The Use Of Medical Exercise Therapy For A Post-operative

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
Gastrocnemius
3,4
Recession
•  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 postoperative physical therapy
management
Examination
Gait Locomo4on http://jbjs.org/content/jbjsam/95/16/1489/F2.large.jpg ; http://www.aidmyplantar.com/_img/anatomy-of-the-lower-leg-achilles-tendon.jpg
5
(MET)
Skin Integrity •  Developed by the Holten Institute
•  60 minutes of graded exercise
•  High repetitions with low weight
•  Functional weight bearing during
functional movement patterns
Purpose
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.
Outcomes
•  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
Difficulty ambula4ng household and community distances Difficulty managing stairs Difficulty performing household chores Difficulty carrying/
playing with child • 
• 
• 
• 
Unable to exercise 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
Pa#ent Specific Func#on Scale 10 9 9 8 8 8 7 7 6 5 Ini4al Evalua4on 4 Discharge 3 3 3 3 3 2 2 1 0 0 Fitness http://help4cmt.com/articles/?id=119&pn=foot-deformities-that-result-from-charcot-marie-tooth-and-surgeries-to-correct-them
Pain Strength Range of Mo4on Symmetry Balance Medical Exercise Therapy
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
Disabili4es •  Affects 9% of all recreational
runners
•  Treatment is variable
•  Surgery is controversial
Home Exercise Program
•  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
Func4onal Limita4ons 1,2
Tendonitis
Impairments Achilles
Case Description
Scale Score Background
Stairs Ambula4on Chores Average Interventions
Discussion
•  70 minutes of physical therapy 3
times a week for 6 weeks.
•  Exercises chosen to promote return
to running.
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.
Manual Therapy • Cross Fric4on, Retrograde, and Effleurage Massage Therapeu4c Exercise • Lower Body Ergometer, Ankle PRE, Terminal Knee Extension, Bridges Acknowledgements
Therapeu4c Ac4vi4es • Deloaded Squats & Step-­‐ups, Single Leg Balance, Standing Hip Abduc4on & Hip/Knee Extension, Eccentric Calf Raises 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
The author acknowledges
Kirsten R. Buchanan, PhD, PT, ATC
for the conceptualization of this report.
References
1Roche
A, Calder J. Achilles tendonopathy: a review of the current concepts of treatment. Bone Joint J. 2013;95(10):1299-1307.
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
2Wiegerinck