General Physiotherapy

Whether it has been two months or two years since your joint pain, sprain, strain or fracture, or your joint replacement surgery, we are here to help. We take the time educate you about your body and partner with you so you can achieve your goals. Life is more fun when you can stand tall, move effortlessly and feel balanced!

During your initial assessment, we discuss with you the treatment options best suited to address your needs. Treatment options can include:

Retraining your walking style and speed.
Trigger point therapy
Instruction in Nordic Walking.
Therapeutic Yoga.
Joint mobilization.
Posture retraining.
Prescriptive exercises.
Myofascial release.

Myofascial Release

Myofascial Release is a form of therapy that gently stretches the body’s fascia. The fascia is a thin connective tissue that surrounds every muscles, organ and nerves in the body. Fascia holds onto physical, emotional and psychological trauma. Releasing fascia can allow us to release the root cause of physical restrictions.

This article was last updated on May 26, 2020

Hip and Knee Replacement Therapy

MelioGuide Physiotherapy provides comprehensive hip and knee replacement therapy treatment programs that can:

Allow you to delay or avoid a hip or knee replacement surgery.
Prepare you for your surgery.
Accelerate your hip or knee replacement recovery time and get you moving again.

Before we go into detail about how we can help, readers might find it useful to learn what makes a healthy joint and understand the process that leads to the degeneration of a joint and its eventual replacement.

This article was last updated on May 26, 2020

1.Understanding our Hip and Knee Joints

Bones connect at a joint. The ends of the bones at the joint are covered with a very smooth surface referred to as articular cartilage. The bones are structurally aligned with the help of the joint capsule.

There are different types of joints in the human body. Of all the different types of joints, synovial joints (see the image to the right) allow the most movement. Our hips and knees are both synovial joints.

The sub categories of synovial joints include the hinge joints and ball and socket joints. Our knees are hinge joints. Our hips are ball and socket joint. Hinge joints allow you to bend and straighten in one plane of motion (flexion and extension) while ball and socket joints allow for multiple planes of motion (flexion/extension, abduction and adduction as well as internal and external rotation).

Both the hip and knee joints contain synovial fluid. The synovial fluid is the lubricant that allows the joints to move with minimal friction. Synovial fluid also provides nourishment to the joint and aids in shock absorption. Movement of the joint stimulates the production of synovial fluid. As the phrase goes: motion is lotion!

The synovial fluid is produced from the synovial membrane as well as from our blood plasma. Synovial fluid sits on top of articular cartilage and also within. The synovial fluid fills all the micro cavities within the cartilage.

As mentioned earlier, every synovial joint has a joint capsule. The joint capsule encapsulates the ends of the two articulating bones. The outer portion of the joint capsule along with the ligaments keeps the two bones together. The joint capsule is made up of the inner synovial membrane and a stronger outer layer called the fibrous membrane.

2.Why Joints Become Arthritic

The two main causes for degeneration of our joints are:

Wear and tear.
Trauma.

Osteoarthritis is a term given to your joints when the healthy smooth cartilage that covers the end of the bones (where they articulate with other bones) start to get cracks and pits. In the early stages of osteoarthritis the cracks and pits in your cartilage are few and small.

As arthritis progresses the space between the two bones diminish and the gaps in the cartilage can expand down to expose the bone.

Severe osteoarthritis is a term used to indicate that at least 60% of your cartilage is lost and the joint space has narrowed considerably.

The loss of a smooth articular surface creates friction which you feel as stiffness and pain. You can often hear the grinding in your knees and feel the stiffness in both your hip and knee joints.

Other causes leading to the degenerative changes in the joints are Rheumatoid Arthritis (RA) and Osteonecrosis. RA is an autoimmune disorder that erroneously attacks your body tissues, including the linings of your joints. Osteonecrosis is a medical condition that occurs when there is a loss of blood to the bone.

In the case of RA and osteonecrosis, there is less control in the hands of an individual to keep the arthritic changes at bay. With osteoarthritis there is much more control. More about this later.

