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

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.

West Highland Terrier, 13, Torn ACL and Luxating Kneecaps in Both Knees

West Highland Terrier, 13, Torn ACL and Luxating Kneecaps in Both Knees

March, 2013

Deborah,

I have a thirteen year old West Highland Terrier who has torn his ACL in both legs. (The vet used the term, “blown-out both knees.” Also, his kneecaps are “floating around.”) What I am wondering is: surgery or no surgery? He is less active than a young terrier, for sure; but not inactive– he injured his first leg during play and the second as a result of over-use. I am taking him to consult with a surgeon this week. In the meantime I have been trying to keep him confined. Despite his age, this has been a challenge. He’s letting me know on a daily basis that he wants to go for a walk and he has no aversion to jumping down from the sofa (accomplished one time only– to my horror). He is not overweight. If you have any advice, I would be very grateful. Thanks!

Hi-

I got your message on my website, and I will continue to write more to you this evening.
Where do you live? Are you in Austin where I am, and do you see a veterinarian here in town?
thanks!
Deborah

Hi Deborah–

Thank you for responding! No, I don’t live in Austin, I live in California.

My little guy is 13 years old. My vet’s diagnosis (by manipulating the knee joints) is that he has “blown-out” both of his knees. After going over and over it in my mind and scouring the internet for information, I’ve decided to wait and watch. I’m concerned that putting him through a very difficult surgery like knee replacement(s) may, ultimately, be worse than his current status. I have, thus far, been restricting his activity– but he has been choosing to walk around the house. I have not allowed him to jump down from the sofa or bed. He is not panting or trembling. And, today, he has for the first time since his injury, showed interest in a toy. I ordered a doggie wheelchair for him and it is scheduled to arrive Friday (tomorrow). I think this will enable him to get out a little more and alleviate his boredom. He has led me out the front door and down the street several times while in his sling (which I use to take him out for potty), so I know he wants a (short) walk.

I would love to hear your input. I’m worried about him and I want him to be happy and healthy.

Yours,  C

Hi!

I have just a short moment right now, so I’ll give you some definitive info that I assure you will help:

Don’t cry, but I really really really really don’t want you to put him in a cart. The cart won’t really help him improve, because he will use his hind legs less. He needs to use the legs in a specific program. Go to my site again, and read the homework for luxating patellas, no surgery, and the homework for torn CCL/ACL, no surgery. I have dealt successfully with 100’s of these cases. I cannot emphasize enough that you not put him in the cart. It will take him downhill, in my experience, and not toward recovery…short story. 

I know this will help, and feel free to write back once you are successful following the first few weeks of the homework.
Blessings-
Deborah

Hi Deborah–

No wheelchair. Got it.

I went to your website and read the protocol for rehab.

One more thing: when I took my guy to the vet, I was told the only solution was surgery on both knees (or implied euthanasia). I now know that advice was not correct for us. I was also told that my dog must be in horrible pain. While I’m positive he is experiencing pain, I’m not sure it’s as horrible as my vet told me it was. I’ve been observing my dog and, as I mentioned, he’s not panting or trembling or refusing food. He IS walking with difficulty and eating less. My vet prescribed a pain reliever: Torbugesic Syrup; and an anti-inflammitory: Novox caplets. One of the two of them gave him horrible diarrhea within about 12 hours. So bad, in fact, that he was eventually passing blood. His discomfort from these drugs was worse (to my observation) than any pain he was having in his knees. We were out during a terrible rainstorm every two hours. I felt so bad for him. I stopped giving him both meds because I didn’t know which one was the culprit– though I suspect it was the Torbugesic Syrup because he had about 4 or 5 doses of that compared to only one of the Novox. I called my vet and he said it was probably the Novox and to discontinue that, but continue with the Torbugesic. I’m not willing to risk it. He has always had a tender tummy and I’m not going to put him through that again.

So, now, he is not on any pain meds. He always gets fish oil anyway and I have started giving him some of my glucosamine and condroitin supplements. I’m trying to be safe rather than sorry.

Thank you again–C

C-

I could write better from my PC but I’m going to dictate to my phone while I wait to talk to a veterinarian who’s in a room with a client…
where in California are you?
based on what you’ve told me I think it’s a good call that you discontinued those medications.
1 of the first patellar luxation cases I had when I was independent of the surgery specialty hospital was for a Westie that belonged to a human radiologist. she also used to be a runner so she understood my program very well. also, what happened to you also happens here, that sometimes people are given the impression they have to euthanize their dog if they don’t have either 1 of the most common knee surgeries.
I have to go now, but look at my paper that says “should my dog still be in pain after ACL surgery?” you will probably find it under 1 of the pain headings in my index-
blessings-

C-

Ok, so, I keep giving you stuff to read about luxating patellas, which is the floating around part, but you should read the stuff about torn CCL/ACL no surgery I have on the site, too. The first four weeks of the homework is the same. I have had several small dogs with both issues at once, in fact, it seems that usually one is due to the other at that size and age.

