Physical Therapy as Effective as Surgery for Torn Meniscus and Arthritis of the Knee, (Human) Study Suggests

Just One of Many Studies Published on This Topic-

My programs for conservative (no surgery) treatment are clinically and anecdotally successful. So, this means that clients and veterinarians do the work and get good results.

Physical Therapy as Effective as Surgery for Torn Meniscus and Arthritis of the Knee, (Human) Study Suggests –

“Surgery may not always be the best first course of action.

A physical therapist, in many cases, can help patients avoid the often unnecessary risks and expenses of surgery. To reinforce that, this study should help change practice in the management of symptomatic meniscal tears in patients with knee osteoarthritis.” Mar. 21, 2013 — A New England Journal of Medicine (NEJM) study showing that physical therapy is just as effective as surgery in patients with meniscal tears and arthritis of the knee should encourage many health care providers to reconsider their practices in the management of this common injury, according to the American Physical Therapy Association (APTA).

The study, published March 19, showed no significant differences in functional improvement after 6 months between patients who underwent surgery with postoperative physical therapy and those who received standardized physical therapy alone.

“This study demonstrates what physical therapists have long known,” explained APTA President Paul A. Rockar Jr, PT, DPT, MS. “Surgery may not always be the best first course of action. A physical therapist, in many cases, can help patients avoid the often unnecessary risks and expenses of surgery. This study should help change practice in the management of symptomatic meniscal tears in patients with knee osteoarthritis.”

According to lead physical therapist for the trial and American Physical Therapy Association (APTA) member Clare Safran-Norton, PT, PhD, OCS, “our findings suggest that a course of physical therapy in this patient population may be a good first choice since there were no group differences at 6 months and 12 months in this trial.

These findings should help surgeons, physicians, physical therapists, and patients in decision-making regarding their treatment options.”

Researchers at 7 major universities and orthopedic surgery centers around the country studied 351 patients aged 45 years or older who had a meniscal tear and mild-to-moderate osteoarthritis of the knee. Patients were randomly assigned to groups who received either surgery and postoperative physical therapy or standardized physical therapy. Within 6-12 months, patients who had physical therapy alone showed similar improvement in functional status and pain as those who had undergone arthroscopic partial meniscectomy surgery. Furthermore, patients who were given standardized physical therapy — individualized treatment and a progressive home exercise program — had the option of “crossing over” to surgery if substantial improvements were not achieved. In this situation, thirty percent of patients crossed over to surgery during the first 6 months. At 12 months these patients reported similar outcomes as those who initially had surgery. Seventy percent of patients remained with standardized physical therapy.

According to an accompanying editorial in NEJM,”millions of people are being exposed to potential risks associated with a treatment [surgery] that may or may not offer specific benefit, and the costs are substantial.” Physical therapist and APTA member Mary Ann Wilmarth, PT, DPT, MS, OCS, MTC, Cert MDT, chief of physical therapy at Harvard University, said, “Physical therapists are experts in improving mobility and restoring motion. The individualized treatment approach is very important in the early phases of rehabilitation in order to achieve desired functional outcomes and avoid setbacks or complications.”

Story Source:

The above story is reprinted from materials provided by American Physical Therapy Association. Note: Materials may be edited for content and length. For further information, please contact the source cited above.

Journal Reference:
Jeffrey N. Katz, Robert H. Brophy, Christine E. Chaisson, Leigh de Chaves, Brian J. Cole, Diane L. Dahm, Laurel A. Donnell-Fink, Ali Guermazi, Amanda K. Haas, Morgan H. Jones, Bruce A. Levy, Lisa A. Mandl, Scott D. Martin, Robert G. Marx, Anthony Miniaci, Matthew J. Matava, Joseph Palmisano, Emily K. Reinke, Brian E. Richardson, Benjamin N. Rome, Clare E. Safran-Norton, Debra J. Skoniecki, Daniel H. Solomon, Matthew V. Smith, Kurt P. Spindler, Michael J. Stuart, John Wright, Rick W. Wright, Elena Losina. Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis. New England Journal of Medicine, 2013; : 130318220107009 DOI:10.1056/NEJMoa1301408

Links to Books and Best Boots for Traction

Hey!

I finally finished adding the links for my books on the first four weeks of recovery post-op and post-injury on this page:

Books!

And you will find links to purchase the booklets from most Amazon platforms around the world. I include Amazon links because the booklets are available on Kindle, and I offer some promotions on both Kindle and paperback versions that are only available on Amazon.
You may purchase the books through any bookseller by asking for them using the ISBN. You may find all the info you need to order from another bookseller by clicking through to the Amazon link and copying what your bookseller requires from the details below the book.

I do not currently offer the booklets in a language other than English, however I hope to translate into Spanish, French, German, and Italian in the near future as well as add other translations too!

I continue to work on editing the new version of the booklets, so clinics and rescues and shelters may still take advantage of the offer I have had in place for many years. You may easily use this page to order at a discount for clinics, rescues, and shelters:

Ordering for clinics, shelters, and rescue organizations!

