My research this week brought me to some great articles and resources that continue to help answer whether or not physical therapy is beneficial after surgery. What my research has also taught me is that there are many factors that play into my research when answering this question. What are those different factors? How does a patient chose what physical therapist to see? The first article I read was PTJ: Physical Therapy Journal titled, "Open Versus Closed Kinetic Chain Exercise: Issues in Rehabilitation After Anterior Cruciate Ligament Reconstructive Surgery," by G Kelley Fitzgerald. In her article she discusses a type of procedure done by physical therapist called open and closed kinetic chain exercises or OKC and CKC. First I want to clarify for my readers what this means. OKC exercises are where forces applied by the body are strong enough to overcome the resistance. Some examples of this are squatting, a leg press, or any exercise that allows for the load to move away from the body. CKC exercises typically incur compressive forces where your foot (for leg exercises) stays in contact with the object. Push-ups, pull-ups or dips are some examples of CKC. Fitzgerald’s article compares the two types of exercises used when treating a patient who underwent an anterior cruciate ligament surgery also known as ACL surgery. I have found through this article that there isn’t a better of the two and that again it all falls back to my statement of every person heals differently. The important finding in all of this is that CKC might work better on one patient and OKC may work better on the next. My question is how does the physical therapist know which one to use when treating patients who had ACL surgery? Is there a way to combine both OKC and CKC into the patient’s therapy program?
I also found a very interesting article in Anesthesiology titled, "Preventing the Development of Complex Regional Pain Syndrome after Surgery," by Scott S. Reuben, M.D. Complex Regional Pain Syndrome (CRPS) is known as chronic pain with an injury that typically gets worse over time. Reuben’s article discusses ways that can help patients to avoid CRPS if possible. There isn’t a known cause for why a patient suffers from CRPS or who will suffer from it, but Reuben’s article discusses that patients who have undergone orthopedic surgeries are known to be effected by it. Reuben also discusses the benefits of physical therapy before the patient has surgery to possibly avoid CRPS. Do physical therapist test for CRPS or discuss it during the first initial appointment? If a patient has suffered from CRPS prior to their surgery and starts a physical therapy program after, that patient may believe that physical therapy hasn’t been beneficial to their recovery when in reality there are other reasons that could be factored in.
Since I work both in the physical therapy department and spend time with patients at the surgery clinic and in the OR I've always wondered if positive thinking and atmosphere play a role in recovery time? Does having a negative attitude inhibit you to recover as quick? I am looking forward to researching this further.
References:
Fitzgerald, Kelley, G. “Open Verses Closed Kinetic Chain Exercise: Issues in Rehabilitation After Anterior Cruciate Ligament.” Physical Therapy Journal. Ed. Lynn Snyder-Mackler, ScD, PT. 12. Dec. 1997. 13 Nov. 2011. <http://www.physther.org/content/77/12/1747.full.pdf+html>.
Reuben, Scott, S. M.D. “Preventing the Development of Complex Regional Pain Syndrome after Surgery.” Anesthesiology. Ed. David C. Warltier, M.D., Ph.D. Vol. 101. Nov. 2004. 13 Nov. 2011. <http://journals.lww.com/anesthesiology/Fulltext/2004/11000/Preventing_the_Development_of_Complex_Regional.23.aspx>
I 100 percent believe that positive attitude has everything to do with your physical recovery. Just from personal experience I know just in every day life that if I walk out the door with a poor attitude I am most likely going to have a bad day. Our minds are incredible machines. They can make things happen by just thinking about something long and hard enough.
ReplyDeleteWe can never expect anything to happen without the power and will of our own minds. We have to want something bad enough for it to happen. Usually if I think about something negative happening to me it usually happens. I think if you think about something long enough, good or bad, it will happen.
"If you do a little research, it's going to become evident to you that anyone that ever accomplished anything, did not know how they were going to do it. They only knew they were going to do it." Bob Proctor.