What is The Role of Manual Physiotherapy in Post-Operative Care??
Physiotherapy has a crucial role in post-operative care.
And it boggles my mind that in this day in age, some surgeons still don’t recommend physiotherapy post operatively!
In most cases, patients are up and moving within 24 hours of their surgery and after a few days of initial healing, physiotherapy can be immensely helpful with positive outcomes postoperatively!
Post-operative physiotherapy care focuses on three main areas.
Priority #1: Monitoring the incision for signs of infection and getting inflammation under control
The first priority in the acute phase is monitoring the incision for signs of infection and helping to get inflammation under control.
Any time we injure ourselves or have a surgical procedure done, our bodies create an inflammatory response to help with the healing process in that region.
So inflammation is incredibly helpful in those initial phases, but the downfall is that it typically makes the area hypersensitive and inhibits muscle activation in that area.
Physiotherapists are trained to help promote circulation to the area by using a gentle massage technique called effleurage.
This helps to reduce pockets of inflammation that have collected in the region becoming stagnant and also helps the lymphatic system promote drainage of the area.
Physiotherapists will typically recommend movement, gentle compression and elevation to aid in the inflammatory control efforts. Ice has been shown to have benefits in controlling inflammation in the first 24-48 hours, but there is increasing caution about overusing ice, as it may interfere with the natural healing process.
Priority #2: Get the joints moving
The next priority for our Toronto Physiotherapy team in post-operative care is to get the affected joint moving.
Hands-on manual therapy plays an important role in increasing range of motion of the joints affected and reducing pain. In the acute phases, the physiotherapist will perform joint mobilization and range of motion during your appointment, while respecting something called the end feel of the joint.
This is the point where it feels like the range of motion of the joint stops. Gentle mobilization of the joint has been shown to “reduce pain via the pain gate theory (Melzack & Wall 1965) and stimulation of the descending inhibitory tracts.
Indirectly, manual therapy can reduce pain via inhibition of muscle spasm which reduces tension on the periarticular structures, lowering intraarticular pressure, or reduces nociceptor (pain receptor) activity (Zuzman 1986)” (Bearne, Hurley 2010).
Manual therapy also helps with remodelling and repair of tissues.
One of the biggest benefits of working with patients early on post-operatively, is showing them what their body is safely capable of doing, as many are apprehensive about reinjuring themselves and become overly cautious with their mobility.
Movement is one of the most important aspects of recovery and we as Toronto physiotherapists play a valuable role in demonstrating a patient’s mobility limits and teaching them where/how they can gently push them.
In clinic, we do a variety of passive and active manual therapy techniques and will teach the patients how they can continue the mobility work at home in an active or assisted way. Patients leave feeling much more confident with what movements and ranges they can safely perform.
Priority #3: Rebuilding strength, balance, endurance, stability, and more
The third and very important final focus is rebuilding strength, balance, endurance, stability and motor repatterning of the affected region.
This is done through a progressive exercise program that challenges the affected area and helps to balance and reintegrate it’s function with the rest of the body, as compensations are typically present. The ultimate goal is to return patients to the activities that they love to do!
When we reviewed the evidence to support manual therapy and other physiotherapy inventions in post-operative care plans, it showed that physiotherapy helps to optimize recovery and reduce the risk of chronic issues.
The evidence is strong, although there is variability depending on the specific surgery and patient population.
A recent meta analysis by Yang et. al. (2024) showed that “The evidence underscores the importance of physiotherapy as a complementary approach to surgical treatment in knee osteoarthritis, contributing to faster recovery and better quality of life for patients”.
A systemic review by Robinson et. al (2019) looking at The effectiveness of physiotherapy interventions on pain and quality of life in adults with persistent post-surgical pain compared to usual care showed that the ‘evidence indicates that physiotherapy could play a role in the management of persistent post surgical pain.’
This has very positive implications for also reducing the amount of medication that patients may need post-operatively.
If you’ve just had surgery or are considering it and are wondering if we are the right fit for you in Toronto, book in a free 10-minute phone consultation to chat here! We look forward to returning you to all the activities you enjoy in life!
Next on your reading list:
References:
Physical therapies - Lindsay M. Bearne PhD MSc MCSP, Michael V. Hurley PhD MCSP, in Rheumatology, 2010
A Robinson, J McIntosh, H Peberdy, D Wishart… - PloS one, 2019 - journals.plos.org
The impact of physiotherapy interventions on enhancing wound healing post knee osteoarthritis surgery: A meta‐analysis — J Yang, R Chu, Z Chen, J Qiu, Z Pang… - International Wound …, 2024 - Wiley Online Library
