What is rehabilitation from surgery?

Rehabilitative medicine is a branch of medicine that aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities. When a patient requires surgery, it is usually because their impairment is not treatable through conservative therapy and following surgery the rehabilitation process begins. Depending on your physical condition prior to surgery, typically rehabilitation involves first recovering from the surgery and then regaining strength, function and fitness. Each joint has is particular and important protocols to enhance recovery and often the surgeon will want you to follow their specific time lines and progressions.  A hip replacement for example is a fairly invasive surgical procedure that is used to remove a diseased hip joint (arthritic) and replace it with an artificial joint or prosthesis.   A hip replacement is usually performed under general anesthetic and usually takes approximately 2-4 hours. Medications, such as antibiotics, are usually administered prior to surgery to prevent potential complications such as infection.   Hip replacement surgery usually involves an incision of approximately 20 - 30cm that is made over the top of the hip. Soft tissue, such as muscle, is moved to expose the hip joint, followed by cutting and removal of the damaged joint surfaces of the acetabulum and femur. The prosthesis is then fixated into position with the use of bone cement to hold the prosthesis in place or alternatively a prosthesis without cement may be used with microscopic pores enabling normal bony growth from the femur into the prosthesis. Plastic or metal are typically used to replace the socket of the hip with metal or ceramic used to replace the stem. Hip replacement surgery without complications usually involves a 5 – 10 day hospital stay.    

How can physiotherapy and massage therapy help from rehabilitation after surgery?

Physiotherapy treatment is vital to hasten the healing process and ensure an optimal outcome in all patients following a hip replacement. This should ideally begin prior to surgery.    

Manual Physiotherapy and Massage Therapy

Early treatment with Manual therapy focuses on restoring mobility and reducing swelling and pain. Manual therapy becomes more important at the 6 -12 week phase including massage, joint mobilization and scar myofascial release techniques are beneficial to improve scar tissue flexibility and joint range of motion.  In the final stages of rehabilitation for patients with a hip replacement, a gradual return to activity can occur as guided by the physiotherapist provided there is no increase in symptoms.    

Start with gentle exercises

Gentle exercises are usually prescribed by the physiotherapist to encourage healing, mobility and strength. The process of exercise starts the first day after surgery. The focus is rehabilitative and to get you back on your feet. Eventually, over the coming days, this progresses to standing, walking and climbing stairs with the use of walking frames or crutches as guided by the treating physiotherapist and surgeon. Stitches may be dissolvable or are usually removed approximately 10 days after surgery.   The vast majority of patients who undergo this procedure experience less pain and improved mobility compared to preoperatively. Recovery times vary significantly from patient to patient although rehabilitation typically lasts 3-12 months or longer. It is important to note that a hip replacement will not function the same as a normal hip.   The following exercises are commonly prescribed to patients following a hip replacement and a knee replacement. These can usually commence once the orthopaedic surgeon or physiotherapist have indicated it is safe to do so. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3-4 times daily and only provided they do not cause or increase symptoms.  
  • Knee Towards Chest Gently bring your knee towards your chest as far as possible and comfortable and not beyond a 90 degree angle, without increasing your pain. Aim for no more than a mild to moderate stretch. Repeat 10-20 times provided there is no increase in symptoms after hip replacement
  • Hip Abduction. Begin this exercise lying on your back. Keeping your knee straight, take your leg to the side as far as possible and comfortable without increasing your pain, then return to the starting position (do not cross your leg past the mid line of the body). Keep your knee cap and toes facing the ceiling throughout the exercise. Repeat 10-20 times provided there is no increase in symptoms after hip replacement
  • Hip External Rotation. Begin this exercise lying on your back with your knee bent and foot flat on the floor. Take your knee to the side as far as possible and comfortable without increasing pain. Return to the starting position (do not let your knee or leg cross the midline of the body). Repeat 10-20 times provided there is no increase in symptoms after hip replacement.
  • Knee bends. Begin this exercise lying on your back with your knee bend and foot flat on the floor. Take your hands and support the leg by holding the upper thigh and pull towards you bending gentle at the knee. Repeat this 10-20 times provided there is no increase in symptoms after knee replacement.
  • Isometric quads and hams. Begin this exercises lying on your back with your leg straight. Push your knee down into the table creating a muscle contraction of your thigh muscles and hold for 10 seconds. Repeat this 10-20 times provided there is no increase in symptoms after knee replacement.
  • Hip lifts. Perform this exercise lying on your side and keep your knee cap facing to the side while you lift your leg about 2 feet and hold. Squeeze your buttock muscle and repeat this 10-20 times provide there is no increase in symptoms following knee replacement. Perform these exercises also while lying on your back with your knee cap facing upward and repeat 10-20 times provided there is not increase in symptoms following hip and knee replacement surgery.
  • Bridging. Begin this exercise by lying on your back in the position demonstrated. Slowly lift your backside, pushing through your feet, until your knees, hips and shoulders are in a straight line. Tighten your backside muscles (gluteals) as you do this and hold for 2 seconds. Slowly return to the starting position. Repeat 10 times provided there is no increase in symptoms following hip and knee replacement surgery
  • Quads Over Fulcrum. Begin this exercise lying on your back with a rolled towel or Foam Roller under your knee and your knee relaxed. Slowly straighten your knee as far as possible tightening the front of your thigh (quadriceps). Hold for 5 seconds and repeat 10 times as hard as possible without increasing your symptoms following hip and knee replacement surgery.
   

