As people may know, there are different levels of intervention normally recommended by medical professionals when a patient consults for an injury or medical condition. In most cases, a conservative approach can be then sufficient to help resolve the problem. However, sometimes surgical intervention is the wiser choice, as it promises the better restoration of anatomy and stability, in particular with regards to more serious conditions (e.g.; ACL or meniscus tear). However, due to the invasiveness of surgery and the risks associated with it, it is normally viewed as the last option after other conservative options have been exhausted.
Following surgical intervention, the affected body part will immediately start healing to repair itself from the damages of surgery. If left unguided, it may take longer for the body to heal due to certain complications. This is when the role of post-surgical rehabilitation comes into play. Rehabilitation is the act of restoring someone back to normal health or before the medical condition. The goals of rehabilitation are to reduce pain, restore mobility, strength & overall movement and guide the tissues to optimal recovery, ultimately helping the person to return to their previous daily lifestyle.
Post-operative rehabilitation should start as soon as possible to negate any adverse effects that may arise after surgical intervention. The misconception on the need for adequate rest before any form of rehabilitation should, at this point, be laid down to rest as prolonged resting after surgical intervention would lead to further complications. This includes a reduction in blood flow to the area and acceleration of muscle atrophy which slows down the healing process and prolongs recovery.
The key concept of exercise in post-surgery rehabilitation is doing the right type of exercise at the right time, with the right dosage. This concept is pertinent in optimizing the recovery process. Finding the right balance between not doing enough and too much exercise is crucial. Thus, neither complete rest nor sporting activities are advisable at this stage. That being said, as time progresses the balance tends to shift from less demanding to more intensive exercises as the rehabilitation intensity is progressed.
Depending on the type of impairment/condition and the end goal, the phases of rehabilitation may vary. The phases of rehabilitation offered here at Rehamed are as below:
- The early phase of physiotherapy
Starting as soon as the patient is discharged from surgery, this focuses on pain relief and reduced swelling, restoration of motion, and muscle activation non-disruptive to the healing process.
- Mid phase physiotherapy
Once the post-operative pain and swelling subside, our focus will be on returning to the normal range of motion, body biomechanics, and strength through joint mobilization, manual therapy to release muscle tightness, and balance/proprioception exercises.
- End phase physiotherapy and sports rehabilitation
Our sports therapists will work on your return to daily activities and sport through advanced and complex balance and proprioception exercises, progression on strength, and the return to sport program.
- Prevention and Re-conditioning
As a final stage of your journey, we want to ensure that your recovery is long-lasting and, just as importantly, your risk of re-injury is minimized. The Prevention & Re-Conditioning program emphasizes on Strength & Conditioning for patients who have been discharged from rehabilitation. The focus of this program would then be to further enhance your overall performance catered to your specific goals.
A few common examples of orthopedic surgeries that we handle here at Rehamed are of the likes of meniscus repairs, ACL reconstruction, hip/knee replacement, spinal discectomy/foraminotomy, shoulder rotator cuff surgery, and fracture repairs.
It is important to note that the period of recovery after surgery may be lengthy and varies according to the type of surgery. Normally, the rehabilitation process may take months and potentially lead up to a year. Therefore, every individual that undergoes surgery should expect one year as the time frame needed for a full recovery. That being said, the actual time needed depends on multiple factors.
As previously mentioned, the intensity of post-surgery rehabilitation is adjusted as time progresses based on milestones set at every stage of rehab. In a way, these milestones can be transcribed into questions that a patient would commonly ask after going through surgery.
Below would be the main questions asked after a lower limb related surgical procedure (e.g.; knee).
“When do I stop using crutches?”/ When is full weight-bearing allowed?
This first criterion mainly depends on the orthopedic surgeon that operated on the patient, as they can estimate how long it might take based on the surgical approach utilized. This considered, the therapist in charge of the rehabilitation should be able to gauge whether or not the person is fit to progress past the first milestone based on their physical capabilities at that point.
