Health Questions Part 2

[ericbrowning]

My name is Eric. I am an orthopedic physical therapist in OKC. I thought it would be interesting to provide answers to questions you might have regarding issues with your joints, muscles, posture, pain, etc. Alot of times, all you need is some good information and you can help yourself quite well.


Eric
Keith PT

[Karried]

I just learned today that my sister in CA has to have surgery immediately as her discs in her neck are dangerously close to her spine. She will have to have bone taken from her hip... does this sound correct? I'm getting second hand news so not sure yet what is going on.

Any idea of what sort of recovery she might be looking at? As in how long will she have to remain stationary.

[ericbrowning]

Yes, the use of bone from the hip is very common when neurosurgeons perform fusions. The idea is the bone creates a bridge between the two vertebrae as it grows. It is usually held there with a cage or plate and screws. The metal creates immediate stability while the bone integrates. Ultimately those two vertebrae become one. The fusion is meant to create stability and minimize irritation to surrounding tissues, like nerves etc. The biggest draw back is: 1. the hip is usually the sorest part of the post surgical recovery early on, and 2. the fusion of the vertebrae will require the surrounding vertebrae to work harder in order to provide motion. The risk is that adjacent vertebrae might become dysfunctional over time too. But this is more likely in a lumbar (low back) fusion because of the fact that more body weight acts on those vertebrae as opposed to the head which weighs about 14 pounds.

Eric

[Karried]

Thanks.

[Thunder]

Hi Eric.

Way back in Junior High, 9th grade, I fell and hurt my left knee badly. Turns out that I had torn my ACL ligament. I tell you, it hurts...bad! When you fall and the injury starts right there, that area swells up and the movement, especially the bending, is impossible. I didn't have surgery until school was out, during the summer. Before then, I fell occasionaly, as it was unstable. I thought it would heal, but doctor urged the surgery option. Finally, I had it done. I did have therapy before and after surgery.

Just when I thought all was well, I mysteriously fell outside the house during high school (forgot the grade year). I don't know what went wrong, but it happened. This time, another surgery, plus a torn cartilage on the inside side of the knee, that was repaired too.

After all was thought to be well again, I fell again, mysteriously, back in college ('04). This time, it was only the ACL ligament (3rd time). It turns out that all the falls, surgeries, unstableness, it was too loose, so they cut open the outter side of the knee to tighten those muscle, as well as repairing the ACL ligament.

Since then, no problem. It is pretty much stable, no shifting. I didn't stay in therapy for too long, because I did not want to flex it out too much and risk another injury.

Now, the past winter, I experienced pain, when waking up or when the knee is stiff from lack of movement, such as during sleep.

Why can't ACL ligament repair itself? How long does it take for the new ligament to be completely 'perfect'? Will I experience pain for the rest of my life during cold weather? Anything I should do about that? Once in a while, all year round, I have discomfort, but doesn't affect my movement. Does all of this, the entire history on the knee, increase greater risk of knee replacement?

[keving]

What is the best stretches for lower back pain?

[Oh GAWD the Smell!]

Hi Eric.

Way back in Junior High, 9th grade, I fell and hurt my left knee badly. Turns out that I had torn my ACL ligament. I tell you, it hurts...bad! When you fall and the injury starts right there, that area swells up and the movement, especially the bending, is impossible. I didn't have surgery until school was out, during the summer. Before then, I fell occasionaly, as it was unstable. I thought it would heal, but doctor urged the surgery option. Finally, I had it done. I did have therapy before and after surgery.

Just when I thought all was well, I mysteriously fell outside the house during high school (forgot the grade year). I don't know what went wrong, but it happened. This time, another surgery, plus a torn cartilage on the inside side of the knee, that was repaired too.

After all was thought to be well again, I fell again, mysteriously, back in college ('04). This time, it was only the ACL ligament (3rd time). It turns out that all the falls, surgeries, unstableness, it was too loose, so they cut open the outter side of the knee to tighten those muscle, as well as repairing the ACL ligament.

Since then, no problem. It is pretty much stable, no shifting. I didn't stay in therapy for too long, because I did not want to flex it out too much and risk another injury.

Now, the past winter, I experienced pain, when waking up or when the knee is stiff from lack of movement, such as during sleep.

