Rehab for Hip and Knee Arthritis

Episode 31 - Rehab for Hip and Knee Arthritis

[00:00:00] Dr. Juliette Dassinger: Welcome to IBJI's OrthoINFORM podcast, where we talk about all things orthopedics to help you move better and live better. I am your guest host, Dr. Juliet Dassinger, physical therapist. Our goal is to provide you with an in depth resource about common orthopedic services that we provide every day. Today, I have the pleasure of talking with Dr.

Chrissy Adelphia. Physical therapist and athletic trainer about the knee and hip osteoarthritis diagnosis. Christy received her bachelor's in science with focus on athletic training from Illinois State University and received her doctorate in physical therapy from Governor State University. She treats patients out of our Westmont location working with all age groups.

She has a passion for learning and utilizing evidence based approaches to her treatments. She is passionate about involving every patient in the rehabilitation to make long lasting functional gains. Chrissy enjoys playing sports and spending time with her family. Please welcome everyone, Dr. Chrissy Adelfia.

Thank you so much for having me. Yay! I'm excited to be here. We're excited to have you. Thanks. , I was mentioning to Ryan who's actually right next to us, um, right before this podcast that you and I had the opportunity to work together even outside of IBJI. So I had the opportunity just to see your approach and I love how you educate everyone that there's an athlete in everyone because you have that physical therapy background and athletic training background.

So no matter what age group you are, you have an athlete inside you.

[00:01:34] Dr. Chrissy Adelphia: Yes, I agree.

[00:01:36] Dr. Juliette Dassinger: And I think that That relates to our topic today because as someone has an athlete inside them, anyone who's listening, , you do have an athlete inside you. I would agree

[00:01:45] Dr. Chrissy Adelphia: also, yes.

[00:01:48] Dr. Juliette Dassinger: But when you do anything that's physical, anytime you put a demand on your body, when us physical therapists, we say demand, we talk about walking, jogging, running, hiking, anything you like to do, it's a demand on your body.

But some people may think, but these demands, could that lead to me having arthritis? And anyone who's listening with this episode, when we say arthritis, we also mean osteoarthritis, or if you hear us say OA, that also means osteoarthritis. Sometimes for us physical therapists, it's hard to tell If you may or may not develop arthritis later in life or why you have developed it, but hopefully this episode can help answer some of those questions.

So Chrissy, let's say we have a patient that goes to one of our IBGI physicians and is referred to you with the diagnosis of knee and hip osteoarthritis. What should a new patient expect on their first appointment with a physical therapist for their new diagnosis?

[00:02:42] Dr. Chrissy Adelphia: Yeah, uh, the first appointment, I like to, , really, like I said, involve the patient with everything.

, I set them up on expectations as just in general as far as what to expect. in therapy moving forward. , but on that first day, I really want to get to know the patient. I want to get to know what's important to them and what they're trying to get back to doing or what they're having difficulty with doing.

, and that's step number one, uh, just to figure out what their overall. , goals are for therapy and why they are there. I know obviously, they're coming to therapy because they're in some sort of pain. And if they get that diagnosis, they probably also want a little bit more information about what osteoarthritis is.

So I spent a lot of time educating on that the first day as well. Um, but again, that first day I'm looking for, , what your goals are, what are you struggling with, and , how can I help you to

[00:03:38] Dr. Juliette Dassinger: Of course, no. I would say, as a physical therapist, our job is to, , get you back to what you want to get back to.

, really one of our main questions is going to be, what is your goal? I'm just curious, knowing that we're talking about both knee and hip osteoarthritis, is there anything specific To the knee that you would like to know and same with to the hip that you'd like to know.

 I don't know if there's anything specific, , I think the biggest thing I want to know is past like history I think, , have you had any injuries to it?

[00:04:08] Dr. Chrissy Adelphia: How active were you before? You know, was there any prior surgeries, things like that, uh, as far as, , hip and knee. Um, but I think my biggest thing specifically would just be, , past history.

[00:04:22] Dr. Juliette Dassinger: That's what I. I completely agree. And sometimes it's interesting. You may not even lay a finger on a patient yet, and you'll have a good idea of what's going on just by their history and what they tell you.

[00:04:32] Dr. Chrissy Adelphia: Well, that's what I think that first day is so important. , we do take, , measurements and, Uh, test strength and look at how everyone's walking and doing all of that. But I really, I think that's that, that one on one care of just getting to know the patient, getting to know, , where they've been and where they want to go.

Um, that's a lot more informative sometimes than, you know, all the tests and measures that we have to take too.

[00:04:53] Dr. Juliette Dassinger: Well, that's a good segue into my next question is, uh, so that first, that first beginning part of that session is. Getting to know you as the patient and getting to know, uh, what you are in for.

But, Chrissy, what are those tests and measures that you take with the patient? What do you take?

