In the last 6 weeks, we have had a 40-year-old come into our clinic after being told he needed a total knee replacement and a 17-year-old with a partially torn medial collateral ligament. In both cases, despite the difference of their ages, they had remarkable recoveries without surgery!
I will begin with the 40-year-old. He had a history of being a hard worker and healthy person. He worked out and was shocked to hear, when he was complaining to his orthopedist, that he needed a total knee replacement at his age. Fortunately, he went to a sports medicine specialist, who called us to ask us to try to save this young man from surgery.
When this patient came in to see us, he was down and was thinking we would help him regain some of his knee motion and strength in preparation for his inevitable knee surgery. Much to his surprise, after only 4 weeks, he was on his own independent workout program. He was able to get all of his knee motion and most of his strength. He has been working on his own and has already regained what he thinks is full use of his knee, and he no longer thinks he needs any kind of surgery.
Our 17-year old’s results were almost as shocking, but he is a 17-year-old! During the first 3-5 weeks following his ligament tear, we decided to use BFR training instead of the high intensity weight training we had typically used with most of our ligament tear patients. He did work extremely hard, but most athletes take 6-8 weeks, and this young man regained all of his strength in only five weeks! 
BFR is a strengthening technique being used mostly with professional sports teams. This strengthening technique is slow to work its way down to everyday patients, but we have utilized this newer strengthening technique with both our young and older patients, and we’ve seen a number of exceptional results.
This technique can help anyone who may need to improve their strength, without the muscle and joint pain. Whether the patient just had a total knee replacement, rotator cuff repair, Achilles rupture, etc.. The typical exercise program is what we call high intensity weight training and usually causes muscle soreness during the strengthening process. The main reason for this soreness is due to the breaking down of muscle fibers from the heavy weights used. The newer Blood Flow Restriction Training or BFR strengthening technique only requires using 10-20% of the weight a patient would normally need to help them regain their strength. There is no muscle breakdown that occurs and, therefore, little to no muscle soreness.
If you are having any difficulty regaining strength in your legs or shoulders, or if you are concerned about your leg strength and balance, please take the time to call. We can help you, no matter what your age, to regain the strength you may be lacking with less pain then you had in the past.
Enjoy the journey!
Fran
Physical Therapy vs Opioids: When to Choose Physical Therapy for Pain Management

According to the Centers for Disease Control and Prevention (CDC), sales of prescription opioids have quadrupled in the United States, even though "there has not been an overall change in the amount of pain that Americans report."
In response to a growing opioid epidemic, the CDC released opioid prescription guidelines in March 2016. The guidelines recognize that prescription opioids are appropriate in certain cases, including cancer treatment, palliative care, and end-of-life care, and also in certain acute care situations, if properly dosed.
But for other pain management, the CDC recommends nonopioid approaches including physical therapy.
Patients should choose physical therapy when ...
  • ... The risks of opioid use outweigh the rewards.
Potential side effects of opioids include depression, overdose, and addiction, plus withdrawal symptoms when stopping opioid use. Because of these risks, "experts agreed that opioids should not be considered firstline or routine therapy for chronic pain," the CDC guidelines state. Even in cases when evidence on the long-term benefits of non-opioid therapies is limited, "risks are much lower" with non-opioid treatment plans.

  • ... Patients want to do more than mask the pain.
Opioids reduce the sensation of pain by interrupting pain signals to the brain. Physical therapists treat pain through movement while partnering with patients to improve or maintain their mobility and quality of life.

The CDC cites "high-quality evidence" supporting exercise as part of a physical therapy treatment plan for those familiar conditions.

  • ... Opioids are prescribed for pain.
Even in situations when opioids are prescribed, the CDC recommends that patients should receive "the lowest effective dosage," and opioids "should be combined" with nonopioid therapies, such as physical therapy.

  • ... Pain lasts 90 days.
At this point, the pain is considered "chronic," and the risks for continued opioid use increase. An estimated 116 million Americans have chronic pain each year. The CDC guidelines note that nonopioid therapies are "preferred" for chronic pain and that "clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient."
Before you agree to a prescription for opioids, consult with a physical therapist to discuss options for nonopioid treatment.
"Given the substantial evidence gaps on opioids, uncertain benefits of long-term use and potential for serious harm, patient education and discussion before starting opioid therapy are critical so that patient preferences and values can be understood and used to inform clinical decisions," the CDC states.
Physical therapists can play a valuable role in the patient education process, including setting realistic expectations for recovery with or without opioids.

MPT Happenings
When it comes to your health, you have a choice. Choose more movement and better health. Choose physical therapy!
McDonald Physical Therapy
(574) 233-5754