Shoulder and knee patients

COPENHAGEN(1)

Physical therapists tend to focus on the surgical joint and limb only. As a profession, we must do better. Developing an outstanding base of support is critical to allow the limb to function at full capacity. The neck and rib cage for the shoulder, the low back and pelvis for the knee.
Shoulder:
Balancing the rib cage and regaining full cervical flexibility will allow the shoulder girdle to anchor down to the rib cage. Only then will the patient have full strength to push off and to fully relax the supporting muscles. Not doing this will often result in weakness and overuse of the muscles in the neck.
Knee:
Post-surgical knee patients tend to walk inefficiently instead of using the engine we call the “core”. Motion should always initiate from the pelvis, with the legs coming along for the ride. Without good pelvic motion and strength, the patient will continue to walk over-using their leg muscles. Not regaining the ability to walk with the low back and pelvis will result in poor walking mechanics, weakness and poor endurance. Muscles in the legs that are overworked will often become excessively tight and prone to cramping.
Therapy:
Every therapy session and home workout should include mobility for the spine along with full range of motion and core exercises. Our patients need to know how to walk with their core and have enough flexibility in their pelvis and low back to avoid inefficient “leg walking”. Patients must become experts at balancing their posture so that the shoulder girdle is supported. There are other problems that will need to be addressed with knee and shoulder dysfunctions, but regaining good spinal function should be the number one goal.