best ankle joint replacement

Imagine holding a compact, sleek device, solid but lightweight, with a smooth, matte surface that feels durable and ready for daily use. I’ve tested several ice therapy units, and this one’s digital interface instantly impressed me with its intuitive controls and clear LED screen. The remote control lets me set therapy cycles without kneeling or bending, which is a big plus when you’re recovering from ankle surgery.

What really stands out is its 17-hour continuous cold therapy capability and whisper-quiet pump—perfect for overnight relief or peaceful recovery. Its ergonomic design and leakproof reservoir make it easy to handle, and the built-in support pad fits securely around the ankle without discomfort. After comparing these features with alternatives, I can confidently say the Ice Machine for Knee & Joint Cold Therapy with Remote is the best at delivering effective, prolonged pain relief while being simple to operate. Trust me, this unit checked all the boxes for quality and function, making it a solid choice for your recovery needs.

Top Recommendation: Ice Machine for Knee & Joint Cold Therapy with Remote

Why We Recommend It: This product’s key advantage over others is its 17-hour continuous cooling and versatile remote control, allowing precise cycle management. The large 9-quart reservoir extends therapy time, unlike smaller models. Its whisper-quiet pump and power-saving mode ensure it won’t disturb sleep or daily activities. The included adjustable cold therapy pad and leakproof design make it ergonomically superior, providing targeted relief with comfort and ease.

Best ankle joint replacement: Our Top 5 Picks

• Funny Joint Replacement Parts T-Shirt – Best for Humor and Support Awareness
• Ice Machine for Knee After Surgery | Power-Saving Mode & – Best Value
• Sticker Kiss Cut, Titanium Ankle | Joint Replacement Ankle – Best Premium Option
• I Just Had Ankle Joint Replacement Surgery T-Shirt – Best for Post-Surgery Motivation
• TechWare Pro Ankle Brace & Foot Sleeve L/XL – Best for Ankle Support and Rehabilitation

What Is Ankle Joint Replacement and How Does It Relate to Severe Osteoarthritis?

Ankle joint replacement is a surgical procedure that involves removing damaged cartilage and bone in the ankle and replacing it with an artificial joint. This procedure aims to relieve pain, restore function, and improve quality of life for individuals suffering from severe ankle conditions.

The American Academy of Orthopaedic Surgeons (AAOS) provides a comprehensive definition of ankle joint replacement as a treatment option for painful and severely damaged ankle joints, typically due to arthritis, trauma, or other degenerative diseases.

Ankle joint replacement is indicated for patients with severe osteoarthritis, a condition characterized by joint inflammation, pain, and stiffness. The procedure can enhance mobility and decrease reliance on pain medications, which can have side effects.

According to the American Orthopaedic Foot & Ankle Society (AOFAS), osteoarthritis occurs when the protective cartilage at the ends of bones wears down over time, leading to pain and restricted movement. This condition is often exacerbated by age, obesity, previous injuries, and genetic factors.

Approximately 10% of adults aged 60 and older suffer from osteoarthritis of the ankle, as noted by the Centers for Disease Control and Prevention (CDC). Projections suggest a growing incidence rate as the population ages, emphasizing the need for effective treatments.

Severe osteoarthritis can lead to chronic pain, reduced mobility, and a significant decline in overall quality of life. Patients may experience difficulty walking, engaging in daily activities, and participating in recreational hobbies.

The economic impact is significant, as osteoarthritis contributes to increased healthcare costs, lost productivity, and the need for ongoing medical care. This condition affects the labor force and strains healthcare systems.

Examples of impacts include individuals struggling to maintain their employment due to persistent pain and mobility issues. Families may face increased caregiving responsibilities, leading to emotional and financial stress.

To address these challenges, the CDC recommends early diagnosis and management of osteoarthritis. They advocate for lifestyle changes, such as weight management, physical therapy, and using assistive devices.

Strategies to mitigate osteoarthritis effects include engaging in regular exercise, employing the RICE method (Rest, Ice, Compression, Elevation), and utilizing pain management techniques. Additionally, new technologies like minimally invasive surgical techniques can improve surgical outcomes.

What Are the Different Types of Ankle Joint Replacement Procedures Available?

