McDonald Physical Therapy News
"Stronger Every Day"
April 2013
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Have a question for Fran?


Whether it's concerns about your treatment or the benefits of physical therapy, Fran is always willing to take time to answer your questions.



Hello to all our friends!   

In 1992 I tore my medial meniscus and chose not to have surgery. It took me only 8 weeks to recover and afterwards I went back to playing basketball and ran the New York Marathon!

You may wonder, how old I was at the time? Maybe I was just so young that I got lucky? Well, I was 39 years old. I guess that is fairly young, but the key, I believe, was that I was willing to try physical therapy first. I chose to see if I could avoid surgery, and I did so with an open mind.

Seventeen years later, when I was 56, I had a slight meniscal tear in my other knee. Did I go for the surgery? No, I once again chose physical therapy. On the disappointing side, I did not heal in 8 weeks like I did in 1992. 

As I reached the 8 week mark, I was thinking about the surgery option, as I was becoming frustrated with my slow progress. One of my friends, who is a physician, informed me that I was 17 years older! He also informed me that I might be a little more patient with my physical therapy before going the surgery route. 

At first, I was upset with his age comment. But I soon realized that I may actually take longer to heal because of the extra years, and decided to continue doing physical therapy.

Much to my surprise and delight, 5 months later, I was pain-free and back to normal activities. Three years have passed and I am still pain free!

If this information is a surprise, please read below and learn what the studies are starting to point out to all of us. 

It is my hope that you realize the avoidance of unnecessary surgery decreases the speed of arthritic changes in the affected joint. So, if you have any questions concerning surgery for your knee, please call.
Physical therapy may be the answer! 


Enjoy! :)
Fran McDonald, PT, DPT
Study: Therapy as good as surgery for knee repair

You might not want to rush into knee surgery. Physical therapy can be just as good for a common injury and at far less cost and risk, the most rigorous study to compare these treatments concludes.


Therapy didn't always help and some people wound up having surgery for the problem, called a torn meniscus. But those who stuck with therapy had improved as much six months and one year later as those who were given arthroscopic surgery right away, researchers found.


"Both are very good choices. It would be quite reasonable to try physical therapy first because the chances are quite good that you'll do quite well," said one study leader, Dr. Jeffrey Katz, a joint specialist at Brigham and Women's Hospital and Harvard Medical School.


A meniscus is one of the crescent-shaped cartilage discs that cushion the knee. About one-third of people over 50 have a tear in one, and arthritis makes this more likely. Usually the tear doesn't cause symptoms but it can be painful.


When that happens, it's tough to tell if the pain is from the tear or the arthritis - or whether surgery is needed or will help. Nearly half a million knee surgeries for a torn meniscus are done each year in the U.S.


The new federally funded study compared surgery with a less drastic option. Researchers at seven major universities and orthopedic surgery centers around the U.S. assigned 351 people with arthritis and meniscus tears to get either surgery or physical therapy. The therapy was nine sessions on average plus exercises to do at home, which experts say is key to success.

After six months, both groups had similar rates of functional improvement. Pain scores also were similar.


Thirty percent of patients assigned to physical therapy wound up having surgery before the six months was up, often because they felt therapy wasn't helping them. Yet they ended up the same as those who got surgery right away, as well as the rest of the physical therapy group who stuck with it and avoided having an operation.


"There are patients who would like to get better in a `fix me' approach" and surgery may be best for them, said Elena Losina, another study leader from Brigham and Women's Hospital.


However, an Australian preventive medicine expert contends that the study's results should change practice. Therapy "is a reasonable first strategy, with surgery reserved for the minority who don't have improvement," Rachelle Buchbinder of Monash University in Melbourne wrote in a commentary in the medical journal.


As it is now, "millions of people are being exposed to potential risks associated with a treatment that may or may not offer specific benefit, and the costs are substantial," she wrote.


Surgery costs about $5,000, compared with $1,000 to $2,000 for a typical course of physical therapy, Katz said.


One study participant - Bob O'Keefe, 68, of suburban Boston - was glad to avoid surgery for his meniscus injury three years ago.


"I felt better within two weeks" on physical therapy, he said. "My knee is virtually normal today" and he still does the recommended exercises several times a week.


Robert Dvorkin had both treatments for injuries on each knee several years apart. Dvorkin, 56, director of operations at the Coalition for the Homeless in New York City, had surgery followed by physical therapy for a tear in his right knee and said it was months before he felt no pain.


Then several years ago he hurt his left knee while exercising. "I had been doing some stretching and doing some push-ups and I just felt it go `pop.'" he recalls. "I was limping, it was extremely painful."


An imaging test showed a less severe tear and a different surgeon recommended physical therapy. Dvorkin said it worked like a charm - he avoided surgery and recovered faster than from his first injury. The treatment involved two to three hour-long sessions a week, including strengthening exercises, balancing and massage. He said the sessions weren't that painful and his knee felt better after each one.


"Within a month I was healed," Dvorkin said. "I was completely back to normal."  

 -Associated Press, 3/24/2013