Author: Dr. Dan Witte

Total Knee Rehab

December 6, 2022

Total knee arthroplasties, also known as knee replacements, have become quite popular throughout the country and the world. Within the United States alone, upwards of 600,000 knee replacements are completed each year. It has become one of those routine procedures used to decrease pain, improve mobility, and help citizens return to their prior level of function. The average age of a total knee recipient has lowered over the years to 66, whereas 70-80 used to be the baseline.

                There are many reasons one may need to consider a total knee replacement. Wear-and-tear is one of them. Throughout the years, our knees carry a heavy load with all of the walking, running, jumping, and squatting activities we complete during our life. All of this heavy-duty activity can cause a natural breakdown of the tissues and cartilage within the knee joint. A breakdown of soft tissue will create excess pain and dysfunction, making these types of activities difficult. Arthritis is one of the top causes of total knee replacements. Arthritis is swelling, pain, and often times crepitus, or “crackling”, within the joint. Overtime, arthritis can advance far enough along to limit your ability to move freely, creating pain with simple tasks such as stair climbing, getting in and out of the car, or standing up from the commode. Replacing the joint helps clear out the arthritis and improve your function as well as give you your independence back when it comes to those simple daily tasks. Prior injury can also be reason for needing a replacement. Damage to the soft tissue has a tendency to create pain and loss of function over time.

                The procedure itself consists of the clearing and removal of damaged bone and tissue, then replacing it with hardware to create a “new” knee joint that functions very similarly to the old. Restrictions following surgery will be minimal-none, so it is likely your doctor will want you to start therapy within a few days. Therapy will be focused on range of motion, strength, and weight bearing tolerance from day one. Most will come out of surgery and be required to use a walker in order to assist in getting around. As the muscles get stronger, a transition from walker to cane, then cane to fully independent walking will occur. Goals will vary with each individual patient, but ultimately your therapists aim at getting your function back to where you were before your knee pain began.

                Therapy can be a little overwhelming in the beginning. Post-surgical swelling, pain, and tightness will cause a difficulty in obtaining your prior level of function. The first couple weeks are generally geared towards gaining motion (getting your full bend and straighten out of the new knee). Many will describe the knee flexion range of motion, or bending, as feeling as though the hardware is going to “pop out of the skin”. This is simply the increased tension within the muscle tendons around the hardware as it all heals. Therapists may apply some soft tissue work, or massage, to the knee joint in order to decrease this tension and make the range of motion a little more tolerable. Obtaining full extension, or knee straightening, is just as important as the knee flexion. There are many different ways to improve knee extension after surgery. Simply propping your heel up on a towel roll with a small amount of weight at the thigh is a great exercise to improve the extension and thus, improve the gait pattern.

Early strengthening begins with isometrics. Isometrics are strengthening exercises that can be completed with the legs without actually moving the joints, making it a little more tolerable. Quad function is pertinent to proper recovery of the knee. The quad is the thigh muscle just above the knee cap. It is in charge of straightening the knee which is needed for a proper gait pattern. We never want to forget about the hip and ankle muscles after a total knee replacement. Strengthening muscles above and below the replaced joint will give a more, well-rounded approach to recovery and allow the entire limb to function as one unit again. Once control of the muscles in the leg has been obtained, you will then move into active and resisted range of motion. This includes any exercises where you are moving the leg on your own, without any assistance. This could include exercises with bands or weights to improve that strength. Progressions through active/resisted range of motion will eventually get you back to recreational activities you once enjoyed.

Weight bearing tolerance must be addressed from the get-go in order to obtain that normal walking pattern again. We begin with gentle exercises such as weight shifts to introduce the leg to the feel of the new knee. We then move into more challenging exercises such as small step ups, single leg balancing activities, squats, or sit to stand transfers. All of these exercises help place your body weight through your leg and ultimately strengthen the muscles to improve your tolerance to daily activities.

While total knee arthroplasties are more commonplace today than they had been in the past, it can still be a process to recover from. Therapy is an important stage in that recovery process and should be completed by each patient choosing to undergo this surgery. Your therapists will work with you to create a regimen that best suits your needs so you can feel as comfortable as possible with the progressions. Completing a therapy regimen following a knee replacement will allow you to return to your prior level of function and daily activities without the dysfunction of the knee joint. If you are considering a knee replacement and aren’t sure whether it is something that is best for you, discuss your options with your doctor and therapist. They will be able to give you the best advice for your given situation.

