There are between 150,000 – 200,000 ACL tears every year in the US, and nearly 100,000 ACL reconstruction surgeries performed.
Out of all the data available with regards to these surgeries, there is one piece of information that is most telling about the future health of the affected knee.
This data point is so telling that one group of researchers drew the conclusion that people who don’t hit this target would have been better off if they hadn't gone through the ACL reconstruction surgery at all.
So what is it?
After ACL reconstruction surgery, one of the primary focuses of rehabilitation is restoring full extension of the knee (or being able to completely straighten the knee).
If full extension is not restored to within 5 degrees of being straight, those who undergo ACL reconstruction surgery will be 2x more likely to develop osteoarthritis in the knee.
A loss of 5 degrees of extension is also tied to:
All of these consequences make it very unlikely that the patient will be able to return to a high activity lifestyle. Without full extension, even every day activities like walking, climbing the stairs, and bending over to pick things up can become difficult.
It goes without saying that restoring full knee extension range of motion after surgery must be one of the top priorities in a successful ACL reconstruction rehabilitation.
And the sooner the better. One research group found that range of motion in the knee at 4 weeks was strongly correlated with range of motion in the knee at 12 weeks.
In other words, if you’re behind in restoring range of motion 4 weeks after surgery, it’s likely you will still be behind 8 weeks later. When you hit the 12 week mark, the likelihood of restoring ROM becomes less and less.
In a recent case study with one of our clients, Bobbie, she started Neuro Therapy protocols 4 weeks after surgery. At the time she started, her knee lacked 5 degrees in extension, which could have been problematic if it remained that way.
In many cases, it takes months to restore the range of motion with traditional therapy. However, within just 1 week of work, Bobbie’s knee extension range of motion was restored, drastically decreasing her chances of developing osteoarthritis in the affected knee.
Neuro Therapy protocols have consistently delivered these types of results for ACL Reconstruction Rehab, as is evidenced by Cameron and Naja’s words on the rehab process below (both returned to their sports at a high level).
Neuro Therapy can yield these types for a variety of ACL reconstruction clients, including the following:
Just click the link below, fill out the form, and we’ll have someone get in touch as soon as we can.
Noll S, Garrison JC, Bothwell J, Conway JE. Knee Extension Range of Motion at 4 Weeks Is Related to Knee Extension Loss at 12 Weeks After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med. 2015;3(5):2325967115583632. Published 2015 May 4. doi:10.1177/2325967115583632
Shelbourne KD, Urch SE, Gray T, Freeman H. Loss of normal knee motion after anterior cruciate ligament reconstruction is associated with radiographic arthritic changes after surgery. Am J Sports Med. 2012;40:108–113
Joints can experience a lot of wear and tear, particularly if you’ve managed to stay active through the majority of your life.
Due to this break down, total knee replacement is one of the highest volume orthopedic surgeries in the US. It’s likely you know someone who has undergone the procedure or is getting ready to.
There were nearly 700,000 total knee replacement surgeries in 2018. Due to increases in population, activity levels, and average weight, that number is expected to increase to more than 3 million by 2030.
Despite how often the procedure is performed, a number of patients (about 1 out of 12) need to be readmitted to the hospital due to complications after surgery. These complications range from infection to wound healing, cardiovascular problems, venous thrombosis, pain, and arthrofibrosis (scar tissue development that limits knee function).
If a total knee replacement is in your future (or someone you know), here are 5 ways you can increase your chances of a successful recovery from surgery.
Prehabilitation is the concept of developing as much strength and range of motion around the knee (and in the legs in general) as possible before surgery. You “pre-hab” by working with a qualified therapist or strength trainer.
By doing so, the theory is that you will have a better surgical outcome, and the research indicates this theory is true. Pre-hab has been shown to:
2. Lose Weight
Weight plays a significant role in your total knee replacement outcome, so much so that certain hospitals have stopped providing the surgery for patients who are extremely overweight. Obsese patients nearly double their odds from infection after surgery. Those who go through surgery at a healthy weight decrease the risk for:
As an added bonus, weight loss should also help those knees feel a little better before surgery.