What post hip replacement patients are instructed to avoid:

  •  Avoid crossing the leg beyond the midline of the body (e.g. not crossing the leg over the other leg)
  • Avoid bending the hip beyond 90 degrees and
  • Avoid twisting the hip and leg excessively
  • Avoid activity which places excessive force thru the hip
  • Avoid excessive weight bearing such as prolonged standing and walking, lifting, squatting, jumping, running.
  • Avoid aggravating activities in general.
  Following hip or knee replacement surgery and discharge from hospital, most patients heal well with appropriate physiotherapy. The success rate of treatment is largely dictated by patient compliance.    

How can exercise and physical development help after rehabilitation from surgery?

Exercise and Physical Development

The final step is to establish a personal improvement health plan to continue to develop physically throughout your life. This is especially necessary after injury or an accident when you have become deconditioned. All of our staff have a combination of health sciences and sports sciences training, having dual training in both kinesiology and physiotherapy and allowing us to provide a biomechanical focus. Once you have recovered from your painful arthritis, our therapists will perform a functional movement screen and analysis to identify individual muscle imbalances that are unique to your inherited structure, to your movement patterns, and to your goals and interests in living a healthy physical life. We develop a individualized program that focus on:
  • Your specific imbalances and movement patterns at work, home, and those evident during the activities that you participate in.
  • You structural and genetic posture and alignment characterizes and how they affect your interests to do activity etc.
  • We look at the ergonomics specific to your workplace and home
   

How can low intensity laser therapy help rehabilitation from surgery?

Low Intensity Laser Therapy (LILT) is the use of monochromatic light. Meditech Bioflex has been producing this technology for 20 years and has an extensive in house clinical lab.   The light source is placed in contact with the skin allowing the photon energy to penetrate tissue, where it interacts with various intracellular biomolecules resulting in the restoration of normal cell morphology and function. This process also enhances the body's natural healing propensities.   Low Intensity Laser Therapy does not heat or cut tissue. Unlike many pharmacological treatments that mask pain or only address the symptoms of the disease, Laser Therapy treats the underlying condition or pathology to promote healing. The technology utilizes superluminous laser diodes to irradiate diseased or traumatized tissue with photons. These particles of energy are selectively absorbed by the cell membrane and intracellular molecules, resulting in the initiation of a cascade of complex physiological reactions, leading to the restoration of normal cell structure and function.   The process is curative and therefore results in the elimination of symptoms including pain. In addition, it enhances the body’s immune system response and facilitates natural healing. The therapy is completely safe and has no adverse side effects. The technology is highly effective in the treatment of musculoskeletal conditions, arthritis, sports injuries, wound healing and a wide range of dermatological conditions. Whiplash injury typically involves injury to muscles, ligaments, and joints and typically involve several levels and a more wide spread area of injury due to the force full nature of the injury. Muscles of the neck, although short, cross over several joints and so the discomfort is generally more global initially. Laser therapy directed by multiple diodes are able to reach these tissues.    

Physiological effects of Low Intensity Laser Therapy

With LILT there is an increased production and release of:  
  • Endorphins which - natural analgesics
  • Cortisol – a precursor of cortisone
  • Growth hormone – instrumental in tissue repair
  • ATP – improves and regulates cellular metabolism
  • An increase in protein synthesis – collagen, DNA, fibroblasts
  • A facilitated venous and lymphatic flow
  • Increased angiogenesis – the elevation of oxygen saturation
  • Enhanced immune response
  These responses are some of the many processes that accelerate cellular regeneration (cartilage, epithelium) and restore normal cell morphology and function. Treatments are typically 25 minutes to over 1 hour depending on the condition and area being treated   The most popular technical / clinical information requested is available on the Meditech website under Laser Reports. You may visit the Meditech website research section directly for detailed abstracts, case profiles and articles on a variety of topics relating to the use of low intensity laser therapy in the treatment of various medical conditions.  

What life style and self-care measures can you do for yourself following surgery of the knee and hip?

Following a hip replacement, patients usually benefit from following applying ice and keeping their limb elevated and wound compressed.
  • Commit to physiotherapy for the first 12 weeks
  • R.I.C.E. This routine is beneficial for the first 72 hours
  • Adapt your home with higher seats, elevated toilet seat with arm
  • Perform regular flexibility and strengthening exercises
  • Exercise emphasis on restoring hip range of movement and gluteal strength.
  • Quadriceps, hamstring and calf strengthening exercises are essential to improve hip joint with weight-bearing activities.
  • Hydrotherapy exercises may be helpful to improve movement and strengthen the hip in a low weight bearing environment.
   

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