Back to Living: A physical therapy story

Physical therapist Scott Ruta (David Reese photo)

Whitefish physical therapist Scott Ruta

By DAVE REESE, Montana Health Journal

Wendell Smith can get back to living the life he did 20 years ago, with help of a new hip and knee.

Smith used to run 20,000 miles a year, back in the 1980s. Even in the last few years he racked up 200 miles a week on his mountain bike and put in 1,000 kilometers a week on crosscountry skis at Whitefish Lake Golf Course.
All that punishment finally took its toll, and in April 2011 he received a new knee replacement by orthopedic surgeon Dr. Larry Iwersen. Smith is perhaps a poster child for the revolution in hip and knee replacement surgery. An older, active man who punished his body with hard-pounding exercises and recreation for decades now gets a reprieve from the arthritic pain that all that activity caused.

Like the aggressive lifestyle that he has led, he chose a physical therapist who would get him back in action as quickly as possible after the knee replacement. That person was Scott Ruta, a physical therapist at Whitefish Sport Center.
“He’s aggressive and competent and will push you to the limit to get what you need back,” Smith said.
Now less than a year after his surgery, Smith said he’s almost back to 100 percent of his knee strength and mobility. “It’s way better than it was,” he said. “I should have had it done a few years ago.”

Delaying the surgery and compensating for the pain in his knee caused Smith to develop hip problems. So he had a hip replaced also.
Getting back to his active lifestyle took a solid regimen of exercises on his own, but also with the help of Ruta. “If you don’t do it on your own, it’s not going to happen,” Smith said. “But physical therapy has helped tremendously.”
Rehabilitating his hip took longer. After hip replacement he was not ordered by his doctor to do physical therapy. But Smith chose to seek Ruta’s help for that also. “Now my hip is starting to come around,” he said.
There are several competent orthopedic surgeons in the Flathead Valley who can perform hip or knee replacements. For Smith, he chose someone he could trust.

“You just have to find someone that you respect and have confidence in,” he said. “There are many here who can do the replacements … it’s a matter of you feeling right.”
Ruta is an advocate of physical therapy prior to surgery also. By preparing your body prior to surgery, the chances of a faster rehabilitation post-surgery are much greater, Ruta said. “Prior to surgery there is already pain in the joint, but there are exercises you can do before surgery that produce better and quicker outcomes after the surgery,” Ruta said. One to three appointments would suffice for pre-operation physical therapy, Ruta said. Visiting with a physical therapist before surgery also helps educate the patient what to expect when they come out of the operating room.
People with stiff or inflamed joints would benefit from physical therapy before surgery, Ruta said.

The goal of knee or hip replacement physical therapy after surgery is to initiate muscle strengthening and gain range of motion as fast as you can, Ruta said.
The body’s tendency is to tighten up muscles that are impacted during surgery, so Ruta helps patients recover their range of motion through a variety of exercises and stretches. For knee replacements, a simple stationary bicycle can work wonders in getting range of motion back, Ruta said. “There are a lot of those bicycles sitting in people’s basements and garages, and it’s a perfect exercise for you to do at home when you’re not in physical therapy,” Ruta said.
Although a patient could do many of these exercises on their own, Ruta said sometimes a physical therapist will help push a person past a low pain threshold and into recovery mode. “A person getting a hip or knee replacement goes into surgery weak. Then they have this traumatic surgery which causes pain, and that shuts off the muscles,” Ruta said. “We need to turn those muscles back on again.”
Once the patient understands the exercise and stretching concepts, they can do those on their own at home.

Because of the way hips have to be put in, there is more rest between surgery and physical therapy. The first four to six weeks after surgery is just letting the tissue heal.
Ruta is now seeing younger people getting hip replacements, as technology has improved. It used to be that physicians would advocate waiting as long as possible for a hip or knee replacement because the components did not last as long as they do now, Ruta said. “The technology is better so we can get replacements at a younger age,” he said.

When the patient is ready after hip surgery, Ruta begins a regimen of strengthening their gluteal muscles to help support the new hip.
When is the right time to think about a hip or knee replacement?
Ruta said to ask yourself these questions: Is this pain interfering with your life? Are you unable perform the activities you would like to, in order to live a healthy, fulfilling life? If you can answer yes to those types of questions, Ruta said, “That’s the time to go talk to an orthopedic doctor. And you’ll know when you’re ready.”