Impression: His arthritic knee was impacting quality of life and ability to work. Arthroplasty was a reasonable option, but to proceed before more comprehensive physio/rehab is questionable. Failure to improve from an OA class is not a failure of physio. 4/ - ThreadSky

camtudor.bsky.social • 105 days ago

Impression: His arthritic knee was impacting quality of life and ability to work. Arthroplasty was a reasonable option, but to proceed before more comprehensive physio/rehab is questionable. Failure to improve from an OA class is not a failure of physio. 4/

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camtudor.bsky.social•105 days ago

But...with established flexion contracture, night pain, substantial loss of range and function, and > 12/12 Hx of pain it can be challenging to get good conservative outcomes without complete patient commitment to a difficult rehab program. 5/

camtudor.bsky.social•105 days ago

What did we do? Five key pillars.

1. Educate. In detail. To succeed, patients with moderate/advanced knee OA need to embark on a fairly demanding rehab program. So they need to understand their condition and the reasoning behind everything they'll be doing. 6/

camtudor.bsky.social•105 days ago

2. Medication: 1/12 course of Naproxen. Oddly, had not tried NSAID’s previously. Immediately helped his night pain. Sleep is important for many reasons, but it’s particularly important during intensive rehab, and can help break a pain cycle. 7/

camtudor.bsky.social•105 days ago

3. Cycling: He bought an exercise bike. 🚴‍♂️ for 20-30 minutes. Every. Single. Day. Good evidence that lubricant secreting cells in synovial joints respond well to cyclical movement. But also a great exercise for restoring belief in the legs, and modulating his knee pain. 8/

camtudor.bsky.social•105 days ago

4. Restore extension: poor extension = poor result. We used *manual therapy* to help. 😬. Twice/week. 😬🤯. For 6 weeks..FFD’s can be hard to change, so he was pushed pretty hard. Patient needs to stretch. A lot. Multiple times daily for at least 5 minutes per time. 9/

camtudor.bsky.social•105 days ago

5. The physio sessions weren’t just ‘hands-on’. Also a combination of coaching and motivation. It’s important for patients to see incremental ‘wins’ to help sustain them through a long rehab. In the initial stages progress can be slow, so in person sessions are invaluable. 10/

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