3. Start rehab early
…And this could mean really early. Ask your doctor how soon they plan to start mobilizing the knee after surgery. Some studies have shown that mobilization within 4 hours of surgery can decrease risks for venous thrombosis (one of the most common causes of hospital readmission).
It can also contribute to a shorter length of stay at the hospital, higher functional scores after surgery, and improved pain control.
Whether your doctor clears you for mobilization after 4 hours or 4 weeks, make sure you adhere to their schedule. Don’t blow off your rehab, as it will significantly affect your chances of a successful recovery.
4. Be Prepared For Setbacks
Expect the unexpected. Even if you’ve done everything right, there’s still a chance there may be setbacks along the recovery process. Make sure your physician and his/her team are educating you on any potential setbacks that may occur after surgery.
By being well educated, you can prepare psychologically for any obstacles in your way during the recovery process and tell yourself that no matter the setback, you WILL make a full recovery.
5. Eat Healthy
If you’re not already well versed on the basics of a healthy diet, now is the time to seek help. Not only will eating healthy help you to lose weight before surgery, but it will also optimize your recovery.
A healthy diet will give you all the nutrients your body needs to make that knee feel brand new. After surgery, your diet might need to be a little higher in protein, fruits, and vegetables. You’ll also want to avoid foods that are likely to cause an inflammatory response.
If you need help in this area, let me know – I’d be happy to connect you with a few of the experts in my network.
If you've already had a total knee replacement and still aren't back to 100%, you'll want to reach out to a member of our team.
We may be able to point you in the right direction to help you restore range of motion, decrease pain levels, build strength, and get back to an active lifestyle.
Click to request a call with a member of our team
1. Wang L, Lee M, Zhang Z, Moodie J, Cheng D, Martin J. Does preoperative rehabilitation for patients planning to undergo joint replacement surgery improve outcomes? A systematic review and meta-analysis of randomised controlled trials. BMJ Open. 2016;6(2):e009857. Published 2016 Feb 2. doi:10.1136/bmjopen-2015-009857
2. O'Neill SC, Butler JS, Daly A, Lui DF, Kenny P. Effect of body mass index on functional outcome in primary total knee arthroplasty - a single institution analysis of 2180 primary total knee replacements. World J Orthop. 2016;7(10):664-669. Published 2016 Oct 18. doi:10.5312/wjo.v7.i10.664
3. Same-day Mobilization following Total Hip and Total Knee Arthroplasty. Alberta Bone & Joint Institute. Published 2009 Oct 1.
This week's blog was written by our Clinical Director of Neuro Therapy, Leah Zinnert. It's a really fascinating piece!
National Geographic recently came out with a documentary called “Free Solo,” about how Alex Honnold became the only person in the world to climb the 3,000 ft wall El Capitan without a rope or other safety gear.
An article written about the climb stated that:
“Elite climbers have pointed to Honnold’s unique ability to remain calm and analytical in such dangerous situations, a skill that Honnold has slowly developed over the 20 years he has been climbing… There are other climbers in Honnold’s league physically, but no one else has matched his mental ability to control fear.”
His ability to remain calm in these high-risk situations intrigued scientists. So much so, that they actually conducted a functional MRI of his brain.
This type of imaging shows changes of blood flow that occur in the brain when a person is performing a certain task or exposed to a certain stimulus. Essentially, what is activated (or not activated) will light up during the scan.
The amygdala, the part of the brain they were especially interested in studying in Alex, is a part of the limbic system. It helps us to interpret and process emotions. It helps us to identify threatening stimuli and regulate our fear response.
What they discovered in Honnold was interesting. When they exposed him to stimuli that, in you and I, would most likely cause a fearful response, it generated nearly no response in Alex’s amygdala. His brain remained in the parasympathetic (rest and digest) state instead of being driven into the sympathetic state that would occur in the typical person.
But how? One hypothesis could be genetics. Some people are just wired to be more ‘chill’ than others. Some of us are better at remaining calm in stressful or scary situations.
Or perhaps it’s a result of his training?
Has the repeated exposure to scary situations given him the ability to actually train and control his responses even at the deepest levels of the nervous system?
Maybe it’s a combination of both.
On the opposite end of the spectrum, what if your amygdala was the opposite of Alex Honnold’s? What if it was OVER active (which studies have suggested would cause the amygdala to be larger than normal)?