3. Symptoms of Osteoarthritis

Here are several symptoms that could indicate that you have osteoarthritis in your hip(s) or knee(s). I explain each of these in detail in this section.

Persistent and intense pain around your hip or knee joints and extending as far as your ankles or feet.
Impairment of function.
Reduced range of motion in the hip or knee joint.

3.1 Pain

Pain that occurs when moving a joint is often an indicator that something is wrong with that joint. In advanced stages of hip and knee osteoarthritis, pain becomes more persistent and intense.

Pain with movement is common especially after long periods of sitting, standing or resting due to the lack of synovial fluid and worn articular cartilage.

A significant amount of the pain associated with hip osteoarthritis is often present in places other than the hip.

In a study looking at pain caused by hip arthritis (1), the authors found that pain emanating from the hip was located in areas near the hip (the groin and thigh) as well as other parts of the body. The authors found that hip joint pain was distributed mainly in the buttock, thigh or groin area. Fewer people experienced pain in or below the knees.

In another study where patients had more advanced osteoarthritis of their hips (2), the distribution of pain was mainly at the front of the knee(s) followed by pain below the knee.

Just because you are experiencing pain in a specific part of your body, it does not mean that that part of the body is the source of the pain. The studies mentioned above demonstrate that pain often gets referred to other areas in your body.

Another common fact is that people who experience pain, reduce their activity level and sometimes stop altogether.

Reducing your activity level is one of the worst things you can do with joint arthritis.

Less motion means less lubrication. Less movement means weaker muscles.

As muscles get weaker, they provide less support for the joints. As joints lose support, wear and tear increases as joints rub against each other repeatedly.

3.2 Impairment of Function

If you find that your normal physical activities are impaired or restricted, this might indicate problems with your hip or knee joints. The following are several examples of functional impairment that might indicate hip or knee joint problems:

You can no longer walk without pain.
You experience pain when you go up or down stairs or get up from a chair.
Pain stops you from doing physical activities you enjoy such as gardening, bowling, dancing, etc.
Your quality of life degrades because you do not want to move.

3.3 Reduced Range of Motion

Morning stiffness as well as stiffness after periods of sitting, standing still, or resting is a common complaint that we hear from our arthritis clients.

Reduced range of motion in your hip or knee joints is a symptom of joint arthritis.

In the early stages of arthritis you may only experience a reduced range of motion during more extreme movements such as stretches, yoga poses or deep squats. As your joint range of motion becomes more limited, you may start to notice more difficulty performing the following activities:

Getting dressed, especially putting on socks and shoes.
Cutting your toe nails.

If you have been experiencing pain, reduced function or increased stiffness we encourage you to consider an assessment. Physiotherapy can reduce the pain and stiffness associated with hip or knee joint problems.

Schedule an Appointment

If you are concerned about the health of your hip or knee joints, visit us for an initial assessment. Click on the image to the right (with the clock) to set a time. Once we complete the assessment we can discuss your options and get your started on your treatment program.

If a knee or hip replacement surgery is required we can help you prepare for the surgery and develop a recovery program.

4. Delaying or Avoiding Your Joint Replacement

Joint replacements are not inevitable. Consider this: you can delay (and possibly avoid) a joint replacement by working with a Physiotherapist. You already know that maintaining a healthy body weight and good nutrition is important. But there is much more to keeping your joints healthy.

Physiotherapists can employ techniques that delay or avoid a hip or knee replacement surgery such as:

Joint traction and mobilization to give you some pain relief and improve your range of motion.
Trigger point massage and myofascial release to optimize the health of the muscles and fascia around your joint(s).
Prescribe exercises that are progressive and address strength, flexibility and balance.
Find the right support for you such as nordic poles or activator poles.

The goal of your Physiotherapy is to reduce your pain and increase your range of motion to help you move more freely.

Most everyone over the age of 35 has some degenerative changes in their hips and knees. You may not be able avoid knee or hip replacement surgery. However, the earlier you act, the better your chance at delaying the need for it by several years.

5. Preparing You for Hip or Knee Replacement Surgery

If your hip or knee joint has deteriorated to the point where you experience persistent pain in the groin, thigh, lower leg or buttock, your Physiotherapist will recommend you speak with your doctor about your concerns.

