I have a client who has pigmented villonodular sinovitis in her left knee. She just had her second surgery to remove the tumors. Consequently, she has very little knee flexion in her left knee, lots of scar tissue, and significant muscle atrophy. In addition, after her first surgery the physical therapist was trying to stretch her left hamstrings and she suffered a grade 2 tear. Moreover, she tends to depend on her right leg too much. What can I do to help her knee? Are there any supplements and/or specific foods to help with nerve regeneration?
It is difficult to give a specific answer without a thorough functional assessment! We strongly recommend interacting with the medical community on any post surgical condition. Post-medical information along with a comprehensive functional assessment will give you the necessary tools to begin designing an individualized program. Please remember, there is no such thing as a black and white protocol for pathologies; if someone tells you different,t they are oversimplifying this amazing, highly sophisticated, integrated machine! What PT on the Net can provide you with is a guideline to help your client. Utilize and modify the information based on your client’s needs and abilities.
THE KEY TO EXERCISE IS CREATING THE RIGHT EXERCISE!
The most important approach for your client is a low load, whole body exercise plan. When applied properly, the program will appropriately load the deconditioned tissues, stimulate repair, remodel, recondition and enhance proprioception while improving basic life functions. Listed are ideas to help in your program design: Good Luck!
- If you decide to stretch your client, immediately follow up with strength exercise that enhance proprioceptive input! I am disgusted to hear that a physical thepapist strained your client’s hamstrings! The hamstrings are tight for protective reasons.
- Safe and effective stretching: Stretch using the contract, relax, antagonist, contract (CRAC) method. CRAC is a modified form of PNF stretching in which the stretcher performs all the work and you act only as a facilitator. For example, during the hamstrings stretch, your client begins by actively moving her leg to the starting position, isometrically contracts, then relaxes her hamstrings. Then, through antagonist contraction of the hip flexors she actively lengthens the hamstrings. If your client is in control, she will not get hurt.
- After stretching, you will have established a new range of motion; therefore, immediately train the brain to use this new range:
- Perform single leg exercises as opposed to repetitive stable surface squats. Single leg examples:
- Split stance knee bends on a ½ foam roll
- Step-ups on a controlled unstable platform (adjust the step to her ability)
- Single leg isometric holds (in standing position, squat down and hold various positions)
- When squatting, use a balance board to regain equal (or close as possible) weight distribution.
- Always stay away from painful patterns. If your client is free to move while performing an exercise, she will unconsciously migrate from pain. Use natural exercises to assess movement abilities, and do not train on fixed pieces of equipment!
- Think patterns, not muscles. Life is not isolated; the exercises should not be isolated!
- If your client is unable to control her balance, chances are, standing exercises with repetitive loads will be uncomfortable. Solution: Start with the more challenging exercises first. Monitor your client’s fatigue levels carefully and adjust accordingly. If loss of balance and control becomes a factor, add as much outside support as necessary to control the movement. The extreme would be lying down. The key is to “micro-simplify”. If you simplify too much (fixed machine training), your client will not gain much from the exercise program.
Supported exercise examples that have functional relevance include:
- De-weighted squat or step-up on a cable cross system, allowing you to de-weight your client. The cable(s) handle is placed above their head with an appropriate load to assist the exercise (this has worked very well for many of my clients that have lower body dysfunction and cannot free squat).
- Lunge with a pole
- Dumbbell or cable chest/shoulder presses using a stability ball instead of a bench.
- To balance and control the body in everyday movements, your brain must constantly process information. The seated American lifestyle can diminish and delay this ability. By performing exercises on the stability ball, specifically those that involve balance and coordination, you can improve sensory input. Increasing sensory input helps to improve every client’s life!
- Concentrate on the other 23 hours in the day that your client is not with you. Too many clients think that exercises are gym related. Movement, posture, and daily activities are all exercises with different levels of intensities. Teach your client how to sit at home, in the car, and at work. Work on movement skills that help regain control of body function.
- Once the program is designed, call the physician to confirm clearance and explain the exercise goals. Because the resistance program is designed to fortify function, you will probably end up with a lot of referrals!
- Recommendations regarding your nutrition question and nerve deterioration
- Eat a diet consisting of fruits, vegetables, nuts, seeds, and whole grains.
- Increase fluid intake.
- Avoid stimulants such as coffee, carbonated beverages, caffeine.
- Herbs: Feverfew, kava kava, passionflower, skullcap, and white willow bark are what herbalists call “nerviness” they may calm and tone nerves. They come in capsule, tea, or extract form.
Based on the information you submitted, your client will benefit from a functionally balanced program. Even if there were a protocol for every client’s problem, it would only target the problem at that point and time. The goal with all dysfunctions is to holistically approach the body; in other words, work with other specialists to get your client to function as best as she possibly can! Good Luck!