​Cellulitis is a common bacterial skin infection that if goes untreated, can lead to serious health issues. A bacterial skin infection is when bacteria enters the body (usually through hair follicles or tears/cuts in the skin). A common cause for these infections such as cellulitis is following surgery (due to an open wound). Having some general knowledge on what to look for when it comes to cellulitis may help prevent getting it, or allow you to get early intervention so that it does not become serious. 

Below are some risk factors that increase the possibility of getting bacterial infections such as cellulitis. If you have some of the risk factors it does not mean that you will get a skin infection but it does put you at a higher risk. So if that is the case you should make sure to take extra precautions when it comes to good wound management (see below) and performing weekly skin checks. ​

Signs and symptoms of cellulitis can often appear like other skin infections so it is always important to reach out to your Doctor and or surgeon. Especially these days when pictures can be easily sent and assessed it is better to be safe than sorry. ​

​​The current treatment for cellulitis is IV antibiotics. So the sooner it can be assessed by a medical professional and diagnosed the quicker they can get medications on board. Other things that may help in the treatment of cellulitis include:

• Cool dressings on infection site
  
• Keeping area dry and clean
  
• Ice and elevating the infected area
  
• Topical antibiotics
  
• Pain medicine as needed 

​While there is no vaccine or true prevention of cellulitis there are measures that you can take to significantly decrease the risk of the infection. The first and most important is to wash your hands often with soap and or alcohol based hand rub, especially before dealing with any open cuts on the body. Clean all minor cuts and injuries that break the skin with soap and water. Clean and cover all open wounds with clean, and dry bandages until they are fully healed. If you have an open wound or active infection, avoid submerging the area in any bodies of water (pool, river, hot tub, etc.) 

If you recently had surgery make sure to follow good wound care practice in order to limit the risk of infection (more info on good wound care can be found here.​

​If you have any questions or concerns it is always best to contact your physician or surgeon immediately so they can decide the next steps to take.

​We know that we need to be active every day to maintain and improve our health; but, lets face it, that gets a lot harder when the days are colder and shorter and we have to battle snow to be outside. I would like to say that it can be good to get out in the colder weather and walk for a few minutes (as long as there are clear, dry sidewalks to walk on); but, assuming you don't feel like donning your winter parka to get your fitness on.... What are some ways to stay active even in the colder months of winter?  

​If you like/prefer to walk, head to your local mall or recreation center and take a walk around.  There are many groups for "mall-walking" around. You can mask up and join a friend or two and walk the mall.  Most recreation centers also have a walking track that you can easily keep track of your distance traveled. Some even have walking groups to keep each other accountable.

​If you want to venture into a different activity, you can also go to your rec center and meet with a trainer to work on some fitness machines for weight training and cardiovascular exercise. It may seem intimidating, but most trainers are skilled at being able to address your needs and adjust to any specific areas of weakness or pain or you can ask your PT for recommendations of exercise equipment.  Plus, everyone was a beginner at some point, right?!

​You can also take a dip in the pool and swim, walk/run in the pool, or take a water fitness class. There are usually a variety of classes and activities in the pool.  Bonus is that water provides it's own resistance and it is less impact on your joints.  

​Lastly, in this digital age, there are so many applications available that will give you ideas of exercises you can do in the comfort of your home.  Don't worry if you don't have any equipment, many don't require anything - just your body weight; but, if you need weight, look around your house for items that you can use - full water bottles, canned food, babies :) etc. all can be used when lifting "weights".

​Don't let winter slow you down and keep you from your goals!  Keep moving and look forward to those warmer months when you can take your fitness back outside!

​We all get bruises. Sometimes we know where they come from and sometimes we don’t even realize we’ve gotten them. So what is a bruise and what do the phases of colors they go through mean?

​The most common type of bruise involves an injury to the small blood vessels below the skin’s surface. Blood pools below the skin and you are able to see the color of that blood showing through the skin. You can also get bruises to bones, muscles, etc. in the case of deeper injuries or surgeries. Most bruises will heal within 2 weeks although some may take longer depending on the size.

After the first 2-3 days, you can gently massage the affected area to encourage blood flow. Gentle  movement of the affected body part  can also encourage blood flow and healing. If the bruise is painful, taking an over-the-counter medication such as Tylenol or Advil can help relieve symptoms. 

