The Benefits of Integrative Manual Therapy on Infection at the Knee Post-Op
Author: Maxine E. Marak
Abstract: The patient portrayed in this case study was a 52-year-old woman who had undergone several knee surgeries to repair a tear of the right anterior cruciate and medial collateral ligaments. Upon intake, the woman was experiencing recurrent infection at the knee secondary to a slow-healing graft site following the most recent surgery at the knee. The patient’s doctor had referred her to Physical Therapy to prepare her for another surgery at the knee. The woman was treated with Integrative Manual Therapy (IMT), focusing on the right knee joint. After several sessions of IMT were completed, the woman went for knee surgery. Following surgery, the woman stated that she was surprised at how quickly the surgery site was healing. She was treated post-op to facilitate healing at the knee. Four weeks after her surgery, the knee was completely healed with now signs of infection or breakdown of the joint tissues.
Key Words: Infection, Knee, Ligament Tear, Staphylococcus, Bone Bruise
History
The client is a 52 year old female who was initially seen on the evening of August 13th, 1999 for a draining open wound of approximately 1" x 1" over the right patella which was the result of tripping over her sweeper. The client reported that she had undergone surgical repair of the same area for a torn right anterior cruciate and medial collateral ligament in 1984. The initial suture line did not close properly and an opening the size of the end of a q-tip remained. The client underwent a series of three surgical skin grafts in an attempt to repair the area. The last of these surgeries, a rotational graft, required intermittent treatment with antibiotics and continuous packing of an open pocket under the graft site until the wound finally closed two years later. She attributes her experience of prolonged and difficult healing for any type of infection and/or wound to Systemic Lupus Erythematosus with which she was diagnosed thirty-three years ago. She has been treated with Prednisone almost exclusively since her diagnosis.
She had seen her surgeon that morning and was scheduled for surgical closure of the area at noon the next day (August 14th, 1999). The surgeon cultured the wound at the client’s request because she believed the drainage could be from infection even though the surgeon felt that the drainage was just bursal fluid [Addendum 1]. The client requested that I check her wound and do any techniques that might be beneficial in preparing her for surgery.
Pre-op Treatment
I treated the client for two hours with Resistance Therapy to Immune Deficiency Motility1 at the following sites: injury site; spleen; kidneys; bladder; and ureters. She was also treated for multiple Disruptions of Membrane Techniques1 and the Bone Bruise technique2 to the organs and the surrounding areas.
Surgery was performed the next day [Addendum 2] with the client receiving an additional two hours of Integrative Manual Therapysm immediately following surgery. Treatment consisted of the Bone Bruise technique2, Immune Deficiency Motility1 and Disruption of Membrane Technique1 to the surgery site. The client was treated the following day for two hours using the same techniques.
Follow-up
Ancef, a broad-spectrum antibiotic [Addendum 4], was prescribed following the surgery. The surgeon received the initial culture result on August 18th, 1999 [Addendum 1], which showed the presence of 3+ Coagulase Negative Staph, a methicillin resistant staphylococcus uniformly resistant to Ancef.3 He then changed the antibiotic to Vancomycin and ordered a second culture. The second culture showed no growth [Addendum 3] and a third culture was ordered [Addendum 3].
Post-op Treatment
I saw the client four weeks post-op and the surgical site appeared to be totally healed with no signs of infection or breakdown. She expressed surprise that the knee had healed so quickly without complication considering her past history.
References
1. Giammatteo, Thomas, D.C.; Weiselfish-Giammatteo, Sharon, PhD., P.T., Visceral Mobilization with Muscle Energy and ‘Beyond’ Technique: The Gastrointestinal Tract, DCR, CT, 1998.
2. Giammatteo, Thomas, D.C.; Weiselfish-Giammatteo, Sharon, PhD., P.T., The Cranial Therapy Series: Course Three, DCR, CT, 1998.
3. Physician’s Desk Reference. Medical Economics Co. Inc: New Jersey, 1999.