Soft tissue treatment and neurological stimulation to increase range of motion after total knee replacement surgery
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1
Georgia Chiropractic Neurology Center, United States
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2
Life University, United States
Background:
A 56 year old male presented to a chiropractic neurology center for a complaint of decreased left knee flexion after a history of multiple knee surgeries, the most recent being a complete left knee replacement six years ago, as well as pain in the left knee that was rated as a 10/10. The patient stated that after the last surgery the knee became fixed in extension. It was at this time that the surgeon discontinued physical therapy for fear of fracturing the patella with forced knee flexion, and the patient was told that he would never regain proper function of his knee. Physical examination revealed full knee extension, 30 degrees of knee flexion and no internal or external rotation in the left knee, ranges of motion of the right knee were within normal limits. Neurological examination revealed a mild sensory loss of pain and temperature on the lateral aspect of the left knee, as well as deep tendon reflexes rated at a 1+ in the upper and lower extremity. Upon palpation adhesions were found in the left medial and lateral hamstring, medial and lateral gastrocnemius, in all tissues surrounding the peripatellar area, as well as the posterior knee and into the left foot. Evaluation using Nexus 10 dynamic surface electromyography (SEMG) biofeedback unit was performed and showed a hypertonicity of the hamstring, quadriceps and the gastrocnemius while at rest.
Methods:
Twenty-five treatments occurred over an 18 week time span and included soft tissue therapy to release fascial adhesions. As range of motion returned treatments in a standing and squatting position were added, utilizing an arthrostim spinal manipulative therapy (SMT) instrument to fast stretch the musculature of the left gastrocnemius as well as the left hamstring.
Results:
Sixteen weeks into treatment, re-evaluation of muscle tone was performed using the dynamic SEMG and was shown to be 60 micro-volts at rest, and greater than 200 micro-volts when squatting in the left gastrocnemius and he was unable to consciously relax the musculature when prompted. Pictures of faces were presented to the patient in the upper left visual field. The patient was asked to describe the details of the face as well as the emotions that were being portrayed. Dynamic SEMG readings while squatting with visual stimulation were seen as low as 15 micro-volts. After this therapy when standing the gastrocnemius was generating 27 micro-volts and the patient was able to volitionally relax and only generated 9 micro-volts. He reported being able to squat with greater ease which was confirmed by the lower SEMG reading. He returned one week later and when standing he had an SEMG reading of 12 micro-volts and he was able to consciously decrease the activation of the muscle to 3 micro-volts while standing and squatting without the use of the visual field stimulation. After four and a half months of treatment, there was an increase in active and passive range of motion of the effected knee, from 30 degrees to 67 degrees. The patient reported that his pain was 2/10, and that he has more endurance throughout the work day.
Conclusions:
In this case the patient experienced pain and a decrease in range of motion due to a complete knee replacement. Through the utilization of functional neurological therapies including myofascial release, the patient was able to regain range of motion and decrease his daily pain. By using the dynamic SEMG to evaluate the tonicity of the gastrocnemius, the patient was able to see the activation levels and volitionally decrease the resting tone of the musculature and allow for a greater range of motion in the knee.
Keywords:
Knee surgery,
Knee flexion,
Chiropractic,
Myofascial,
chiropractic neurology
Conference:
International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function, Orlando, United States, 7 Oct - 9 Oct, 2016.
Presentation Type:
Poster Presentation
Topic:
Abstracts ISCN 2016
Citation:
Ellis
M,
Mundie
EM,
Ranvik
K and
Esposito
SE
(2016). Soft tissue treatment and neurological stimulation to increase range of motion after total knee replacement surgery.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function.
doi: 10.3389/conf.fneur.2016.59.00023
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Received:
31 Aug 2016;
Published Online:
07 Sep 2016.
*
Correspondence:
Dr. Susan E Esposito, Life University, Marietta, United States, susanesposito@gmail.com