​If it affects the function of the related body part
If it worsens rather than healing within the first 2 weeks
If the bruise is significant and has no identifiable cause
If there is a suspected fracture
If the size of the bruise increases notably 

​Not to scare you but this is NOT a comfortable surgery to recover from. I frequently tell my patients who are planning this surgery to expect to be miserable for 1-3 weeks. Miserable is a very strong word yet very few of my patients say it wasn't as bad as they thought it was going to be. What surprises many of my patients is how long the knee remains uncomfortable after surgery, many of them think "I am tough" or "I am in good shape going into surgery" so it shouldn't be that bad. Unfortunately this is basically carpentry of the body and it hurts. Toughing it out for a few days isn't enough because it still hurts after week one and two. With that said, the outcomes are EXCELLENT and almost everyone is glad they had their surgery and often wish they had it sooner. 

​Fortunately the pain gradually subsides and the new complaint is STIFFNESS. If you leave your knee straight too long it hurts and if you leave it bent too long it hurts. Stationary bikes are really helpful at keeping the knee from getting too stiff and it is quite rewarding the first time you make a full revolution on the bike. Most of my patients will struggle to get knee extension (straightening) OR knee flexion (bending), rarely do patients have trouble getting both directions. Knee extension is the priority as it allows you to stand and walk properly. If you are fortunate enough to have your range of motion come back easily, your rehab is much more comfortable. The stiffer you are, the harder/longer it needs to be pushed on by the patient or therapist. 

​ A total knee replacement or total knee arthroplasty is exactly what it sounds like. You are getting a "new" joint. Many patients have two "bad" knees by the time they are thinking about joint replacements. It isn't uncommon that the knee that looks worse on x-ray isn't the more painful knee. Most patients choose to have the more painful knee done first and it isn't long after surgery before your "bad" knee becomes your "good" knee. Your new knee will NOT look like your old knee, not only will you have a nice scar down the front of your knee, the knee itself will appear wider than your non-surgical knee, many of my patients think this is swelling that will subside and are disappointed when I tell them it is actually just the shape of their new knee. If you have both your knees replaced, you will then have a matching set! Swelling and bruising are common and frequently not a concern, if you have concerns about how your incision looks please contact your surgeon or PT. Your knee/leg often aren't too pretty in that first week but will improve quickly. 

​Orthopedic surgeons that specialize in joint replacements do a lot of them, some average 8 or more a day. That high volume allows the surgeon and their entire surgical team to be very good at them. The outcomes are generally EXCELLENT. 

​Total knee replacements are the most common surgery I see here at Altitude Physical Therapy and myself and our other therapists are very confident in treating patients afterwards. Some of those treated before surgery are able to delay surgery or eliminate the need entirely. Please don't hesitate to reach out to any of the Altitude clinics if you have further questions or concerns of what to expect. 

Total knee replacements -- or total knee arthroplasties (TKA) have become one of the most performed orthopedic surgeries in the world. According to the Agency for Healthcare Research and Quality, in 2017, more than 754,000 knee replacements were performed in the United States. In the PT clinic I treat as many patients after total knee replacements as any other orthopedic surgery. In orthopedic healthcare, total knee replacements are widely regarded as one of the most successful surgeries. The AAOS notes that over 90 percent of replacement knees are still functioning after 15 years.

​Knee replacements are most often done when a person’s knee joint develops severe arthritis. This is when the cartilage in the knee joint -- at the bottom of the femur (“thigh bone”) and the top of the tibia (“shin bone”) -- degrades and the joint becomes painful and usually inflamed. Cartilage acts as padding in the knee joint and to decrease friction as the knee moves. When a person loses most of the cartilage in the knee this can be described as “bone on bone” arthritis and can require a TKA. Most of the time this loss of cartilage is due to wear and tear and is described as osteoarthritis. In some cases this can be caused by an inflammatory condition called rheumatoid arthritis or trauma like a motor vehicle accident.

​Knee replacement surgery was first performed in 1968. Since then, improvements in surgical materials and techniques have greatly increased its effectiveness. Recently more and more surgeons are utilizing robotic guided surgical techniques and generally with excellent outcomes.

