I coined the term POLITE Method for how I treat my patients. The ‘P’ is for improving posture and creating a plan of treatment.
The ‘OL’ is optimal loading. This means figuring out self-management activities for knee pain that are not too easy and not too difficult.
The ‘I’ in instruments that I use in the office for knee pain such as laser, DMS, and shockwave therapy that give effective short- and long-term pain relief benefits.
‘T’ is for taping the knee and I’ll teach you how to apply simple kinesio-tape to the knee for pain relief.
‘E’ is for education regarding the progressive nature of osteoarthritis (OA) and for pain management education; joint-sparing exercise advice including daily walking, balance tips, and falls prevention; and emotional and cognitive skills to improve quality of life; Eating for weight loss for those who are overweight or obese. Weight loss has been shown to improve mobility and reduce pain. For every one pound of weight lost, there is a 4-pound reduction in the load exerted on the knee for each step taken during daily activities. A weight loss of only 15 pounds can cut knee pain in half for overweight individuals with arthritis.
A low-carbohydrate diet has been shown to reduce weight in obese patients by ?10% and lead to improvements in self-reported scores for overall progress and functional ability.
If you like my POLITE approach call 310-444-9393 for an appointment.
Here is a great question from Dr. Ray Sue. I thought you might want to see my response.
I had a long time elderly patient come in that has been suffering from falls of late. After going through a battery of tests (for her eyes, ears and CT for her brain) it was determined that she simply needs to get in better condition and gain more strength.
My thoughts were to work on her ankle/knee/hip balance and proprioception (with 1 and 2 legged stances with eyes open and closed), strengthen her quads (with ball squats) and her glutes with prone glute squeezes and extensions. I’ve had her try and do sit and stands but, she definitely has trouble.
Is there anything else you’d recommend or changes to what I’ve recommended?
Thanks so much!
Dr Tucker’s RESPONSE:
I think you are definitely on the right tract. Now lets make it functional!
Additional programming could include this progression:
Single-leg (SL) Balance w/ multiplanar reach with the up leg (she can hold on to a chair)
SL, 1-arm Diagonal movements while holding a light weight in the moving arm
SL windmill moves with the arms
SL Romanian deadlift (partial movement)
Double leg squats (or 1/2 squats or just small knee bends) progressing to SL squat (or 1/2 squats, or just small knee bends) holding something (free weights) in her hands (not holding onto a chair)
Begin lunge progression or at least stepping forwards and backwards
Begin going up and down a step
Hope this helps.
One-leg hops on the spot: Two sets of 40 secs on each leg.
- Stand in a relaxed position, with your full body weight supported on your left foot only.
- Lift your left heel slightly, so that the force of body weight is passing through the ball of the left foot (your right knee is flexed so that your right knee is off the ground).
- Then, hop rapidly on your left foot at a cadence of 2.5 to 3 hops per second (25 to 30 foot contacts per 10secs) for the prescribed time period, while maintaining relaxed, upright posture.
- Your left foot should strike the ground in the area of the mid-foot and spring upwards rapidly, as though it were contacting a very hot burner on a stove. Your hips should remain fairly level as you do this; try to minimise vertical displacement of the upper body.
A 12-week course of low-frequency vibration appears to be safe and feasible for improving dynamic balance in women with fibromyalgia, new research findings suggest.
Narcis Gusi, PhD, with the University of Extremadura in Caceres, Spain,
and colleagues reported their findings in the August 2010 issue of
Arthritis Care & Research.
As most of you know I use the Deep Muscle Stimulator (DMS) for neural and musculoskeletal rehab, but this article discusses whole-body vibration (WBV). In WBV, a patient stands on a platform that oscillates at a particular frequency and amplitude, causing muscle contractions through stimulation of sensory receptors.
The study included 41 women aged 41 to 65 years who were randomized
either to a control group or to the vibration intervention, which
included a 30-minute session of instruction plus 3 sessions of
self-administered WBV per week for 12 weeks. Each session consisted of 6
repetitions of a 45- to 60-second, 12.5-Hz vibration.
WBV has been shown to improve body balance and bone mass density (osteoporosis) in women. It may help muscle conditioning, endurance, and pain.
Arthritis Care Res. 2010;62:1072–1078.