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BoneSmart philosophy for sensible post op therapy

Discussion in 'Exercises, therapy, walking aids' started by Josephine, Jul 4, 2017.

  1. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator
    Thread Starter

    Member Since:
    Jun 8, 2007
    The North
    United Kingdom United Kingdom
    You will have noticed there is a significant opinion here about the hazards of PT. You may feel that your therapists are experts and know what you should be doing. However, over the last several years I've been here, I have observed that the more intensive the regimen of exercising, the more problems people get.

    These issues can include
    1. excessive pain
    2. excessive swelling and stiffness
    3. inability to obtain good pain management
    4. poor ROM
    5. a slow and worrying progress in recovery
    6. general malaise and depression because of prolonged pain and poor progress​

    A point to note is that it's not the exercising that gets you your ROM, it's time. Time to recover, time for swelling and pain to settle and time to heal. One thing that seems to be missing from all the PT's protocols is that all your ROM is there right from the start, just waiting for all that to happen so it can show itself. In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Exercise as in strength training is counter-productive and does more harm than good. Normal activity is the key to success.

    After questioning numerous members, I have observed that certain exercises are more of a hazard than a benefit and have therefore taken to advising members to assert their right of consent and decline to do these.

    The worst exercises include these though there are others, in fact, any that cause you undue pain and cause swelling can be included

    1. 'assisted' heel slides, often done to the point of extreme pain with stories of patients being given pillows to bite on and to muffle their screams! It will inevitably cause excessive pain and swelling
    heel slide with pull.jpg

    2. force bending the knee by the therapist - also causes excessive pain and swelling
    pt pushing knee.jpg

    3. squats and lunges - except narrow squats but even then, not to excess! Can cause generalised tendinitis particularly in quads, glutes and hamstrings

    4. steps - up and down on a block - a low number are okay but some have been known to do 30 or more at a time! Can cause generalised tendinitis particularly in quads, glutes and hamstrings

    5. high marching. Can cause generalised tendinitis particularly in quads, glutes and hamstrings
    high marching 1.JPG

    6. bridges - can cause generalised tendinitis particularly in quads, glutes and hamstrings

    7. clamshells - especially hard on the IT band

    8. abduction/adduction exercises - also hard on the IT band (abduction) and psoas tendon (adduction)

    9. extension stuff


    All these forms of 'exercise' are invariably painful and result in an increase in pain, swelling and stiffness.

    There are also another types of exercise which are to be avoided - the use of weights and bands like this

    abduction 1.jpg abduction 3.jpg

    adductor exercises.jpg

    bending knee with starp prone.jpg weights 1.JPG

    TheraBand 3.jpg

    therabands 1.JPG

    Gym machines are designed for healthy people to achieve improvements in health, strength, stamina and balance. They are NOT supposed to be used during recovery in the first 3 months for a THR or 6 months for a TKR. They place far too much demand on the surgical area and can cause areas of inflammation and loss of ROM, especially with the TKR.

    LEG CURL for strengthen hamstrings - should NOT be used to increase ROM
    leg curl.JPG

    LEG LIFT OR EXTENSION for strengthening quads - should NOT be used to increase ROM
    leg lift.JPG

    LEG PRESS for strength training of all leg muscles - should NOT be used to increase ROM
    leg press.JPG

    TOTAL GYM MACHINE allows the user to do a number of manoeuvres but shouldn't be used post-surgery
    total gym machine.JPG

    This is an ill-advised machine to use this after a TKR as it can require the use of torsional manoeuvres which could result in loosening of the tibial component.

    another multi-exercise tool which should NOT be used post-surgery
    wobble board.JPG

    A member left us this valuable bit of info on Dec 17, 2016 - The Mayo Clinic no less!


    This philosophy is based upon simple common sense.

    - dispelling the dangerous 'no pain, no gain' notion which was promoted in the 80s when keep fit videos were all the rage, fronted by various celebrities who were clearly not experts! Even in the fit and healthy it was soon roundly trounced by a variety of orthopaedic surgeons who went public at the time after being swamped with patients suffering all manner of muscle strains and tears. But the myth persists.

    - dispelling the 'window of opportunity' which many members have given the lie to after reporting increases in ROM after 12 months or more.

    - ignoring the simple and obvious concept that injured limbs need rest and care, not punishing exercise!

    So far, all those who have tried this have reported a significant reduction in pain, improvement in ROM and general mental and physical state.

    The 'BoneSmart way' works!

    In addition, there have been numerous members who have done no exercises at all and yet obtained excellent results! I am one of them.

    You might also gain some insight into what initially caused me to come to these conclusions by reading this PT: the seriously grave consequences of doing too much of it
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  2. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator
    Thread Starter

    Member Since:
    Jun 8, 2007
    The North
    United Kingdom United Kingdom
    Defining consent
    For consent to be valid, it must be voluntary and informed, and the person consenting must have the capacity to make the decision. These terms are explained below:
    • Voluntary – the decision to either consent or not to consent to treatment must be made by the person themselves, and must not be influenced by pressure from medical staff, friends or family.
    • Informed – the person must be given all of the information in terms of what the treatment involves, including the benefits and risks, whether there are reasonable alternative treatments and what might happen if treatment doesn't go ahead.
    • Capacity – the person must be capable of giving consent, which means they understand the information given to them, and they can use it to make an informed decision.

    If an adult has the capacity to make a voluntary and informed decision to consent to or refuse a particular treatment, their decision must be respected.

    Someone could also give non-verbal consent, as long as they understand the treatment or examination about to take place – for example, holding out an arm for a blood test.

    Consent should be given to the healthcare professional directly responsible for the person's current treatment, such as:
    • a nurse or phlebotomist arranging a blood test
    • a GP prescribing new medication
    • a surgeon planning an operation or other treatment
    • a physiotherapist about to commence therapy
    • any other medical technician such as a radiographer, physiotherapist/physical therapist, occupational therapist, etc.
    If someone is going to have a major medical procedure or treatment, their consent should ideally be secured well in advance, so they have plenty of time to obtain information about the procedure and ask questions.

    If they change their mind at any point before (or during the procedure where appropriate), the person is entitled to withdraw their previous consent.

    Some findings by the General Medical Council1, NHS Choices1, the British Journal of Medical Practitioners2, NCBI article3
    1. A competent patient has the right to refuse treatment and their refusal must be respected, even if it will result in their death. If they change their mind at any point before the procedure (or during where appropriate) the person is fully entitled to withdraw their previous consent.

    2. A patient’s consent to a particular treatment may not be valid if it is given under pressure or duress exerted by another person.

    3. Patient has got the right of self-determination. Obtaining consent is not only an ethical obligation, but also a legal compulsion. No doctor can sit in comfort with the belief that the “consent” can certainly avoid legal liability. This is highlighted by the note of The California Supreme Court

    This means that if a patient withdraws consent and compliance with a schedule of physio or physical therapy, they must be free to do so without any argument or pressure to change their mind. If a patient chooses to refuse a certain part of therapy, such as having their knee forcibly bent after a TKR, then this too must be respected.

    Refusal of consent
    NCBI1, BMA2,
    1. There is also a legal angle to this concept. No one has the right to even touch, let alone treat another person. Any such act, done without permission, is classified as “battery”or physical assault and is punishable by law.

    2. "A doctor who operates without the consent of his patient is guilty of the civil wrong of trespass to the person; he is also guilty of the criminal offence of assault." This also applies to nurses, therapists and technicians of all types and where consent has verbally been withdrawn at the time.

    You have a right to decline therapy or parts of therapy that are painful and/or distressing to you.
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