Nate is a fantastic physical therapist and had me back in shape for my ski trip in no time. Without his guidance and assistance, I do not think I would have had such a positive ski experience.
Nate was my physical therapist for about two months after a minor car accident. I was experiencing back pain. Very warm welcoming, and down to earth experience. Typically with doctors I feel rushed and as if I am not heard. He pays every close attention to detail, and is not out for anyone’s money. He does therapy to educate patients so they do not have to depend on him or someone else. After two months feeling back to a 100 percent
Nate is by far the best physical therapist I have ever seen. I have played soccer for 17 years and injured my knee several times throughout my career so I have seen many physical therapists as a result, and Nate still stands out to this day as the best physical therapist I went to. I saw him when I tore my ACL and he pushed me out of my comfort zone to try and get me back on the field, while also listening to me and understanding when I was pain or having a hard day. He was extremely knowledgeable about what he was doing and I really trusted that he was always leading me in the right direction. I really appreciated how professional Nate was but also very personable. He was very easy to contact as well, so if I ever needed him he responded very quickly and was also willing to work with my athletic trainer which allowed me to get back that much faster. I can only think of good things to say about Nate he really is the best, of the best.
Vestavia Student Athlete
Collegiate Athlete
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Arthrofibrosis (AF) is abnormal internal scarring inside the knee joint and surrounding structures. It may begin with sticky adhesions that can gum up the surfaces that are close to one another, such as the suprapatellar pouch above the patella, the anterior interval behind the patellar tendon, the area around the cruciate ligaments and the capsular ‘gutters’ at the side of the joint.
The abnormal ‘gumminess’ of these normally mobile tissues leads to painful knee stiffness. Attempts to bend the knee result in sickening pain above the knee in the region of the suprapatellar pouch. Aggressive physiotherapy tends to make the knee hot, swollen, red and painful, and instead of mobility improving it tends to worsen. Lack of understanding about the arthrofibrotic process may lead to doctor and physiotherapist berating the patient for not trying hard enough, and the patient may feel demoralized and angry.
Manipulation Under Anesthesia
The objective of manipulation under anesthesia (MUA) for the knee is to break sticky adhesions gumming surfaces together before these adhesions turn into proper scar tissue. To this end, the procedure should be done early once it is appreciated that physiotherapy is no longer improving range of motion (ROM) or that ROM is getting worse. During the procedure the patient needs to be fully anaesthetized and under the influence of true muscle relaxants. The hip should be bent to 90 degrees and the surgeon hold the thigh near the knee and apply a gentle rocking motion of the lower limb through flexion and extension while observing improvement.
Not every practitioner will perform the manipulation in exactly the same way. By having the patient under anesthetic or deep sedation, the clinician is able to gently but firmly take the knee through as much of a range of motion as possible in order to free any adhesions. A danger of course is that the inexperienced practitioner may be too rough and cause damage to the tissues.
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