My pain posts have info about standard drugs that would be good in this situation. It is possible that, depending on where you are, you could work on getting a vet on board with your conservative treatment of this issue and would prescribe some of the medications I mention.

The torn ligaments will be painful for a number of weeks. The luxating patellas sooner than later stop being painful, once the tendon and muscle either tighten with my exercise or the tendon stretches completely out.

Until you get adequate meds, you may use ice before exercises, using a cube going around the knee for 10 min. on top of the fur, before the walks so he uses the knee better and the exercises are more beneficial. The exercises are most beneficial if he is using the leg in gravity-based, land-based exercises, and he will use it best with additional help from pharmaceuticals until he is no longer lame.

Blessings-

Deborah

Hello Again, Deborah–

Thank you so much for your helpful advice. I am using your protocol and I must say that my little guy is already showing a little improvement. Every day seems a little better. He ate his full dinner last night, he’s going both kinds of potty on his own (no sling) and he walks freely around the house (or shall I say toddles?), he even showed interest in a toy for the first time since the pain in his second leg. I think rehab is going to be the best route for him.

I will use some ice on his knees and then take him for a five minute walk today.

And to answer your question: I live in Bakersfield, California. We don’t have any holistic vets here. Not even close. Heck, we are lucky to have one natural foods grocery store! I really appreciate your help since I am navigating unfamiliar waters. I am an advocate of natural medicine and only turning to pharmaceuticals when there’s no other choice. My fear almost made me forget those things. Almost.

I’ll keep you posted on my little buddy, D. I really appreciate your help.

Sincerely, C

Great-
I’m glad the ideas are working out for you!
Also, you might measure out his regular food from before injury, reduce it by 1/4 c daily (just guessing for now), because he doesn’t need all his usual food if he is restricted, and then divide the meals into 3 daily if that works for you.
Do you mind if I use our communication on my website as a learning tool for others? I will take out your name and some of the things that are more personal and/or detract from the point…

Blessings-
Deborah

Hi Deborah–

My dog knows more than I do because HE’S the one who’s been reducing his meal portions. I’ve been saving the leftovers for his breakfast (which he doesn’t usually have). So, yes, I think your plan will work for us!

Please use our correspondences if you think they will be helpful to others. We dog lovers should help one another as best we can to ensure our pups live long, happy lives– and all the better if we can use natural remedies as much as possible!

Sincerely, C

 

 

Torn CCL/ACL on 10 yr. Old Lab, Been Torn a Year…

Torn CCL/ACL on 10 yr. Old Lab, Been Torn a Year…

Hi Deborah – I’m so glad I found your blog/website after researching for hours. I am at a total loss of what to do for my beloved yellow lab, Sam. Sam is 10 years old, weighs 98 pounds (vet said he had a large girth) and that his weight was fine. A year ago this vet said he had a pulled or torn ligament in his left leg. She said he could have surgery even though he was old, or prescribe adequan (very expensive) or keep him inactive. There was no guarantee of either treatment. I kept Sam inactive for quite a few months, with limited leash walks. I thought he was getting better but he’s not. There have been a few times; he took off running across our yard, which I know was bad. But I’m more careful now about opening the door and him on the leash. I took Sam for a 2nd opinion yesterday (1 year later), this vet said he had a torn cruciate ligament and needed surgery. He gave no medication for pain or recommendation of using anti-inflammatories. Neither vet recommended Xrays or other tests. They just did the manually testing of his leg. He is slow to get up, limps for a minute but then walks on that leg, but does not put full pressure on it. He doesn’t limp when he’s walking. It’s mostly after he’s been lying down, he struggles to get up, limps for a minute or two, then he seems fine. I limit his walking to about 5 minutes 4 times a day. He never seems like he’s in pain. He’s always wagging his tail even when he’s lying down. The only thing I’ve really noticed is at night while we are watching TV, he normally sleeps; now he seems to stay awake and look around, which maybe that means he’s in pain, I just don’t know. I really don’t want to do surgery on Sam, not at his age. I’ve read quite a bit on your site, and it looks like there may be a nonsurgical route for ACL injuries…. I thought you might allow me to ask you a few questions: Deborah, I live in Foley Alabama, is there anybody like you my area that you know of? Anybody you can recommend? Can you give me any kind of advice of what I should be doing for Sam? Should I let the Vet give Sam Adequan? I will do it if you think it will help. When is surgery really necessary and should it be done on a 10 year old lab? I don’t know who else to turn to, please help. Thanks Lisa from Alabama

