91 year old with knee pain

Danielle

Mastery Member
Mentorship Member
Joined
Oct 22, 2020
Messages
7
Hi Shane
I have been seeing a 91 year old lady for the last few weeks. She was suffering from cramp which was waking her up at night and R knee pain going up and down stairs. Can do one at a time but not going up or down normally. Also some L LBP.

Goals
get rid of cramps at night which are waking her up (along with need to go to toilet) and finds it difficult to get back to sleep with them
currently difficult to put shoes and socks on
pain going up and down stairs. (Ok walking 30 mins with dog daily)
Ideally getting rid of walking stick around the house

Medical history:
L hip fracture 1 year ago. Hip replacement and been using a walking stick since when outside. Recently needs to also use around the house. Had been doing Pilates since the op 1 x week (now doing online)
R hip replacement 15 years ago due to OA
L patella fracture 20 years ago
Arthritis and pain R big toe - keeps strapped

Osteoporosis
High blood pressure

Examination
Khyphotic and reduced rib cage mobility - all directions
L SIJ dysfunction
Hip ROM - 90 degrees B
L knee ROM 100 degrees
R Knee ROM 90 degrees
ankle GROM B
L big toe 5 degrees
R big toe 15 degrees

I have managed to get rid of her LBP and cramps. Got her ROM up to about 120 degrees in knees about 95 degrees in hips so far (will really concentrate on these this week and toes). Have given her some seated leg stretches to work on her ROM / mm tension.

I guess my questions are....
* how much range of movement am I likely to really achieve with her
* she already does sit to stand with her Pilates teacher - I am getting her to slow this down and go down on heel and up on ball of foot. But not sure she is really achieving this (especially with the big toes)
* Given her seated back relaxation exx - but a bit worried about whether this is a good idea due to balance / possible dizziness
* how I can take this patient forward as I am struggling to know what to do with her next. Have spoken to her Pilates instructor who is also having similar issues made more difficult due to technical difficulties of being online and patient hard of hearing.

Any thoughts gratefully received.

Thanks Danielle
 

Shane

Head Therapist
Staff member
Staff Member
Joined
Sep 9, 2020
Messages
126
Hi Shane
I have been seeing a 91 year old lady for the last few weeks. She was suffering from cramp which was waking her up at night and R knee pain going up and down stairs. Can do one at a time but not going up or down normally. Also some L LBP.

Goals
get rid of cramps at night which are waking her up (along with need to go to toilet) and finds it difficult to get back to sleep with them
currently difficult to put shoes and socks on
pain going up and down stairs. (Ok walking 30 mins with dog daily)
Ideally getting rid of walking stick around the house

Medical history:
L hip fracture 1 year ago. Hip replacement and been using a walking stick since when outside. Recently needs to also use around the house. Had been doing Pilates since the op 1 x week (now doing online)
R hip replacement 15 years ago due to OA
L patella fracture 20 years ago
Arthritis and pain R big toe - keeps strapped

Osteoporosis
High blood pressure

Examination
Khyphotic and reduced rib cage mobility - all directions
L SIJ dysfunction
Hip ROM - 90 degrees B
L knee ROM 100 degrees
R Knee ROM 90 degrees
ankle GROM B
L big toe 5 degrees
R big toe 15 degrees

I have managed to get rid of her LBP and cramps. Got her ROM up to about 120 degrees in knees about 95 degrees in hips so far (will really concentrate on these this week and toes). Have given her some seated leg stretches to work on her ROM / mm tension.

I guess my questions are....
* how much range of movement am I likely to really achieve with her
* she already does sit to stand with her Pilates teacher - I am getting her to slow this down and go down on heel and up on ball of foot. But not sure she is really achieving this (especially with the big toes)
* Given her seated back relaxation exx - but a bit worried about whether this is a good idea due to balance / possible dizziness
* how I can take this patient forward as I am struggling to know what to do with her next. Have spoken to her Pilates instructor who is also having similar issues made more difficult due to technical difficulties of being online and patient hard of hearing.

Any thoughts gratefully received.

Thanks Danielle
Thoughts here @Danielle
 

Shane

Head Therapist
Staff member
Staff Member
Joined
Sep 9, 2020
Messages
126
Brilliant thanks that is really helpful. Forgot to mention before yes it is both hips where she is loosing it on MO testing in sagittal

(y)
Laura said you were seeing this patient again today so let us know how you get on!
 
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