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Greetings to you all!

I wanted to share with you a story that recently occurred.  
I have a friend from New York that I have known since high school, who called me two weeks ago concerned about problems he was having with his knees. He, like me, is 63 years old. He recently had two total knee replacements performed on November 9th and December 21st 2016 respectively. He had been following his orthopedic surgeon's advice and had been in their physical therapy clinic ever since. The reason for his call to me was that he was still having stiffness getting out of bed in the morning, difficulty going up stairs and standing on his feet for more than 30 minutes. He was calling me to ask how long before he feels better about his decision to have both of his knees done? 

Since I know my friend well and I know he is retired, I asked him to come to South Bend and visit me. During his stay, we could examine him and assess how far he was from achieving his goals. So, he got on a plane and came to my home, visited and was examined. What is so sad about this story is the inadequate care and direction he had been receiving. How do I know?
The two areas physical therapists focus on for their patients,who have had total knee replacements, are active range of motion and strength. If a patient regains motion and strength, function will follow. If a physical therapist tries to move from range of motion to function and bypasses strength, there will be a number of problems! Unfortunately for my friend, this is what happened. As a result, he is five months post-op on his right knee and four months on his left and wondering why his knees are no better than before his surgery. This is so sad because I am sure, the surgery was what he needed.
As usual, he did believe he was receiving the best care in physical therapy because the orthopedist sent him to their physical therapy clinic. He was thrilled when he progressed so quickly to exciting activities with resistive bands and eventually running. Unfortunately, since his pain had actually gotten worse than before the surgery, he, understandably so, thought he made a mistake for allowing the orthopedic surgeon to replace his knees and felt forced to call me.
During his visit to our clinic, we tested his strength, and found out he had 25% strength in his quadriceps. If we see any athlete ( which I believe we should all be treated as well and with as much care and concern ) we would not let them run without at least 80% strength. Anything less, increases the athletes chance of further injury. The good news about my friend is we know what he needs to do to have success and get him back to feeling good about his decision to have surgery. I still believe he will get better and be thankful for his new knees, but I am disappointed with the care and direction he did receive. He is back in New York, working on his strength and I hope to let you all know in the near future that all is well.

As is usually the case in every newsletter, please advocate for the best care when you will be having any serious surgery. Most good surgeons will tell you that your physical therapist is just as important (and sometimes more important) than the surgeon in regaining you life back following the surgery.
I'll keep you posted!

Health Information
    Your Body on a Running Regimen
    A running regimen often reveals the body's inefficiencies or misalignment. For example, improper foot alignment can cause hip pain, or improper hip alignment can cause knee pain. Physical therapists help runners adjust their running technique, thereby reducing risk of injury and improving race performance
    Here are some common injuries, pain points, and form issues runners may experience:
    1. Female runners are more likely to experience hip pain and should
    speak with their physical therapist about proper running technique,
    which may improve hip alignment and control. Imbalances
    at the hip can cause iliotibial ban d syndrome, which appears as
    pain on the outside of the knee.
    2. Knees are the number one site of injury for runners. In fact,
    anterior knee injuries make up 20 percent of all runner injuries. 1
    3. Patellafemoral syndrome, or runner's knee, is often a result of over striding.
    When over striding, the foot lands too far from the body causing the leg to take
    on unnecessary stress that can injure the knee. Shortening the stride can reduce sharp heel strikes to lessen stress.
    4. The most common sites of injury are different for runners over age
    40. The Achilles tendon and calf are more vulnerable, and runners
    may experience an increase in soft tissue injuries.
    5. Feet are complex. Achilles tendinitis, plantar fasciitis and over pronation
    are all sources of discomfort for many runners. The correct
    footwear can help in many situations, but this isn't a cure-all.
    Exercise has been shown to have a beneficial effect on common
    running injuries, even for the foot.
    6. Stress fractures are common in runners under age 30. They are
    often the cause of pain in the second metatarsal, the longest bone
    in the foot that stems out to the second toe. A University of Delaware
    study 2 conducted by physical therapist Irene Davis, PT, PhD,
    found that runners who were cued to "run softly" reduced force to
    their legs by 30 to 50 percent, greatly reducing the likelihood of a
    stress fracture.
    Does any of this sound familiar? Consider seeing a physical therapist to evaluate your functional mobility and movement patterns before you experience an injury. A physical therapist can help you recover from most running injuries, and learn how to continue to safely train. A physical therapist can help you become a stronger and smarter runner, which in the long term can help you prevent injury.
    1. Taunton JE, Ryan MB, Clement DB, McKenzie DC, Lloyd-Smith DR, Zumbo BD. A prospective study of running injuries: the
    Vancouver Sun Run 'In Training' clinics. Br J Sports Med. 2003;37:239-44.
    5. Crowell HP, Milner CE, Hamill J, Davis, I. Reducing impact loading during running with the use of real-time visual feedback.
    J Orthop Sports Phys Ther. 2010;40(4):206-213, Epub 12 March 2010
    The Physical Therapist's Guide to Healthy Running American Physical Therapy Association

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