The Lowdown on Post-Op Physio
February 28, 2020 at 11:12 AM
In this day and age there are countless types of surgery that are performed on patients everyday throughout New Zealand, and the number of different surgeries continues to grow. In 2018, over 23,000 people had a surgical treatment across 11 different categorical types in Auckland alone! It is commonly thought amongst surgical patients that once their procedure has been performed, and they have been discharged, that their recovery is done and dusted and their surgery was a success. However, no matter how pin-point perfect the surgery went, this is only the first step to becoming the fully-functional human-being you were before your injury/condition developed. The reality is the moment you wake up from your surgery is the exact moment your road to rehabilitation and recovery begins to reinforce all the good work your surgeon has done to get your back into working order. The best person to safely guide you through this (sometimes) lengthy process is a qualified post-operative care physiotherapist who will be able to design a personalised rehabilitation programme for you to help you reach and exceed your goals post-operation.
What happens when I wake up from my surgery?
After an operation, your hospital-based physiotherapist will provide you with some light exercises and advice in order to prevent any potential complications that can arise after surgery due to spending a period of time under anaesthetic, and being relatively immobile in your hospital bed. These include preventing any potential blood clots forming (known as Deep Vein Thrombosis), or hospital-acquired chest infections. Your hospital physiotherapist will work to make sure you have the adequate mobility and functional capability to be able to be safely discharged back home. Besides your routinely set check-ups with your surgeon, this is where it becomes your responsibility to start your rehabilitation journey towards increasing the strength, flexibility and function of your surgical body site.
Don’t worry, we know this can sound like a daunting task and it is very normal to feel a little apprehensive about moving your newly-fixed body part in the way you used to! This is where our qualified post-op physiotherapists at Auckland Physiotherapy become your person to call. Our physiotherapists are highly experienced at creating an individualised rehabilitation programme suited to your own surgery, needs, and the goals you want to achieve.
Every single surgery that is performed differs from the other: from the body site it is performed on, to the age and wellbeing of the patients they are done on. Because of this, every rehabilitation recovery time is going to vary, so it is important that your programme is personalised to work specifically for you. Although there is this variation in recovery times, it is important to know that post-operative rehabilitation is a long process for everyone, and is unfortunately not something where your superhuman strength is going to return back to you overnight. However, with some trust and determination to stick to your rehab programme, and listening to the advice of your physiotherapist, you will see the time you spend recovering decline and will be back to your normal functioning self in a much quicker time period. It is very much like ‘the more you put in, the more you will get out of it’.
Common Surgical Procedures requiring Post-op Physiotherapy
Although common in an array of surgeries, the procedures that in particular require post-operative physiotherapy care to aid in their long-term rehabilitation include:
Knee reconstruction surgeries (e.g. ACL + other ligament reconstruction, meniscal repairs, chondroplasty, fractures)
Total Hip and Knee replacements
Shoulder surgery (e.g. reconstructions, rotator cuff repairs, stabilisation surgeries)
Ankle/Wrist/Elbow operations (e.g. reconstructions, fractures, ligament repairs, carpal tunnel release, tennis elbow release, golfers elbow release)
Spine/Neck/Back operations (e.g. discectomy, spinal fusion, laminectomy)
How does Post-operative Physiotherapy help?
Not only does following a rehabilitation programme help speed up the time of recovery, it also enhances the body's natural healing processes to assist you in regaining full function and mobility on your surgical site. It aids in:
- Pain relief: Post-operative physiotherapy aids in relieving any pain or discomfort that you may have developed due to the impact of the surgery on your body. By increasing the amount of movement occurring at the surgical site, it in turn will increase the blood flow to the area. With increased blood flow comes increased oxygen and nutrients to the muscles, providing them with more energy sources to help in moving. It also helps in flushing out waste products at the site including any small ‘pain mediator’ and ‘inflammatory’ cells. These cells accumulate as a protective mechanism to look after the vulnerable newly fixed body site, and produce a pain response which we feel.