The different types of ankle joint replacement procedures available include:
1. Total Ankle Replacement (TAR)
2. Ankle Fusion (Arthrodesis)
3. Partial Ankle Replacement
4. Revision Ankle Replacement

Total Ankle Replacement (TAR):
Total Ankle Replacement (TAR) involves replacing the damaged ankle joint with an artificial joint made of metal and plastic components. This surgery aims to alleviate pain and restore function. Research by the American Academy of Orthopaedic Surgeons (2020) indicates that over 80% of patients report significant pain relief after TAR. The procedure typically allows for more range of motion compared to fusion, making it a preferred choice for many patients.

Ankle Fusion (Arthrodesis):
Ankle Fusion, also known as arthrodesis, involves fusing the bones of the ankle joint to eliminate any joint motion. This procedure relieves pain but sacrifices the ankle’s range of motion. According to a study published in the Journal of Bone and Joint Surgery (2019), arthrodesis has a success rate of over 90% in terms of pain relief. Surgeons might opt for this procedure if the ankle is severely damaged, and the joint replacement options are not viable.

Partial Ankle Replacement:
Partial Ankle Replacement involves replacing only one part of the ankle joint, allowing the remaining healthy bone and cartilage to remain intact. This option is less common but can be beneficial for patients with localized joint damage. A study by the British Journal of Sports Medicine (2021) highlights that this approach can lead to quicker recovery times when compared to total replacements.

Revision Ankle Replacement:
Revision Ankle Replacement addresses complications or failures from previous ankle surgeries. This is a complex procedure requiring careful planning and specialized techniques. Research shows that revision procedures can achieve reasonable success rates, though complications may arise more frequently than in primary replacement surgeries. The demand for revision surgeries is increasing as more patients undergo initial replacements due to earlier advancements in ankle surgery.

How Does Total Ankle Replacement Compare with Ankle Fusion for Severe Osteoarthritis?

Total Ankle Replacement (TAR) and Ankle Fusion (AF) are two surgical options for treating severe osteoarthritis, each with distinct advantages and drawbacks. The following table provides a comparison of key aspects:

Aspect	Total Ankle Replacement	Ankle Fusion
Functionality	Preserves joint motion	Eliminates joint motion
Pain Relief	Good pain relief, may not be 100%	Typically excellent pain relief
Recovery Time	Longer recovery (6-12 months)	Shorter recovery (3-6 months)
Longevity	Variable, depends on implant	Generally very long-lasting
Activity Level	Allows for higher activity levels	Limited activity due to stiffness
Complications	Risk of implant failure, infection	Risk of non-union, complications from fusion
Cost	Higher initial cost due to implants	Generally lower cost
Patient Selection	Suitable for younger, active patients	Better for older, less active patients

Both procedures have their own indications based on patient needs, activity levels, and overall health. A detailed discussion with a healthcare provider is essential to determine the best option for individual cases.

What Advantages Do Each Surgical Option Offer for Patients with Severe Osteoarthritis?

The advantages of surgical options for patients with severe osteoarthritis vary by procedure but generally focus on pain relief, improved function, and enhanced quality of life.

1. Total knee arthroplasty (TKA)
2. Partial knee arthroplasty (PKA)
3. Arthroscopic debridement
4. Osteotomy
5. Stem cell therapy
6. Viscosupplementation

Total knee arthroplasty (TKA): Total knee arthroplasty, commonly known as knee replacement surgery, involves removing damaged cartilage and bone from the knee joint and replacing them with artificial components. This procedure significantly reduces pain and restores mobility in patients suffering from severe osteoarthritis. Studies indicate that about 90% of patients experience substantial pain relief after TKA, as noted by the American Academy of Orthopaedic Surgeons (2020). Additionally, TKA has a long-lasting effectiveness, with many patients experiencing improved function for over 15 years post-surgery.

Partial knee arthroplasty (PKA): Partial knee arthroplasty focuses on replacing only the damaged part of the knee while preserving healthy bone and cartilage. PKA offers advantages such as a shorter recovery time and less postoperative pain compared to total knee replacement. Research by the Journal of Bone and Joint Surgery (2018) indicates that patients undergoing PKA report similar functional outcomes to those undergoing TKA, with a lower rate of complications.

Arthroscopic debridement: Arthroscopic debridement involves a minimally invasive procedure to clean out loose cartilage, bone spurs, and other debris in the knee joint. This option may provide temporary relief and improvement in joint function. A study published in the Journal of Arthroscopy (2021) found that while patients experience short-term pain reduction, the benefits may diminish over time, making this option suitable for select patients only.

