The term arthritis, or more specifically Osteoarthritis (OA), refers to degeneration of the articular cartilage of the knee. While OA is most commonly associated with knee pain in 40-60 year olds, it is not something specific to old age. In fact, most people—regardless of their age—have some form of OA, but it’s the severity that usually determines the onset of pain.
What causes arthritis in the knee?
Photo Credit: AAOS OrthoInfoMost of the body is comprised of cartilaginous tissue, and having arthritis means that that cartilage is breaking down. When you have OA, the “hyaline cartilage” at the end of the long bones in your leg (Tibia and Femur) is breaking down. Healthy hyaline cartilage provides cushion to long bones and provides a smooth surface for movement to occur; in appearance, this tissue is very white and smooth. In contrast, degenerative hyaline cartilage appears red and irritated.The breakdown of this articular cartilage leads to excessive wear and tear on the joint, causing inflammation, which ultimately results in pain.
OA can also form through injury to the intra-articular (joint) surface of the knee. Injury to the (tibiofemoral) joint can lead to bleeding within the joint, which leads to further degeneration of the knee.
How can I avoid arthritis in the knee?
While many people may think arthritis is just a part of growing old, there are steps you can take to help minimize the risk of arthritis effecting your knee or your quality of life.
Improve strength in your core, not just your legs
Since humans walk upright, our pelvic and core stability can determine the effectiveness of those knee stabilizing muscles. Hip strengthening exercises can improve the stability of the legs and decrease abnormal stress to the knee joint.
Activity modification
If you knee is painful and inflamed, switch to lower impact activities. For example, if running is irritating your knee, go for a swim or bike ride instead; these two activities still allow for good cardiovascular training but decreases stress to the knee.
Strengthen your legs
The body adapts to the daily stress we place upon it. While we can often tolerate our day-to-day routine without over-stressing our knee, we are all one-weekend-trip-at-Disneyland away from causing damage to the knee joint. As simple as it sounds, strengthening the muscle surrounding the knee can help to reduce the risk for arthritis. The goal of strengthening is to place the load into the muscle, which takes the stress away from the knee joint.
Four ways to improve arthritis-related pain and function
While unfortunately this condition is degenerative and non-reversible, those who are diagnosed with OA can still address limitations to improve knee function and manage pain. Four ways to improve function with OA-related related pain include:
BY LYNDSAY DEFILIPPO, DPT, RAUSCH PHYSICAL THERAPY
If you have ever undergone physical therapy, chances are that at one time or another you have received a home exercise program (HEP) from your therapist. As a physical therapist, I do my best to stress to my patients how crucial HEPs are to their recovery, but despite my best efforts I’ve found that only a small percentage of patients ever complete their program. And I get it! The whole reason you schedule a PT appointment is so you can focus on your recovery for a solid hour because outside those clinic doors you have a busy life and schedule. Sure you’ll plan to do your HEP after work, or after you put the kids to sleep, or before bed, or you’ll wake up early tomorrow… but slowly it disappears off the “to-do” list. Unfortunately when that happens, your recovery ebbs and flows instead of you making continued progress.
So, stop sabotaging your recovery! Completing your HEP will aid in a quicker, more successful long-term recovery. Once you’ve decided to commit yourself to your health, wellness and recovery, it’s actually very easy to incorporate a program into your daily routine, even with the busiest of schedules and with little to no equipment.
I’ve made a list of the four most common HEP-related complaints I hear on a daily basis, as well as some accompanying tips and tricks on how to stay compliant with your HEP simply by getting creative and making the choice to commit to YOU!
Complaint 1: I don’t have time to perform the program every day.
Solution: Incorporate portions of your program throughout your day.
If you don’t have time to complete all your exercises in one sitting, try spreading them throughout the day instead. Practice your single leg balance, heel raises, toe yoga, arch lifts, etc. while brushing your teeth. While you’re waiting in line for your morning coffee, stuck in traffic, or taking a break from the computer, do your chin tucks, neck stretches, or shoulder squeezes. If you’re a student and are unable to participate in the demands of gym class or sports because of your injury, perform your home program during practice/class time. Finding those little spaces in your day to sneak in an exercise or two will ensure you are keeping up with your program—without jeopardizing your free time.
