This is the story of Peg, a patient who came to React after a year struggling with lacking 20+ degrees of knee extension. This means that she couldn’t straighten her knee; she was walking, working, and doing everything with a knee flexion contracture that caused a leg length discrepancy of 2.5 centimeters.
Peg had undergone knee replacement surgery one year before and developed arthrofibrosis. Arthrofibrosis is a condition sometimes occurring after injury or surgery to a joint, where scar tissue forms excessively as the body’s response to the trauma, thus limiting joint range of motion.
When Peg came to React for her initial evaluation, she had already undergone a manipulation under anesthesia procedure and a course of PT attempting to restore full range of motion and function. Even after all this, Peg still had limitations that kept her from being able to perform several activities that were important to her. She works as a grade school administrator and was unable to sit down or stand up from the floor—something that was important to her in order to be level with her young students. She was unable to walk without pain in her knee, or sometimes in her hip or back (due to compensations for her leg length discrepancy). She even had difficulty sleeping sometimes. Previously, she was very active, walking 6+ miles regularly for exercise.
Knee flexion (bending): 77 degrees
Knee extension (straightening): *22 degrees from zero (in flexion)
Pain: at worst 8/10 and at best 3/10
Difficulty sleeping, transferring in/out of car, to/from floor, walking, prolonged sitting, standing
After 4 weeks of PT:
Knee flexion: 105 degrees
Knee extension: (8) degrees from zero
After another 4 weeks:
Knee flexion: 112 degrees
Knee extension: (7) degrees from zero
Pain: at worst 4/10 and at best 0/10
After 8 weeks, Peg was able to walk 7 miles outdoors, squat to 90 degrees, sit for >1 hour, and sleep through the night, all pain-free.
What made this patient successful?
1) Strong compliance: Even with time constraints of long work days, she made time to perform her Home Exercise Program (HEP) every day, whether that was in her office at work, or in the evening before bed.
2) Communication: When life inevitably got in the way (travel, sickness, etc.), she kept her physical therapist updated on progress or setbacks at home, so we were able to work as a team to adjust the plan.
3) Patience and trust: Despite previous attempts with therapy or procedures, Peg was consistent in PT, trusting in the often difficult manual therapies and exercises that were required in her rehabilitation, sometimes in different areas of the body including the pelvis, back, and ankles. Implementing a whole-body approach allowed for actual changes in entire body mechanics rather than just temporary changes in the involved knee.
Peg’s rehabilitation is an example of the possible positive outcomes when you pair a whole-body approach in physical therapy with a committed patient.