[00:05:12] Dr. Chrissy Adelphia: Of course. So, I utilize what they said to me as far as their goals to pick what kind of tests I do. I think generally, uh, , we want to find the range of motion. Where are they at? Are they limited in their ability to bend their knee or, , flex or extend their hip?

 And then also the strength. I want to know, , Do you have any weakness in your hips? Do you have any weakness in the muscles of your thigh? And then on top of that, , how does that relate to function? So sometimes I'll do functional tests as far as, like a walking test or a sit to stand test.

Um, and I also like to, if I, if I have the time and , It's available. See, how does it look if you do a step up, right? If that's something that they're having trouble with, I want to see it. So, typically, if a patient comes in and they say, I have trouble getting up and off a chair, it hurts a lot when I do that, or it hurts when I walk, I want to look at that.

So, there's tests that we'll do. incorporate those activities. So after we do, , the range of motion, strength test, um, I'll do some of those functional tests that, like I said, are more meaningful for what they want to accomplish in therapy.

[00:06:18] Dr. Juliette Dassinger: What's excellent a lot of times about that first appointment is Some patients may experience pain, but may not know why they're experiencing pain or what have caused this.

And I think that first appointment is excellent to test all those things. Range of motion, strength, functional testing, which is like you mentioned getting up and down from a chair or stairs or walking in general. Sometimes it's excellent even to show the patient themselves. I mean, putting them in front of a mirror, it's like, this is what I'm noticing here.

Do you also notice that? Is this when you're experiencing pain? So I think it's, Trying to give that patient also an awareness of this is what I've noticed with my testing, do you experience the same thing? I agree. So let's say you, you've gathered your data, you, you found maybe a knee that has limited range of motion and that was through testing through bending it and straightening it.

What are those initial treatments look like? What do you like to do when you have gathered data on someone who may have limited knee or hip range of motion, limited knee or hip strength, any functional strength deficits?

[00:07:21] Dr. Chrissy Adelphia: So that initial treatment, I'm you know, obviously sometimes we can put you in a little or it can be discomforting to do some of the tests and measures.

So that first day too, I'm looking at giving you interventions that will calm down some of the symptoms. And a lot of that time that's hands on, , sometimes we'll do some mobilizations of the knee, uh, soft tissue massage, things like that of nature that I first start with. Um, so like you said, if they come in and, I realize that there's a range of motion deficit.

I'm going to try to get in there and move the joint a little bit, try to loosen it up and free it up, make it feel a little bit better, and then try to it gained more range of motion afterwards. So we'll do some, , bending of the knee, straightening of the knee, same thing with the hip, um, after we've already done some hands on treatment.

And I like to start there with, that, and then move into maybe some, some strengthening things that they can start with low level at home, , that will also help to kind of decrease and minimize some of that discomfort.

[00:08:16] Dr. Juliette Dassinger: I think you can second this as a physical therapist where that day one, you want Make sure that they come back that second time, right?

Correct, correct. , so hopefully we don't do too much that very first time. Yes. Because, of course, over time, we're hoping that symptoms progress and that you get better with the things that we provide. But with that first appointment, it's really just to get to know you and giving you some things to start initially low level.

What education? Do you like to provide with that first visit or even those first few visits? Some of

[00:08:49] Dr. Chrissy Adelphia: the education I provide is letting patients know that it's okay to continue to move. Um, that's, I think the biggest thing is that you're not going to be causing damage if you continue to move. And actually with osteoarthritis, the joint's actually a like movement, so I'll educate them in that, that, , I understand that hurts.

Um, but. , typically what we see with other patients that have the similar diagnosis is once you get it loosened up and move it, it actually likes that motion. So, , I give them the exercises that initial day, I say, try these out, , first and then keep moving. That's the biggest thing, um, education wise.

I think sometimes when you're having that pain, people are fearful to move and continue because they're worried that, , they may, , damage something more, um, or cause more issues. And I like to educate them that our bodies are meant to move. , that's what we're, we were made to do. And the more that we do it, the better it can eventually get.

 If we, , sit back and don't do that, those things, then things get weaker, things get stiffer, things get tighter. Um, and so I say as much as you can tolerate and do, keep doing it. And that's, that'll be great for you to start with while we're working on getting, where you want to be.

[00:09:58] Dr. Juliette Dassinger: That's what's interesting about this osteoarthritis diagnosis is we, or patients who experience osteoarthritis and pain in the hip or knee, believe if I have pain I should not move and that's where a physical therapist is excellent and a good person to start with your treatment for osteoarthritis because we can educate on you're not going to make your osteoarthritis works even though you are experiencing pain with range of motion, but you can actually improve your pain with motion, your joints like motion, they're meant for motion.

Um, so

[00:10:34] Dr. Chrissy Adelphia: I, and that's a huge , for many people they're like, because yeah,, that's our body's way of saying something's wrong, , when we feel that pain. , it's very normal and I tell everybody, I, Totally get it, right? If something hurts, I'm not going to move because that's our, that's our brains telling us, Hey, what's, what's going on here?