On This Date In History…

November 29, 2022

As I was starting to think about what to write for a blog on November 29, 2022, I did a quick Google search to see if any important historical events happened on this date. I found that one big event did happen that involves the state of Nebraska. According to www.thepeoplehistory.com, the Louisiana Purchase happened on this date. Meaning that the land that currently forms Nebraska was bought from the French in 1803 for 15 million dollars. This was the important first step for the ability for Nebraska to become a state 64 years later.

After reading up on the Louisiana Purchase, I also searched for other important information about the month of November, as it is about to end. I learned that November is National Bladder Health Awareness month, among other things. This caught my attention as we have a Pelvic Health therapist, Natosha, who has learned how to help with and treat several bladder issues. Many of us think of pelvic health and bladder issues as mostly affecting women, but 13 million Americans suffer from incontinence and 33 million have an overactive bladder. Another 81,000 are diagnosed every year with bladder cancer. All these issues can cause a variety of problems for the patients that they affect.

Physical therapy can help with your bladder issues. Natosha works with our patients on addressing these concerns through pelvic floor muscle training, biofeedback, urinary diaries, nutritional concerns, and other factors. She works to set up an individual treatment plan that is based on your needs and is constantly adjusting and implementing changes to help our patients earn their best results. Whether you are a man or a woman, if you are having incontinence, bladder issues, or other pelvic pain, Witte Physical Therapy can help you address these concerns.

References: https://ejfhc.org/events/national-bladder-health-month/#:~:text=November%20is%20National%20Bladder%20Health,is%20to%20your%20overall%20health.

What Am I Thankful For?

November 23, 2022

Every year during this time we often find time to spend with our families. Many families have a tradition of gathering around the table for a big meal and giving thanks for that meal and their year. Some families also spend time going around the table and stating what they are thankful for. I would like to use this blog to talk about what I am thankful for.

1. My family: I am thankful for my wife and my kids. They often put up with my busy schedule and show an understanding for my time constraints. They work hard to keep things going at home and to provide time for our family. My parents also are very helpful with the kids and helping to support our family. Finally, my brother, in laws, and extended family that help shape who I am.
2. My staff: I have the best staff in the business. They care about and for their patients and they come to work every day ready to help get their patients better. They make going to work and coming to therapy fun. They are the heart of the company, and I am thankful for them.
3. Our patients: Our patients really buy in to what we are trying to do for them. They come ready to work and get better. They support what we do and take pride in what they are doing.
4. Our communities: I love the communities we serve. I love the people who live and work in those communities. I am thankful that I grew up in a small town and in a family that emphasizes certain values. I try to emphasize those values in our clinics and our staff. I am thankful for our communities and what they represent.
5. Life’s Blessings: It is easy sometimes to think “why me”, but as I sit down to compose this blog, I am reminded of how fortunate I am. I have my family, my health, great friends, terrific co-workers, and I get to work with some of the best patients and communities.

I hope this Thanksgiving you can find time to enjoy your family and your friends. I hope you can find time to be thankful for what is going well for you in your life. I hope your 2022 Thanksgiving goes very well!

Reference: https://www.istockphoto.com/photos/thankful

The Freedom to Choose Your Physical Therapy Clinic

November 15, 2022

World Freedom Day was first established as a federal observance on November 09 by President George W. Bush in 2001. This holiday celebrates the fall of the Berlin Wall in the year 1989. The wall was originally built to separate East Berlin, which was under Soviet control at the time, and West Berlin. It prevented the immigration of citizens, creating a divide between families and signifying the control of the communists.

This wall angered citizens, and they eventually came to climbing over the wall to escape control and reunite with families. This rebellion resulted in death of citizens as well as destruction of the wall itself. The destruction became the ultimate demise of the wall, and it fell in 1989, allowing for immigration between East and West Berlin to resume. The fall of the wall not only ended communist control in this region, it signified freedom and the great power of a democracy.

After the Berlin Wall fell, citizens were suddenly free to travel about between East and West Berlin, free to reunite with their families, free to work where they wanted, and able to finally live free of communist control. Freedom was reinstated for these citizens in every aspect, and it is this freedom that makes World Freedom Day one to be celebrated by all.

