POST-PROCEDURAL REHABILITATION: NICE TO DO OR NEED TO DO?
Main Article Content
Keywords
physiotherapy, rehabiitation, exercise, osteoarthritis
Abstract
Patients with musculoskeletal disorders who are recalcitrant to formal rehabilitation may seek non-surgical interventions such as orthobiologics. The care pathway following an orthobiologic procedure may include but is not limited to ancillary modalities, supplements, booster injections, and formal rehabilitation. In some cases, the decision to pursue post-procedural rehabilitation may be questioned due to a paucity of evi-dence supporting efficacy and safety following orthobiologic procedures. Moreover, patients and physicians may possess a level of uncertainty in pursuing an intervention that may have been previously unsuccessful. Although higher-level evidence does not exist to support routine post-procedural rehabilitation, a body of evidence supports enhanced physical functioning as well as cellular and molecular effects synergistic to orthobiologics. Given the potential benefits of post-procedural rehabilitation, there would seem to be little downside to participation, provided that the physician and rehabilitation specialist consider individual patient characteristics such as the current pathoanatomical diagnosis, stage of acuity, and pre-morbid activity levels.
References
2. McKay J, Frantzen K, Vercruyssen N, et al. Rehabilitation following regenerative medicine treatment for knee osteoarthritis-current concept review. J Clin Orthop Trauma. Jan-Feb 2019;10(1):59–66. https://doi.org/10.1016/j.jcot.2018.10.018
3. Iijima H, Isho T, Kuroki H, Takahashi M, Aoyama T. Effectiveness of mesenchymal stem cells for treating patients with knee osteoarthritis: a meta-analysis toward the establishment of effective regenerative rehabilitation. NPJ Regen Med. 2018;3:15. https://doi.org/10.1038/s41536-018-0041-8
4. Gibbs N, Diamond R, Sekyere EO, Thomas WD. Management of knee osteoarthritis by combined stromal vascular fraction cell therapy, platelet-rich plasma, and musculoskeletal exercises: a case series. J Pain Res. 2015;8:799–806. https://doi.org/10.2147/jpr.S92090
5. Kolber M, Purita J, Hanney W. The Effect of Combined Bone Marrow Aspirate, Lipoaspirate, and Platelet-Rich Plasma Injections on Pain, Function, and Perceived Change Amongst Individuals with Glenohumeral Osteoarthritis: A Pilot Study. Biologic Orthopedics Journal. 2022;4(SP1):e83–e95. https://doi.org/10.22374/boj.v4iSP1.49
6. Centeno CJ, Al-Sayegh H, Freeman MD, Smith J, Murrell WD, Bubnov R. A multi-center analysis of adverse events among two thousand, three hundred and seventy two adult patients undergoing adult autologous stem cell therapy for orthopaedic conditions. Int Orthop. Aug 2016;40(8):1755–1765. https://doi.org/10.1007/s00264-016-3162-y
7. Kolber MJ, Purita J, Duarte Lana JFS, Salamh PA, Hanney WJ. The Effect of Combined Bone Marrow Aspirate, Lipoaspirate, and Platelet Rich Plasma Injections on Pain, Function, and Perceived Change Amongst Individuals with Severe Knee Osteoarthritis. Bio Ortho J. 2021;3(1).
8. Dyson-Hudson TA, Hogaboom NS, Nakamura R, Terry A, Malanga GA. Ultrasound-guided platelet-rich plasma injection for the treatment of recalcitrant rotator cuff disease in wheelchair users with spinal cord injury: A pilot study. J Spinal Cord Med. Jan 2022;45(1):42–48.
https://doi.org/10.1080/1079026 8.2020.1754676
9. Curtis KA, Drysdale GA, Lanza RD, Kolber M, Vitolo RS, West R. Shoulder pain in wheelchair users with tetraplegia and paraplegia. Arch Phys Med Rehabil. Apr 1999;80(4):453–457. https://doi.org/10.1016/s0003-9993(99)90285-x
10. Cheatham SW, Kolber MJ, Salamh PA, Hanney WJ. Rehabilitation of a partially torn distal triceps tendon after platelet rich plasma injection: a case report. Int J Sports Phys Ther. Jun 2013;8(3):290–9.
11. Pithadia P, Surya P, Tulpule S. Effect of platelet rich plasma therapy in conjunction with physical therapy for rotator cuff tendinopathy. Int J Rheumatol. 2021;16(7):216–220.
12. Khan KM, Scott A. Mechanotherapy: how physical therapists’ prescription of exercise promotes tissue repair. Br J Sports Med. Apr 2009;43(4):247–252. https://doi.org/10.1136/bjsm.2008.054239
13. Hirose L, Nosaka K, Newton M, et al. Changes in inflammatory mediators following eccentric exercise of the elbow flexors. Exerc Immunol Rev. 2004;10:75–90.
14. Ohberg L, Lorentzon R, Alfredson H. Eccentric training in patients with chronic Achilles tendinosis: normalised tendon structure and decreased thickness at follow up. Br J Sports Med. Feb 2004;38(1):8–11; discussion 11. https://doi.org/10.1136/bjsm.2001.000284
15. Hameed M, Toft AD, Pedersen BK, Harridge SD, Goldspink G. Effects of eccentric cycling exercise on IGF-I splice variant expression in the muscles of young and elderly people. Scand J Med Sci Sports. Aug 2008;18(4):447–452. https://doi.org/10.1111/j.1600-0838.2007.00714.x
16. Häkkinen K, Pakarinen A, Newton RU, Kraemer WJ. Acute hormone responses to heavy resistance lower and upper extremity exercise in young versus old men. Eur J Appl Physiol Occup Physiol. Mar 1998;77(4):312–319. https://doi.org/10.1007/s004210050339
17. Heinemeier KM, Olesen JL, Schjerling P, et al. Short-term strength training and the expression of myostatin and IGF-I isoforms in rat muscle and tendon: differential effects of specific contraction types. J Appl Physiol (1985). Feb 2007;102(2):573– 81. https://doi.org/10.1152/japplphysiol.00866.2006
18. Emmons R, Niemiro GM, De Lisio M. Exercise as an Adjuvant Therapy for Hematopoietic Stem Cell Mobilization. Stem Cells Int. 2016;2016:7131359. https://doi.org/10.1155/2016/7131359
19. Marycz K, Mierzejewska K, Śmieszek A, et al. Endurance Exercise Mobilizes Developmentally Early Stem Cells into Peripheral Blood and Increases Their Number in Bone Marrow: Implications for Tissue Regeneration. Stem Cells Int. 2016;2016:5756901. https://doi.org/10.1155/2016/5756901
20. Wardyn GG, Rennard SI, Brusnahan SK, et al. Effects of exercise on hematological parameters, circulating side population cells, and cytokines. Exp Hematol. Feb 2008;36(2):216–223. https://doi.org/10.1016/j. exphem.2007.10.003
21. Kolber MJ, Purita J, Paulus C, Carreno J, Hanney WJ. Platelet Rich Plasma: Postprocedural Considerations for the Sports Medicine Professional Strength Cond J. 2018; 40(5):95–107. https://doi.org/10.1519/ SSC.0000000000000403
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
Joseph Purita, PUR-FORM, Boca Raton, Florida
Dr Joseph Purita, M.D. is an orthopaedic surgeaon and medical director of Pur-Form at the Institute
William J. Hanney, University of Central Florida, School of Kinesiology & Physical Therapy, Orlando, FL
William J. hanney, DPT, PhD, is an associate professor in the Department of Physical Therapy at the University of Central Florida.