Greetings! I hope you are all well! I can't believe we are now in the middle of November! Time flies by faster and faster!!   

I have had a number of patients who had total joint replacements return to our office eight to twelve months post-surgery. They are in pain and are second guessing their decision to have had the surgery months ago. The patient had left physical therapy feeling great and returned to their normal lifestyle. Unfortunately, their pain came back, and they are calling, concerned about what to do.

Each patient is scared and wondering if they will need another surgery or, even worse, as I mentioned before, they are wondering if they might have made a mistake in getting the replacement in the first place. I think part of the problem is our inability to fully understand and have our patients fully understand what their responsibility is, following surgery. For whatever reason, there is a misconception of the responsibilities and possibilities that may and can occur regarding total knee and hip joints replacements.

As we age past 30, we all lose muscle mass at a rate of 1% per year. When we have the opportunity to live to 65 and beyond, this muscle loss accelerates to 1.5% per year. Therefore, unless we develop a habit of exercising in some way, most of us will get weaker in time. Adding any knee or hip surgery accelerates your osteoarthritis progression and muscle weakness. It is one of the major reasons we all need to go to physical therapy to regain our strength and stability following these surgeries. After regaining your strength, you start enjoying your life, and all is well. However, often, patients stop exercising and at around the eight-to-twelve-month period, many patients begin having pain again, and their knees may feel weak to a point of giving out when they climb stairs or even walk!

The main reason for this occurs because the patient slowly forgets the importance of their exercises and stops them all together. As a result, they slowly, without notice, become weaker and their pain returns. They begin to get frustrated and worried. "Maybe I didn't need my knee or hip repaired? Why do I have the same pain?" They find themselves discouraged, sad and a bit depressed.

We have seen three patients in the last few weeks with these issues. After getting each one of these patients back to proper exercise and strengthening of their hips and knees, their pain disappeared entirely. 

As I mentioned, this problem is not unusual. Please remember, if your knee or hip pain from a total joint replacement surgery begins to return, there may be a solution worth pursuing! Most of the time, it is a result of strength loss when you stopped performing your necessary exercises or did so inconsistently or improperly. Most of the time, when we examine the strength, following these situations, the patient has lost 50-70% of their leg strength over time.

Have no fear if this happens! There is a solution! This does happen and people get better! All you need to do is call your physician or our office to get back into physical therapy for an evaluation and treatment plan to help you regain your strength. By doing this, you will improve your strength, decrease your pain, and get back to the life you had always enjoyed living!

Enjoy the journey,

Fran McDonald President/CEO

Chronic Pain in Children and Physical Therapy:

What You Should Know

Chronic pain is pain that lasts for more than three months. For children, chronic pain can affect their ability to be active, leading to weakness and poor endurance. Chronic pain in childhood can impact participation in many aspects of life, including social relationships with peers. It can interfere with a child’s ability to actively engage in play activities, sports, school, or other social activities, all of which are important to a child's growth and development.

Causes

The most common types of pediatric chronic pain include:

• Abdominal pain.
• Headaches.
• Musculoskeletal pain.
• Widespread pain.
• Back pain.

The most common pediatric chronic pain syndromes include:

• Amplified musculoskeletal pain syndrome.
• Complex regional pain syndrome.
• Overuse syndromes.

Chronic pain is also commonly associated with the following conditions:

• Sickle cell disease.
• Juvenile idiopathic arthritis.
• Skeletal defects.
• Cancer.
• Neuromuscular disorders.

How Physical Therapy Can Help

Physical therapists play a vital role in the treatment of pediatric chronic pain conditions. A physical therapist will work with you and your child to create a treatment plan specific to your condition, needs, and goals. Interventions may include manual therapy, therapeutic exercise, functional retraining, and pain education. Goals are individualized for each child’s life and activities and may include:

• Return to prior activities.
• Increase independence.
• Decrease pain.
• Increase participation in everyday activities.
• Increase energy levels during daily activities.
• Increase muscle strength.
• Improve the ability to move.
• Improve posture.
• Improve quality of life.
• Improve sleep patterns.
• Increase child and family knowledge of chronic pain.
• Renew self-esteem and build confidence.
• Reduce the use of assistive devices.

 **choosept.com

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