Post-operative rehabilitation is incredibly challenging. It is a collaboration between the patient and the physiotherapist, to formulate the best possible plan and achieve the desired result, returning the patient to their chosen level of activity or sport.
Communication with Consultant/physiotherapist
Initially, post-surgery patients are often very nervous in not wanting to move the involved area – shoulder, knee, hip, back, wrist post-surgery as they feel they might cause further damage.
Consequently, one of the most important aspects is for the patient to check post-surgery; what they can do, and also what they can’t do.
Patients should talk to their consultant following their operation to find out what they can and cannot do. Often patients are quite surprised to find out how much they can do even in the first few weeks following their operation. This is a very positive sign and starts the recovery process.
Patients have to be careful not to overdo their rehabilitation, so it is important they check with their consultant/physiotherapist.
In most cases, with any Orthopaedic type surgery patients may be an in-patient for one or two days.
The most common side effect post Orthopaedic surgery is pain.
Consultants and physiotherapists usually measure pain on a visual analogue scale (VAS). This is normally scored from 0 to 10. 0 being no pain, and 10 the worst pain a patient could imagine. Everyone’s pain level and tolerance are different, hence why this individual scale is used.
Post-surgery and throughout patients’ recovery, it is important not to have a high pain VAS. If patients pain score is high, it will inhibit their recovery.
Therefore, it is important to liaise with the consultant, nurses and physiotherapist, to ensure patients are using appropriate and regular pain relief (Paracetamol or non-steroidal anti-inflammatories).
Post-operative Physiotherapy in hospital
As an in-patient, a physiotherapist will provide basic, but very effective, post-operative exercises that patients need to continue until they see their outpatient physiotherapist.
These exercises might seem very basic and simple for some, but in other cases, they might be very demanding.
Whatever category they fall into, it is important that patients follow the guidelines from the consultant and the physiotherapist, and undertake the appropriate exercises alongside taking adequate pain relief.
Physiotherapy post-Orthopaedic surgery
All patients should organise an early assessment with their outpatient physiotherapist, following Orthopaedic surgery. The prompter patients see their physiotherapist the earlier they can start their recovery, addressing pain control, swelling, reduced joint range of movement and muscle weakness.
Following surgery, it is likely there will be swelling locally in the area of the operation and potentially more distally, such as the ankle or hand.
In the early stages, the aim of Physiotherapy is to try to minimise swelling, so it does not become painful and inhibit patients’ recovery. An easy way to do this is to follow the acronym PRICE:
Protection – this may involve using a sling, crutches or an Aircast boot.
Rest – this may require having some time off work and not undertaking regular duties around the house.
Ice – this would include 15-20 minutes, three to four time a day around the operated area.
Compression – Applying light pressure when icing. It should feel like the patient is gently “squeezing” the area to push out any extra fluid. Equipment such as a Cryo Cuff or Game Ready are very useful in achieving this and can be purchased online.
Elevation – the use of gravity can be incredibly beneficial in reducing swelling peripherally around the ankle or the hand. Again, with ice and compression, it should be undertaken regularly throughout the day.
Following patients’ initial assessment, the most common type of exercises patients will be given are a range of movement exercises. It is vital post-surgery to start moving the joint if allowed and stop any significant complications such as a frozen shoulder or muscle shortening.
Usually, the patient will complete these exercises regularly throughout the day over the next few weeks.
The other exercises patients might be prescribed will be strengthening. These could potentially include strengthening rotator cuff muscles around the shoulder, activating quadriceps muscles around the knee, or glut muscles around the hip/lower back.
Following this exercise program is an essential part of patients’ recovery, and if patients are not compliant or able to undertake these exercises, it will significantly delay their recovery.
Middle stage rehabilitation
This can vary but is around six to twelve weeks.
At this stage, patients are progressing well, being back at the gym, while other patients are still struggling with pain, limited movement and weakness only able to complete basic exercises.
Patients need to be seeing their physiotherapist regularly who will be progressing their rehabilitation appropriately.
This may involve advancing of strengthening, motor control and core stability exercises. Patients are likely attending the gym regularly and re-started cardiovascular exercises.
Additionally, most patients at this stage will be back at work and returned to their normal activities, balancing that with physiotherapy rehabilitation is often challenging.
For a lot of patients, they can start to see the light at the end of the tunnel!
It is quite common for patients to skip this stage as they feel like they are recovered.
Patients may return to their sport or their regular activity, but struggle as there are ongoing deficits in strength, motor control and proprioception that need to be addressed.
In many cases, the physiotherapist can work alongside the patient’s personal trainers, Strength & Conditioning (S&C) coach, yoga/Pilates teacher, helping patients return to their pre-surgery activity level.
Following Orthopaedic surgery, post-operative Physiotherapy is essential to ensure a complete recovery.
It requires a full and thorough physiotherapy assessment, alongside regular reassessment and progression of treatment/rehabilitation to keep the patient informed and motivated.