Hello to all our friends,

In January, at our McDonald Physical Therapy’s monthly meeting, I told the staff that it is time to get back on track after all everyone’s been through with the Covid era! I emphasized that we, as a medical provider, need to work harder than ever to be fully staffed and get our patients in as quickly as possible.

I realize we are all sick and tired of the COVID excuse for waiting for physician appointments and orthopedic and/or specialist surgical procedures. Patients we see are waiting more than ever to get their MRIs, CT scans, surgeries and even physical therapy appointments. Everything, since COVID, seems to take longer and longer. Patients are waiting at home in pain or worrying about their particular injury. Their situation is made worse by not having the diagnosis or reason for their pain.

Each patient needs to step up, (and I realize this is difficult and time consuming) and push their medical providers to be clear about the diagnosis, types of tests needed, timeliness of the tests and their return to whatever provider they need to see. This is so important, because your overall health and in some cases, even your life, can be in jeopardy! If you think I am exaggerating, please feel free to continue reading about 2 patients we have seen in the last few months and what they have been experiencing. These stories are about what they been going through because of the present medical model, following COVID. Losing so many medical providers and the immense power of the insurance companies has affected patient care immensely.

These two patient cases are a result of lack of communication in the medical providers’ offices and/or hospital systems. The first is the most difficult to believe and most painful to be a part of. I have changed a little of the story to protect the patients’ privacy. A very young 70-year-old who cycles, fell 5 months ago and hurt his neck. He went to the emergency room; X-rays were taken; He seemed to be doing well and was sent home. Within a few days, he began noticing some weakness in his legs and arms. It took a couple of weeks to get in to see his physician, who then decided he needed an MRI. The insurance approval process took 4 weeks before he could get the MRI. He continued to get weaker. After the MRI results, which looked very troublesome, he was referred to a neurosurgeon. This took another 3 weeks. By the time he saw the neurosurgeon, he was walking on a walker. After seeing the MRI and examining this patient, the neurosurgeon informed the patient that he needed surgery immediately because his symptoms would only get worse. The surgeon did think he would be seeing this patient soon for surgery. Unfortunately, the staff who had to schedule this patient had no idea of the urgency of this case, and set up his surgery for 3 months from that day!

Long story short, his relative shared his story with one of our physical therapists who knows the surgeon and thought it might be a miscommunication, based on so many patient miscommunication stories since COVID. The physical therapist called the surgeon and informed him of this possible mistake. The surgeon understood why the patient went along with the scheduled surgery date because he thought the surgeon, after seeing his MRI was good with him waiting. Here is the big mistake with patients and all medical providers, (including us). If you think your injury needs to be taken care of sooner than later, please get in touch with your physician or demand the business manager!

After hearing this information, the surgeon scheduled this patient immediately. As a result of our physical therapist’s call, this patient will be getting his surgery quickly. Why was that so important? By the time our physical therapist called the surgeon, this patient was in a wheelchair and had already lost some of his bowel and bladder control. This is why the surgeon wanted this patient in so quickly! He knew the injury was much more severe than anyone else, including his schedulers, realized!

A less serious, but extremely painful case which also was a result of miscommunication issues, had to do with a patient who had a lumbar fusion by a very reputable surgeon. This patient had her surgery in a big city. After 6 weeks of waiting for her physician to give her the OK to come to physical therapy, she came to us in more pain than we usually see following this surgery. At six weeks she still was unable to sleep, sit or walk without excruciating pain? In this case, the patient did call to let her surgeon know. Unfortunately, she did not get to speak with her surgeon and was told her pain was normal and in time, all would be well.

She continued to have excruciating pain and could barely walk, sit or sleep more than 2 hours a night! Our physical therapist asked this patient to get him the CD of her X-rays following her lumbar fusion. These films were taken to a special group that meets every Friday morning at Notre Dame. When the films were examined at the group a very big fracture in this patient’s sacrum was noticed! This fracture, unfortunately was missed and she now had the reason for why she was having so many issues with walking, sitting and sleeping. With this information, she called her surgeon in the city with this new information. (How this was missed is anyone’s guess, because this surgeon is very good at what he does.) Nevertheless, when he looked further at her case, (he had never received any information that she was having unusual pain from his staff?) he was able to help this patient begin to heal and gain her life back.

These are only two of many patient cases we, at McDonald Physical Therapy, hear about and get involved in with our patients. We are blessed to have direct communication with the physicians and surgeons in our community and in some of the cities. Most medical providers want the best for their patients. When things do not go according to plan, because of scheduling mishaps or unusual results from surgery, the surgeon wants to know! In these cases, the surgeon didn’t know, and this is why I am stressing the importance of following up for yourself or your family member!

I hope these two examples help anyone reading this to step up and become more of their own advocate. It may mean avoiding a major setback and possibly many more months of pain and misery.

Please take the time to take charge of your case or a family member’s when you think someone  

P.S. It’s the Readers’ Choice Award voting season again! Voting ends July 20^th. You can vote daily if you choose to! It means a lot to us to be considered your “preferred provider”, and we are so grateful for your votes! Will you please take a moment and go to the South Bend Tribune website and scroll down to the Reader’s Choice picture? After clicking on that, you can go to the Beauty and Health category and find the Physical Therapy subsection to find McDonald Physical Therapy.

