Total hip arthroplasty (THA) is one of the most common joint replacement surgeries performed around the world. In the past, it was common for patients to stay in the hospital for up to 2-3 weeks post-op and were typically forced to bedrest. Recently, however, there has been a shifting sentiment towards a “fast track” approach that greatly reduces the length of stay (LOS) in the hospital and leads to a quicker recovery overall.

In a study by Klapwijk et al, the first 6 weeks after a patient’s discharge from the hospital following a THA with fast track were observed. This prospective cohort study was performed in the Netherlands in 2015, and involved 94 patients who received a THA with an anterior approach. Each patient was provided a diary to document their pain and function on a daily basis for 6 weeks following their discharge from the hospital or outpatient center. These forms included…

• Hip injury and osteoarthritis outcome score physical function short form (HOOS-PS)
• Oxford hip score (OHS)
• EuroQol quality of life (EQ-5D)
• NRS pain score
• 12-item short-form health survey (SF-12)
• Intermittent and constant osteoarthritis pain score (ICOAP)

Out of the 94 patients who participated, 52 received an inpatient surgery and 42 were in an outpatient setting. The average LOS was one night for inpatient and released the same day for outpatient. Overall, the study found that over the first 6 weeks, patients reported gradual and significant improvements in a variety of factors including pain, sleep quality, walking ability, and functioning for daily activities (OHS, HOOS-PS, SF-12 PCS). Another result this study identified was that patients reported an improvement in a variety of these surveys within the first week post-op relative to their scores pre-op.

Although the study did have some limitations including limited sample size and only utilizing self-reported subjective values, it did shine a light on the efficacy of a fast-track approach following THA. They found that 97% of the participants reported that the were satisfied with their shorter LOS, and over the first 6 weeks patients’ pain gradually decreased as their function gradually increased.

Source:

Klapwijk LCM, Mathijssen NMC, Van Egmond JC, Verbeek VM, Vehmeijer SBW. The first 6 weeks of recovery after primary total hip arthroplasty with fast track: A diary study of 94 patients; Acta Orthopaedica 2017; 88 (2): 140–144

Golf is one of the most popular recreational activities in America, with approximately over 25 million players country-wide. One of the most appealing aspects of golf is the ability to continue playing well into our 60s, 70s, and even 80s, but although the sport may not seem as physically demanding as others, injuries can be quite common. Losing the ability to play golf due to back pain can be very frustrating, but there has been research into rehabilitation in order to return to the sport quickly as well as prevention strategies to reduce the risk of reinjury. In an article by Christopher Finn, MSPT, CSCS, TPI CGMP, these concepts are reviewed and discussed.

As people age, the spine’s mobility and ability to absorb forces decreases. This can lead to lower back pain (lumbar pain) which has been attributed to approximately 1/3 of all golf injuries. The majority of these injuries are caused by the repetitive motions of the golf swing over time instead of one traumatic event, and are more likely to occur if muscular imbalances or poor swing mechanics exist. These injuries can include muscular strains, facet joint inflammation, spondylosis, disc herniation, and even stress fractures of the ribs.

The treatment of these issues usually benefits from a multidisciplinary approach involving both Physical Therapy to assess muscular imbalances and weakness, and PGA pros to assess flaws in swing mechanics. Physicians may also order medical imaging for further diagnosis, prescribe medication, or utilize cortisone injections to help reduce pain in the short-term.

Physical Therapy has been shown to be very effective in treating low back pain and other injuries in golfers. During someone’s time in physical therapy, they can expect to receive screening and treatment to restore muscular balance throughout the body. These include:

• Core stabilization exercises
• Spinal mobility and range of motion assessment
• Diaphragmatic breathing techniques
• Muscular flexibility training
• Hip, trunk and shoulder strengthening
• Transversus abdominis and multifidus activation

Since the body works in unison throughout a golf swing, it is difficult to say any one exercise is the most important. Muscle groups are constantly activating while others are simultaneously turning off, all while the joints and muscles require the proper mobility and flexibility to freely move through their required range of motion during the swing. Therefore, it is beneficial to have a professional identify these areas of limitations in order to develop a personalized plan for recovery and reduce the risk of injury in the future.

If you are interested in reducing your low back pain while golfing or would like to learn of any muscular imbalances that could be affecting your game, physical therapy may be a great option for you! The therapists at Physical Therapy First have an extensive background in treating orthopedic and sports injuries of all kinds, and are able to dedicate the one-on-one treatment time that you deserve to get you to where you want to be.

Sources:

Christopher Finn, MSPT, CSCS, TPI CGMP. Rehabilitation of Low Back Pain in Golfers: From Diagnosis to Return to Sport. In Sports Health. July/August 2013. Vol. 5. No. 4. Pp. 313-319

Viewpoint Article backed by Research

As physical therapists, we encounter many different types of people with various personalities and diverse backgrounds. These people come see us to move better and to feel better with the mindset that physical interventions can help them achieve their goals. However, we cannot disregard the psychological impact we can have on our patient care and the language we use is a HUGE component of this.

In a viewpoint article published in the Journal of Orthopaedic and Sports Physical Therapy, the authors give us insight on how the language we use with our patients can impact their understanding of their condition, their ability to improve, and the overall rehab process. Some common words that are mentioned to patients in day to day orthopedic care may actually be harmful and set them up mentally for a more challenging rehab process.

Below is a great chart that displays some of these common words that may have a negative connotation and can affect the rehab process. On the right side are suggestions for alternative words that patients can think of instead and what more clinicians should start using:

Each word or phrase on the two sides have similar meanings, however the words on the right take some of the medical jargon out allowing patients to have a better grasp on their condition and be helpful for their rehab process.

The human body is complex and musculoskeletal rehab can be complex! But THAT’S OKAY, the physical therapists at Physical Therapy First are here to help make your rehab process go smoothly with less confusion. We have 1 on 1, hour long sessions with all of our patients which gives us the ability to provide you great care, get you feeling better, AND answer all the questions you have along the way!

Check out the article below for more information on this topic

Reference:

Stewart M, Loftus S. Sticks and Stones: The Impact of Language in Musculoskeletal Rehabilitation. J Orthop Sports Phys Ther. 2018; 48(7):519-522