Here in the United States, freedom gives us the power to choose. We can wear what we want to wear, drive what we want to drive, receive an education at the school we want to attend, and so on. This freedom extends to our lives in every aspect, including healthcare. It can be easy to passively participate in our own healthcare. We listen to the doctor’s recommendations and typically accept them, assuming He has the best answers for us. However, we have the power to take complete control of our healthcare. This includes the medicines we take, the scans we receive, and the practitioners we choose to entrust with our health. As physical therapists, we know how important it is to find a practitioner or clinic you feel completely comfortable in and are happy with.

Knowledge is power. Don’t be afraid to do your research for the right fit for you. Don’t be afraid to stand up to your medical provider and say “No!” if you feel there is a better option! Many will bring their recommendations to the table, but what if you have a history with a clinic and you appreciate their care? Let the doctor know! Taking control of your healthcare is one of the most important things you can do for yourself. Utilize the freedoms our leaders and soldiers have fought so hard for. Appreciate the power to choose and take advantage of it! It is what makes our country so great!

References:

Transitioning Workouts from Outdoors to Indoors

November 1, 2022

                Fall is officially here! The weather is beginning to cool down, the pumpkins are out on the porch, and the smell of soup is in the air! All we want to do is curl up under a blanket with a good book or puzzle and keep warm. The weather changes can make it difficult to want to continue our workout routines, especially if we are used to walking or jogging around the streets in our neighborhoods. We may even find it challenging to adapt to the cooler temperatures. Ideally, we’d avoid the cold weather all together, right? We want our bodies to be comfortable as we work out, otherwise we will struggle reaching our optimal potential. But how do we make the leap from outdoor workouts to indoors? What should we keep in mind when changing our atmosphere? Here are a few tips.

1.) While outdoor activity gives you a healthy dose of Vitamin D from the sun, indoor activity is completed in an environment that can easily be manipulated. We can control the temperature at which we workout when we are inside. It is recommended that we complete our exercise in an environment around 70 degrees Fahrenheit. Any warmer and we may be at risk of dehydration. Any colder and we run the risk of hypothermia or, in more severe cases, frostbite. By having the power to control the HVAC system, we can keep the temperature of our bodies, as well as the temperature of the room, regulated. Find what’s comfortable for you and you’ll rock your indoor routine!

2.) Get creative. It is very easy to get stuck in a monotonous exercise regimen when you feel trapped within the four walls of a gym. This mundane routine can cause a disinterest in the task at hand and maybe even cause you to lose motivation altogether! There is a wide variety of indoor exercise activities you can complete to challenge your body in various ways and continue to reach your potential each day. If you are one that needs to run through parks or by the lake and cannot stand staring at the wall ahead of you while on a treadmill, try a HIIT class! HIIT (High Intensity Interval Training) routines are known to burn just as many calories (if not more!) and get that heart rate up, just as running would do!

3.)  Stretch, stretch, stretch! We all know how important stretching can be with any type of physical activity. It keeps our muscles loose and joints mobile, so we have optimal range of motion with exercise. What we tend to forget is how stiff and tight our bodies can feel with weather changes. When it is cold, the body will push blood flow and energy to our core in order to keep our temperature regulated. This decreases the blood flow in our extremities, causing the muscles to tighten and lose contractility. By shifting your workouts indoors, you may not experience quite as much tension in the muscles, but that doesn’t mean it isn’t there! By continuing to stretch before and after your workout, whether inside or out, you will keep your limbs running at optimal level and leave you feeling flexible as you work out.

4.) Join a class! It is pretty easy to run outside by yourself. The scenery alone will keep your mind occupied. But running inside is a little trickier! You get stuck staring at the same spot on the wall or floor ahead—there isn’t anything exciting about it! So, think about joining a class. Grab a friend or two and engage in the workout together. The wide variety of choices makes it easy to find a class catered to your personal needs. You may even find yourself enjoying the work out routine! Plus, it will feel less like an obligation and keep you wanting more, despite the cold weather!

Buuurrrr…….How Seniors Can Thrive As It Gets Cold Outside

October 25, 2022

How Does Cold Weather Affect the Elderly?

As the temperatures in certain areas of the country drop, the risk of injury and health complications among older adults is expected to rise.  Winter weather and its effects can exacerbate common problems faced by seniors. Snow and ice, for example, can increase the likelihood of falling, and changes in pressure caused by cold fronts can worsen joint pain.

