Third-year physical therapy students at Andrews University in Berrien Springs, Michigan, learned about the importance of knee extension, how to provide evidence-based care and how to establish relationships with referring physicians during a four-hour visit by a team from Shelbourne Knee Center on February 20, 2019. K. Donald Shelbourne, MD, orthopedic surgeon, gave three presentations and physical therapists William J. Claussen, MPT, and Laura Bray-Prescott, PT/LATC, answered the students’ questions and demonstrated some of the devices used in physical therapy at Shelbourne Knee Center.
“How physical therapists treat patients changes all of the time. We want students to be well equipped to be able to treat knee problems,” says Bray-Prescott.
The Importance of Knee Extension
The three presentations included:
- Thirty-five Years of ACL Reconstruction
- Nonoperative Treatment of Knee Osteoarthritis and Rehabilitation After Total Knee Arthroplasty
- Mechanism of Non-Contact ACL Injury.
A key theme of the first two presentations was the importance of full knee extension in returning to normal activities and optimal surgical outcomes.
Dr. Shelbourne learned this by studying his patients for more than 35 years. The Shelbourne knee Center research program tracks patient outcomes and studies factors related to those outcomes. Data cover more than 13,000 patients. Physical therapists like Bray-Prescott and Claussen actively participate in research, including by conducting their own studies.
The first presentation highlighted Shelbourne Knee Center’s research-based ACL reconstruction process, designed to enable patients to achieve and maintain normal range of motion (ROM), starting with knee extension. Key components of the process are:
- Delaying ACL surgery to obtain full ROM, gain leg control and eliminate swelling
- Pre-operative rehabilitation
- Use of a contralateral patellar tendon graft for ACL reconstruction
- An accelerated ACL rehab protocol that prevents post-op swelling and starts full extension exercises the day of surgery.
Physical Therapy Improves ROM
The students also learned that ROM can be improved in stiff knees, despite the presence of osteoarthritis (OA), and that as ROM improves, symptoms decrease and function improves. The Knee Rehabilitation Program for OA at Shelbourne Knee Center focuses on improving ROM, primarily knee extension.
Results for 451 patients who participated in Shelbourne Knee Center’s OA Rehab Study show that:
- Most patients improved with non-operative treatment
- Only 24.4% went on to have a total knee arthroplasty (TKLA)(1).
For patients who went on to have TKA, the pre-op improvements made through rehab facilitated a better surgical outcome and a faster, easier recovery.
“Physical therapists need to educate orthopedic surgeons about how they can help OA patients before TKA,” says Bray-Prescott.
Extension Devices for Knee Problems
A knee extension device, such as the IdealKnee or the Elite Seat, is very useful in patients with knee OA, and in regaining ROM before and after surgery. “Few physical therapy facilities have these devices and the students hadn’t seen them before,” says Bray-Prescott. She and Claussen demonstrated the use of these devices.
The Business Side of Physical Therapy
Bray-Prescott and Claussen also provided guidance about building a referral base among physicians and obtaining insurance coverage for necessary services. They highlighted the need to establish relationships with and educate orthopedic surgeons about how physical therapy can help their patients. Recommendations for doing this included attending conferences with orthopedic surgeons and using the pharmaceutical rep model of scheduling brief meetings with referring physicians.
The Shelbourne Knee Center team also advocated for conducting research as a way to prove the value of physical therapy services to orthopedic surgeons and payers. “Collecting data and doing research will help new physical therapists provide evidence-based care and get the coverage they want for their patients,” says Bray-Prescott.
For more information about knee care at Shelbourne Knee Center, call 888-FIX-KNEE.
References
- Shelbourne DK. Nonoperative Treatment of Knee Osteoarthritis, presentation at Andrews University, February 2019.