Acceleration Physical Therapy specializes in post-surgical rehabilitation. We strive to maintain good communication with your surgical team so that you can have an excellent outcome. If you have specific questions about your current or upcoming post-surgical physical therapy, feel free to email us a question or call the office. We have offices in North Spokane as well as Deer Park, and all insurance plans are accepted.
Many patients assume that after an injury either orthopedic surgery or physical therapy are indicated, but usually the most successful outcomes come from collaboration between the two. Physical therapists generally look at orthopedics from a perspective of restoring normal movement and stability through that range of motion, where as surgeons tend to look at the structures that are producing pain. Many times resolution of movement and strength issues will calm the pain producing structure, and other times surgical intervention is required to remove inflamed tissue or repair torn structures. This article will explore the relationship between physical therapy and surgical intervention, in an attempt to understand how best to restore pain free function to an injured joint with surgery, PT, or a combination of both.
The focus of pre-surgical physical therapy is to resolve biomechanical dysfunction. For any joint to be healthy, not only does that joint need to move correctly, but the joints and soft tissues above and below must have a balance of mobility and stability. After an injury or due to long term postural dysfunction, joints can become stiff and/or lose the ability to properly stabilize through their normal range of motion. The purpose of physical therapy is to mobilize joints that are stiff and restore dynamic stability. That stability comes from strengthening all of the joints and muscles above and below the injury such that forces, such as lifting a box, are distributed more evenly.
Physical therapy cannot resolve tendonitis and other overuse type injuries by performing modalities and manual techniques directly to the irritable structure. While electrical stimulation, ultrasound, cold laser, and other modalities designed to work directly on irritable tissue can have a positive effect, failure to resolve the underlying biomechanical dysfunction will ultimately result in a reoccurrence of inflammation. Physical therapy is most effective when treatment is focused on a combination of calming irritable tissues with resolving joint dysfunction. After mobility issues have been resolved, the focus of treatment becomes progressively loading the whole area so that forces can be spread over multiple structures.
If physical therapy is unsuccessful with calming irritable tissues because of structural damage that does not heal appropriately, surgical intervention becomes a good option. Some patients think that physical therapy and surgery are an either/or question. When performed in a collaboratively, pre-surgical physical therapy can greatly improve surgical outcomes by creating better surgical candidates with less movement dysfunction and then providing the patient a structured environment for the post-surgical process.
Post-surgical physical therapy is vital to a successful surgical outcome. While surgical technique is the most important factor for a surgical procedure, it is not the only factor to ensure a patient’s full recovery. Early in the rehabilitation process, it is important for the PT and surgeon to have good communication about range of motion restrictions and whether the patient is able to tolerate active motion. While some surgeries require patients to be immobilized, most surgical procedures will have a better outcome with early passive motion. As surgically reconstructed soft tissue such as a rotator cuff repair or ACL graft heal to the point where some loading can take place, patients are allowed to perform higher level exercises and in turn increase function.
With a few notable exceptions due to surgical protocol, joints can and should move through normal range of motion early in the process. Surgical trauma creates pain, which in turn creates protective muscle guarding. Much of the early phase of post-surgical rehabilitation is focused on decreasing muscle guarding associated with gentle motion. Ideally, at the point in time when the patient is able to move into a loading phase of post-surgical rehabilitation, the joint moves through relatively normal range of motion, and is pain free at rest.
The final phase of post-surgical rehabilitation involves progressively loading the healing tissues and restoring biomechanics of the joints and surrounding soft tissues so that the patient can perform increasingly stressful movements. As the patient is able to tolerate higher level activities in the PT gym, increased functional activities are allowed during the normal daily routine. A patient with a successful outcome should be able to demonstrate pain free full range of motion, near normal strength, and resumption of moderate to heavy work and sport specific activities. Most orthopedic surgeries continue to heal and strengthen over a twelve month period. While formal physical therapy may only follow the patient for three to six months post surgically, it is important to maintain and build upon the home exercise program until normal function has been restored.
The journey from pre-surgical therapy to surgery through post surgical physical therapy can be a character building process. The key is always to listen to your healthcare professionals and follow guidelines based on the stage of healing or surgical protocol. In the end, restoration of pain free function is the goal, one that is most likely attained with a collaborative team approach.