Physical therapy, however, can help reduce some of the risks wintry weather may pose for older adults. Wondering how physical therapy can assist you or an older loved one in staying safe while still enjoying the winter? Read on for our best winter safety tips!

Prevent Injury

Ice is known to help reduce aches and pains — except for when it’s on the ground.  Falls are the leading cause of injury among older Americans. According to the CDC, more than one in four people aged 65+ falls each year. As our bodies age, we tend to lose stability, flexibility and balance, putting those individuals at a higher risk of falling.

Falling, however, is not an inevitable result of aging and cold weather. Through individualized routines, balance exercises and regular movement, physical therapy has been shown to improve coordination, build confidence and boost overall health. Working with physical therapists to regain stability and strength can help prevent future falls or injury.

Remain Active Indoors

While sitting by the fireplace all season long sounds ideal, being sedentary can lead to a variety of physical health issues, such as pain, weight gain and muscle loss. Here are some great ways to remain active inside your home:

• Stretching is a fantastic way to improve posture and keep blood flowing. PTs recommend simple and effective stretches throughout the day to keep you energized and pain-free.
• Equipment-free workouts, such as yoga or body weight exercises, can be done anywhere and eliminate the need for pricey workout gear.
• Deskercise, or exercises you can do while sitting, gets your muscles moving on those days when the fireplace is truly too enjoyable to abandon.

Manage Pain

You don’t have to be a psychic to feel a cold front coming. In lower temperatures, our muscles contract and our joints get tighter, which can cause aches throughout our bodies. Those with chronic health problems, such as arthritis or osteoporosis, may be especially prone to feeling these effects in winter months.

Whether you suffer from general bodily pain or a chronic condition, physical therapy can help in providing long-term relief. It’s been found that those who exercise have an improved ability to manage pain as compared to those who do not engage in physical activity.  Additionally, research shows that physical therapy reduces the need for alternative pain management treatments, like opioid prescriptions, and costly medical services like imaging and ER visits.

Promote Mental Health and Independence

Despite its name, the positive impacts of physical therapy are not limited solely to physical health. Physical therapy plays a vital role in helping patients regain independence and get back to feeling like themselves. This is especially true for senior patients, who may be frustrated by the impacts of aging.

PTs collaborate with patients to set and help them achieve their individualized goals, thus helping boost their self-esteem and improve their overall quality of life. Education is equally as important as exercise. Physical therapists provide patients and families with the knowledge necessary to maintain progress gained and empower patients to take charge of their recovery.

A focus on mental health is always important in winter months, as social isolation among older adults can increase. It is especially relevant during the coronavirus pandemic. In addition to physical activity, an established routine and frequent interaction with others can greatly benefit the mental and physical health of seniors.

How can Physical Therapy help Vertigo?

October 11, 2022

Vertigo is a common condition that results in dizziness and feeling like you or the world around you are spinning. There are many types of vertigo, however the most common is BPPV (Benign Paroxysmal Positional Vertigo). You may experience one, a few, or many of the symptoms associated with BPPV. Symptoms include dizziness, nausea/vomiting, lightheadedness, tinnitus (ringing in your ears), pressure in your eyes, ears, or head, headaches, sensitivity to light and sound, double/blurred vision, fatigue, difficulty concentrating, balance issues, and problems walking. Symptoms typically worsen with rolling in bed, sitting up, quickly changing positions, and moving your head and/or eyes. BPPV can greatly impact your daily life and physical therapy can aide in your recovery.

Your physical therapist will perform a series of tests to determine the cause/trigger of your dizziness/vertigo. Most of the tests are performed in a sitting position involving movement of your head, eyes, and trunk. Specific positional tests are performed in sitting, side-lying, or while rolling to figure out which area of your inner ear is mostly affected. Your vestibular system is located in your inner ear and is responsible for telling your brain where your body is in relation to the world around you. Often, this system stops working properly, resulting in dizziness and other vertigo symptoms. The exact cause of BPPV may not be known for each person, however sinus/ear infections, trauma, Meniere’s disease, and aging are all possible factors.

Physical therapy helps retrain your brain, muscles, nerves, balance system, and inner ear to function properly which helps to decrease and eventually resolve your symptoms. You will be prescribed exercises to complete at home which will speed up the recovery process. You will also be provided with education specific to your type of vertigo that will decrease occurrence of symptoms as most people have isolated triggers. Usually, physical therapy can significantly reduce your issues and resume life as normal within 2-8 treatments depending on the severity of your symptoms. Please do not hesitate to reach out to Witte Physical Therapy if you are experiencing dizziness or vertigo related problems to get back to living your life.

