What is Postoperative Physical Therapy?
Postoperative physical therapy refers to the care you should receive after a surgery. There are many different orthopedic surgeries, but all of them require some form of physical therapy afterwards. Unfortunately, many people assume that surgery will fix their injury and they will be fully healthy. This is rarely the case. You are often in more pain immediately following surgery, and there can be requirements including limiting mobility or weight bearing on the surgical site.
Many people think that postoperative physical therapy is addressing what occurred in the surgery, but it often goes beyond that. First of all, you are typically suffering for a long time before surgery. If you have experienced knee pain for 2 years before surgery, you were probably using different movement patterns and avoiding stressing your knee. This may have limited the strength and range of motion of the knee long before the surgery even occurred.
Postoperative physical therapy should also return you to your desired level of activity. If you are a runner, but you took two years off of running due to knee pain, then this needs to be addressed in physical therapy. Your physical therapist should help you safely progress back to your prior activities so that you do not re-injure yourself.
How Should Postoperative Physical Therapy Progress?
Postoperative physical therapy depends on the type of surgery that was performed. The severity of the operation is a good starting point to determine how physical therapy should progress. More invasive operations such as a meniscus repair that involve the surgeon sewing the meniscus back into place may take longer. A meniscectomy where the meniscus is simply removed will allow for a quicker recovery in general.
Immobilization is important to allow for healing in some cases, but it can delay recovery. Not moving the affected joint or muscle can cause further weakness and loss of mobility. This will take longer to recover, but is necessary to ensure a successful operation.
Pain relief is typically the first goal after surgery. While medications may limit pain, most surgeons and patients wish to decrease their use as soon as possible. Moving the surgical site can provide significant pain relief on its own. Isometric exercises that involve muscle activation without motion can allow for pain relief by increasing blood flow to the injured tissue. Decreasing pain will make the recovery process simpler as it is easier to move when you are not guarding the area.
As pain levels are decreasing, early mobility is important. Prolonged immobility can limit long term outcomes after surgery, and it is important to move the surgical site as soon as it is allowed. Some surgeries only allow for passive movement if a muscle is healing. Your physical therapist should be able to instruct you on safe and effective mobility exercises that will not strain the surgical site. Eventually, active mobility can be resumed to improve strength as well as muscular control through a range of motion.
After mobility exercises have begun, strengthening should commence. Strength is important for day-to-day activities, but it can also hasten healing of injured muscles and other tissues. Strengthening exercises will progress in weight and intensity as tolerated and based on any surgical guidelines.
Endurance is the next physical quality that should be trained. As you get stronger, it is important to build capacity for repetitive tasks. Standing up is an important activity and an easy example. Early in physical therapy you may struggle to have the strength to stand up, but eventually you need to stand up multiple times in a row to simulate daily life. We rarely do any activity once, including standing up, walking, reaching overhead, and lifting. Therefore, physical therapy should include repetitive tasks to build endurance.
Power is the ability to perform an activity rapidly. Once you are able to stand up many times in a row, you want to practice standing up quickly. This is often overlooked in physical therapy, but it is an important quality. Many people struggle with activities because they lose power. Watch an older person try to get out of a chair. They may be able to do it, but it takes longer and that makes it more difficult. Power is one of the first qualities we lose from prolonged immobilization and it can be the hardest to recover.
Finally, physical therapy should transition you to return to any activities that you wish to perform. If you are a baseball player, then your postoperative physical therapy should include a return to throw program. Unfortunately, we often discharge people from physical therapy once they are able to walk and perform essential daily activities. Exercise has numerous benefits, and you should be able to return to your previous level of activity after surgery.
Things to Look for in Postoperative Physical Therapy
Finding the right physical therapist after surgery is crucial to your recovery. You will spend much more time and effort in physical therapy than you did in surgery. The first step is to find a physical therapist that you enjoy spending time with and can learn from. We often overlook compatibility with healthcare providers, but this is crucial when you are spending hours with someone each week.
Experience with your particular surgery is important when selecting a physical therapist. While most surgeries have post-operative plans, there is usually some variation based on your individual presentation. You want a physical therapist who has seen multiple patients with a similar surgery so he or she can decide on how aggressively you can be progressed.
I personally believe that one-on-one care is crucial in physical therapy. I worked in clinics that utilized physical therapy technicians so that the physical therapists could see multiple patients at a time and I believe it leads to worse outcomes for the patients. Some people do get better through this model. I would not want to gamble that I will follow the normal route with my postoperative recovery. I would want a physical therapist who is with me at all of my appointments and can determine if something needs to be changed or addressed.
It is also important to have the same physical therapist during your recovery. Obviously there are extenuating circumstances, but you should not be seeing a different physical therapist at each appointment. They will spend time having to evaluate you for themselves, which can waste your time and be confusing. If one physical therapist says something contradicting another, who are you to believe? It is better to have one voice that you trust leading the process. This allows you to relax and know that you are in good hands.
Finally, an often overlooked part of physical therapy is the equipment and facility. If you are a weightlifter and the clinic only has resistance bands and weights that go up to ten pounds, it may be difficult for you to have full faith that they will return you to weightlifting. Similarly, if you are a baseball player and there is no space for plyometric throwing drills, then how will the physical therapist know that you are ready to get into a return to throwing program? A lack of equipment can lead to guessing when you are ready to progress and this is a dangerous idea. You do not want to leave your recovery up to guesswork.
There are many factors to consider when it comes to selecting a physical therapist or any healthcare provider. These are just a few of the ones that I find important. We were motivated to create Eclipse Wellness based on my observations working in other clinics. Even if you are unable to work with us directly, this should give you some tools to find the right physical therapist for your postoperative care!
As always, if you are suffering from pain, nerve symptoms (numbness, tingling, or weakness), or anything else significant, please see a healthcare provider. This blog is meant to be educational and is not a substitute for medical advice.
Hopefully you learned something about the importance of postoperative physical therapy. It is necessary for health and performance reasons, but often overlooked by healthcare providers and coaches. If you found this blog helpful, please share it with someone. We hope to continue to grow and help people better understand how our bodies move and work. If you want to subscribe so that you don’t miss any other posts, click the sign in button on the top right of this page. Once you have created an account, click the drop-down menu in the top right next to your name and go to your settings page. Click the subscribe button next to “Blog Subscription” and you won’t miss any future posts! If you are in the Sterling, Virginia area and would like to work with me or you have any questions, please email me at danny@eclipsewellnessnova.com or follow me on Instagram or Twitter @drdannydpt.