As my colleague prepares to take a well-deserved vacation, I pause to reflect on what happened the last time he went away, when I absorbed a few extra patients onto my caseload. He had been seeing a patient s/p total knee replacement who had poorly controlled diabetes, obesity, a moderate amount of residual swelling, and a delayed start to therapy. Despite this, he had done wonders in restoring this patient to good functional ROM and a reasonable amount of strength. But when I saw her, the patient complained that she still had significant anterolateral knee pain that was preventing her from performing some of her home strengthening exercises successfully, and she was feeling frustrated at not being able to advance her activities.
As I looked closely at and palpated her problem knee, I noticed that the patella was tracking laterally and appeared to be frictioning on the edge of the prosthesis, not a common sight in our practice. Had her muscles gotten seriously out of balance during the delayed start to therapy? Was the swelling shutting down her VMO function so severely that her VL had taken over with a vengeance, dragging the patella into a painfully subluxed position? After explaining my theory to her, I tried McConnell taping — no easy task on such a large and swollen knee — but four glide strips helped centralize the patella and brought down her pain level when trying out the therapy step. Since that day, she hasn’t looked back and is going from strength to strength, taping for her exercises as needed.
Am I some sort of miracle worker? Not in the slightest. What I brought to the treatment table was no miracle but a fresh pair of eyes, something I highly recommend we all try from time to time when we’re feeling stuck on a clinical problem.
Have you had similar experiences with your patients? Let me know — I’ll write back after I’ve had the chance to consult with my colleague about one of my own problem patients before he leaves.
Anne Ahlman, MPT
I like it. I think switching up patients every once in a while is good for us and the patients. especially those who are not showing improvement with what we are doing. Some therapists get posessive with their patients and that is a disservice to them and to us.
Posted by: jason | May 10, 2009 at 10:24 PM