I also just finished locating the boots and shoes I use to help pets with neurological problems to gain traction and stability (plus for hot pavement, ice, snow, jagged streets and terrain…) on many Amazon platforms around the world, including the USA, so I posted the links here:

Boots & Shoes for Traction + Instructions

I have included a lot of instruction and helpful hints from my 12+ years of working with different boots, shoes, socks, and more to gain traction for pets on this page and even more instructions are in a separate post linked from the page in the link just above this paragraph. I have a lot more items to post about that will help around the home, besides boots, shoes, etc…but this is what I have finished now, and I didn’t want to wait to put this info right in front of you.

Thank you-

Blessings-

Rehabdeb

2/22/17

Cavaletti (Obstacle) Photos

Some Examples of Cavaletti Equipment my Clients Have Used in their Home Environments –

Since my practice is mobile, I look around the client’s home or workout environment to find cavaletti equipment or tools to get the (obstacle) work done. These drills are for proprioceptive benefit as well as range of motion and isometric strength building.

Cavalettis should technically and scientifically be done only after establishing a base with this program.

First…

I look around the home environment to help people with ideas that are inexpensive and easy to set up the right size and spacing of cavalettis for their pet. Finding options for the right kind of obstacles in the home environment makes it easier for the people and the pets to be compliant with the work. Less time demand and easier access makes for greater compliance. Even if people have to buy stuff to use for these drills, sometimes pool noodles or something from the home supply store, these tools are inexpensive.

Cavalettis Original Design 2-27-14I lined up these bricks along a house to make range of motion and isometric drills for a mid-sized herding dog with non-surgical rehab of torn cruciate ligament.

Cavalettis 3 Cavalettis 4

Later, her person caretaker raised the bar by raising the bar and building a more elaborate brick-scapade across the back yard!

Second –

10-11-14 Cavalettis

This was the cavaletti path for a large Pit/Lab X doing non-surgical rehab for torn cruciate ligament and torn meniscus. She also had a tarsal (ankle) injury that I discovered at the same time!

This client was unable to work her large, happy, strong dog outside with much success. She had great success doing all the advanced drills inside the home.

She also didn’t have the right size and type of items for the drills lying around the home, so she spent a little bit of money on wood. After doing the introductory drills at this height, the client then placed flat 2×4 blocks under the ends of the boards to raise them.

After several successful sessions at an introductory level, pets need to continue the drill at increasingly higher bar levels. For videos of cavaletti instructions, click here!

This client bought wood, nails, and pvc –

Cavalettis 2-27-14

This was level 2 cavaletti height for a Goldendoodle doing non-surgical rehab for torn meniscus and torn cruciate ligament. She also had hip pain issues that after muscle atrophy from the knee injury. This resolved after she started my program for muscle-building and received the proper pain medications from her veterinarian.

The next level for her was to put 2 x 4 blocks under the pvc. You already see that in the picture.

Cavs 2 7-11-14Cavs 7-11-14 These were from the woodpile out front at this mid-sized dogs home. I set them up to help her recover from her neurological event, an FCE (fibrocartilaginous embolism). I directed them to begin this work only after completing my base work of fitness and muscle strength.

BJ Cavs 1 8-8-14

BJ Cavs 8-8-14

Yes, these ARE speaker stands inserted into milk crates. Only in Austin, TX (and maybe Nashville…)

Cavalettis

I DO work with many cats. This one is Kacey, and there’s a vid on this site of her doing cavaletti repeats…

Chile R 6-26-13 Cavs Happy

And this guy is getting a start using his own standard cavaletti equipment he usually uses for agility training. Recovery cavaletti drills are much different than agility training work with jumps. There is no jumping in recovery cavaletti drills.  He was working on this drill to help with his disk disease and degenerative myelopathy.

 

(Original Post November 3, 2014. Updated March 27, 2018)

Neurological and Paralysis – German Shepherd FCE

FCE Rehab for Yiqqyir the Shepherd Mix

“Y” had an FCE (fibrocartilaginous embolism) and has regained almost “normal” function in her left hind leg while her right is dragging and lagging 🙂 This is our first meeting, and Y is doing much better than it sounded like she might be doing when we were exchanging emails! She was not knuckling (bending over her paw and dragging or walking on the top) during our visit when she was made to go very slowly. I began her on a basic endurance and foundation strength-building walking program. Some of our discussion is in the video, and hopefully it begins to answer some questions you may have.

Update: Y’s caretaker emailed this to me shortly after our visit:
“Have been working out with Yiqqiyr as directed. She is doing FABULOUSLY!”
“Friday after I went home from seeing you, we did a walk and two massage sessions. Saturday we walked 3×15 min and did 3 massage sessions. Sunday was the same. Monday I was off work at the office for the holiday, so we were able to keep the same schedule.”

By the way, my videographer has a dog that had similar problems after back surgery years ago, and he has done great! His rehab went well, family followed instructions, including restrictions, and years later he is going strong and able to play rugby with his kray-kray sister dog 🙂

There are MANY conditions that can lead to an animal dragging the hind feet, and the number one cause I see is protruding disks. If your pet is not paralyzed, you DO need to see a vet and work on getting a diagnosis. The treatments are different for the different causes of nerve damage. If your pet IS paralyzed, the sooner you get to the vet, the better. In my area complete lack of limb use gets you an appointment with a surgery specialist. Mild to moderate nerve issues may be dealt with using appropriate drugs and restrictions, depending on the diagnosis.

Blessings-