Could it signal a fear response in a situation that may not be appropriate, which would increase anxiety, fear, and even pain levels?
And what if we have the ability to train our brains to interpret stimuli differently?
Here are 5 tips that have been proven effective at training (and shrinking) your amygdala, so you can be more in control of your fear response.
1. Face your Fears
Avoid Avoidance. Is there something that your fearful of? Often, repeated or controlled exposure to these things can help decrease fear, help you to manage anxiety, and stress. If you’re unsure of how to do this, talking to a professional can help.
It all starts with the breath. Ever been stressed out, feel like you can’t control anything happening around you? One thing you can always control – your breath. Try this exercise to drive your brain in to chill mode:
The goal here is to increase focus and calm. There is a lot of information you can find online about best strategies to initiate a meditation practice if you are unsure. https://www.wikihow.com/Meditate or App’s such as Headspace or Calm can be helpful.
It has long been proven that regular aerobic exercise helps to release endorphins, which naturally stabilize mood, decrease anxiety, and decrease stress. Not sure where to start? Pick something simple that you know you’ll enjoy doing!
5. Why are you fearful?
Take some time to explore why you may react or be more sensitive to certain stimuli. Once you are more aware of the WHY behind certain behaviors, they are easier to manage.
Do you know someone who would benefit from training their amygdala?
Send them this article!
There's not much in the world that can be accomplished in 30 seconds. But there is a simple self check you can do to assess whether or not your knee pain has a strong correlation to the nervous system.
Around 40% of the clients we see have neurologoical communication issues in the quads and hip flexors that are contributing to their knee pain.
The quads and hip flexors play an extremely important role in everyday movement. When they aren't functioning properly, they don't absorb force properly, and can cause problems in the joints below the waist, including the knees.
So how can we tell if the quads and/or hip flexors are causing your knee pain?
It's as simple as laying on your back and rasing your leg. And grabbing a friend.
The self-check for the quads (see first picture below):
Lay on your back, keeping the back flat against the surface you are laying on. Raise your left leg off the ground. Once the leg is up, ask your friend to push down with moderate resistance on the leg. It's important to understand this isn't a strength test to see who is stronger. It's designed to see how quickly your quad can respond to a little bit of force going into it.
When your friend pushes down, resist and don't allow the leg to drop.
If you're able to resist, switch to the opposite leg and repeat.
If you're unable to resist or the leg drops for a moment before you're able to resist, it means that activation of the quad is not occuring efficiently.
This problem is almost definitely contributing to your knee pain, and needs to be examined further.
The self-check for the hip flexors (see picture below):
This test is very similar to the first test. The only difference is that in the previous test your back was flat on the table. In this test, you need to arch your lower back (think about lifting your ribcage to the ceiling).
Once you're in the correct position, raise your leg, have your friend push down on the leg, and see if you're able to resist.
If you're unable to resist or the leg drops for a moment before you're able to resist, it means that activation of the hip flexors is not occuring efficiently.
Similar to the quads, this is almost deifnitely contributing to you rknee pain and needs to be examined further.
These two assessments are two of the easiest tests we run to determine whether or not a neurological problem is contributing to your knee pain.
If you've passed both of these tests, but are still dealing with knee pain, we can run a host of other asssessments during your Initial Evaluation at Premier Neuro Therapy to get to the bottom of it.
The Initial Evaluation (or Discovery Session as we like to call it) is a free way to learn more about what's causing your knee pain and whether or not Neuro Therapy is a solution for you.
Just click the link below to apply:
This week’s post highlights a success story from one of our clients, Ned.
Ned heard about Neuro Therapy through one of his friends who knew he had been dealing with an injured shoulder for years (26 to be exact).
The injured shoulder was keeping him from working out, feeling strong, and wrestling around with his kids.
After hearing about Premier Neuro Therapy, Ned filled out an online form to schedule a time to talk to a member of our team (click here to do the same), Within a day, we got in contact with him via phone call to answer his questions about the Neuro Therapy process.
We also let him know that the best way to understand how Neuro Therapy can help is experiencing it, and that we offer the first session (we call it a Discovery Session) for free. He decided to schedule a Discovery Session within the next few days.
