for more efficient emptying of your bladder.
By Stacey Knowles, PT, MS, CFMT, FAAOMPT | Myths of Physical Therapy, Qualifications of Physical Therapist | Functional Manual Therapist | Exercise Prescription
Myths of Physical Therapy
People often associate physical therapy with an accident or injury. They often stigmatize physical therapy as something that does not work and they are better off taking medication or having surgery, anyone can perform physical therapy so it is just better to do the exercises on their own. However knowing what physical therapy (PT) is, who is qualified to practice PT and some of the conditions PT used to treat may give you a better understanding of how a physical therapist can be a great resource to helping you achieve some of your health and wellness goals this year!
What are the qualifications of a physical therapist?
According to the American Physical Therapy Association (APTA), physical therapists are movement experts who optimize quality of life through prescribed exercise, hands-on care and patient education. Physical therapists must graduate from an accredited university, pass a national licensure examination in order to practice physical therapy in that individual state and attend yearly continuing education courses to maintain their licensure.
Physical Therapist: A Functional Manual Therapist®
Physical therapists have various different areas of expertise that makes each therapist unique. A Functional Manual Therapist® (FMT) for example is a physical therapist who has taken extensive post-graduate coursework from the Institute of Functional Art and passed both written and practical examinations to earn a certification that indicates they have mastered coursework in the study of hand-on skills and analysis of optimal human movement.
Development of Exercise Prescription
Yes exercises are prescribed for each patient that comes to physical therapy based on the findings of the physical therapy evaluation. Just like a physician who prescribes medication, a physical therapist will prescribe specific exercises to each patient to address strength, flexibility, endurance as necessary to improve the desired patient goal such as being able to lift a small child, climb the stairs at the train station or resume a running program.