Why can't ACL ligament repair itself? How long does it take for the new ligament to be completely 'perfect'? Will I experience pain for the rest of my life during cold weather? Anything I should do about that? Once in a while, all year round, I have discomfort, but doesn't affect my movement. Does all of this, the entire history on the knee, increase greater risk of knee replacement?

It'll never be perfect, and will get worse as you age. My knees are junk. THANKS UNCLE SAM!

[Thunder]

It'll never be perfect, and will get worse as you age. My knees are junk. THANKS UNCLE SAM!

I can't think of a word, but I guess, completely done with healing and strengthning.

[ericbrowning]

Why can't ACL ligament repair itself?
- Ligaments are unique in that their makeup doesn't allow for them to repair themselves like a tendon or muscle. But remember that even as a tendon or muscle repairs, the repair site is replaced with scar tissue. So even the muscle or tendon isn't as good as it once was.

How long does it take for the new ligament to be completely 'perfect'?
-Perfect? Never, because it's never as good as the first. But, it should take a good 16-20 weeks to heal solidly.

Will I experience pain for the rest of my life during cold weather?
Anything I should do about that?
-In all likliehood yes, and here is why. These are the things you have going against you. Mulitiple surgeries on the same knee. Missing cartilage, which ultimately mean less cushion between the bones. You had abnormal movement in the knee for quite a while because of the laxity of the repairs (1 and 2) and so you may have some early stages of arthritis. Finally, if you don't have full range of movement now because you have protected it, you may be bearing weight on the knee, putting pressure in inappropriate spots. Barometric pressure will cause pain, forever unfortunately.
But, it doesn't mean all is lost....you should consult a PT even if it is to check the flexibility and strength in it, to make sure it is balanced with the other side. This could be done over one visit.


Once in a while, all year round, I have discomfort, but doesn't affect my movement. Does all of this, the entire history on the knee, increase greater risk of knee replacement?
-Your history puts you at risk for a total knee replacement. You need to choose low impact exercises to minimize stress to your knee.


Eric

[ericbrowning]

Good question....but the answer is highly dependent on what is tight on you. There are easily 10 muscles that directly affect the back, so you would need to be assessed for that.

I can't tell you what is right for you, and the last thing I want to do is arbitrarily give you something to do that actually might make you worse.

Back pain is so prevalent. What is even better is figuring out what is causing the back pain, and treating that, rather than just trying to keep it tame.

[Thunder]

Hi Eric,

I can walk, run, and ride a bike. I don't play sports, since I stay away from any roughness.

You know how a person can bend their knee all the way, such as the back of lower leg touch the back of upper leg. Well, this one, I can't bend it all the way and decided that it was good enough for me, just to not stretch any muscle out further. Good idea? What you think?

I do have a habit of controling the knee when I walk. Typically, when a person walk, their legs is completely straight. For me, on this knee, I have an automatic habit (without being aware) of making sure this knee don't go any straighter. It is not really noticeable by anyone I'm walking by.

I believe I do have all the cartilage, unless they mysteriously disappear. lol

[ericbrowning]

You need to make sure you can straighten your knee all the way....if not, you might as well be walking on a short leg. This assymetry will affect your hips and back over time because everything will be slightly off level. The bending of the knee is important for the knee cap. When the quad/thigh gets excessively tight, the knee cap will not move appropriately when you walk, bend etc.

However, I do understand your rationale on protecting it. It makes sense, just understand that there are consequences with anything that deviates from normal.

[Oh GAWD the Smell!]

So...What about when your knee bends BACKWARDS?

It hurts a lil :'(

[FritterGirl]

So...What about when your knee bends BACKWARDS?

It hurts a lil :'(

Not if you're "double-jointed!" :-)

[Oh GAWD the Smell!]

I don't call it double-jointed, I call it hyper-extended. My kneecap pops out and it folds WAY beyond where it should.

Then I lay on the floor of the garage (only place it seems to happen) and blow snot bubbles for a few minutes until it goes numb and I can push my kneecap back into place.

It's AWESOME to watch.

[Karried]

Then I lay on the floor of the garage (only place it seems to happen) and blow snot bubbles for a few minutes

I'm really thinking Prozac is in order now.. lol

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~


Eric,

My husband has a rib that is out of place. It pops in and out of place. He thinks the cartilage is torn or weakened. It is very uncomfortable. If he twists a certain way or pushes on his chest, it can pop back in - the chiropractor can pop it back as well.