- Increasing strength: When a particular body part is not used for a long period of time, a process called ‘muscular atrophy’ occurs whereby muscle wastes away due to lack of physical activity. So by the time your surgery has been performed, the muscles affected by the injury may be weaker, and smaller in size than what you originally had. When exercises and physical activity presume in the rehab programme, a reverse process known as ‘muscular hypertrophy’ occurs where the muscles increase in strength and size due to reactivating the muscle ‘myofibrils’ to work again. With weighted exercises targeting these muscles included in your rehab programme, the myofibril muscle fibres are able to grow, and so increase your strength
- Break-down of scar tissue: Scar tissue develops to help in repairing your skin when you have become injured or have damaged your body. In order to access our bones and muscles, we have no option but to go through our skin, and so are ‘damaging’ some of our skin fibres, resulting in a scar formation. Although scarring is a natural part of the body’s healing process, the scar tissue that forms is smaller than the body’s natural muscular tissues and therefore can become very tight and restrictive. This is where we experience pain and decreased range of movement. Exercises in a post-op rehabilitation programme help to increase the elasticity of the scar and break it down to relieve us of this restrictive discomfort we feel.
- Self-management Education: Along with creating your own programme, our Physiotherapists will help to teach you how to look after your own recovery at home. Once you are comfortable with the course of your rehabilitation, the physiotherapist will show you how to follow your programme at home and instead will see you at set milestones and stages along your road to recovery for appointments. This also allows you some more freedom of not having a second home at our clinic! However, of course your physiotherapist will always only be a quick email away for any questions or concerns you have and will also see you for additional appointments if needed too.
Programme Progression with the Body’s Stages of Healing
The key element that every rehabilitation programme must have is progression, i.e. continually adapting the exercises in your programme once you are able to achieve them to something more challenging and stimulating, to ensure you continue improving and getting better with each day that goes past after your operation. Your Physiotherapist will work to make sure these progressions occur at a suitable time in your programme for you. They do this by advancing the exercise progressions at the same time as your body’s natural healing processes of Inflammation, Proliferation and Remodeling.
The inflammatory stage occurs automatically in our body’s as a result of the trauma from the surgery it has just undergone. We see this as reddening of our skin as blood rushes to the ‘damaged’ area to bring nutrients and cells to help fight infections and promote healing. Inflammation typically occurs in the very early stages of your post-op journey. It is likely you will be in hospital for a period of this, so the hospital physiotherapist will be initiating your management here and will include lots of RICE (Rest, Ice, Compression and Elevation) along with moving your body within a pain-free range of movement.
In the second stage of healing known as proliferation new tissue begins to build at the surgical site to form a scar to help strengthen the wound site and accelerate the healing process. ‘Granulation tissue’ also forms which allows tiny blood vessels to enter the injury site so cells, oxygen and nutrients can enter to further enhance the body’s repair process. While this is occurring, the physiotherapist will work to achieve full range of motion with you as well as begin some ‘concentric’ strengthening training to start increasing your strength once again. Simply put, ‘concentric’ is just a fancy name for shortening a muscle while you contract and move it. The therapist may also begin to initiate some stretching in order to increase the flexibility of the scar tissue that has developed. .
Moving into the remodelling phase, the new tissue fibres reorganize themselves at the surgical site to optimise themselves to cope with oncoming tensile strength. In other words, allowing your body to be able to cope with more forceful movements and heavier loads without reinjuring yourself. This is when the therapist will begin to increase the intensity of your exercises, both in complexity and load. This is done through adding weights to exercises, and also introducing ‘eccentric’ exercises where your muscle is lengthening under additional tension and load. With optimal strength gained, your therapist will finally prepare your body for the ‘unexpected’ in real life to make your rehab functional to what you do in your day to day life. This would include adding aspects like speed, endurance, obstacles, changing unpredictable environments, and equipment to your exercises.
The Physiotherapists here at Auckland Physiotherapy are all highly experienced and qualified in aiding you in your rehabilitation journey, and are all passionate about making your recovery as effective, time-efficient and enjoyable as it can be. They will work with you to ensure your programme is aimed at getting you back to what you love to do, and will provide you with the most effective exercises and advice to achieve this.
Give us a call on 09 366 4480 and our reception staff will happily guide you in the right direction of booking an appointment to start your post-operative journey to recovery with us!
Written by: Georgia White