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Message Board>
Total Knee Replacement
Lou 33
2 posts
Oct 20, 2009
11:16 AM
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I had 3 TKR patients in the last 2 months that I used TMR on. Before TMR I always tried to get increase ROM to affected knee by heat, pushing into end range,ect. It took about 5-6 weeks in an extended care rehab before patients were able to go home. The last 3 patients, I used TMR on the patients while in supine working both UE arm raises, and the good LE. Instead of the 20sec hold, it seemed to work better when the patients did 20reps x 2 of arm raises and 20reps x2 of knee flex. on good side. Then they pulled their own bad LE into flex by themselves. With each set of exer. they were able to increase the ROM on bad LE without me doing any pushing.When they reach a new range I helped them maintain that new range for a couple of sec. before they proceeded to another set of exer. After the exer. they rode a stationery bike for 10-15min.
These patients were able to go home in 3 weeks. with good range, increase body strength,posture, balance, and gait pattern. Has anyone else ever used TMR on TKR
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AKPT
5 posts
Dec 17, 2009
10:04 AM
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Lou,
I routinely see post surgical patients, including TKA, THA, ACL recon, miniscal repairs, RCR, labral tears, etc. Without exception, I progress them with TMR approach. The reason for that is that it works far better than what I had done in my previous 19 yrs of practice. What I mean by using TMR is that I use the Fab 5 w/ some mods (for simplification) as my first line of "attack". The exercises are performed in either seated or supine positions, depending on pt needs and/or benefits offered by a particular position.
The benefits of this approach are usually large bumps down in pain (intensity and coverage), swelling, and large gains in A/PROM, strength (likely d/t removal of pain-inhibition), and function. The presentation is really a contrast: they come limping in with high pain ratings and pain-behavior and often leave that session with dramatic improvements in many or all measurements.
Once improvements are secured w/ Fab 5, I then tend to progress toward a version of the Super 6 that is performed in sitting or supine. I just go through all the planes of the hip, knee and ankle to find deficits (strength and/or ROM) then "use the good side" to get rid of them. I call it "mirror therapy" so the patients will understand how to treat the opposite side. When able, we progress to standing positions w/ inclusion of S6 multi-planar lunges. While the results often have a systemic benefit like the Fab 5, the local results help me to insure that all deficits are adequately addressed.
When appropriate and able I add function-specific training appropriate to the individual needs of the patient. There are many courses and proponents of this that influence my thinking. For the athlete we push sport-specific, for the older client, we may push basic balance, stairs, squats (as to get up/down from gardening), etc. Where TMR factors in is that I emphasize reps on the good side when they have trouble on the other. That’s an ace card as it tends to “clean up” problems fast.
Lastly, one cue that can be gained from the BKTR is possible SI involvement. (TMR 2 helps shed the light brighter on this.) There are many occult SI dysfunctions just "smoldering" and are waiting to be found. The BKTR (or a calf stretch) can give valuable insight to this. Once treated, you will often find detrimental muscle-tone patterns absent that were directly related to the SI. Yes, SI dysfunction can affect knee, LB or ankle pain... remember, it's a whole body involvement. (For those who deny SI dysfunction, treat out the pelvic obliquity or LB musculofascial imbalance the same or similar way and call it by a different name.)
There you go, my $0.02.
Todd
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