Before starting at Premier Neuro Therapy, Ned had spent the previous few years only being able to bench around 185 lbs. It wasn't necessarily that he couldn't go higher, but if he pushed the shoulder too much, he would really pay for it in the days to follow.
During his Discovery Session, we identified Neuro Communication issues with Ned's anterior deltoid and medial biceps that were keeping the shoulder from healing properly and feeling strong.
After just a few weeks of work getting these problems corrected, Ned was benching 255 lbs for 10 reps - a huge jump from what he had been able to do prior to Neuro Therapy.
Not only did Neuro Therapy help him to feel better, but it also helped him to become stronger. As Ned puts it, he hasn't been this strong since he was in his 20s.
If you're wondering if Neuro Therapy can help solve your biggest pain problem, be like Ned and schedule a time to talk to a member of our team by clicking this link:
This article was written by Premier Neuro Therapy co-owner, Zach Michael.
A few weeks ago, I started working with a client that has multiple sclerosis (MS). Despite living with MS, she is one of the most positive, hard working clients I have had the pleasure to work with at Premier.
In conjuction with her Neuro Therapy sessions, we have talked a lot about how she can optimize her diet to give her body what it needs to decrease the symptoms associated with MS, like fatigue, muscle spasms, loss of balance, and pain.
While I am no expert in the area, the client had already read a book by Dr. Terry Wahls who was able to drastically turn around her MS journey by eating a special diet. Because I wanted to help in way I could (and was curious about Dr. Wahls' approach), I decided to give the book a read.
What I found out is that following the rules of this diet can not only help those living with MS, but optimize everyone's health and drastically reduce the risk of developing chronic diseases.
For those of you that don't know, multiple sclerosis is diagnosed when an overactive immune system starts to attack the nervous system. It leaves lesions in the spinal cord and brain, which can cause neuro communication issues throughout the body.
But this same "overactive immune system" can cause different issues from person to person. In one person, it may attack the nervous system, meaning you have MS. In another, it may attack the cardiovascular system, putting you at risk for heart disease.
Note; Other dieseases linked to an overactive immmune system include: allergies, Alzheimer's, ALS, anemia, arthritis, asthma, autism, cancer, cardiovascular disease, diabetes types 1 & 2, fibromyalgia, common intestinal disorderes, kidney failure, lupus, pain, pancreatitis, and psoriasis and eczema, just to name a few.
In general, the immune system is responsible for generating an inflammatory response when it senses a threat. It's a great thing to have when we need it. However, if it becomes overactive, it can generate chronic inflammation, which can lead to the host of diseases listed above.
When the immune system is overactive and the inflammation becomes chronic, reactive free radicals of the inflammatory process start to destroy the healthy tissue around it.
So what is Dr. Wahls' "miracle"diet for dealing with the symptoms of an overactive immune system (in her case, multiple sclerosis)?
And how can this apply to optimizing our everyday health, even if we aren't living with MS?
It all comes down to one basic principle:
Limit the number of things you ingest that trigger an inflammatory response. If you limit the number of times you "trigger" your overactive immune system, you will lower the risk for developing a chronic disease.
Dr. Wahl's suggestions (slightly simplified) for doing so include:
For a more detailed breakdown, you can head here. The article at the link below does a great job providing a detailed breakdown of the book and diet.
When you boil down chronic diseases (and chronic pain) to this one basic principle involving the inflammatory response, health becomes so much more simple.
And it makes you realize how much more in control you really are over your health!
You are 100% in control over what goes in your mouth. Even if you are exercising regularly to burn the residual calories, there's other ways your diet can adversely affect your health, and we all need to start being more conscious of it.
Start thinking about how you can optimize your diet NOW to decrease the risk of developing chronic diseases over time.
At Premier, we see a fair amount of clients after catastrophic knee events. Whether it is an ACL tear, MCL strain, dislocation, or total knee replacement, the body responds in a very simlar way.
When most people think about these types of events and what happens to the body afterwards, they often describe physiological symptomss like inflammation, weakness, stiffness, and pain.
But what is it that triggers these events?
It's the nervous system.
As soon as the nervous system senses that something is "not right" with the knee, it responds by putting the knee in lockdown mode.
