+1 484-351-8050 info@hawkgrips.com

John is a 58-year-old, 5-foot-11, 220-pound retired correctional officer. He experiences left knee pain and range-of-motion (ROM) restrictions from past knee surgeries that have been unresolved by previous therapies. His medical history includes a left total-knee replacement (TKR) in November 2012, followed by another surgery in December 2012 due to a staph infection. Although he underwent physical therapy, it was limited due to pain and soft tissue restrictions around the scar matrix and into his left hip and lumbar spine (L/S).

knee replacement TKR HawkGrips IASTM extended flexed

These photos depict the patient’s left knee post-replacement in both extended (top) and flexed (bottom) position.

In February 2014, the patient had surgery to add a spacer in his left knee, only to undergo a second TKR on that knee in May 2014. John began physical therapy treatment shortly after this surgical intervention but it proved ineffective, again limited by pain and soft tissue restrictions. His left knee was also manipulated in October 2014, followed by physical therapy that produced little positive impact.

Since the last surgery, John remains active but has multiple compensatory patterns throughout his left knee and hip region, affecting his gait mechanics and L/S mobility. He has spent the past three years doing whatever he can to minimize his knee pain while refusing further surgical intervention. John is also skeptical about any physical therapy treatment, having tried three prior regimens without much success.

Presentation and Examination

He reports left knee pain anteriorly in the peripatellar region and along his 12-inch scar. His pain ranges from 0-7 out of 10 on the Visual Analogue Scale (VAS), and he describes it as achy, stabbing, sharp, and shooting. John states the pain is worse with stair negotiation, as well as with trying to stand and move after sitting for a prolonged period of time, only to be resolved by weight-bearing/walking for a longer period of time. He is right-side dominant and hasn’t had any recent diagnostic testing.

His physical examination demonstrates: mild temperature in the left knee region, minimal to moderate swelling, and varicose veins with bruising to the mid-left quadriceps musculature. No lateral lumbar shift, and no significant muscle-guarding during ambulation or transfers. The patient appears alert and oriented and is cooperative with exam and history-taking.

No significant tenderness to palpation of lower quadrant and sacroiliac joints. He presents with an increased L/S lordosis and thoracic spine (T/S) kyphosis with moderately poor posture. L/S AROM (active range of motion) is within normal limits, 2/6 hypomobility with posterior-anterior intervertebral mobilization (PAIVM) testing, and no crepitus or discomfort at end-range.

Hip AROM is within functional limits for his age-specific range, and strength rates 5/5 in manual muscle testing (MMT). Left is limited 0-65 degrees with moderate hamstring tightness and 15 degrees of knee flexion to complete the task. The patient demonstrates 3+/5 MMT abduction on the right, 0-30 degrees, 4/5 MMT on the left, 0-20 degrees, and gluteus medius deficiency 4-/5 MMT. Internal/external rotation is limited on the left due to poor knee mobility, extension 0-10 degrees with multiple compensatory patterns, and altered firing pattern between the hamstrings and gluteus maximus (3/5 MMT).

Knee AROM on the right is 0-125 degrees, 5/5 MMT, left AROM -10 to 81 degrees, and PROM (passive range of motion) -8 to 87 degrees with swelling. Abnormality is present in the scar region, with moderate to severe adhesion formation approximately 1/2-1 inch around his scar. Patellar mobility is limited L>R in all directions, lateral lying to the left. Gait mechanics are altered with knee valgus, hip varus, and bilateral ankle pronation with proximal instability on the left. Trunk rotation is altered bilaterally, with decreased weight-bearing on the left and a positive Trendelenburg sign. Negative neurological exam, normal pulses, with both dorsal pedal and posterior tibial pulses strong and regular.

knee replacement TKR HawkGrips IASTM scanner tongue depressor range of motion

Expert treatment with the HawkGrips HG8 “Scanner” (top) and HG9 “Tongue Depressor” (bottom) proved instrumental in restoring range of motion to the patient’s knee joint.

The treatment plan for John is to improve mobility throughout his L/S, hip, and knee; as well as improve gait mechanics, balance and kinesthetic sense; utilizing modalities, manual therapy, gait training, therapeutic exercise, and a comprehensive home exercise program. He is being treated two to three times a week for 8-12 weeks or until his goals are met. John has currently been seen for 12 visits, demonstrating the following treatment outcomes:

Visits 1-5

During this time period, treatment included modalities to the left knee to improve blood flow and initiate soft tissue mobility. Specifically, we utilized the HawkGrips HG8 (“Scanner”) and HG9 (“Tongue Depressor”) around the scar, working proximal to distal initially away from it, using a sweeping and then strumming stroke. The Scanner was applied around the quadriceps with the left knee supported at 30 degrees (resting position), progressing to end-range for the patient (87 degrees of knee flexion). We integrated manual therapy to improve L/S and hip mobility with joint mobilizations, and closed-kinetic-chain exercises for proximal stability (gluteus medius/maximus). Gait training was started to promote bilateral heel strike and stance time.

Results: Knee AROM improved -3 to 94 degrees, with decreased adhesion formation around the scar. Regarding gait mechanics, John demonstrated improved stance time bilaterally, 50-percent improvement in trunk rotation with reciprocal arm swing, straight leg raise on the left 0-70 degrees, and 9 degrees of knee flexion.

Visits 5-Present

This part of the treatment regimen included warm-up on the elliptical machine for 5 minutes followed by IASTM utilizing HawkGrips (HG8 and HG9) to the scar region in both a static and dynamic position. Statically in supine, full-knee flexion, per patient to 94 degrees of flexion using IASTM around the scar and surrounding tissues (quadriceps/medial collateral ligament/lateral collateral ligament region), including the Tongue Depressor over the patellar tendon. Began working into AROM, asking the patient at end-range knee flexion where he felt the limitation, and using HawkGrips instruments to work out the tissue in the area.

