Hydrotherapy helps personal trainer get back on her feet

Something didn’t feel quite right in Irma Nieves-Torres’ left knee after weightlifting. She’d had surgery on that knee before, but this was different.

“When I was in the eighth grade, we discovered that my patella (kneecap) floats congenitally, meaning the back doesn’t land within the femur and tibia,” Irma explained. “I had patellofemoral syndrome reconstruction at that time where they took the ligaments and muscles from my tibia and used them like a band-aid to keep my kneecap from moving around.”

Irma Nieves-Torres

Irma didn’t experience any issues with her knee after the surgery in her teens. The Puerto Rico native went through high school and committed to strength training. She played college soccer for four years at Universidad Metropolitana de Puerto Rico and earned a bachelor’s degree in Exercise Science before moving to the Midwest to attend Kansas State.

“I stayed active, worked at a gym, practiced and competed in Olympic weightlifting and did some CrossFit for fun,” she said.

As a certified personal trainer with a master’s degree in kinesiology, Irma knew that she needed help to deal with the pain and swelling she developed. She turned to a physical therapist in Manhattan but after using therapy and dry needling without success, she sought out an orthopedic surgeon to help alleviate the pain. Scans showed that Irma didn’t have a meniscus tear as the team originally thought. It was worse. She had grade three degeneration in the knee, meaning that her knee was literally bone on bone.

“With that diagnosis, it was time for more aggressive treatment. My surgeon recommended a cartilage restoration procedure called MACI, so we did an initial scope to clean out the knee and harvest cartilage before scheduling a second procedure after Christmas,” Irma said.

Membrane Autologous Chondrocyte Implantation – or MACI for short – uses a patient’s own cells to regrow cartilage for use in knee repairs. It’s most commonly used for young adults and athletes with an acute injury to the cartilage, but it’s also used for patients whose cartilage develops improperly.

Long rehabilitation process

Hydroworx pool at the LMH Health West Campus

After knee surgery, life doesn’t generally go back to normal right off the bat. Irma was in for a long road of rehabilitation – one predicted to take up to 18 months – but she couldn’t just hit the ground running. Patients with injuries where weight-bearing activities are limited, such as stress fractures, or those with post-operative weight limitations, as in Irma’s case, may be good candidates for hydrotherapy. And for that, she turned to Dan Lorenz, sports medicine director at LMH Health Therapy Services, for help.

“The extent of Irma’s injury didn’t allow for her to do any weight-bearing activities because of the post-operative instructions. Our Hydroworx pool was the perfect solution,” Dan explained. “The water is far less compressive on the joint in terms of shear force. Having that environment meant we could still be mindful of the healing process and help improve her function through earlier weight-bearing activities.”

LMH Health Therapy Services at the West Campus is the only location in Lawrence to offer treatment using the Hydroworx 2000. As Irma had weight-bearing limitations, the warm water, adjustable depth, jets and treadmill allowed her to perform exercises in the water that she couldn’t on land. They began her therapy as soon as her incision closed.

“I jumped in and we started with walking. Having my patella realigned during the surgery really changed my gait. I also discovered that I had pronation, as well as tight and underactive muscles I didn’t know about,” Irma shared. “Using the pool helped me gain confidence. I became comfortable walking and got back to that heel-toe movement.”

After a bit of walking, Irma began strength training with exercises such as lunges and squats in the pool. She progressed to running, kicking and swimming. And when the time was right, the team turned on the jets, which provided more resistance while kicking. After about 12 weeks in the water, Irma was ready to get back to work on land.

“Dan and his team made the call when it was time for me to get back on land and into the gym setting,” she said. “I continued to work in a pool on my own with the knowledge that they provided. It built confidence and was reassuring for me to be able to jump in on my own and continue my rehab.”

Cutting-edge technology

Incorporating technology isn’t new to the team at LMH Health, it’s commonly used. Therapists at the West Campus have access to the Hydroworx pool, as well as other advanced technology.

• Isokinetic testing: One of only a few machines in the state of Kansas, this machine provides the most objective measure of joint function following injury or surgery to either the upper or lower extremities.
• Force plate testing: The newest addition to LMH Health is force plate technology from VALD Performance, the only location in the region boasting this technology for everyday athletes and orthopedic patients. The plates use sensors to detect differences in forces exerted onto the ground that therapists may not be able to see with the naked eye.

“LMH Health and OrthoKansas provide innovative treatments and therapies for people of all ages and abilities,” Dan said. “We have the providers, technology and facilities to provide healthcare that’s not only exceptional for a community hospital – it’s among the best anywhere.”

Looking to the future

As Irma nears the end of her rehab journey, she shares that she’s mostly back to normal. She experiences occasional swelling due to the long hours she spends on her feet as a personal trainer, but taking Tylenol or Advil, elevating her legs and using ice takes care of that.

“There’s still some stuff that occasionally feels funky, but I don’t have any pain. I may have some discomfort after I’ve done a little too much or stepped wrong, and I’m very aware of my walking because it’s been a change from the way I’ve done it for 25 years,” she explained.

Irma said that when looking for a physical therapy provider, it’s important to make sure they fit your needs. That makes the rehab process easier to get through. She learned more about Dan by reading his biography on the LMH Health website and knew he’d be the perfect therapist for her.

“There are a lot of dark times in your rehab. Your therapist is your person, so it’s important to build a rapport with them. Dan understood where I came from and that I wanted to get back to the best level I could again – 1% better every day,” she explained. “At LMH Health, you never feel like you’re just a patient. You know that you’re being well taken care of.”