In lockdown mode, the nervous system shuts down neurological communication to the muscles of the quad (even more specifically the vastus medialis and vastus lasteralis). It refuses to use these muscles, because it fears using the muscles will put too much stress on the knee.
And without proper use of the quads, the knee feels extremely stiff and the leg can feel weak.
This is a beneficial response for the body, at first. It ensures that you will not continue to participate in activities that can put the integrity of the knee at risk.
But what about when it's safe to start using the knee again? Does the brain automatically turn the neurological communication back on to these muscles?
Unfortunately, the answer is no. And it's one of the major challenges of recovering from a catastrophic knee event.
Even when it's safe to start using the knee, the brain has latched on to the idea that the brain needs to be protected. It continues to lockdown the quadriceps muscle, which actually delays your recovery and puts you at a higher risk for re-injury.
In order to addreses this problem at Premier, we combine direct current electrical stimulation of the quadriceps with active range of motion exerecises. By doing so, we re-train the nervous system to relax the quadriceps, which promotes a more efficient recovery and quickly decreases symptoms like pain, inflammation, and stiffness.
If you, a friend, or family member are dealing with the after effects of a catastrophic knee event (whether it's been 1 day or 1000 days), make sure you ask your therapy team what they're doing to address this problem - it is the number one reason recovery from these events doesn't always go as well as planned.
This week’s post highlights a success story from one of our clients, Liz.
We met Liz at an open house at Reflex Functional Fitness, and found out she had been dealing with a string of repetitive foot and ankle injuries.
Not only were the injuries affecting her ability to go for runs and work out (and feel confident doing it), but they were also causing her hips, back, and even neck to feel tight.
After learning more about Liz’s history at the open house, we scanned her leg, foot, and ankle for any Neuro communication issues that could be contributing to her repeat injuries and muscle tightness.
During the scan, we identified an area around her big toe that seemed to be the driver for her problems. Liz was surprised – she used to have pain in that exact spot, but she thought the issue had gone away.
It turned out that while the pain went away, the issue hadn’t, and it was causing a host of problems for the rest of her foot, ankle, hips, back, and even neck.
Within 2 weeks of Neuro Therapy, Liz was back to running 2-3 miles without pain. Within 4 weeks, she was ready to sign up for her first half marathon since 2013.
Watch the video below to hear more from Liz on her Premier Neuro Therapy story.
If you're wondering if Neuro Therapy can help solve your biggest problem, schedule a time to talk to a member of our team by clicking this link:
This week's blog post was written by Leah Zinnert, Clinical Director of Neuro Therapy. I think she did a really great job with it - hope you enjoy!
I was working with a client the other morning, and the session started like any other at Premier - with a conversation. After a longer than usual discussion about his recent concerns, we got to talking deeper about his frustrations surrounding what had started to feel like a lifetime of pain.
In the midst of this conversation I asked him “How would you feel if you didn’t have pain?”
His answer gave me chills... and maybe some of you can relate.
“Terrified,” he responded, “the world would be too big.”
I then asked him to envision a typical day if he woke up and no longer had his pain. He told me he would have to re-evaluate almost every action and activity.
As long as he can remember, even back to college, he has had some form of pain.
He bounced around between medical professionals, who gave him an array of diagnoses or suggested that if he just did this "one thing" the pain would go away (sound familiar?...)
Eventually, it got to the point where he underwent complex surgeries on bilateral shoulders in an attempt to alleviate the painful sensations down his arms.
Unfortunately, the surgeries were met with little success.
What was interesting to me is that because he had been in pain for such a long time, it had become something that he described as being able to fall back on. He could use it as a way out of certain situations, almost like a crutch.
So much so that he was fearful of the pain going away. Could this thought process be what is keeping his body from letting go of the pain?
Let's break this down a little further...
The traditional biomedical health care model focuses on purely biological factors and excludes psychological, environmental, and social influences.
In this model, pain has nothing to do with how you think about it (which we know is incorrect).
For certain people, especially those who receive a wide variety of diagnoses and are repeatedly told their bodies are "damaged", this traditional model can wreak havoc, and often times leads to and endless cycle of frustration and failed attempts at a solution.
