By: Dr. James DiGregorio, PT, DPT
With the advancements in surgical procedures and technologies, many surgeons are opting for patient’s to not perform “pre-hab” (physical therapy prior to surgery) and physical therapy following a partial joint replacement or a total joint replacement surgery, most commonly done at the hips or knees. Although this is an option that might work for some, it has been proven to not be the best option for the following reasons.
- Stretching and Range of Motion: Focusing on achieving knee flexion and extension motion and most importantly hamstring and quadriceps length/flexibility. A total joint replacement will fix the bony deformities by removing the damaged bones around the knee; but it does not address the muscular issues. If someone has limited knee/hip range of motion leading up to surgery, then likely the muscles around the joint are tight. Following the surgical procedure, this will make it tougher for the first stage of recovery, to regain the range of motion, since you need to fight the muscles.
- Walking: A normal walking pattern is controlled by something called a CPG or central pattern generator in the brain. This is why a person is able to walk without thinking about it. Typically prior to a total joint replacement, a person will develop a limp on one side due to pain in the knee or hip. Developing a normal walking pattern in the brain prior to the surgery will strengthen this CPG; making recovery quicker following surgery.
- Strength: One of the most important reasons for pre-habilitation is gaining strength prior to a total joint replacement. Improving strength prior to surgery not only reduces the pain following surgery, but also reduces recovery time. Strength gained prior to surgery is maintained and carried through after the total joint replacement.
- Following Surgery: The first thing to work on is the knee bending and straightening range of motion. The first few weeks and up to a month after a total joint replacement is crucial for range of motion; if it is not achieved, muscles can be shortened and make it harder for range of motion to return and then more pain is caused. A range of motion of at least 115 degrees is important for normal daily function. Joint mobilization techniques and stretching are very important after a total joint replacement for a reduction of pain during recovery.
- Walking, Stairs, and Transfers: Some of the most simple mobility tasks such as standing up from a chair, rolling over in bed, or going up and down stairs can become difficult or painful following a total joint replacement. Targeted strengthening, neuromuscular re-education, and functional mobility tasks are put in place to make these tasks easier and with less pain. Repetition with these tasks will make them easier, but building proper muscle activation and proper techniques with each movement is important for proper recovery.
- Pain Management: A total joint replacement can be accompanied with pain, as this is normal and common with any surgery. Manual treatments and modalities performed by a physical therapist are techniques to reduce pain and make recovery more enjoyable for the patient.
Physical Therapy is a Necessary Part of Healing for Returning to a Pain Free Life Following a Total Joint Replacement.
If you still have additional questions regarding physical therapy, you can call any one of our offices to schedule your appointment today.
Montvale:(201) – 746 – 6577
Closter:(201) – 784 – 2700
Oradell:(201) – 254 – 7240