This traumatic incident is a truly inspiring story of a young, active Dad who came to see us in AposTherapy®; he was desperate to get his life back on track and be able to play with his 5 year old son again…..
In November 2011, James (32) was joking and playing around with his mates one day, and during the fun & games one of his mates playfully jumped on his back. His right patella dislocated, and was re-located in A&E.
A couple of months later, In January 2012, an artery in his right leg was causing him symptoms. After having the leg examined it was discovered he had ruptured his Right PCL and LCL (likely to have been caused at the same time as the dislocation). The reconstructive surgery took place in January 2012, however his recovery was delayed due to the knee being infected. After weeks of rest/antibiotics, his knee seized up, so to help improve the movement and break down scar tissue, an MUA (manipulation under anaesthetic) was performed; however he still had very restricted movement and limited function.
Following this an intensive rehab programme of physiotherapy and hydrotherapy daily to increase his flexibility, &improve his muscle function.
However during this process he started to complain of right ankle pain/stiffness; he went though a vicious cycle from then on whereby as the ankle settled, the knee would worsen; and then if the knee settled, his ankle would worsen. This went on for months, and eventually led to him having an arthroscopy to the right knee in Oct 2012. After a few weeks of relief, things started to deteriorate again in the knee.
At his Initial Consultation in Nov 2012 in the AposTherapy® Centre, he reported being severely restricted in his daily functional tasks; he couldn’t walk more than ½ a mile, going up/down stairs was extremely awkward and painful, and he was woken up at night by the pain. All hobbies and play time with his Son had to be put on hold. As you can imagine he was very distressed by this, as was his son.
The physical examination revealed he had significantly reduced movement of the knee; he was unable to bend or straighten it fully. Also the medial joint line was tender on palpation and his right ankle had limited mobility. During gait assessment he had quite a marked limp – as pain was limiting his tolerance of pressure through it, most the weight was going over to his left leg. He had limited hip flexibility, causing his step length to be reduced, and he was not using the muscles effectively in the right knee during heel strike, causing his knee to be bent throughout the stepping cycle. There was a lot of muscular tightness (or ‘bracing’) at his lumbar spine, which was leading to him walking slowly, and with short steps. The muscular bracing and instability was the main cause of his antalgic gait pattern- for symptoms to improve, this needed some serious attention!
How does AposTherapy® work?
The biomechanical device was calibrated to apply two principles of rehabilitation to the knee; re-alignment of pressure, and neuro-muscular re-education.
With James the goal was to redistribute the force, and direct it away from where he was feeling most of the pain. For James, this meant we needed to offload the medial compartment of his knee joint.
So the location of where the pertupod was set was instantly causing this realignment of pressure.
To train the local muscles to function more appropriately to bring about better stability to the joint, a concave/round pertupod was attached to the base; In barefoot, James was quite unstable, so we chose a relatively flat pod – but this small amount of instability would in time lead to new movement patterns being taught, and would reduce the overall bracing that was occurring.
During his first walk in the AposTherapy® system, James was immediately able to load the right leg more. His gait was far more symmetrical, he walked faster, muscular bracing was reduced, and pain levels were drastically better.
James followed out a specific treatment programme tailored for his condition; He started by wearing the device once a day each evening, over dinner time, for 30mins; over the next 5 weeks this increased to 90mins. The beauty about this treatment is that it fits in with normal life –it is functional, easy to use, and gives pain-relief.
At his first follow up, after just 5 weeks of using the device, he had significant reduction in pain levels. He wasn’t waking at night, & could walk faster and further than he’d been able to for months.
At his second follow up, 16 weeks after starting treatment, he could walk at a normal/comfortable pace for 2 hours.
After just 6 months, he was cycling 140 miles a week, walking up and down stairs easily with heavy shopping bags, and playing with his son as he used to.
At each follow up consultation as well as getting feedback from James to find out how things have improved, I have made alterations to the device to challenge his muscles more and re-position where the pressure passes through the joint.
If he twists or jolts the knee, he still gets a twinge, and does report mild ankle stiffness. Therefore we will continue to monitor James for the foreseeable future to ensure we make further improvements to his pain/mobility/stiffness/function.
The change of James’ condition in 6 months is quite remarkable – he looks like a different person walking into the centre now and his family are delighted he can play again!