Complaint 2: There are just so many exercises…
Solution: Ask your PT to prioritize your exercise list.
As you get better and are able to do more, your HEP also progresses and consequently might seem more lengthy than it was in the first few sessions. I find that a huge list of exercises often gives patients anxiety, which is one of the reasons I tend to start my patients off with two to three exercises, then build accordingly. Although the basic fundamentals are always important as they are your building blocks, you can discuss with your therapist the most important exercises for you to complete at your current status and break them up throughout the day.
Complaint 3: How am I supposed to perform the exercises if I don’t have the equipment!?
Solution: Not all exercises require the exact equipment we have at the clinic—get creative!
By substituting in household items, you can still target certain muscle groups and movements and ensure you continue making progress without any clinical equipment. For example:
Clinic Equipment
Household Substitute
STRETCH OUT STRAP
Yoga strap, dog leash, belt from a bathrobe, regular belt, or long beach towel
1 LB. WEIGHT
Full water bottle or soup can
CABLE COLUMN
Resistance bands strapped over a door
FOAM MAT
Bath towel folded multiple times or a pillow on a carpeted or secure surface
(Avoid placing on slick surfaces to decrease your chances of slipping!)
CUFF WEIGHT
Insert a soup can or other weighted object in a purse or small bag; hang off your ankle for leg lifts, knee extensions, etc.
SLIDERS
Washcloth or towel on a hardwood floor
CALF SLANT BOARD
Using a yoga strap/leash/belt/towel, perform the calf stretches in sitting position
**IMPORTANT** As with all exercise safety, please ask your therapist if you can substitute equipment, as this blog is only a recommendation and does not apply to all medical cases.
Complaint 4: I’m going on a work trip/vacation, so I won’t be able to do my HEP
Solution: Home exercise programs are designed to be done anywhere.
Most clinics will give you a print out of your home exercise program sheet, or in our clinic’s case, make it accessible online at homeprograms.net. This means that your HEP is accessible anywhere.The substitutions above are also great ways to stick to your program while you’re traveling, as most hotels offer water bottles, bathrobes with belts, towels, etc.
With summer coming up, incorporate and utilize your environment.
If your family lives in the pool all summer… Ask your PT if you would benefit from a water program.
Heading on a tropical vacation? Sand acts as an unstable/uneven surface to promote balance and proprioceptive training.
If your trip requires a long flight… It’s always good to incorporate a program to avoid prolonged sitting and potential for blood clots, such as frequent walking breaks, ankle pumps, heel raises, marching in place, etc.
BONUS QUESTION! BUT, if I were to purchase items, which do you recommend most?
Depending on the injury you are recovering from and the outlined program that your PT has developed for you, a few must have items I would recommend for continued health include:
Foam roller
Lacrosse ball
Stretch out strap
Portable resistance-style bands
At the end of the day, your PT cares about your recovery and s/he would not personally create your individualized home program if s/he didn’t think it would be beneficial. It’s important to also invest in your health and take all aspects of recovery seriously. Like all things, once you make the changes and incorporate your exercises into daily life, it will become routine and therefore easier to adhere to on a daily basis. You will also reap the rewards, and return to the things you love most that have inevitably been altered since your injury.
Lyndsay DeFilippo PT, DPT, CKTP received her Doctorate of Physical Therapy from New York University in 2010. She’s a Graston Practitioner and a Certified Kinesiotaping Practitioner. Lyndsay looks at each injury as a constantly changing puzzle, which is only solved when her patient returns to what s/he loves doing. She enjoys helping with the full recovery process, which includes providing the education, tools and fundamentals to prevent re-injury and the potential for new injuries.
After falling from 14 feet in the air, Todd Clarke was quite lucky to be alive. It was the following series of happenstance that led Todd to his perfect physical therapist, and with that a renewed appreciation for his body and its wellness.
