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

How You May Help Rescue Organizations and Animal Shelters with Rehab!!

This is an exciting opportunity to help animal shelter and rescue rehabilitation to save money and pets!!

Dog in Blinds

This is a great way for you to get involved in rescue rehabilitation and rehab for animal shelters in the USA right now (and maybe around the globe later)!

WHAT?

If you read  >>> the reviews <<< on this site, you will see that several veterinarians and others have mentioned that this book ∨∨∨

should be available to more shelters and rescues for new caretakers of adopted pets, and we’d like to offset the expense to shelters of handing out these books to new pet adopters. (Note: if you have blocked Amazon, the book link will not show up above. If you are interested in searching for it on your own, you may use the ISBN 9780615900476 for more info.)

To donate to this program through me, you must use the PayPal link below for the discounted price. Otherwise, if you just want to purchase some and hand them out or use for yourself, then use the Amazon link, above ∧ ∧ by clicking the pic of the book.

HOW?

There is a drop-down menu associated with this PayPal button ∨ ∨ so that you may choose your donation amount…
check it out-


After Torn Knee Ligament Recovery Book
Message From You to Recipients



(This is a secure site & so is PayPal, just fyi)

WHY?

People want the book for dogs in rescue organizations and dogs in animal shelters so that the inexpensive and less-traumatic recovery options offered in the book may be followed instead of immediately pursuing surgery for torn knee ligaments.

IMPACTFUL CONSERVATION…

The other exciting part of this equation is that by following the rehab protocol outlined in the book, instead of first going to surgery, more funds could be made available for other newly admitted pets with much bigger medical problems! This is a very exciting effort toward overall conservation and community wellness.

MORE DEETS-

I am currently editing these original 4-week, foundation-building rehab books, and in the meantime, for every $5 donated, I am able to give one of these original books to an established city/county shelter or verified rescue organization in the contiguous United States.

These books will accompany new pet caretakers at adoption, and the new adoptors will be able to follow the directions while working with their veterinarian on follow-up for pain control, continued recovery, and additional wellness.

SO MUCH NEEDED HELP, IN MANY WAYS (AND THANK YOU ALL)!

I will be posting pics below this post as books are donated so that you will be able to see the benefits of your donations. I will also post pics and follow-up info from the new pet parents too, when they share it with me!

Thank you in advance for participating in this adventure!

Blessings-

Deborah

Q & A

May we buy books from you at this same discount for our clinic, to hand out to clients?

If you are a clinic owner or associate, you may also use this option to purchase books for your clinic. Many of you are already doing this though personal contact with me. If you have not previously ordered from me, be sure to include your clinic name and shipping information in the comments section of the Paypal purchase. Also, to make sure the info gets sent to me, fill out the short private contact form below.

When will this option be available for clinics and shelters in other areas besides the United States?

On the one hand, I could implement this option at any time. On the other hand, I’d need to first know shipping destination outside of the US. Then I would know how many books I could send for a particular donation amount. Currency exchange rates are a factor. Please contact me using the form below, and we will work out the details via email. Please include your clinic or shelter email where the contact box asks for it.  You may provide your personal email if you are a principle veterinarian at the facility. The info you put into the contact box goes directly to  my email, so no one else should see your information.

Should My Dog (or Cat) Still be Limping After ( Knee ) Surgery?

Pain, pain, and also pain –

This info about pet limping and pain could apply to almost any orthopedic surgery…
and some of it applies to almost all injuries as well!

Chocolate Lab lying on floor with bandage on leg after surgery

 

 

 

Pet limping after injury or surgery is overwhelmingly due to pain. The pain is caused by one or more of the situations I introduce in this post. Continued pain is so common that this post on my website has been the most visited post for over a decade. The most common answers I give to questions about limping are as follows, based on what I have found true in my practice:

Limping –

If your pet is limping, your pet is very likely in pain.

Many clients say they don’t think their limping pet is in pain and/or their vet said their pet isn’t in pain. Trust me, limping is usually because of pain.

Bandage –

If your pet has on a bulky bandage, as Jake does in the photo, and your pet is limping, it is likely because of the bandage or cast, that they are bulky…and there may also be pain.

Eating, Drinking, Happy –

Eating, drinking, running, tail-wagging… if your pet is doing some of these things, it doesn’t mean they are not in pain. (Hint: Most pets shouldn’t be running anyway after surgery)

In contrast, if your pet is NOT doing these things (wagging, eating, drinking, seeming  happy), that could indicate pain.