Here is the first answer I sent you via Facebook-

Hi-
Here is my FB rehab page, and you may already be a fan, since we have at least one friend in common, but there is no easy way for me to search and sort who follows this page
I will get to answer your post on my website as soon as I can. Otherwise, I do know the answers to all of your questions are on one or both of my sites…it just takes a lot of reading ! So while you wait for me to be able to answer, check out the homework and other related posts if you haven’t already.
Sam does need pain meds of some sort and he does not need to rush into surgery based on what you have told me. X rays won’t show torn ligaments, however they will show clouding in the joint which just tells us what we already know, that there is joint disruption and damage.
See the post I just made on the wordpress blog regarding Clark, the hip dog.
Blessings-

And here are more answers now that I have some time:

I will always do a paid phone consult, so if you are interested, let me know and we will set that up.

I do not know of anyone else that practices the way I do, with standard therapy interventions and certification within veterinary medicine (CCRP) yet using the tried and true, long-standing principles of athletic training and strength training protocol. There are a few people in the U.S. that I know of who also carry the strength and conditioning certification that I do, the CSCS®.

The protocol for dealing with this situation did not exist that I could find when I first came into companion animal practice, in 2004-05. I began writing simple programs based on my background and experience. These have been refined and honed and proved to be beneficial.

Additionally I was blessed with a Great Dane companion for 10.5 years who was bone-on-bone in both knees, had all three ligaments torn in the right knee and two torn in the left. She had a genetic bone disorder called OCD (for short), and had two TPLO’s that didn’t work out, or, the end result was not what we would have aimed to accomplish. I am not anti-surgery and not because of her situation. It is through her situation that I learned even more about improving function non-surgically or in the face of very complicated circumstances.

At the least, I have substantiated with some vets in this area and around about (who have inquired and followed my simple homework) the beneficial effect of slow, weight-bearing, pain-controlled return to function after surgery. I built my Grace’s thigh muscles to better support her joints, and I had plenty of opportunity to see the benefits of increased muscle mass in her case. I have also appreciated the benefits in other cases.

I hope that you have found many of the other answers you were seeking elsewhere in this blog.  I suggest pretending like it all just happened and start at the beginning of my homework suggestions (under “homework”) and I strongly suggest, as I said previously, that you obtain an anti-inflammatory if Sam’s system will support it (your vet will do blood work to substantiate this), and if not an nsaid, then use Tramadol or Gabapentin. There are lots of options for pain control (see my Q&A post regarding limping after surgery), and if you just pretend like it happened recently and really start again at the beginning, building up from there, I really think you will realise great benefit for Sam.

Adequan seems to work really well on relatively few dogs (animals). I tried it a lot in my Grace, and I was working with a surgeon friend, so we tried it three different ways (IM, IA, SQ)on three different trials, to no effect for her. Some of my clients say it has helped their dogs substantially. A surgeon on the East Coast told me in 2005 that he didn’t think it would work for my Grace and that they had stopped using it in horses due to little effect. It’s expensive, yes, and it’s great if it works on your dog.

In the meantime use fish oil and a glucosamine/chondroitin/msm combo for joint health. Your vet may carry these products. I have info posted elsewhere regarding these supplements. If Sam takes off running and injures the joint, then make him rest for the remainder of the day and he has to go back to slow leash walks until he is no longer lame. You may also use ice, right on his knee, 20 min, when he has a limping/lameness episode. Hopefully you will be able to have a veterinary relationship where more pain medicines are utilised for greater overall benefit. Check out www.ivapm.org for more pain management info. I’m with you in that he is probably uncomfortable at night. Pain meds will help this, and the other options I gave you will help it some.

If he were my dog, I would definitely follow my homework and the supplement advice, the pain med advice, and I’d recheck with me when the first four weeks of homework are completed. I would not have surgery on him right now based on what you have told me, however I also have seen older dogs do well in surgery…so it’s not the surgery that is offputting; it’s just that I think he can thrive, based on what you have told me, without surgery. You have opportunity to find out if you get strict with the restrictions and homework again. He will have difficulty every time he spazzes out until he builds more thigh muscle. Then the joint should suffer less impact. At the least, if you follow this simple homework, it could serve as pre-hab, and if you decide on surgery, he will be in better shape and presumably recover better after surgery.

That is all I have time for right now.

Our next consult should be a paid phone consult if you’d like to go further. Thanks for presenting Sam to us-

Blessings-

Deborah