Pregnancy and Physical Therapy

October 4, 2022

Pregnancy comes with a lot of physical changes to your body which can lead to low back pain, nerve problems, general aches and pains, issues with balance, and several other symptoms. Physical therapy can help with most issues related to pregnancy by designing an exercise and manual program that consistently evolves as your body and needs change.

Physical therapy can help manage low back pain, joint problems, and pain throughout your body with movement, strengthening, and hands on techniques. Nerve issues like carpal tunnel are very common during pregnancy and can be improved or even resolved with stretching, strengthening, and massage. Strengthening your entire body and working on muscular and cardiovascular endurance will improve your health, decrease pain, and improve breathing.

As your body changes, your center of gravity, posture, and balance are affected. Exercises targeting balance and posture will allow retraining of your muscles to decrease instability and fall risk, improve coordination, and reduce pain associated with poor posture. Core and pelvic floor strengthening are vital while pregnant and during labor and delivery. Physical therapy can improve strength in both areas and improve your success and reduce pain/tearing while laboring.

Once your baby arrives, physical therapy can aide in your postnatal recovery. Physical therapy helps with upper and lower body strengthening, urinary incontinence, pelvic floor weakness, balance and coordination, posture, pain, and your core strength especially if you experienced diastasis recti. Please do not hesitate to reach out to a physical therapist at Witte Physical Therapy while pregnant or postnatally to improve your overall health and wellbeing.

How to Recover from Post Exercise Soreness

September 27, 2022

                Have you ever participated in a sports game, ran around the yard with the kids and family dog, or even completed a physical therapy or training session and thought to yourself “Man! I am sore!”? This is a very common reaction the body may have to any sort of physical activity. As we use our muscles, whether it be in competition or with general exercise, small micro-tears occur within the tissues. This process is necessary in order to build muscle mass. As the tissues repair themselves, they repair in a stronger form than what they were previously, allowing the muscles to grow. But what do we do when we are sore? How do we get rid of the soreness or, at the very least, decrease the soreness so we can play again tomorrow? There are a few things to keep in mind when trying to help your body through the recovery process.

1. Stay hydrated! Keeping hydrated will help the muscles during the repair process. Water assists in the transfer of nutrients to the cells. If the cells don’t have enough nutrients, it will be more difficult for them to repair, forcing a longer recovery process. Water will also take away any waste the body does not need to recover. Mountain Dew and iced tea cannot do this! I get the question all the time— “Can’t I just drink my iced tea or my pop? It helps quench my thirst.” The answer is no! While specific sports drinks have the ability to replenish electrolytes and assist in recovery, they do not have the ability to push nutrients and remove waste. So drink that water!
2. Ice! Ice! Ice! Icing can have a couple different effects on the muscles and joints following a workout. The main contribution ice makes to the recovery process is decreasing edema, or swelling, in the area. After playing or exercising at higher levels, it can be common to see an influx of swelling due to the rate at which those body parts are working. Ice will constrict the blood vessels and decrease the amount of fluids to the area. Keeping swelling low will allow for greater flexibility and range of motion in the joints and muscles and decrease overall tightness you may be feeling.
3. Stretch! This one may seem obvious, but it is important enough to mention over and over! As our bodies move throughout the day, our muscles are constantly contracting and relaxing. This repetition can increase the tension within the muscle bellies, creating stiffness in joints and muscles. Now picture that at a much faster rate as your running around the baseball diamond or squatting with weights in the gym. By stretching muscles for at least 30 seconds at time, we can effectively change the extensibility, or flexibility, within the tissues and improve the length of the muscle itself.

So next time you’re feeling tight and sore after a workout, take a few minutes to work through these steps. While completing one of these steps, you may feel a little relief, but it likely won’t be enough to make much of a difference on your body. Combining these three recovery strategies will not only help you feel better following a workout or game, but also get you back in the game faster. If you experience soreness and discomfort that lasts longer than 48-72 hours, there may be something more happening within the body that simple stretching can’t cure. Contact your doctor or local physical therapist to determine the issue. Us physical therapists here at Witte Physical Therapy can get you set up on an individual treatment plan that will get you down the road to recovery! Call us today at 402-234-3333 and we can help you schedule a consult or evaluation with a licensed therapist.