On December 3, 2015, Todd Clarke was hanging Christmas lights on the roof of his Laguna Niguel home when an ill-fated step sent him plummeting to the ground. Luckily Todd survived, however he did suffer a concussion, tears in his shoulder, and about 30 bone fractures in both wrists and thumbs, face, skull and spine. After surgery and an eight-day stay in the hospital, Todd, a husband and father of two, was just grateful to be home in time for Christmas. Still, the accident left him unable to drive or go back to work as a teacher and multi-sport coach, and all together Todd was on disability for five months.
At about six weeks after his accident, Todd started physical therapy out of his orthopedic doctor’s office, focusing on treatment to restore function in his hands and shoulder so he could begin to take care of himself again. However, as time went on the nature of Todd’s true injuries became more apparent and unpredictable, and his focus shifted from his obvious hand and wrist injuries to the pain and stiffness in his neck and back. He also began experiencing vertigo, as the concussion he suffered caused lingering issues in the form of BPPV. Todd says that the “ever-changing landscape” of his injuries required a change in PTs, since his previous PT didn’t have a neck or back specialist on staff.
So, as soon as his hand and wrist function improved, Todd hopped on his computer to research local physical therapy clinics, which is when he stumbled upon Rausch Physical Therapy & Sports Performance. With seven physical therapists on staff, Todd had a 14% chance of being matched with Ashley Heller, MPT, but Todd says he’s glad he wound up on her table by happenstance.
It was seemingly an innate connection that led the two down a path of discovery littered with fun coincidences: Ashley had attended sixth grade at the same school where Todd was a fifth grade teacher; both attended UCSD and have a passion for surfing; they even share the same birthday!
“If Ashley was not friendly and thoughtful, we would have never had the conversations that led us to discover these wonderful connections,” Todd said.
Fueled by their fateful bond, these two kindred spirits have been hard at work to get Todd back to 100%, although with the multitude of his injuries Todd says this will likely take at least a year to fully recover. However, Todd has made great progress in just a short time; in the two months since starting treatment with Ashley, Todd says he hasn’t had any dizziness or balance issues from BPPV, which has allowed him to do what he loves most: spending time with his wife and two children. Todd is also back to doing most of the activities he enjoys, such as golfing, surfing, hiking, playing guitar and volleyball—and yes—even doing a few handy projects around the house.
“The best part [of PT at Rausch Physical Therapy] has been seeing positive results in my body and awakening the desire to be physically fit again,” he said. “Ironically, I am more active and feel healthier than I have in 10 years.”
In the end, Todd is lucky he survived his fall, it was chance he was matched up with his PT Ashley, and we’re very fortunate to have him as a client and to be a part of his recovery written in the stars.
“Heaven forbid it, but if I ever need PT again, Rausch PT will be the first place I go and I’ll look forward to going… as strange as that sounds.”
Hi, I’m Jessica, and I’m a doctor of physical therapy.
Rausch PT physical therapist Jessica Snyder receiving her doctorate in physical therapy in 2012.
As a licensed DPT, I treat many high school-aged patients (or their parents) who will often ask me what it takes to become a physical therapist. Since June is graduation month and there are thousands of high school students out there wrapping up one chapter of their life and looking to the next, let’s talk career planning and professional education for the field of physical therapy.
The Path to Becoming a Physical Therapist
Before you can even start down this career path, you must first complete your undergraduate education. After that, you’re on to… yep, more school! “PT school” is a graduate-level program that typically takes three years to complete. However, just like any other graduate program, getting in to PT school is a tough process. So, set yourself up for success and research the requirements for different PT schools while you’re still an undergrad.
Generally, all PT schools will require:
Bachelor’s Degree
Prerequisite Courses
Again, PT school is a graduate level, doctorate degree, so upon graduation, your formal title is “Doctor of Physical Therapy.” It is not a PhD.
Picking the Right Major for Your Future
The undergrad years are essentially “prep time” for anyone who is PT school-bound (or Physician’s Assistant school or Med school, for that matter.) You’ll spend your first few years completing your general education courses, and then you’ll move on to any and all courses required for your declared major.
As far as PT school is concerned, certain undergraduate degrees will transfer better than others into a graduate-level physical therapy program. For instance, most of the required PT school courses are already built in to an Applied Health, Kinesiology or Athletic Training/Sports Medicine major. So, of those three, which should you pick?
