For a patient with SMA to be able to function with their maximal amount of independence, it is important to have as much range of motion possible. As with the majority patients with SMA, my current patient with SMA spends most of his time in his wheelchair. Therefore, he has contractures in his knees and ankles, causing him to lack range of motion in those joints. He also has not used footrests on his wheelchair in many years secondary to limitations with things such as sitting close to a table. This has caused him to have decreased dorsiflexion of both his ankles.
We have begun to work every other week on increasing his range of motion in his knees and ankles by passively stretching him out reclined on a table and re measure once a month to track our progress. We start by stretching out his hamstring by pushing his knees into extension and holding for approximately ten seconds and then relaxing. We repeat this motion about twenty times throughout the treatment. We alternate between knee and ankle passive range of motion. We have found that the most effective way to stretch out his ankles to increase dorsiflexion is to flex his knee and bring his foot towards his bottom, pushing down on his knee to approximate the heel to the table. Some weeks we were able to push into more dorsiflexion that others secondary to increased swelling in his ankles.
Please see the following tables for measurements of PROM knee extension and PROM dorsiflexion.
| PROM L knee extension | PROM R knee extension | |
| 04/19/19 | -18o | -21o |
| 03/13/19 | -20o | -23o |
| 02/12/19 | -23o | -23o |
| 01/15/19 | -23o | -25o |
| 12/18/18 | -23o | -26o |
| 11/20/18 | -21o | -27o |
| 10/30/18 | -27o | -40o |
| PROM L dorsiflexion | PROM R dorsiflexion | |
| 04/19/19 | -30o | -37o |
| 03/13/19 | -30o | -28o |
| 02/12/19 | -26o | -27o |
| 01/15/19 | -29o | -28o |
| 12/18/18 | -25o | -27o |
| 11/20/18 | -19o | -26o |
| 10/30/18 | -34o | -28o |
As you can see, the ankle measurements haven’t improved as much as his knee passive range of motion has. One reason that could be causing this was the amount of swelling this patient was struggling with in his ankles. This patient has recently started taking diuretics, so we may begin to see improvements from this. It is also important to reinforce the importance of wearing compression stockings and properly elevating legs to decrease swelling in lower extremities.
We have discussed continuing some of these stretches that don’t require skilled physical therapy at home since stretching for one hour once every two weeks doesn’t have a huge effect on his joints and muscles. It is important that he keep up with his home exercise program to see the maximum benefits and improve range of motion.
Emily graduated from University of Texas at Arlington in December 2014 with her bachelors degree in Exercise Science. She then attended Tarrant County College and became board certified Physical Therapist Assistant in July 2017. Currently, she works as a PTA in an outpatient setting in Irving, Texas, working with a variety of patients from orthopedic injuries to those with neurological disorders.
How about knee surgery
Wardell – Thank you for your question. My name is Michael Morale and I’m the one featured in this article. First, I want to apologize for taking so long to respond to your question. I was never notified that there were questions and responses, so I promise in the future to respond in a more timely manner. Regarding your question about knee surgery, I’m not sure if you are asking this question for me, or for you. For me, I’ve been in a wheelchair for nearly 54 years due to spinal muscular atrophy. My physical therapists transfer me from my wheelchair to the therapy table every other week, and we work on stretching and range of motion exercises on my hips, knees, legs, ankles and feet. About 30 years ago, I was in a car accident and shattered my left knee cap. The orthopedic surgeon that I went to refuse to do surgery because he said that this was a non-weight bearing joint. He was afraid that if he did orthoscopic surgery to repair the damage, he was afraid that he would break a blood clot and calls further damage and even death. Since surgery was out of the question back then, and given the fact that I’ve been in a wheelchair for his many years as I have, surgery on my knees would be very difficult for me to recover from because it would be difficult for me to rehab. I have found that physical therapy has helped to eliminate much of the discomfort that I go through on a day-to-day basis.
If this question was for you, I would recommend that you speak with your doctor about doing physical therapy. If they give you permission to take physical therapy, I would try to locate a physical therapist that lives in your area and consult with them. They probably would have some exercises that could help eliminate some of the pain, depending on how much damage you have in your knees.
Again, thank you for your question and please feel free to respond back if you have any further questions or comments.
I have arthritis in my knee and hip it’s hard for me to walk will this help me
Pamela – Thank you for your message. My name is Michael Morale, and I’m the one featured in this article. First, I want to apologize for taking so long to respond to your question. For some reason, I was never notified that there were 2 questions, so I promise to respond in a more timely manner for any future questions or comments. While I don’t have arthritis in my knees and hips, I do have severe muscle damage in my right hip, caused by sitting in a wheelchair for nearly 54 years. When my physical therapist and her assistant transfer me from my wheelchair to the therapy table, they work on stretching and range of motion in my hips, legs, knees, ankles and feet. Sitting for as many hours as I do per day, I have quite a bit of atrophy in my bones, so stretching and range of motion exercises have definitely helped me. I don’t want to give you any medical advice regarding whether or not these exercises would help you, but I would talk to your doctor first and asked them if exercising your hips and knees would help, and if they tell you yes, then I would contact a physical therapist that lives in your area and consult with them. I really don’t know a lot about arthritis, but I know my father had to have both of his knees replaced due to arthritis.
Thank you for taking time out of your day to read the articles and thank you again for your question. I hope that I have helped in some way. If you have any further questions or concerns, please feel free to respond back.