Pain – 

There will be general pain on average for about 2 weeks after surgery, because…surgery. Plus, sometimes the surgery doesn’t go well or complications occur with surgery methods. In those cases, the pain will last a lot longer.

There may be other pain, on top of general pain, due to overuse of the body part that had surgery and…

There may be pain due to an obvious or a hidden infection. This one happens A LOT.

Lesson is: your pet can be in a lot of pain and could still be wagging their tail, eating well, and chasing prey!

That’s the short answer section.

Your pet is not limping “just because he/she had surgery”

I put part of that sentence in quotes because many times I’ve heard people (clients, veterinarians, clinic staff, etc…) say the pet is limping because of surgery or injury as if surgery and injury are somewhat abstract and causing the pain. Surgery is painful, and torn ligaments and other soft tissue damage are painful, too. Your pet is usually limping because they are in pain.

I try to bring people around to understanding factors other than a good surgery or injury can cause the limping. Pain is the #1 reason for limping.  Additionally, injury is painful, surgery is painful, infection is painful, bandages are awkward and may cause a feeling of instability, torn connective tissue may lead to a feeling of instability, and all these factors can contribute to limping.

When we work out a cause for the pain/limping/lameness, then we may work  on more correct solutions to the problem.

Your pet is limping because he/she is painful after surgery (or injury) in almost every case.

Your pet should not be limping more than a couple of days after surgery if

1) they have enough of the right pain medications,

2) don’t have an infection,

3) the right procedures were followed in surgery,

4) your pet didn’t destroy the surgery by chewing or with too much incorrect activity.

I have worked with many pets that have limped or been lame more than a full year after surgery. In some cases the lameness has been going on for a few years. Some of these limping cases are because there are problems with the surgery.

All of my cases have improved when we have done the right work as best possible for the true problem causing the lameness. This may mean getting x-rays to check the surgery if there was surgery. This may mean getting another opinion if necessary about post-surgical limping. You may need to try out antibiotics if the other factors I’ve mentioned are all eliminated. You may also need to get better pain management drugs plus use them to the best benefit to go with rehabilitation work.

An exception to the “limping due to pain” rule would be as in Jake’s case (above photo), because if your pet’s surgeon is using a bandage on your pet after surgery, the bandage or cast will be a little awkward. The awkwardness will make your pet walk funny. Your pet will probably act a little weird with the bandage in place. They may not want to walk in the bandage, they may be a drama queen, they may take exaggerated movement strides, etc…

Most surgeons have discontinued bandaging after knee surgery.

Don’t worry that your pet does or does not have a bandage after surgery. Without bandage is proved to be best in general.

Whether they have a bandage or not, most pets will do best with the e-collar around their neck until 2-3 days after stitches or staples are removed if they have had surgery.

The post-surgical or post-injury pet limping is not an abstract limp caused by mystery forces.

The limp and lameness have overwhelmingly turned out to be because of pain, in my experience with hundreds of cases.

With right amounts of pain medications for your pet’s particular situation, body chemistry, and processing ability, the severe lameness almost always stops. Sometimes “right amounts” of pain medications for your pets particular situation” includes antibiotics. The “particular situation” may be a sneaky little persistent infection. Medications for pain usually do not help very much in combating infection pain; usually only antibiotics will stop infection pain.

Next step is often to try a course of broad-spectrum antibiotics. Infections are not always hot, not always swelling tissue and joints, and they do hurt! At the same time, your veterinary team should be checking out the surgery area to see if it is in tact from what they can feel. They will likely want to do another x-ray to see what is going on inside your pet. This is a good idea in most cases; an x-ray shows random surgery failures as well as cloudiness from swelling in the area, among other things.

If the pet limping does not stop after thoughtful application of treatments I have mentioned in this post, then other factors may yet need to be discovered. Again, your pet should not continue limping more than a day or two after surgery if the above factors are met. The same goes for pets that have had re-do surgeries; if they are limping, there are other problems. The main problem in these cases is usually not enough of the right pain medications.