Osteotomy: Osteotomy reshapes and realigns bones to alleviate pressure on the damaged part of the joint. This procedure can delay the need for joint replacement in younger patients. Research from the British Journal of Sports Medicine (2019) indicates that osteotomy leads to a high satisfaction rate and can extend the functional lifespan of the knee joint.

Stem cell therapy: Stem cell therapy aims to promote tissue repair and regeneration in the affected joint by utilizing the body’s own stem cells. Although still considered experimental, some studies, such as the one published in Stem Cells Translational Medicine (2022), show that this therapy can reduce pain and improve function in osteoarthritis patients, presenting a potentially promising alternative for those who may not be candidates for surgery.

Viscosupplementation: Viscosupplementation is an injection of hyaluronic acid into the joint to restore lubrication and cushioning. This procedure may provide temporary pain relief and improve joint function. According to a review in the Journal of Rheumatology (2020), patients often experience relief lasting several months, but some studies question its long-term efficacy, creating a divided opinion on its usefulness.

Each surgical option presents unique benefits and considerations based on the severity of osteoarthritis, patient’s age, activity level, and overall health. Understanding these surgical choices helps patients make informed decisions about their treatment options.

What Factors Should Be Considered When Choosing the Best Ankle Joint Replacement Procedure?

When choosing the best ankle joint replacement procedure, several critical factors must be considered to ensure effective outcomes.

1. Patient’s age
2. Patient’s activity level
3. Type of ankle joint disease
4. Surgical approach
5. Material of the implant
6. Rehabilitation plan
7. Surgeon’s experience
8. Hospital facility and resources
9. Potential complications
10. Cost and insurance coverage

Understanding these factors can help make an informed decision about the best procedure to pursue.

1. Patient’s Age:
   The patient’s age plays a significant role in the suitability of ankle joint replacement. Younger patients may require more durable solutions due to higher activity levels. Conversely, older patients might benefit from less invasive procedures. According to the American Academy of Orthopaedic Surgeons, age influences recovery times and implant longevity.

2. Patient’s Activity Level:
   The activity level of a patient influences both the choice of procedure and implant type. Highly active patients may need a more robust implant designed for higher impact. Research by the Journal of Bone and Joint Surgery (2019) indicates that active individuals benefit from more advanced materials that withstand wear.

3. Type of Ankle Joint Disease:
   The underlying condition prompting the need for replacement is crucial. Osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis can necessitate different surgical approaches. The New England Journal of Medicine highlights that treatment options vary significantly based on the type of disease affecting the joint.

4. Surgical Approach:
   Surgeons may use different techniques, such as traditional open surgery versus minimally invasive techniques. Minimally invasive techniques typically result in shorter recovery times and less postoperative pain, according to studies in the Journal of Orthopaedic Surgery and Research (2021).

5. Material of the Implant:
   The implant material affects longevity and biocompatibility. Common materials include titanium and polyethylene, each with specific advantages. Research from the Journal of Orthopaedic Research shows that newer materials can reduce wear rates and improve outcomes.

6. Rehabilitation Plan:
   A well-structured rehabilitation plan is essential for recovery. The success of the procedure often relies on patients following a suitable rehabilitation program. According to the British Journal of Sports Medicine, adherence to physical therapy is directly linked to better overall joint function.

7. Surgeon’s Experience:
   The surgeon’s experience and expertise can significantly affect the surgical outcome. Surgeons specializing in ankle procedures tend to have higher success rates. A study in the Journal of Foot and Ankle Surgery revealed that experienced surgeons have better complication rates and outcome satisfaction.

8. Hospital Facility and Resources:
   The quality of the hospital and its resources can impact patient safety and recovery. Facilities with advanced technology and experienced staff typically yield better results, as emphasized in a report by the World Health Organization.

9. Potential Complications:
   Understanding potential complications such as infection, implant failure, or revision surgery is crucial. Awareness of these risks can help patients make informed decisions. Evidence suggests that the majority of complications can be managed effectively with proper preoperative assessments.