Yeah. So, um, and I think that, that gives people a little bit of hope too. Then that's why I enjoy what we do. Um, cause I'm able to give them that information of like, it's okay. You know, like it, that is, there is a signal there and it is telling you it's uncomfortable, but , just rest assured that it's not damaging.

[00:11:09] Dr. Juliette Dassinger: When do you think it would be necessary? For someone to follow back up with their physician. Let's say you're seeing a patient for in between four to six weeks, one to two times a week, and there's still noticing pain. They may have some improvement, may have not improvement, but if they're, they're still having difficulty, when do you find it necessary for them to follow up with their physician?

[00:11:34] Dr. Chrissy Adelphia: Yes, that's a great question. Um, that's why I think it's very individualized what we do and what I try to do for each patient just because they have the same diagnosis doesn't mean everyone will have to go back or anything like that. So what I do is I sit down and I review the goals at a certain point, right?

I want to know, , what's our range of motion? What's your functional capabilities? Have we met these any of these goals? If they're still significantly in pain though, . Then I see, are we taking anything for that? , maybe we need to send you back to the physician to talk about potential other interventions that can be done such as medication or injections.

Um, and if the, if we're not getting range of motion and it's very debilitating for their quality of life, that's another time you want to send them back so that they can have a conversation about, you know, other interventions.

[00:12:23] Dr. Juliette Dassinger: And it's interesting, sometimes it's nice to have that physician here to discuss this part, but would you say if you ever brought someone back to see their physician?

Does that always mean surgery?

[00:12:35] Dr. Chrissy Adelphia: No, that's a great question. Yeah. A lot of people, , patients that I have will ask, well, does that mean I'll have to have surgery? Cause a lot of people don't want to have surgery. , and I think that's a, that's a very valid concern, right? Um, But no, it doesn't mean going back to your physician, you're, you're gonna have to have surgery.

Like I said, there's a lot of other interventions, and I would say most of our doctors are really great about trying all those other interventions before we go in for surgery. , and that's why you, you check in, and that's why we send you back. And I think that again, a lot of that has to do with You know where you're at in your goals, but for me, it's also your quality of life.

And that's what I tell each patient. I say it's all dependent on your quality of life, right? And, and each conversation is different per patient, right? If they've tried other interventions and things like that. But definitely if we, send you back to the physician, it's not , right away surgery.

It's, it's let's have a discussion. Let's figure out , what, what. next treatment option is best for you and we'll give that a try. Sometimes it's in conjunction still with therapy and sometimes it's not. Um, but I think that, , don't be worried if we're like, this isn't 100 percent working out at this point.

, sometimes it's just, we need a little extra help.

[00:13:45] Dr. Juliette Dassinger: Yeah. And sometimes I find that follow up with the physician a second chance where I know you mentioned where if they do follow up with their physician, there may be a potential for receiving. Um, if the audience have heard this, cortisone injections or gel injections, which are options for that hip and hip or knee osteoarthritis.

But once again, that could be that second chance. Let's try physical therapy out with an injection, seeing if we can at least manage pain so that we can improve your range of motion, your strength. Returning back to those goals to see what do you want to return back to and with an extra assistance of the medication or injection, can we meet those goals?

So that can still be those options before we discuss the big S word, S surgery. Yes. Yeah. How about this? If someone is listening to this episode and they're nodding along and they say, I know someone with osteoarthritis, I myself have hip and knee pain. What advice would you would like to give that one person who's listening?

[00:14:44] Dr. Chrissy Adelphia: That it's okay to come see us. , I think that's a people, Individuals are, you know, not sure what they can and cannot do. And I think that even if you don't need, per se, an entire, , four weeks or six weeks of therapy, at least come and talk to a physical therapist. Come see one of us and our physicians here, and we can start guiding you in the correct direction.

If

[00:15:08] Dr. Juliette Dassinger: someone's listening, And they have received that osteoarthritis diagnosis. What would be your advice to that person listening?

[00:15:16] Dr. Chrissy Adelphia: My advice to the individual listening would say, Come and, , have an initial evaluation with one of us. If the doctor recommends it, obviously, take that chance, that opportunity, and come see us, let us know, , your goals and your worries, and let's, let's find a plan and get you, moving better and feeling better.

[00:15:38] Dr. Juliette Dassinger: For those listening, there was a recent blog post. Later, 2023. That describes navigating life after an osteoarthritis diagnosis. This blog post is posted on our IBGI.

com website and we'll make sure to have it in our episode notes too. And for anyone listening as well, Dr. Chrissy Adelphia works out of our Westmont Clinic. Thank you, Chrissy. It was a pleasure to have you on this episode of Ortho Informed discussing the hip and knee osteoarthritis diagnosis. Thank you very much.

It was a pleasure.