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PRI Integration with Postoperative Knee Patient

Hey everyone, thought I’d drop in a brief example of how a PRI paradigm helps me in clinic.

In my practice, I treat about 25% postoperative patients.  Yesterday, I began a session with a patient who is seven weeks status post right ACLR who I had been predominantly treating "per protocol guidelines" with the patient improving functionally using that approach.  However, yesterday the patient presented subjective symptoms similar to those of pes anserine bursitis in the affected knee--she could not straighten her knee very well and noted end range pain, had difficulty with normal stride length on the right and could not stand on her affected right leg without severe pain in the anteromedial right knee.

Objective findings showed straight leg raise 65°on the right (60 left) adduction drop test positive bilaterally, Hruska adduction lift test 1/5 bilaterally and a 20° lack of end range knee extension on the right.  Patient had palpable tenderness over distal aspects of the semitendinosus and semimembranosus, noted comparable sign with resisted knee flexion. There was palpable tenderness over pes anserine bursa of the proximal tibia and noted swelling in the same area.

After repositioning the patient, she had 5° lack of extension, or 15° improvement, 85 degrees of SLR, the ability to stand and walk on the right knee without pain and significantly increased step and stride length functionally.  Patient was then able to perform functional closed-chain strengthening activities without pain and will now be progressed through a PEC algorithm of treatment integrated with her postoperative protocol. 

Though I begin implementing PRI concepts of respecting position, triplanar functional control and utilizing polyarticular muscle chains that affect postoperative care at different times dependent upon the patient, the apt time presented itself to me with this patient at the start of this session. 

Attaining neutral position of a pelvis gave functionally “longer” hamstring musculature, taking the strain off of the distal attachment sites of the medial hamstrings, thus decreasing pain, increasing functional end-range extension ROM and immediately allowing me to progress with rehabilitation of her right knee s/p ACLR.  In this case, PRI principles and techniques allowed me to progress a patient s/p ACLR more quickly than with traditional orthopedic rehab methods alone and will improve not only the patient’s recovery from surgery, but her quality of movement and function during and after recovery.  A fun session for both therapist and patient!
 

Posted May 2, 2014 at 4:55AM
Categories: Clinicians

Comments

Karen Taylor Soiles Posted May 6, 2014 at 1:34:53AM
I really appreciate this article as it mirrors closely what I have observed. I simply add PRI into the protocol and results are enhanced. Typically we start with an appropriate repositioning technique, then follow the protocol and close with repositioning or other non manual technique.

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