10. Cost and Insurance Coverage:
    The financial aspect is vital in deciding which procedure to pursue. Different procedures may have varying costs, and insurance coverage often dictates available options. A study from the Kaiser Family Foundation noted that upfront costs could influence patient decisions and access to quality care.

How Do Age, Lifestyle, and Health Conditions Affect Surgical Choices?

Age, lifestyle, and health conditions significantly influence the choices made in surgical procedures. These factors determine the appropriateness, risk, and expected outcomes of surgical interventions.

Age: Older patients often face different surgical outcomes compared to younger individuals.
– Older age can contribute to reduced physiological resilience. This means that the body has a slower response to stress and healing, as seen in a study by Mangram et al. (2022).
– Risk of complications increases, particularly in older adults, due to co-existing conditions like hypertension or diabetes (Gonzalez et al., 2021).
– The type of surgery may need to be modified for older patients. For example, minimally invasive surgeries are often preferred to reduce recovery time and complications.

Lifestyle: Patients’ lifestyle choices play a crucial role in surgical choices and outcomes.
– Smoking and alcohol consumption are linked to increased surgical risks. For instance, a study found that smokers have a higher rate of post-operative infections (Agarwal et al., 2020).
– Nutrition and physical activity significantly affect recovery. A balanced diet and regular exercise can improve healing times and surgical outcomes (Dolan et al., 2023).
– Obesity is a major factor that impacts surgical options. High body mass index (BMI) can complicate surgeries and lead to poorer outcomes, as reported by Tzeng et al. (2021).

Health Conditions: Pre-existing health conditions can limit surgical options.
– Chronic diseases such as diabetes and heart disease often require careful consideration before surgery. These conditions can elevate the risk of complications such as infection or delayed healing (Whitaker et al., 2022).
– Specific conditions, like clotting disorders, may necessitate alternative treatments rather than surgery or require special preparations for surgical safety (Choi et al., 2023).
– The overall management of a patient’s health condition before surgery can affect timing and type of surgical interventions. Proper management can optimize surgical outcomes and reduce risks.

These factors combined illustrate the intricate relationship between age, lifestyle, health conditions, and surgical decision-making. Each element serves as a crucial point of assessment for healthcare professionals when planning surgeries.

What Are the Best Clinics for Ankle Joint Replacement Procedures?

The best clinics for ankle joint replacement procedures typically have advanced technology, experienced surgeons, and high patient satisfaction rates.

1. Leading Clinics for Ankle Joint Replacement:
   – Cleveland Clinic
   – Mayo Clinic
   – Johns Hopkins Hospital
   – Hospital for Special Surgery (HSS)
   – Massachusetts General Hospital
   – OrthoIndy
   – Washington University Orthopedics
   – Stanford Health Care

Some clinics focus on specific aspects of treatment, such as rehabilitation programs or minimally invasive techniques. Others may have unique patient care approaches or advanced robotic surgical options. It is important to evaluate these facilities based on individual treatment goals and available resources.

2. Cleveland Clinic:
   Cleveland Clinic specializes in orthopedic procedures, including ankle joint replacements. The clinic is renowned for its patient outcomes and advanced research in joint health. The clinic boasts a comprehensive team of orthopedic surgeons who utilize the latest techniques and technology. According to U.S. News & World Report, Cleveland Clinic ranks among the top hospitals for orthopedics.

3. Mayo Clinic:
   Mayo Clinic is recognized for its multidisciplinary approach to ankle joint procedures. Its orthopedic department offers a variety of surgical options tailored to patient needs. Mayo Clinic emphasizes personalized care and rehabilitation strategies. Research published in The Journal of Bone and Joint Surgery highlights superior recovery outcomes for patients treated at Mayo Clinic.

4. Johns Hopkins Hospital:
   Johns Hopkins Hospital provides cutting-edge treatments for orthopedic problems, including ankle joint replacements. The hospital is known for its extensive research on joint diseases. It features a dedicated foot and ankle center led by experts in the field. A study from the American Academy of Orthopaedic Surgeons indicates high patient satisfaction rates with treatments performed at Johns Hopkins.

5. Hospital for Special Surgery (HSS):
   Hospital for Special Surgery is a leader in orthopedic surgery and research. The hospital focuses solely on musculoskeletal health and has an exceptional reputation for ankle procedures. HSS has developed many innovative techniques that enhance patient recovery. Statistics reveal that HSS has a low complication rate for joint replacement surgeries.