Applied Health
Essentially, pre-med. Applied Health is a great major if you think you may be interested in becoming a nurse (can be a undergrad/grad combo), occupational therapist (Master’s Degree), physician assistant (Master’s Degree), or some other healthcare profession (e.g. pharmacology, radiology, etc.) Pro: you have so many options and opportunities for grad school! BUT, you do have to go on to grad school. Applied Health is pre-med—something else has to follow 🙂
Kinesiology
Kinesio is a bit more targeted in your professional career options, but the coursework is not as demanding as Applied Health (there’s less emphasis on the “hard sciences.”) This would be a good option if you think you may want to go into biotech, product development or prosthetic device/adaptive equipment design. You could also go into teaching at the high school-level, however this would require that you complete a credentialing program (another two years of schooling after undergrad.)
Athletic Training
The biggest advantage to completing an Athletic Training Education Program (ATEP) is the amount of on-field, clinical experience you get as a student. You are hands-on with athletes and patients from the start, learning valuable evaluation, assessment and treatment skills , plus you get to spend less time in the lab and more time on the field! Pros: When you graduate, you can start working (and getting paid!) right away; you can work with sports teams at the high school, college, or professional level, or you can work in a PT clinic, hospital, or sports performance facility. Many ATEP graduates take the national board exam to become certified athletic trainers, which is something I highly recommend as it makes you more desirable both as an employee and as a PT school applicant.
The overarching “pro” of all of these majors is that you know that the majority of PT school prerequisites are already built into your undergraduate degree. Just remember that there may be a few classes that you will need to take as electives.
Planning for Prerequisite Courses
Every PT school has its own prerequisite coursework listed as a part of their application criteria, so check those lists and make sure you take all the necessary classes to avoid having to take those classes after you graduate (i.e. at a local junior college) before being able to apply to grad school. The Physical Therapy Centralized Application Service (PTCAS) website is a good tool for researching the general classes required by the majority of PT Schools (e.g. Anatomy, Physiology, one year of Chemistry, one year of Physics, certain psychology classes, etc.) so get organized early to ensure you at least take these classes. However, don’t forget to also check the program websites for your PT School(s) of choice to see if they might require some additional coursework. For instance, some schools require Trigonometry, while others are satisfied with College Algebra, so make sure you check!
Actions Speak Louder than Transcripts
While signing up for the right class or major can boost your chances of making it into PT School, your attitude and actions will inevitably decide whether you get that doctorate degree or not. As someone who’s been down this path before, here are my last bits of personal advice for realizing your dream of becoming a licensed doctor of physical therapy.
Go the extra mile. PT school (well, graduate school in general) is getting more and more competitive! Take every opportunity to participate in research, internships, and volunteer opportunities to make yourself a more desirable candidate.
Be memorable and recommendable. You will need letters of recommendation from your professors and employers when applying to PT school, so earn them! Work hard, network, and stand out (in a good way.)
Act with your future in mind.In any healthcare field you must qualify for licensure, and all accrediting/licensing bodies—federal and state—will perform thorough background checks. Drug and alcohol use/violations, such as DUIs, are not taken lightly and can delay or even prevent you from receiving your license. Have fun in college, be “well-rounded,” but DON’T be stupid.
Think before you post. In our current time of social media, it’s good to remember that what happens on the internet, stays on the internet (Yes, even Snap Chat!) Trust me, I didn’t just make this up, I have friends in high tech places who will tell you that everything on the internet lives forever. Is it your dream to be a licensed doctor of physical therapy? Then keep that in mind when posting on social media.
Jessica Snyder (PT, DPT, ATC, CSCS) received her Doctor of Physical Therapy degree at the University of St Augustine for Health Sciences – with an emphasis on orthopedics, movement science, and manual therapy. Jessica started her career as a Certified Athletic Trainer working with high school, college and professional athletes. She is also a Certified Strength and Conditioning Specialist (enhancing her ability to build custom strength, stability and performance-centered rehabilitation and return-to-sport programs) and Certified Natural Running Coach. Being a runner herself, Jessica specializes in running-related injuries, including the entire lower extremity. She is also passionate about treating headaches and neck/shoulder pain.
