After a surgical procedure, understanding what you should and shouldn’t do is important for protecting the surgery site and having an optimal return to activity.

As orthopedic specialist physical therapists in Happy Valley, we help people with post-surgical conditions day-in and day-out. Here are some pro tips to:

  • Reduce surgical complications (e.g. DVT (blood clot), muscle atrophy, dislocation, etc.)
  • Reduce pain and inflammation
  • Protect the surgical repair
  • Regain mobility, strength, balance and motor-pattern-sequencing
  • Optimize return to activity

1. Listen to your surgeon and PT. Follow all your weight-bearing precautions, work modifications, lifting restrictions, and medications as indicated by your surgical team and PT.

2. Cryotherapy. In acute situations such as surgery, cryotherapy (AKA cold therapy or icing) can be very effective in the recovery process in 3 primary ways. At our clinic, we use a GameReady cryotherapy and intermittent compression device.

a. Reducing Inflammation—Inflammation (AKA swelling) is the accumulation of fluid in a body area. Inflammation is a natural part of the healing process, however, excessive swelling can lead to prolonged recovery. Cryotherapy can help reduce excessive inflammation by constricting blood and lymph vessels (vasoconstriction).1

b. Pain Reduction—Cryotherapy is often a very effective pain-management treatment in acute situations like surgery and has been shown to improve recovery times and decrease the need for medication use such as opioids.2–4

c. Improve motion—Inflammation is an accumulation of fluid in a body area. This fluid exerts pressure on your tissues and can therefore restrict range of motion especially if it is within a joint. Imagine a soda can. Is it easier to bend a soda can in half when it is empty, or when it is full? If we reduce the inflammation and pressure within the tissues, we can help improve the pliability of the joint and improve joint mobility.4

3. Compression/Elevation. You want to encourage fluid to move out of the surgery site and back into circulation. Elevating the body part above your heart is one way to let gravity do the work. External compression can also help move fluid out of a localized area and back into circulation.3–5 This might be a compression garment or wrap. In our clinic, we use the combined cryotherapy and compression GameReady device. Try to elevate several times a day, spaced throughout your day.

4. Get up and Move! (appropriately) Being stationary allows blood to become stagnant. This increases our swelling, stiffness, and risk for DVT. Change position frequently and get up to move around if you are able/allowed.6,7

5. Restore Movement. Don’t fear movement! Often after surgery we are worried about damaging the operation if we move the wrong way. Movement in the right way is very important for tissue healing, reducing inflammation, reducing contraindication risk, and minimizing scar tissue formation (adhesions, arthrofibrosis).5,8,9

Post-surgical pain and inflammation can influence muscle inhibition.10 After an operation, we want to minimize muscle atrophy and movement is one way to help maintain muscle function and strength. You’ll just want to make sure you’re doing the right movements, the right number of times, and with the correct amount of resistance. You should always seek guidance from a physical therapist who is a specialist in orthopedics to help you with this process. Generally, the movement progression goes like this:

a. Passive Movement. This means someone or something other than your own muscle power is creating movement at the surgical area. This is very common after a rotator cuff surgery, or other joint operation where we do not want to activate the muscle that was operated on, but we still need the benefits of movement.

b. Active-Assistive movement. In this phase, the tissue isn’t quite ready for full independent use and it needs some help to perform movements. Active-assistive exercises allow for some use of your own muscles, but also someone or something to assist with the movement.

c. Active Movement. This means you are moving the body part under your own muscle power. The position and the type of movement will have tremendous impact on the amount of muscle and joint load so follow your PT’s guidance to manage the forces appropriately.

d. Resisted movement. Now you are moving the body part under your own power against resistance (weights, resistance bands, etc). The workload is usually prescribed as reps, sets, times per day, and days per week. In general, the higher the number of repetitions, the more Type 1 slow-twitch muscle fiber use and the more muscle endurance training you will achieve. As loads increase and reps decrease, you will be training more Type 2 fast-twitch muscle fibers. The type of exercise and the loading (periodization) should match the type of activity you need that body part to perform in life.

e. Plyometrics.
The final stage of recovery for some people is training rapid load absorption and expulsion. Plyometrics take advantage of the elastic properties of our muscle-tendon units and the recoil from movement to propel us into the next movement. This is a very important way to train for active people who participate in sports or fitness. Not everyone is appropriate for this type of loading and guidance by your PT is critical.

Plyometric Video

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With these principles and guidance by an orthopedic specialist PT (OCS), you should feel confident in your rehab. Don’t hesitate to contact us if you have any questions, we’re always here to help.


Sources:

  1. Freire B, Geremia J, Baroni BM, Vaz MA. Effects of cryotherapy methods on circulatory, metabolic, inflammatory and neural properties: a systematic review. Fisioter em Mov. 2016;29(2):389-398. doi:10.1590/0103-5150.029.002.AO18.
  2. Algafly AA, George KP. The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance. Br J Sports Med. 2007;41(6):365-9; discussion 369. doi:10.1136/bjsm.2006.031237.
  3. Su EP, Perna M, Boettner F, et al. A prospective, multi-center, randomised trial to evaluate the efficacy of a cryopneumatic device on total knee arthroplasty recovery. J Bone Joint Surg Br. 2012;94-B(11_Supple_A):153-156. doi:10.1302/0301-620X.94B11.30832.
  4. Schroder D, Passler HH. Combination of cold and compression after knee surgery. Knee Surgery, Sport Traumatol Arthrosc. 1994;2(3):158-165. doi:10.1007/BF01467918.
  5. Janssen H, Treviño C, Williams D. Hemodynamic alterations in venous blood flow produced by external pneumatic compression. J Cardiovasc Surg (Torino). 1993;34(5):441-447. http://www.ncbi.nlm.nih.gov/pubmed/8282751. Accessed June 29, 2018.
  6. Partsch H, Blättler W. Compression and walking versus bed rest in the treatment of proximal deep venous thrombosis with low molecular weight heparin. J Vasc Surg. 2000;32(5):861-869. doi:10.1067/mva.2000.110352.
  7. Doran FSA, White M, Drury M. A clinical trial designed to test the relative value of two simple methods of reducing the risk of venous stasis in the lower limbs during surgical operations, the danger of thrombosis, and a subsequent pulmonary embolus, with a survey of the problem. Br J Surg. 1970;57(1):20-30. doi:10.1002/bjs.1800570105.
  8. Pearse EO, Caldwell BF, Lockwood RJ, Hollard J. Early mobilisation after conventional knee replacement may reduce the risk of postoperative venous thromboembolism. J Bone Joint Surg Br. 2007;89(3):316-322. doi:10.1302/0301-620X.89B3.18196.
  9. Haller JM, Holt DC, McFadden ML, Higgins TF, Kubiak EN. Arthrofibrosis of the knee following a fracture of the tibial plateau. Bone Joint J. 2015;97-B(1):109-114. doi:10.1302/0301-620X.97B1.34195.
  10. Stokes M, Young A. The contribution of reflex inhibition to arthrogenous muscle weakness. Clin Sci (Lond). 1984;67(1):7-14. doi:10.1042/CS0670007.