Major surgery can cause weakness, immobility, possibly pain, and even depression. Most patients desire a complete and rapid recovery post surgery so they can return back to the activities and sports they love. More and more, both doctors and patients are understanding how physical therapy is an essential component of a healthy and successful outcome post-surgery.

A Study by the National Institutes of Health (NIH)  demonstrated a lack of movement after surgery causes loss of function, muscle weakness, and increased postoperative complications. When patients remain immobilized and on bed rest, they tend to lose muscle strength and heart & lung capacity due to a lack of physical activity.  Many recognize the best solution to avert this problematic outcome is a carefully planned and supervised physical therapy program for those recovering from surgery.  

Physical therapy is helpful in regaining mobility, recovering faster, and increases the certainty that any replacements or repairs made during the surgery heal properly.  Physical therapy can also be an effective option for managing pain and eliminating the need for any pain relieving opioid medications.

Post Operative Physical Therapy Improves Recovery Following Many Procedures:

ACL & Meniscus Repair: Following repair to the ACL knee ligament along with tears to the meniscal cartilage (which can be independent of each other), physical therapy is required. The reduction of swelling and restoration of range of motion is one of the primary early objectives in recovery from ACL surgery. Generally without the guidance of a physical therapist, the knee is kept in one position following surgery. However leaving the knee kept in a fixed position risks the development of increased scar tissue and mobility related issues, making long-term recovery more difficult. Hence physical therapy focuses on restoring range of motion reducing edema and ultimately promoting a seamless recovery. While tenderness, stiffness, pain and weakness are common post surgery, you may be able to bear some weight on your repaired knee with the assistance of crutches and a brace following surgery.  The objective of exercises during the first month of therapy is a return to your range of motion in the joint and muscle control in your leg, along with ensuring the patella does not lose mobility, sustain flexibility and strength in the hip and ankle, and regain your stability.   

Back Surgery:   Participating in physical therapy post-surgery will enable you to perform tailored stabilization exercises, increase flexibility of the muscles and tissues surrounding your spine, and practice loading techniques to safely increase the resiliency of the recovering structures. We look at full body movement with walking, running, fundamental and sports specific movement patterns to determine improper patterns at each joint. For instance, you may have a tight ankle joint that is causing your hip to perform a compensatory movement that is putting your lower back in a compromising position with a task such as squatting. Physical therapy will ‘course correct’ this and any other abnormal movement threatening your rapid recovery from your specific back surgery.

Rotator Cuff Surgery: A Study by  Gallagher et al 2015 looked to determine if there are differences between early and delayed physical therapy rehabilitation after arthroscopic rotator cuff repair in terms of clinical outcomes and healing.  The Study concluded reporting significantly increased functional scores within the first 3-6 months with early passive range of motion physical therapy rehabilitation compared to the delayed group. After a rotator cuff repair, physical therapy may be necessary to help improve the range of motion and strength of your shoulder. You can expect to work with your PT for eight to twelve weeks (maybe longer depending on your goals) after a rotator cuff repair.

Shoulder Surgery: Patients undergoing shoulder surgery commonly receive physical therapy prior (pre-habilitation), and after surgery (post habilitation).  Pre-hab generally starts 6-weeks before surgery with exercises intended to keep the shoulder strong and flexible yet supple, while also ensuring that further damage is not sustained. After surgery, physical therapy is designed to achieve these goals:

• A stronger shoulder — Post surgery, your shoulder needs to recover from both the procedure and time period (months and sometimes years) of being injured.  Exercises that strengthen will help in stabilizing the region while improving function. 
• Better range of motion —  Improving flexibility is a primary goal of post-surgical rehabilitation, achieved through targeted stretches and joint mobilization. 
• A quicker healing process — While rest is vital, being sedentary is not helpful for healing. Physical therapy reinvigorates blood flow, helps to work through muscle and joint restrictions that negatively impacted your mobility after your injury,  and fortifies muscles to return to their intended function.

