the use of medical exercise therapy for a post-operative
TRANSCRIPT
Eccentric calf raises
• Instructions: rise onto toes of both feet. Slowly lower left heel down, then return to start position.
• 3x30 sets at least 3 times a day
Standing Calf Stretch • Gastrocnemius and Soleus • 3x30 seconds each
Achilles Tendonitis1,2 • Affects 9% of all recreational
runners • Treatment is variable • Surgery is controversial
Gastrocnemius Recession3,4 • Small incision to postero-medial
lower leg to release gastrocnemius tendon • Most commonly used to treat
equino-varus contracture • Lack of literature when used to treat
chronic achilles tendonitis • No known literature for the post-
operative physical therapy management
Medical Exercise Therapy (MET)5 • Developed by the Holten Institute • 60 minutes of graded exercise • High repetitions with low weight • Functional weight bearing during
functional movement patterns
The Use of Medical Exercise Therapy for a Post-operative Gastrocnemius Recession Patient After Multiple Conservative Physical Therapy Treatments Failed: A Case Report
C Cross, BS, DPT student University of New England
Purpose
Case Description
The purpose of this case report was to report the use MET for a patient after a gastrocnemius recession as treatment for chronic achilles tendonitis.
Background • 30 year-old female who was an avid
runner with chronic achilles tendonitis in her left ankle • Pes cavus foot structure • Underwent a gastrocnemius
recession after 3 failed attempts of conservative physical therapy • Chief complaints after surgery:
pain, weakness, and instability • Goal: run 30 minutes without pain
Outcomes
Acknowledgements
References
Short Term Goals • Regain left ankle ROM • Improve left ankle strength to 4+/5 • Be able to walk 3 days a week for
20 minutes without report of increased pain
• LEFS score of 40/80 & PSFS score of 7/10
Home Exercise Program
Interventions
Manual Therapy • Cross Fric4on, Retrograde, and Effleurage Massage
Therapeu4c Exercise • Lower Body Ergometer, Ankle PRE, Terminal Knee Extension, Bridges
Therapeu4c Ac4vi4es • Deloaded Squats & Step-‐ups, Single Leg Balance, Standing Hip Abduc4on & Hip/Knee Extension, Eccentric Calf Raises
• 70 minutes of physical therapy 3 times a week for 6 weeks.
• Exercises chosen to promote return to running.
• Improvements made in all areas • MMT: goal met, except for
plantarflexion which was 4/5 • Pain: decreased from constant
3-4/10 to constant 2-3/10 • Able to walk for 30 minutes and
bike for 20 minutes without increased pain; did not trial running
Discussion MET was a viable intervention for a patient after a gastrocnemius recession as treatment for chronic achilles tendonitis. The patient reported satisfaction despite constant pain and slow return to activity. The slow-paced improvements may be related to the chronicity of the tendonitis, length of time she spent inactive, and her pes cavus foot structure. Future research should be conducted with a larger sample size for a longer duration.
The author acknowledges Kirsten R. Buchanan, PhD, PT, ATC
for the conceptualization of this report.
http://jbjs.org/content/jbjsam/95/16/1489/F2.large.jpg ; http://www.aidmyplantar.com/_img/anatomy-of-the-lower-leg-achilles-tendon.jpg
Disabili4
es
Func4o
nal Lim
ita4o
ns
Impairm
ents Pain
Strength Range of Mo4on Symmetry Balance Gait Locomo4on Skin Integrity
Difficulty ambula4ng household and community distances Difficulty managing stairs Difficulty performing household chores Difficulty carrying/playing with child
Unable to exercise
http://help4cmt.com/articles/?id=119&pn=foot-deformities-that-result-from-charcot-marie-tooth-and-surgeries-to-correct-them
Examination
http://www.physicaltherapyfirst.com/files/photos/massage-therapy/calf.jpg ; http://www.reasonforgod.com/wp-content/uploads/2014/03/stationary-bike-stand.jpg ; http://www.beexercise.com/storage/Step-up-B.jpg?__SQUARESPACE_CACHEVERSION=1281728531146
1Roche A, Calder J. Achilles tendonopathy: a review of the current concepts of treatment. Bone Joint J. 2013;95(10):1299-1307. 2Wiegerinck J, Kerkhoffs G, Van Sterkenburg M, Sierevelt I, Van Dijk C. Treatment for insertional Achilles tendinopathy: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2013;21(6):1345-1355. 3Gurdezi S, Kohls-Gatzoulis J, Solan M. Results of proximal medial gastrocnemius release for Achilles tendinopathy. Foot Ankle Int. 2013;34(10):1364-1369. 4Kiewiet NJ, Holthusen SM, Bohay DR, Anderson JG. Gastrocnemius recession for chronic noninsertional Achilles tendinopathy. Foot Ankle Int. 2013;34(4):481-485. 5Torstensen TA. Medical Exercise Therapy for patients with hip, knee, and ankle pain—dysfunction of the lower extremity. Holten Institute. Accessed at: http://www.holteninstitute.com/media/pdf/Course41_content.pdf . Accessed on November 1, 2014
0
3 3 3
2
3
9
8 8
7
0
1
2
3
4
5
6
7
8
9
10
Fitness Stairs Ambula4on Chores Average
Scale Score
Pa#ent Specific Func#on Scale
Ini4al Evalua4on
Discharge