The decision to have orthopedic surgery can be intimidating, whether it’s a rotator cuff repair, joint replacement or other soft tissue surgery. This guide was written by a physical therapist to help you prepare for your orthopedic surgery and rehabilitation. It will outline the stages of healing, what you can do to prepare prior to surgery, and touch on the rehabilitation process.
Stages of Healing After Surgery
When considering surgery, it is helpful to understand what the healing process looks like. There are three general stages of recovery: the inflammatory phase, the proliferative phase and the maturation phase
- Inflammatory Phase: This stage starts the healing process and lasts for about 3 weeks. During this time, pain and swelling will start to work their way down. Your therapist will manage these symptoms with manual therapy and exercise. It is not uncommon to feel stiff during this time. The range of motion exercises your therapist prescribes will help keep this at bay. Ice (discussed later) and medication can help as well.
- Proliferative phase: This stage is where much of the swelling goes down and lasts from week 3 to about week 12. Your body is starting to lay down scar tissue, which is both a good thing and a bad thing. Scar tissue is what will ultimately heal any soft tissue. However, too much scar tissue in the wrong spot can result in the joint to become stiff. This can be prevented by consistent home exercise performance. You will get back to some of your valued activities during this time.
- Maturation phase: This phase goes from 12 weeks post-op until 1 year post op. During this stage, your body stops making scar tissue and remodels what is there. This will make the surrounding tissues stronger. You will work your way back to the remainder of your activities under the guidance of your PT and surgeon.
Before Surgery
Making a plan with your medical team and family prior to surgery will reduce stress during your recovery.
Here are some questions that you should ask in advance:
- Would prehabilitation be helpful?
In many cases, it is beneficial to have 1-2 physical therapy visits prior to surgery. During this time, your therapist can discuss how to use a walker or cane, give you exercises to increase strength and range of motion before surgery, and discuss ways to help with sleep after surgery.
- Will you need any special equipment?
It’s not uncommon to either use an assistive device or wear an immobilizer such as a sling after surgery. Going to prehab prior to surgery may be helpful to allow you to learn how to use an assistive device properly prior to surgery. It may be helpful to purchase a few icepacks to have on hand (more on that later).
- Will you be doing home health or outpatient PT?
Home health PT is when a physical therapist comes to your home for a few weeks following surgery. This is to ensure you’re moving around safely prior to transitioning to outpatient PT. Consider having a conversation with your primary care physician about home health—especially if you are having a total knee replacement or a total hip replacement.
- Will you need someone to look after you?
It’s helpful to have someone to assist you for the first couple weeks after the surgery. If you do not have anyone to give you a hand with things like meal prep, cleaning and basic mobility, then home health can offer modified ways to manage these activities.
- What are your do’s and don’ts after surgery (the precautions)?
Understanding the do’s and don’ts after surgery is vital. Oftentimes the doctor will send home written instructions on how to protect yourself after the surgery. They can include things like weight bearing restrictions, range of motion restrictions and wound care.
The Rehabilitation Process
It is important to recognize that recovery from surgeries vary. Generally speaking, joint replacements heal faster than soft tissue repairs (rotator cuff repairs and ACL reconstructions). Your surgeon and PT will go over the specific of your rehabilitation timeline.
One last pearl of wisdom is that ice can be your best friend after surgery. There are a lot of different ways to get ice over a joint. Some orthopedic surgeons recommend the use of a cryo cuff after surgery (a device that pumps ice-cold water into a sleeve which can be wrapped around the joint). If this device is not available, ice packs are an excellent option as well. These can be purchased on amazon for a reasonable price. Ice should be applied for 15 to 20 minutes, four to six times a day to help with pain and inflammation.
If you have an orthopedic surgery coming up and would like to see one of our Physical Therapists, please give one of our offices a call!
Written by: Sean Darrow, PT, DPT