Simply put - this traditional model leaves people suffering from chronic pain feeling lost, hopeless, and fearful.
The conversation highlighted above raised my awareness to the idea that everyone sees life (and pain) through a different lens.
Therefore, it's important to have an awareness of how all aspects of health (some of them highlighted above as biological, psychological, and sociological) impact pain.
In this client's case, there were clear psychological factors affecting his pain.
Healthcare needs to be patient-centered, holistic, and focused on individualized clinical reasoning and communication.
Your health professional must take in not only what is being said, but how, and when, and in what environment. They must take the time needed to listen to you and hear what you are saying.
I bet there are so many people reading this that can relate to my client’s response about being fearful of being pain-free, and have felt unheard by provider's in the past.
Your healthcare professionals are doing you a disservice if they do not strive to better understand the individuality of your situation AND help you to let go of those fears surrounding it.
We hear it all the time… “I have X every few days, but that’s pretty normal. I just take a Y and it goes away within a few hours.”
Insert any of the following for X:
Headaches, back pain, tightness, numbness, digestive problems, heart burn, anxiety attacks, fatigue/lack of energy, bouts of depression, etc…
And the following for Y:
Aleve, Advil, Tylenol, Tums, Xanax, Coffee, Red Bull, Testosterone, etc…
And this is very normal in modern living.... but should it be?
Isn’t the idea that we have to take medication to manage symptoms on a regular basis just giving in to mediocre health?
I have no issues with medication in general, provided all other avenues have been pursued.
There’s a time and place for them, but I don’t believe they should be regularly used to manage minor symptoms until all lifestyle factors have been optimized.
Keep in mind that medications are altering the chemistries in your body and come with a host of side effects. You may never actually “feel” any of these side effects, but they may be altering your long term health outcomes.
It’s important that before turning to regular does of medication, we consider alternatives.
Before turning to medication, we need to stop and ask ourselves:
Most times, optimizing lifestyle factors comes down to the “boring” things we already know about:
If you’re dealing with any of the problems listed above, here’s a few quick pieces of advice on each of them.
My challenge to you is to pick one and start working towards optimizing it to your needs.
It’s time to stop settling for mediocre health!
Ideal nutrition varies from person to person. What causes an inflammatory reaction in your body may not be the same foods that cause an inflammatory reaction in another person’s body.
If you suffer with chronic health problems (even minor ones), consult a registered dietician or functional medicine specialist. Ask them how they can help to identify the foods that cause inflammatory reactions (and your symptoms) in your body. If they don’t have a good answer, call another person.
If you’re already active and exercising regularly, think critically about what activities and movements seem to make you feel worse versus better. If you can identify these, you don’t need to cut them out, but should modify them and try to determine which part of the movement is causing symptoms.
If you’re not already active, start with something as simple as walking 10 min/day a build from there.
An adult should target sleeping 7-9 hours per night. At a bare minimum, you need 6 hours of sleep/night. If you’re unable to sleep, try seeing a sleep coach or undergoing a sleep study in order to optimize your life for a good night’s sleep.
Try to drink between half to all of your body weight in ounces of water each day. For instance, if you’re 150 lbs, you should target 75-150 oz of water.
If you constantly feel stressed out (and don’t enjoy being stressed), optimize your lifestyle for less of it. I know this easier said than done, but remember this is all about NOT accepting mediocre health.
If you don't know where to start, consult a mental health coach or psychologist - no, this doesn't meant you're crazy!
Yes, genetics do play a role in our health, and no, there isn’t much you can do about them.
However, in large part, genetics only predispose us to certain health conditions – they do not guarantee those conditions.
If you work to optimize all other aspects of your lifestyle (and find someone who can help you account for your genetics), you will have a lower likelihood of getting the worst of your genetic predispositions.
Ladies and gentleman, it is time. Time to stop settling for mediocre health, time to stop “managing” our everyday symptoms or making excuses for them.
What can you start doing today in one of the areas above to optimize your health?
About the Author
Evan Lewis is a nationwide leader in Neuro Therapy and founded the Baltimore area's only specialist Neuro Therapy facility.
Download now: 7 Quick & Easy Tips To Reduce Back Pain (without painkillers,, injections, or seeing the doctor)!