​In a traditional TKA the surgeon uses preoperative x-rays, intraoperative anatomical landmarks, and manually positioned alignment jigs to guide bone cutting and implant positioning. These handheld techniques can lead to less reliable alignment-guide positioning, inadvertent sawblade injury to the knee muscles and ligaments, and limited ability to fine-tune the implant positioning. Suboptimal implant positioning may lead to poor functional recovery and reduced implant survivorship. (At this point I should note that I work with many surgeons who have done hundreds or thousands of these traditional TKAs with great clinical outcomes.)

​Robotic TKA uses computer software to convert anatomical information into a virtual patient-specific 3D reconstruction of the knee joint. The surgeon uses this virtual model to plan optimal bone cutting and implant positioning based on the patient’s unique anatomy. An intraoperative robotic device helps to execute this preoperative patient-specific plan with a high level of accuracy. The action of the sawblade is confined to the preoperative surgical plan which limits soft-tissue injury and bone trauma.

A 2019 systematic review about robotic total knee replacement found the following:

• Robotic TKA improves the accuracy of implant positioning compared to conventional jig-based TKA.
• Cadaveric studies have shown robotic TKA is associated with reduced injury to the soft tissue around the knee compared to conventional jig-based TKA.
• Robotic TKA is associated with decreased postoperative pain, enhanced early functional rehabilitation, and decreased time to hospital discharge compared to conventional jig-based TKA. However, there are no differences in medium- to long-term functional outcomes between conventional jig-based TKA and robotic TKA.
• Limitations of robotic TKA include high installation costs, additional radiation exposure, learning curves for gaining surgical proficiency, and compatibility of the robotic technology with a limited number of implant designs.

If you are considering getting a TKA there is clearly a lot of evidence that robotic TKA are effective and in some ways superior to a traditional TKA. That being said, there are many other factors to consider when looking for a surgeon to do your TKA including:

• Number of TKAs the surgeon has done: in general I recommend surgeons who have done hundreds of TKAs as they are both proficient and efficient in the operation. The less time you are on the operating table, the less opportunity for tissue damage or infection.
• Relationship with a surgeon: if you have a surgeon you know and trust who uses a traditional technique you are still likely to have excellent outcomes. 
• Proximity to home: if there aren’t surgeon’s in your immediate area who do robotic TKAs you may have to travel for your surgery and pre-op and post-op visits.

Once you've made your decision don't forget the importance of rehab! All of our physical therapists are experts in both pre and post op knee replacement rehab. For more information about what to do once  you've made this big decision, check out this informational page and reach out to one of our clinics to set up an appointment!

​There's a term we use in physical therapy called "respect the healing process." I've decided to shed a little more light on what we mean by this. Ultimately, the body is supposed to go through certain processes after an injury. These phases are inflammation, proliferation, and remodeling. Each phase has its frustration with respect to our patients. Contrary to popular belief, physical therapy will not make any of these phases go FASTER. 

​The inflammation phase is the immediate response to an injury. It is the swelling and the PAIN! Physical therapy works to help manage this phase through soft tissue work, light joint mobilizations, TENS units, exercise for facilitation and activation of surrounding musculature, gradual return of range of motion and more. The goal of getting into physical therapy this early is so that we can be prepared to move into the next phase: proliferation. 

​The remodeling phase is when we restructure the scar tissue to align appropriately with the component it is trying to heal as well as increase exercise demand and tolerance for the surrounding areas. For example, if the achilles tendon was injured or slightly torn, we will emphasize exercise and hands on work to promote the vertical nature of the fiber alignment in the achilles tendon. This is also achieved with select tissue loading that is usually more weightbearing and functional.

​This is the phase where physical therapy transitions to a routine more targeting your goals. If you want to get back to hiking, we will start lunges and squats. If you want to get back to running, we would start light plyometric and speedwork. These exercises are built upon the exercises you've been doing in the proliferation phase. As you can see from the chart above, this is the longest phase of healing. I always like to tell my patients that once you injure a structure or tissue once, you are at a greater risk of injuring it again. Physical therapy will give you all the keys and exercises necessary to reduce this risk as much as possible!

The phases of healing are overlapping in nature but never to be rushed. Physical therapy guides each patient individually through inflammation, proliferation and remodeling to ensure the best recovery and reduce your risk of re injury. A key component during your physical therapy experience at Altitude is that we will identify how you injured yourself in the first place which I have found is the best approach to not letting it happen again! Remember, you can start physical therapy even BEFORE you get injured, too! :-) ​