There is probably some “odd” discomfort and/or feeling of instability after surgery or after those injuries that involve tearing or rupturing of supportive connective tissue, and…

Maybe things feel a little “different” or unstable to your pet. Usually you will notice pets being reluctant to walk on slick floors or are using more caution over tricky surfaces when they feel unstable. I have torn connective tissue in my shoulders, hips, and knees, and I find that I guard my body while doing certain movements. Sometimes I subconsciously tend to be suspicious of my joint’s dependability in some situations. I have been active in body science for many decades, and I know my body well.

This body guarding happens in pets, too, and overcoming this disuse is a big part of my work on them and with their humans to achieve better overall function.

I do in-person and phone consults to help people help their pets to solve pain issues. I will write more on topics that are introduced in this post. In the meantime, please search the words “infection” or “pain” in the search box. Please look over the Q&A and some case stories on this site. I have hundreds more stories than I’ve had time to post, and I’d like to post them to help you. I will as time allows 🙂

It is often a LOT of work to get to the bottom of continued limping problems. In my opinion getting to the bottom of limping diagnosis takes so much time because

1) people do not know that their pet should not be limping after a few days in most cases.

2) people have not followed a solid recovery base program like this for injuries or this for surgeries,

3) veterinarians are hesitant to override the medications the surgeon has given.

Sometimes they are not well-versed in multi-modal pain moderation. Most doctors are not taught a lot about pain evaluation and pain control in school. What your vet learns about pain control is mostly from drug reps, journals, through word of mouth from colleagues, from conferences, and personal experience working with hundreds of cases. I have also learned this way over the decades. Personal experience with hundreds of cases is the best long-term teacher if the learner is open to making changes and solving puzzles.

4) In some cases the surgery has failed.

Surgery failure happens most often because the pet is too active, the pet’s body rejects some of the surgery technique, or the surgery technique wasn’t complete. The last event happens frequently in FHO surgeries, in my experience. I have created successful non-surgical programs for recovery from all hip and knee issues without surgery. I have recovered lots of pets that had too much bone remaining on the femur after FHO and the client didn’t want another surgery. In those cases, we followed deep pain control protocol and my foundation-building programs as well as my advanced drill programs.

If you can get your veterinarian to work with you on the steps I mentioned while you are following strict restrictions and a program like mine, then you will be able to solve the limping issues much sooner. I have a local “team” of veterinarians who have come to understand working on pain in a more focused manner. Some are members of IVAPM and have worked on discovering more about animal pain. Some of them also perform acupuncture as therapy for pain, and often the client and I bring one of them onto the evaluation and treatment team. More on this later or elsewhere on this site…check Q&A for now.

me giving laser therapy treatment for pain control and nerve regeneration on Magnolia the Weimaraner after spinal surgery

These are some basic bits of information for your thought. I mostly deal with continued pain cases, surgery complications, non-surgical interventions, and neurological cases. Daily I work with people and pets to help them pursue avenues to in order to get to the bottom of things and reduce or eliminate pain.

Blessings-

Deborah

(Revised January 27, 2018. Originally posted 2007)

 

AFTER SURGERY FOR TORN KNEE LIGAMENT

Guidelines for Home Rehabilitation of Your Dog: After Surgery for Torn Knee Ligament: The First Four Weeks, Basic Edition

Preface to the book, found on Amazon and Barnes and Noble online:

Some of the information contained in this volume has been published previously by me on my websites beginning in January, 2007. Until this particular current publication, I have had available on my various sites (and on some sites that co-opted the material) a general outline for the first four weeks of post-surgical or post-injury rehab because the demand for this information has been so great. The updated content of this volume is not available on any of my sites, nor has the full content been previously available, and most of the definitive information regarding exercise protocol that is contained in this volume has been removed from my websites and personal social media pages as of this publication.

When I first began publishing a simple home-based plan to the internet it was only a four-week, progressive walking exercise plan, useful for a variety of rehab situations. An expanded version of that is what is contained in this booklet.

What has happened though over time is that I have encountered many situations wherein people have interpreted these basic instructions in contrary ways, often omitting bits they thought they could and often in a way that has been detrimental to the pet.

Therefore, what this booklet also contains is a more thorough explanation of how to enact the plan well …and enact it simply. There is no “bullet point” version, because bullet points will not describe the details of functional rehab so that the animal receives more benefit while receiving less harm or discomfort.

As it is, I continually want to add to or modify bits of this edition, and I have to stop somewhere! This is the basic edition, the closest you may come to bullet points outside of my professional website.  Thank you, on behalf of your pet, for taking this time to learn more about the healing methods available for them.

Blessings-