Hip Labral Repair : Physical therapy prior to hip surgery commonly accelerates speed of recovery. After surgery, physical therapy is initiated within the first few days of the procedure. Your therapist will work with you to understand what you can and can not do. They will also provide the appropriate level of movement/exercise throughout the course of your rehab. Physical therapy after hip labral repair surgery will help in:

• Restoring normal movement to your hip
• Improving your ability to control your hip for overall joint health

• Increasing circulation and reducing the possibility of blood clots

• Easing your pain

• Reducing swelling

• Strengthening the muscles in your hip
• Returning you to your previous level of function/sport

Other Surgical Procedures that we commonly see at Perfect Stride:

• Bunionectomy 
• Biceps Tendon Repair 
• Ulnar Nerve Transposition 
• PCL/MCL/LCL Repair 
• Achilles Tendon Rupture Repair 
• Knee Arthroscopy
• Pectoralis Tendon Repair
• Knee Menisectomy
• and many others . . . 

Post Surgical Physical Therapy Techniques: What to Expect?

Some of the most common types of physical therapy techniques post surgery include:

• Techniques to help reduce swelling and pain such as soft tissue mobilization, taping, Grasston (IASTM), floss band, cupping and more

• Treatments focused on restoring mobility are utilized to establish the necessary range of motion needed to carry out all movement and activity

• Motor Control exercises aimed at understanding and controlling newly established ranges of motion 

• Exercises focused on building tissue resiliency – This will ensure that you are able to better handle the loads and stresses that the real world demands bring your way. As we say at Perfect Stride, “make it take more to break you!”

• Low-impact cardiovascular exercises such as walking or using an exercise bike have positive effects post operatively as they help to circulate blood and nutrients to the healing tissue. Also, after major surgery, simply taking a few steps is a significant accomplishment, and the sense of achievement patients feel as they progress helps recovery going forward

Post Surgical Rehabilitation Benefits

1. Increases mobility, strength and  balance: Surgery can result in limited mobility in the affected region or body part (as the  body’s natural response is to protect the area of trauma). This can produce swelling, muscle/tissue tightness, spasms and limited range of motion. Physical therapy can help patients regain mobility through movement, strengthening exercises, manual therapy techniques and various modalities. It’s also worth noting exercises to strengthen and stabilize muscles in the surrounding regions can greatly improve recovery at the surgical site. 

2. Relieves pain and reduces swelling: Swelling post surgery is an expected part of the healing process and can vary greatly from person to person. Chemicals that stimulate nerve endings are released, and the excess inflammation compresses the nerves, creating pain.  A reduction in swelling accelerates healing and improves mobility, both of which diminish overall pain. Movement and exercise as part of your  rehabilitation program can help reduce swelling and prevent any pains from surgery becoming chronic.In sum, after surgery, physical therapy rehabilitation accelerates the healing process, and gives you insight on the best approach to self-care and a successful return to your daily activities. 

3. Reduces the formation of scar tissue:  Post injury or surgery, scar tissue commonly forms, and soft tissue typically contracts as part of the natural healing process. Surgery anywhere on the body can produce excess scar tissue reducing movement and function for months or longer after a procedure. A physical therapist can perform many types of tissue mobilization techniques, including Grassston (IASTM), floss bands, cupping, taping and various manual therapy techniques to restore joint mechanics, mobility and return patients to optimal functioning.

4. Decreases the potentiality of secondary issues: Blood clots, infection, and other debilitating  secondary complications can occasionally occur after surgery. Your Doctor of Physical Therapy will tailor a plan of care for your unique situation and monitor your progress to greatly reduce the risk for infection, blood clot and contractures. 

5. Increases flexibility: Being inactive can lead to weakened muscles and increased stiffness, which can contribute to further injury. When muscles are restricted and joints are stiff, normal daily activities such as reaching overhead, climbing stairs and rising from a seated position can be severely affected.  Among the first activities introduced after surgery are gentle mobility exercises designed to keep vulnerable muscles and joints mobile.

Your course of rehab after surgery will vary depending on the surgical procedure you had performed, your response to the surgery and your rehabilitation. However, your Physical Therapist at Perfect Stride will be working alongside you each step of the way. They will progress you accordingly and get you back to performing at your be