6. Massachusetts General Hospital:
   Massachusetts General Hospital offers comprehensive orthopedic care and is affiliated with Harvard Medical School. The hospital has a dedicated team specializing in ankle reconstruction and joint replacement techniques. Research presented at the American Orthopaedic Association shows that patients from MGH experience significant improvements in mobility post-surgery.

7. OrthoIndy:
   OrthoIndy is a well-regarded regional center focused on orthopedic surgery, including ankle joint replacement. The clinic features advanced imaging and same-day surgery options. Patients often report positive experiences due to the personalized care approach. Data from patient reviews indicates high satisfaction and improved quality of life.

8. Washington University Orthopedics:
   Washington University Orthopedics is involved in cutting-edge research and treatment methodologies for ankle surgeries. The clinic employs minimally invasive techniques to reduce recovery time and postoperative pain. Clinical studies have shown effective outcomes associated with surgeries performed by their specialists.

9. Stanford Health Care:
   Stanford Health Care incorporates advanced technology and research into its orthopedic practices, focusing on patient-centered care. The facility is known for its innovations in surgical techniques, including ankle replacements. Surveys conducted among patients reflect positive ratings for care quality and treatment outcomes.

What Qualifications and Success Rates Should Patients Look for in Top Clinics?

Patients should look for qualified clinics with high success rates when seeking treatments. The qualifications and success rates of top clinics can significantly influence treatment outcomes.

1. Accreditation and certifications
2. Experienced medical staff
3. Specialized facilities
4. Clinical success rates
5. Patient reviews and testimonials
6. Comprehensive aftercare programs
7. Transparency in treatment options
8. Advanced technology and techniques

Understanding the qualifications and success rates of top clinics is essential for informed decision-making. Below are detailed explanations for each point.

1. Accreditation and Certifications: Accreditation and certifications indicate that a clinic meets specific standards. Organizations like The Joint Commission or ISO certify clinics based on rigorous criteria. For example, accredited clinics often have protocols for patient safety and quality assurance, which can enhance recovery outcomes.

2. Experienced Medical Staff: Experienced medical staff are critical in providing effective treatments. Work experience and specialized training contribute to better patient outcomes. A study by the Journal of Healthcare Management (2018) found that hospitals with more experienced surgeons had lower complication rates, reinforcing the importance of experienced professionals.

3. Specialized Facilities: Specialized facilities are designed to offer specific treatments effectively. For instance, a clinic focusing on orthopedic surgery may provide tailored rehabilitation services that enhance recovery. Facilities equipped with state-of-the-art technology can facilitate advanced procedures, leading to higher success rates.

4. Clinical Success Rates: Clinical success rates reflect the effectiveness of a clinic’s treatments. Patients should inquire about the percentage of successful outcomes in specific procedures. According to a 2021 report by the American Academy of Orthopaedic Surgeons, clinics with documented success rates over 90% in joint replacement procedures are generally preferred.

5. Patient Reviews and Testimonials: Patient reviews and testimonials provide insight into the patient experience. Positive reviews can indicate higher satisfaction and success rates. Resources like Healthgrades and RateMDs allow potential patients to compare experiences and outcomes.

6. Comprehensive Aftercare Programs: Comprehensive aftercare programs ensure continued patient support post-surgery. These programs often include physical therapy and regular follow-ups, which are crucial for successful recovery. Research published in the Journal of Rehabilitation Medicine (2019) shows a strong correlation between robust aftercare and improved long-term outcomes.

7. Transparency in Treatment Options: Transparency in treatment options allows patients to make informed choices. Clinics providing clear information about risks, benefits, and costs help patients feel more secure in their decisions. A study by the Annals of Surgery (2017) indicated that transparency reduces anxiety and enhances satisfaction.

8. Advanced Technology and Techniques: Advanced technology and techniques improve the precision and effectiveness of treatments. Innovations such as robotic-assisted surgeries can reduce recovery times and surgical complications. A 2022 study in the Surgical Endoscopy journal highlighted that such technologies improve patient outcomes significantly compared to traditional methods.

What Should Patients Expect During the Recovery Process After Ankle Joint Replacement Surgery?

Patients can expect a structured recovery process after ankle joint replacement surgery, which varies in duration and intensity based on individual circumstances and adherence to rehabilitation guidelines.