Anything he can do to fix this? He has had xrays and Dr. appts... Dr says he should be wrapped up and stationary for a long time to let it heal.. that can't happen.

He now thinks it is affecting his nerves in his spinal column... it seems to travel from his area to his back muscles which in turn are radiating up to his spine.

I know he should go to a dr again and check it out, but do you have any insight on ways to alleviate some of the discomfort?

[Thunder]

Eric, I'm working on that, as time goes on, I become more safe and able to let the knee to be straight while walking.

Karried, get your hubby to a specialist. They can do something about it quickly.

[ericbrowning]

Karried,

It sounds like he may have a rib cartilage problem if the pop is on his chest side vs. the spine side. If it is a cartilage thing then that is very difficult to heal because of the lack of blood flow to that area, but if it is a popping more near the spine, then wrapping it front to back might be helpful. If it remains unstable like that, there are sclerosing injections that may help....Dr. Eric Eckman is excellent at that but you would want to see an orthopedist first.
Did the problem start after a manipulation? or and injury?

[Thunder]

Eric,

Here is this about my mom. She recently had surgery on her shoulder on the 4th. It is something about rotator cuff, tendon, whatever tissue all torn up inside. She had it repaired. A week after that day, the doctor checked up on her and told her 2 excercises to do for 5 weeks, then check back on the 15th of next month. After that, start therapy. What do you think? Should she be starting therapy already or is this wait time good for her shoulder?

[ericbrowning]

Regarding shoulder rehabilitation:

In my opinion, it is important to get a patient in as soon as possible after surgery to start passive movement excercise (this is probably what he has her doing) but also accessory movement glides. These glides are performed by a physical therapist to gain movements in the joint that a person can't get by moving the arm alone. This helps keep the scar tissue from forming in such a way that the dynamic 3-dimensional movements are not impaired later.

Usually what I will do is see the patient frequently until they have full range of motion, then I back off on frequency until they are ready to go ahead with more agressive exercise (hence his 5 week wait period).

I am curious now who the doctor is.

[Thunder]

Dr. Miller from St. Anthony, a building on Lee, north or northwest of the main hospital building.

What should I do now? Should I take her to therapy and have them get started, or does she have to wait for Dr. Miller to write out referral for therapy? She is on Medicare.

[ericbrowning]

Dr. Miller from St. Anthony, a building on Lee, north or northwest of the main hospital building.

What should I do now? Should I take her to therapy and have them get started, or does she have to wait for Dr. Miller to write out referral for therapy? She is on Medicare.

Well, she will need an script for therapy. Paul Miller MD may have a perfectly good reason for not starting therapy right now. If anything you might just ask if there is any reason why she couldn't start right now? It is not the end of the world if she doesn't start for 5 weeks.

[Thunder]

I know. At the time, I had taken off a day to take her in for surgery and stay there. I couldn't take off again one week later and the office refused to be flexible, so I didn't get the chance to hammer that guy regarding therapy.

[ericbrowning]

Just make sure your mother is compliant with everything they asked her to do. It is a critical time in healing, and even though she may start feeling better and more confident, don't sway from their instructions.

[Thunder]

She is doing the two excercises 5 times a day. Things are really tough for her, I'm hearing her complaining and actually crying about only able to use one hand. I dunno what to say, she need to stop being down about it. I gone thru surgeries on my knee several times and look, it is all over. She had a major life-saving surgery done on the back of her head/neck when she was about 30 something, that was so much worse than what she is going thru now.

On that thought, she always saying, just wait until a few more years, I may just go thru what she had done, life-saving surgery to live, just as she had gone thru. I think not. She is 51 and I am going to be 24 next month and we're still alive, despite what doctors predicted a long time ago. You know that movie, Mask with Cher? That poor dude. Look at us, we're doing just fine. Can you imagine how many people think we have some kinda relation with Cher?!

You know, I do have an issue of this bone, stubbornly growing to close up this ear canal. No one knows why. My whole head was checked a few years ago, all is fine. Mysterious bone growth just to cover up the canal. *shakes head*

Eric, you know anything about Cranial Facial Dyplasia? If you do, you would know about how tough our bone can be. Unbreakable. How much part does that play with her shoulder?