Today, I want to introduce to you a new feature called Follow-Up Friday! I recently chatted with one of my patients about doing a weekly update on her progress at physio. Without me having to beg or grovel, she willingly agreed to be part of our learning experience! A round of applause please!
Let’s call this gem Olivia because she reminds me of Olivia Pope from Scandal (yes, I watch way too much TV). She shares the same characteristics as Olivia – bright, tough, and inquisitive – but lacks the whole “sleeping-with-the-President” thing (thank goodness).
Olivia first came to me in late July. She clambered into the clinic using a pair of crutches and sporting a hardcore knee brace that spanned her upper thigh to calf. She told me of an unfortunate event where she took a wrong step and ended up rupturing her patellar tendon.
Folks, let me tell you this: rupturing any tendon, let alone a very strong and big one like your patellar tendon, is not a fun thing. If you are looking for a party, stay away from tearing tendons! Your patellar tendon is located right below your knee cap (aka patella). You know that spot you smack underneath your knee to make your leg kick as a reflex? That’s your patellar tendon. Imagine ripping that tendon off the bone it attaches on to! OUCH.
This kind of tendon rupture is repaired via surgery. Orthopedic surgeons perform operations on bones, joints, muscles, and ligaments. In this case, an orthopedic surgeon sutured Olivia’s tendon was back down on the bone where used to connect. To ensure the procedure was not compromised, Olivia was put in a big ol’ leg brace that stopped her from moving her knee. This prevents the chance of the tendon splitting apart again.
And I digress… Olivia fills me in on this story and away we go! Our first goal is to restore her range of motion. In other words, we need to get her knee moving properly again so that she has full bending (aka flexion) and straightening (aka extension). A normal knee joint should have roughly 5 degrees of hyperextension and 140 degrees of flexion.
On day 1, I whip out my fancy goniometer and measure the range of motion in Olivia’s knee. It turns out she has full extension and hyperextension but her flexion is very limited – only 5 degrees of bending.
Wait… 5 degrees? But you said 140 degrees is the norm. Yes, you are totally correct. Good memory, friend! But this is a consequence of being immobilized after surgery. It only takes one day of “bed rest” to cause your muscles to atrophy (shrink and weaken). When you don’t use them, you lose them! Because Olivia had to wear her brace for weeks, she experienced a lot of atrophy in her leg muscles.
Fast forwarding… Today marks the 7th week since Olivia’s injury and the 4th week since she started physio. It’s been a fun (for me) and grueling (for her) month. We’ve thrown a ton of exercises at her to help with swelling, range of motion, and strength. We’ve reunited her with a stationary bike to kick start her cardio and push her mobility. We’ve mentally and physically practiced proper walking form. We’ve zapped her with a variety of modalities, including neuromuscular electrical stimulation (NMES). And now it’s time for another knee measurement… Nervous? Excited? Nauseous? Pumped? So am I!