Enjoy the journey!

Fran McDonald President/CEO

Physical Therapy Guide to Meniscal Tear

Physical therapists often can help people manage meniscal tears without surgery. A few treatments by a physical therapist can help determine whether you can avoid surgery. Your physical therapist can help you control pain and swelling in the knee area. They will work with you to restore full strength and mobility to your knee.

Physical therapy treatment for a meniscal tear may include:

1. Manual therapy. Your physical therapist may use manual (hands-on) therapy. This treatment can help to reduce swelling and stiffness and restore muscle function around the knee. Hands-on therapy may include massaging, stretching, or mobilizing the joint.
2. Icing. Your physical therapist will apply ice packs to the knee to help control any pain and swelling. They also may teach you how to apply ice at home, and how often. Swelling is an important "guide" that can indicate your level of ability and recovery. If you experience an increase in swelling, your physical therapist will modify your treatment program or activity level. They will ensure your safest, most effective recovery.
3. Compression. Your physical therapist may recommend using compression bandages, stockings, or pumps. These can help reduce or prevent further swelling. They also may use them as part of your regular treatments and teach you how to use them at home.
4. Neuromuscular electrical stimulation. Your physical therapist may use a treatment called neuromuscular electrical stimulation. NMES uses electrical current to gently stimulate and contract the muscles around your knee. This can help improve muscle strength.
5. Assistive devices. You may need to use crutches, a cane, or a walker in the short term. Your physical therapist will recommend which walking aide is best for you. They also can teach you how to use it to reduce strain on your knee.
6. Strengthening exercises. Your physical therapist will design exercises to help you build and keep your strength during recovery. Building strength will help restore full movement to your knee. They also will provide you with a home exercise program specific to your condition. Strengthening the muscles around the knee and throughout the leg helps ease pressure on the healing knee tissue.
7. Fitness counseling. As you recover, your physical therapist will advise you on ways to improve and maintain your fitness. They will recommend activities that are safe for you to do. They also will help you decide when you are ready to return to full activity.

How Can a Physical Therapist Help Before and After Surgery?

People with more serious meniscal tears, or those who don’t respond to physical therapy, may need surgery. Surgery to remove the torn cartilage (a procedure called a meniscectomy) is usually a simple procedure. It requires physical therapy treatment after surgery to help you restore function and recover. After surgery, and about four months of physical therapy treatment, many people are able to return to their previous activity levels, including sports. However, each person is different. Your physical therapist will design the safest, most effective treatment plan to meet your specific needs and goals.

Meniscus removal. After a simple removal of the torn part of your meniscus, your physical therapy treatment plan will be similar to that for nonsurgical meniscal injuries. Your physical therapist may use ice and compression to control pain and swelling. They will show you how to use these treatments at home. The main focus of your treatment will be on helping you get back your strength and movement. Your treatment plan will include a series of exercises done in the clinic and at home. Your physical therapist also may use hands-on treatment (manual therapy). At first, you likely will need to use crutches or a cane to walk. Your physical therapist will help guide you toward gradually placing weight on your knee to stand or walk. This progression will allow the remaining meniscus and other tissue in the knee joint to adjust to increased pressure.

Meniscus repair. Sometimes your surgeon will be able to repair instead of remove a torn meniscus. Research shows that if a repair is possible, it can reduce the risk of arthritis developing later in life. Physical therapy after a meniscal repair is slower and more extensive than with meniscal removal. This is because the repaired tissue must be protected while it is healing. The type of surgery, the extent of your injury, and your surgeon’s recommendations will determine how quickly you can:

• Put weight on your leg.
• Stop using crutches.
• Return to your previous activities.

After a meniscal repair surgery, your physical therapist will:

• Help you control pain and swelling.
• Guide you through progressive reloading of weight to the knee (i.e., standing and walking). This will allow the cartilage to slowly adjust to increased stress and pressure.
• Help restore your knee and leg range of motion.
• Teach you exercises to help restore your muscle strength.

Return to activity. Whether your torn meniscus recovered on its own or required surgery, your physical therapist will play an important role in helping you return to your previous activities. They will help you learn to walk without favoring the leg and perform activities like going up and down stairs with ease.

Return to work. If you have a physically demanding job or lifestyle, your physical therapist can help you return to these activities. They will help teach you how to properly perform repeated movements in order to put less stress on your knee.

Return to sport. If you are an athlete, you may need a more lengthy course of physical therapy to return to your prior level of activity or competition. Your physical therapist will help you maximize your return to sport and prevent reinjury by working with you to fully restore your:

• Strength.
• Endurance.
• Flexibility.
• Coordination.

Return to sport varies greatly from person to person. It depends on the:

• Extent of your injury.
• Specific surgical procedure.
• Surgeon’s recommendations.
• Type of sport in which you take part.



Your physical therapist will consider these factors when designing and adjusting your treatment program. They also will work closely with your surgeon to determine when it is safe for you to return to sports and other activities.

* from choosept.com

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