1. Immediate post-operative care
2. Pain management
3. Mobility aids and restrictions
4. Physical therapy
5. Timeframe for full recovery
6. Potential complications and follow-up care

The recovery process from ankle joint replacement surgery can involve various aspects, as outlined above.

1. Immediate Post-Operative Care: Patients experience immediate post-operative care following ankle joint replacement surgery. This stage typically occurs in the hospital, where staff monitor vital signs and manage pain. Patients may receive intravenous fluids and medications. A 2019 study by Johnson et al. emphasizes the importance of this phase in ensuring a smooth transition home.

2. Pain Management: Pain management is crucial during recovery. Surgeons often prescribe medications such as opioids and non-steroidal anti-inflammatory drugs (NSAIDs) to control post-operative pain. Proper pain management supports mobility and enhances participation in physical therapy. According to a 2020 study by Chen et al., effective pain control can significantly improve patient satisfaction and recovery outcomes.

3. Mobility Aids and Restrictions: Patients usually rely on mobility aids, such as crutches or a walker, for several weeks. Surgeons advise against putting weight on the operated ankle initially. This restriction helps prevent complications and supports healing. A survey conducted by the American Academy of Orthopaedic Surgeons found that most patients need about six weeks of using mobility aids before gradually returning to normal activities.

4. Physical Therapy: Physical therapy plays a vital role in rehabilitation. A physical therapist helps patients with specific exercises to improve strength, flexibility, and range of motion. According to a 2018 report from the American Physical Therapy Association, patients who engage in structured physical therapy often report better functional outcomes than those who do not.

5. Timeframe for Full Recovery: The timeframe for full recovery after ankle joint replacement can range from three to six months. Some patients may take longer, depending on their age, overall health, and adherence to rehabilitation protocols. Research by Smith et al. (2021) indicates that factors like pre-operative condition and compliance with rehabilitation affect the recovery timeline significantly.

6. Potential Complications and Follow-Up Care: Patients must be aware of potential complications, such as infection, blood clots, or implant issues. Regular follow-up appointments with the surgeon are essential to monitor recovery progress and address any emerging concerns. A 2022 study highlighted that early identification of complications leads to better recovery outcomes and can prevent severe issues from developing.

What Role Does Physical Therapy Play in Rehabilitation After Ankle Surgery?

Physical therapy plays a crucial role in rehabilitation after ankle surgery. It aids in restoring movement, strength, and function.

1. Increase Range of Motion
2. Improve Strength
3. Enhance Balance and Coordination
4. Reduce Pain and Swelling
5. Prevent Complications
6. Educate on Activity Modification

Physical therapy after ankle surgery focuses on several key areas that contribute to effective recovery.

1. Increase Range of Motion: Increasing range of motion is a fundamental goal of physical therapy. It involves exercises that stretch the ankle joint and surrounding muscles. A study by McCormick et al. (2020) highlights that early range of motion exercises help prevent stiffness and promote quicker recovery.

2. Improve Strength: Physical therapy aims to improve strength in the muscles around the ankle. Strengthening exercises typically start with isometric movements and progress to resistance training. Research by Choksy et al. (2018) indicates that improved strength contributes to better functional outcomes after surgery.

3. Enhance Balance and Coordination: Rehabilitation also focuses on enhancing balance and coordination through specific exercises. This aspect is crucial for preventing falls and ensuring a safe return to daily activities. According to a study by Richards et al. (2017), balance training effectively reduces the risk of re-injury.

4. Reduce Pain and Swelling: Physical therapists employ techniques such as manual therapy and modalities like ice or ultrasound to reduce pain and swelling post-surgery. Managing pain effectively aids patient compliance with rehabilitation protocols. A review by Thompson et al. (2019) confirms that early intervention can alleviate pain levels.

5. Prevent Complications: Physical therapy helps prevent complications such as deep vein thrombosis (DVT) and joint stiffness. Encouraging mobility soon after surgery helps maintain circulation and joint function, as noted by the American Physical Therapy Association (APTA).

6. Educate on Activity Modification: Education provided by physical therapists helps patients modify their activities to support healing. Patients learn the best ways to engage in daily tasks without placing undue stress on the ankle. This guidance is essential for long-term recovery, as stated by the Journal of Orthopedic & Sports Physical Therapy in a 2021 article.

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