Spine CPM Unit

Spinal CPM

 

Following a Total Knee Replacement, many surgeons will immediately place their patient's leg into a CPM or Continuous Passive Motion Unit in order to 'get the knee moving' so that functional range of motion may be reached as soon as possible.  Some surgeons are advocates of the CPM, while others avoid it.  As it is very common to see a knee or even a shoulder CPM unit, for me years ago it was not so common to see a Spine CPM unit.  However, the clinic I had worked for purchased one for more than $50,000 and used it for many of the patients suffering from lower back pain.  I initially used it but did not notice much of an improvement in my patients' progress.  Many of them actually felt worse.  As I studied more about treating lower back pain, I learned that although many of these patients have limited trunk range of motion, my goal should be to stabilize and strengthen their spine in the neutral position, while maximizing hip and knee mobility, rather than attempting to maximize their spinal flexibility.  Once the patient has progressed through stabilization and into endurance and strength training, then trunk flexibility may be focused on.  However, this is not the main focus and many studies even show that increasing spinal flexibility does not predict whether a patient will or will not have recurring back trouble.  My take home message is that for clients suffering from lower back pain, I must first work on trunk stabilization in the neutral position, and not be so concerned about their spinal flexibility. 

 

Check out this video on the Spine Six Biomotion Unit and let me know if you have had successful or unsuccessful experiences with it: Spine Six Biomotion.  You may also recognize the picture below, which is similar in concept, but was being sold to households.

CPM Unit following a Total Knee Replacement

CPM Unit Set-Up Following a Total Knee Replacement

 

 

Many times, immediately following a Total Knee Replacement surgery, a patient will wake up to find their surgical leg in a contraption that bends and straightens their knee.  This unit is called a C.P.M. or Continuous Passive Motion unit.  Some doctors strongly believe in its utility, while others are against it.  I have found that the doctors who oppose the use of the CPM unit feel this way because many times the unit is set up incorrectly, and this may cause more harm than good.  The purpose of the CPM is to bend and straighten the operative knee as much as the patient can tolerate in order to maximize their rehabilitation potential.  It is advised to use the unit 6-8 hours a day and to increase the flexion range of motion 5-10 degrees each day.  The initial goal following a Total Knee Replacement is full knee extension (full straight), while flexion takes a bit more time.  The goal range of motion of the knee is 0-135 degrees or symmetry between both knees.  For function, usually 0-117 degrees is needed.  For walking, 0-60 degrees is necessary.  Below is what a CPM looks like and how it should be set up.

 

 

Some points on the set up:

1.  Avoid direct contact between the skin and the metal parts of the unit.  Make sure the wool covers all areas that your leg will touch

2. Your foot should rest flat on the foot rest.  The length of the lower leg portion can be adjusted to guarantee this.

3.  Try to set it up so that your hip is not abducted out to the side but is in a more neutral position (foot in line with your hip)

4.  The hinge on the middle portion of the unit should line up with the center of your knee joint to allow smooth flexion/extension motion

5.  For this to be set up properly, the upper thigh section of the unit  has to be positioned very close to your hip.  You will practically be sitting on it.

6.  Make sure when the unit is bending your knee, that your knee and toes are pointing up to the ceiling.  You do not want any rotation of the hip.

7.  Use a tibial (lower leg) strap and/or thigh strap to maintain proper position

 

Following use of the CPM, make sure to use ice on your knee.

 

For more information on Total Knee Replacement Rehabilitation, go to www.strengthondemand.com