What is rehabilitation from surgery?
How can physiotherapy and massage therapy help from rehabilitation after surgery?
Manual Physiotherapy and Massage TherapyEarly 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 exercisesGentle 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.
How can exercise and physical development help after rehabilitation from surgery?
Exercise and Physical DevelopmentThe 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?
Physiological effects of Low Intensity Laser TherapyWith 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
What life style and self-care measures can you do for yourself following surgery of the knee and hip?
- 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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