John progressed to riding the bike for 10 minutes, followed by the leg press/shuttle machine with HG8 treatment along the scar and to surrounding tissues throughout the movement. Clinical observations included negative skin check prior to treatment, petechiae forming throughout treatment, minimal swelling and no ecchymosis, with full patient education before and after all IASTM treatment. This was followed by the application of RockTape to sustain proper blood flow and mobility in the left knee.

Results: Currently the patient can actively flex his knee to 98 degrees and extend to -2 degrees, with improvements in gait mechanics and overall balance and transfer transitions. The scar matrix is decreasing, with minimal to no swelling in the area, as well as minimal adhesions (< 1/4 inch) around the scar (more proximally than distally). Gait mechanics include symmetrical trunk rotation, minimal left Trendelenburg, and improved bilateral heel strike.

Conclusion: Since his last surgery in 2014, John has progressed from 81 degrees to 98 degrees (a difference of 17 degrees over 12 visits), and can now ambulate with improved mechanics, better balance, and enhanced soft tissue mobility around his left scar. His physician is very happy with the results and has increasingly referred patients to us while specifically requesting that HawkGrips be utilized in treatment. For John to achieve such a high degree of AROM progression after three years, as well as make such significant gains in functional ability through soft tissue mobilization, is a testament to the importance of integrating HawkGrips into any plan of care.

Dr. Chris Capilli received his undergraduate degree in sports medicine from Canisius College, Buffalo, NY, followed by his master’s and doctoral degrees in physical therapy from D’Youville College, also in Buffalo. He completed his Fellowship in Manual Therapy at Daemen College, Buffalo. Dr. Capilli works for Arnot Health in Elmira, NY, and has been a practicing clinician for more than 10 years, working in a number of different settings but primarily outpatient orthopedic.

Combining IASTM with Chiropractic Care to Achieve Optimal Outcomes

chiropractic IASTM outcome Dr. Shannon Turek DC chiropractor HawkGripsAs a doctor of chiropractic, I see many patients who suffer from limited range of motion, whether it’s cervical, lumbar or even an extremity. When I examine a patient and identify limited mobility in an area, my treatment protocol will not only consist of a chiropractic spinal adjustment, but also instrument assisted soft tissue mobilization (IASTM) with a HawkGrips instrument, along with corrective exercises and stretches. HawkGrips instruments are great tools to utilize in combination with chiropractic spinal adjustments…

Los Angeles Dodgers Physical Therapist Dr. Steve Smith Praises HawkGrips as the Best IASTM Products on the Market

Los Angeles Dodgers Major League Baseball HawkGrips physical therapist Dr. Steve SmithMy name is Dr. Steve Smith and I’m a sports physical therapist and certified strength and conditioning specialist. I’ve been a member of the Los Angeles Dodgers organization since January 2012 and currently hold the position of major league physical therapist. Prior to joining the Dodgers, I earned a master’s degree from the The University of Maryland Department of Physical Therapy and Rehabilitation Science in 2002, followed by a doctoral degree in 2003. I spent the first several years of my career working as a staff…

IASTM: A Performance Enhancement Tool

The human skin is the the largest organ of the integumentary system. It is enriched with dense neurological tissue that permeates the entire body and provides a uniquely accessible means of influencing tone and function of underlying structures. Fascia and muscle generate and transfer kinetic energy in an environment by which functional movement relies on a combination of elastic recoil and eccentric control around a focal, multi-planar axis.

U.S. Navy Veteran Reveals How HawkGrips Helped Him Recover from Severe Musculoskeletal Dysfunction

HawkGrips IASTM VA San Diego Healthcare System Tyrone King Navy veteranI have a condition that the medical world calls “hallux valgus.” Also known as a bunion, it basically means a foot deformity. To put it mildly, I actually have extreme deformities. Over the years, the symptoms worsened and began to affect my ability to walk and run. My lower-extremity muscles were always tight and I felt no relief throughout the day. Soon, my knees became impacted as well and I blew out both, resulting in bilateral meniscal repairs. My hamstrings and quads would constantly get strained and the result was…

Vietnam Vet and Former POW Ralph Galati Praises the Healing Power of HawkGrips

Ralph Galati U.S. Senator John McCain World Affairs Council of Philadelphia Vietnam prisoner of warAs his F-4 Phantom jet fighter raced across the skies over North Vietnam, U.S. Air Force co-pilot Ralph Galati glimpsed a surface-to-air missile streaking menacingly toward him. Unable to evade this deadly projectile fired by enemy troops below, the Phantom shuddered from the explosive impact. It was February 16, 1972, and the Vietnam War had been raging for nearly seven years. The most controversial conflict in the history of the United States, it would eventually claim the lives of nearly 60,000 American servicemen…

How to Treat Lymphedema with HawkGrips

lymphedema lymph nodes cancer treatment swelling extremity HawkGrips IASTMLymph is responsible for transporting essential immune cells throughout the body. When lymph becomes stagnant, it causes swelling of affected tissues, which leads to pain and dysfunction. This condition called lymphedema causes the affected skin and subcutaneous tissues to become inflamed and hardened, or fibrotic. Typically, treatment includes manual lymph drainage, a specialized hands-on technique that stimulates superficial lymph vessels to move. Instrument assisted soft tissue mobilization (IASTM) has been proposed to…

Be the first to know.

Find out the latest news, and take advantage of limited deals, specials and discounts. 

You are officially connected! Just confirm your email, and you'll get your first reward.

This Area is Widget-Ready

You can place here any widget you want!

You can also display any layout saved in Divi Library.

Let’s try with contact form: