PHYSICAL THERAPY
Injuries happen and the natural wear and tear process of aging or work-imposed physical demands are inevitable. Our joints and muscles are stressed over time, but often times conservative management and treatment, including rest, activity modification, medication, physical or occupational therapy, and/or injections help combat those effects and allow people to maintain and return to their prior level of function with a satisfactory quality of life.
In some instances, failed conservative management necessitates the need for surgical intervention. Orthopedic surgery can help repair the structure of our joints, and enable people to fully return to the activities, work, and lifestyles they love with no pain or restrictions.
But surgeries are not without a recovery process. All surgeries require an appropriate recovery timeline, consisting of rest, pain management, physical or occupational therapy, adherence to post-op precautions, having a consistent home exercise program, and appropriate activity modifications. Patient compliance and adherence to this short-term period after surgery will maximize their recovery and eventual return to their desired level of function.
The use of detailed patient education helps patients navigate their individual post-op recovery process. It starts during their pre-op visits, including making the decision to have surgery. Our medical providers and therapists educate the patient about the nature of the surgery and the general recovery process that will follow. This includes post-op follow-ups with the doctor as well as a physical or occupational therapy (PT or OT) evaluation after surgery.
During this initial PT or OT evaluation, the therapist paints a picture of the overall recovery process, including the expected recovery timeline (weeks/months), how long they will attend therapy, the importance of adhering to an individual home exercise program (HEP), and surgery specific precautions and activities to minimize/avoid.
In most cases, patients will attend PT or OT two times a week for 4-6 weeks, followed by a re-evaluation to determine a future plan of care. Therapy visits include a variety of treatments, including exercise, manual therapy, and function specific interventions that are tailored to the patient’s goals.
There are both physical and mental hurdles that patients will confront after surgery. It is vital to educate our patients as to how to navigate these challenges, and how they will gradually progress and return to their desired level of function based on their specific surgery. It is important to act as cheerleaders for our patients, highlighting the progress they have made and offering continual positive reinforcement. We must also note the areas needed for improvement, where they can re-focus their home exercise program, while still reinforcing the expected recovery timeline.
Physical hurdles and ways to address them include:
(1) Pain management
• Managed by use of pain medication, ice/elevation/heat, activity modification, manual therapy techniques, TENS unit, etc.
(2) Restoration of joint range of motion
• Passive, active assisted, and/or active range of motion exercises in accordance with the specific surgical protocol, performance of HEP
(3) Improvement of muscle strength
• Safe progression of strength exercises with transition to performance at home
(4) Function specific goals (ex: progression of gait to full weightbearing or without assistive device OR ability to dress, shower, or eat with affected arm
• Functional exercises performed during PT/OT visits with safe transition home
Mental hurdles and ways to address them include:
(1) High pain levels
• Educate patient regarding pain management strategies at home and expected duration of pain, oftentimes most pain is experienced in the first 4-6 weeks after surgery
(2) Patient frustration with lack of progress
• Education regarding the post-op recovery timeline and explaining that having pain or limitations is normal in the initial phase of recovery, provide positive reinforcement about progress made
(3) Unable to perform previous level of function activities (ex: unable to take stairs normally, squat, lift heavy objects, or perform work related tasks)
• Functional exercises performed during PT/OT visits with education about expected return to functional activities
In conclusion, it is important to utilize patient education to not only treat the physical impairments and functional limitations of our patients, but to also consider the mental and psychological aspects. By doing so, this will help manage patient expectations and frustrations, will maximize patient adherence to precautions and their PT/OT plan of care, and will enable them to safely return to their desired activities with the highest quality of life.
