If you have an orthopedic surgery coming up, odds are you can plan on getting to know your physical therapist much better. Physical therapy is pretty standard after surgeries like knee replacement, hip replacement, rotator cuff repair, spinal fusion, and many others and it is an important part of your recovery. That is the time to control pain, improve range of motion, and increase strength. Basically, that is when you regain your function and get back to doing all of the things that you USED TO do. Those are the obvious reasons and most of us know someone who will tell you, “I didn’t do my physical therapy on my knee and now I can’t straighten it.” Most of the less obvious reasons are educational. For example, if you have a hip replacement, you might want to wear slip-on shoes for a while. You might also decide that eventually you want to wear lace-up shoes again. Both of those are things that your physical therapist will help with—partly because your motion is better, but also because they can teach you some tricks.
The interesting thing to me is physical therapy BEFORE surgery. Traditionally, the thought is that if you work with your physical therapist before a surgery, then after the surgery, you can hit the ground running (pun intended) because you will already have improved strength and motion. The truth is, there is not much evidence to support that idea. Don’t get me wrong. It definitely doesn’t HURT to work on exercises before surgery and it makes sense to me that it could help a bit in your recovery, but the evidence just isn’t there.1
There IS good evidence of pre-surgical physical therapy being helpful in terms of education.
On the other hand, there IS good evidence of pre-surgical physical therapy being helpful in terms of (again) education. Some of it is obvious. For example, say you get home after a knee replacement and realize that the bathroom is upstairs, you could be in a world of hurt if you don’t know how to get up there. If you have already talked to your physical therapist before surgery, they can teach you how to get up (and down) the stairs with a knee that doesn’t yet want to do what you tell it to do. You will also have learned how to use a walker so that you don’t have to figure it out while your brain is focused on other things after the surgery.
The less obvious benefits of education prior to surgery are actually related to understanding the pain post-surgery. You would probably be stunned at how many people I see after surgery who are surprised that they have pain. They have just been cut open to have part of their body removed and another part hammered in, but since the surgery is to fix their pain, they thought that they would be pain-free when they woke up. In fact, people who are educated about their pain before low back surgery felt more prepared and less afraid. They also required less treatment in the year after surgery resulting in 45% less cost to them (over $2000 on average). This is similar to findings for knee replacement.3
Three-Fold Takeaway:
1. Physical therapy after surgery is important (you already knew this part)
2. Physical therapy before surgery is also important, but
3. You probably don’t need to worry too much about the traditional exercises. Education is the important part.
Sources:
1. Husted R, Juhl C, Troelsen A, Thorborg K, Kallemose T, Rathleff M et al. The relationship between prescribed pre-operative knee-extensor exercise dosage and effect on knee-extensor strength prior to and following total knee arthroplasty: a systematic review and meta-regression analysis of randomized controlled trials. Osteoarthritis and Cartilage. 2020;28(11):1412-1426.
2.Louw A, Diener I, Landers MR, Puentedura EJ. Preoperative pain neuroscience education for lumbar radiculopathy: a multicenter randomized controlled trial with 1-year follow-up. Spine (Phila Pa 1976). 2014 Aug 15;39(18):1449-57.
3. Louw A PT, PhD, Zimney K PT, DPT, Reed J PT, DPT, Landers M PT, DPT, PhD, Puentedura EJ PT, DPT, PhD. Immediate preoperative outcomes of pain neuroscience education for patients undergoing total knee arthroplasty: A case series. Physiother Theory Pract. 2019 Jun;35(6):543-553.