If needed, a Physiotherapist will contact your doctor to request an X-ray. An X-ray will show the state of your joint health. If you have worsening symptoms and X-rays show severe degenerative changes, your physician will refer you to a specialist to be considered for a joint replacement.

The waiting period for your joint replacement can take months. This is a very good time to optimize the health of the muscles in your lower body. Consider it an opportunity to build your torso and upper body strength, too. This preparation will make your hip or knee replacement recovery period easier and get you back in your game faster.

6. Hip and Knee Replacement Surgery

During the hip or knee replacement, the worn part of your joint is surgically removed and replaced with a prosthesis. The purpose of the prosthesis is to restore your functionality and reduce your pain.

However, the prosthesis alone will not solve your problems. Your muscles need to be strong to support your new joint and subtle enough to allow you to regain functional motion around the joint.

Your hip or knee replacement recovery can be optimized if you follow a Physiotherapy treatment program that is designed specific to your needs.

Once you get the prosthesis and you become active again, you may experience pain. Frequently, people find that they replace one joint and other joints start to complain. These joints may have been complaining before your surgery but not as loudly as the one you got replaced.

However, the pain might not be associated with the replaced joint or arthritis in another joint. Trigger points that developed during the period before the surgery can mimic joint pain.

Trigger points do not always cause pain in the location of the trigger point. For example, trigger points in your buttock muscles can refer pain around your sacrum and sacroiliac areas. Trigger points in your thigh muscles can refer pain into your knees.

7. Knee Replacement Therapy for Jane

Jane (not her real name) recently had a knee replacement surgery. Three months after her knee replacement she experienced tremendous pain in both of her knees. She had difficulty walking and experienced considerable pain at night. This is when she decided she had to call me.

This came as a surprise to Jane. Before her knee replacement surgery, she was told that her pain would diminish and she could continue her active lifestyle. She wondered what went wrong and why she was experiencing problems.

Jane had been very active her whole life, exercised regularly, and played sports. She attended the recommended exercise classes three times per week at the hospital where she had her surgery with the same intensity level that she committed to her sports.

An examination showed that her knees joints were fine but her muscles had developed many trigger points in the months leading up to her knee replacement surgery. Her quadricep muscles had also tightened up. Jane was taught how to do self trigger point massage and some new stretches. She worked on the massage points daily, stretched as directed and took a break from her strength exercises.

After a few visits Jane was able to enjoy her new knee. Her muscles were ready to engage in exercise again. She returned to being independent in all her daily activities and was walking without pain.

6. Hip Replacement and Knee Replacement Exercises

Some patients, in preparation for their hip or knee replacement surgery, are not prescribed exercises specific to their needs by the hospital performing the surgery. The exercises are targeted at a wide audience and often too general to be effective.

A majority of people about to have a hip or knee replacement surgery benefit from these general exercises. But if you fall outside the group norm, the exercises may be too easy or too hard for you. In the end, this could waste your time or worse cause trigger points that could lead to pain after the surgery.

We will work closely with you and tailor fit the exercise program best for you in advance of your hip replacement or knee replacement surgery.

7. Knee or Hip Replacement Recovery Time

Knee replacement and hip replacement recovery time can be as short as three months and as long as a year. Recovery time after surgery can vary depending on the success of the surgery, your level of fitness going into the surgery, the exercise program you are prescribed after the surgery, and how well you adhere to the prescribed exercise program.

At MelioGuide Physiotherapy our one-on-one, private, personalized approach means we have the time to offer you whatever you need along the spectrum of your joint health including:

Joint traction and mobilization to give you some pain relief and improve your range of motion.
Trigger point massage and myofascial release optimize the health of the muscles and fascia around your joint(s).
Prescribe exercises that are progressive and address strength, flexibility, and balance.
Find the right support for you such as nordic poles or activator poles.

In addition to the strength exercises, we will provide you with targeted and progressive flexibility, balance, and cardiovascular exercises. The exercise mix will change depending on your progress over your recovery time.