In principle, for the person to reach the first milestone, they would need to have fully regained the range of motion needed to stand independently and assume a normal walking gait. In addition, they should have an absence of inflammation, swelling, and more importantly, be pain-free. Inflammation, swelling, and pain are important indicators of whether the structure involved is ready to bear weight. Therefore, full weight-bearing should not be attempted and should be postponed if the abovementioned indicators are still present, even having passed the typical timeframe for recovery. Otherwise, you may end up worsening the condition.
To reach this milestone, your therapist will rely on more hands-on manual therapy techniques, and electro modalities to help ease pain, navigate through inflammation and swelling. In addition, active range of motion, as well as light intensity strengthening exercises, will be prescribed to improve joint mobility. This is the foundational strength for further advanced exercise which will be prescribed in the future, but also to prevent the degrading loss of muscle due to a period of inactivity post-surgery.
“When can I start jogging/running again?”
There are a few criteria that need to be achieved before a person is able to start running again:
- Pain-free walking. Pain is always the first criteria on the checklist that needs to be ruled out to progress to the next milestone. Even if there is still a lingering/residual feeling of discomfort during walking, running should not be attempted.
- Recovered joint range of motion needed to run. This has to be achieved as running requires more freedom in a joint range of motion compared to walking and to avoid compensation and assume normal running gait.
- Recovered single-leg strength is equivalent to at least 1.5x bodyweight. An appropriate level of strength in the lower limb has to be recovered before a slow run/jogging is attempted. Studies have shown that a person can exert force up to 2-3x bodyweight per leg during running. Thus, a person should be able to recover at least strength 1.5x bodyweight per single leg strength to be able to attempt such high force activity.
As the person progresses to the second milestone, their joint range of motion should have reached its full capacity and focus would gravitate more towards strengthening the lower limb.
At Rehamed Therapy, various physical tests are done as the person reaches different stages of rehabilitation in order to form a baseline reference. Further, these data allow us to determine whether the person can progress to the next milestone. Such tests may vary from the range of motion assessment to balance, strength, functional mobility as well as sports specific assessments.
To reach the second milestone, the therapist would design a program tailored to improve balance, coordination as well as functional strength.
“When can I return to sport?”
Ultimately, it all comes down to the question of when you are able to return to the sport that may or may not be the reason for your surgery in the first place. Here, there are four main criteria that have to be fulfilled before you can cross-check this final milestone:
- As previously mentioned, the surgeon is the one that operated on the area, and hence consultation with them ahead of returning to sport would be beneficial..
- The person should at this point have regained full range of motion with the absence of pain and swelling.
- Symmetrical leg strength. The previously operated leg should have regained 100% strength capacity and there should be no strength deficit between the injured and non-injured leg. This is important as any deficit would cause compensation and may increase the chances of re-injury. Depending on the sport the individual wants to return to, there may be a target weight each leg will have to achieve before returning to sport.
- Recovered endurance capacity. Studies have shown that fatigue is associated with an increased risk of injury therefore the person should have made full recovery in their endurance to minimize the chances of re-injury.
At this point, the therapist would design a functional exercise program that is specific to the sport that the person plays and is gradually progressed by slowly duplicating all the movements and stresses of the sport (within a safe environment).
Returning to sport after surgery is never an easy, straightforward task. While there are guidelines and protocols that can be followed, it is important to remember that everyone is built differently and will adapt and react to treatment differently. There are multiple approaches one can use when it comes to treatment and therapy in rehabilitation. More often than not, the therapist will have to adapt to the individual in question and find the optimal form of treatment for them.
Do not make the mistake of taking Google’s word as scripture, consult a therapist now. If you want to know more about Post Surgery Rehabilitation, feel free to give us a call at 03-50315946 or send us a Whatsapp or Make an Appointment. We at Rehamed Therapy are always here to help!