Physical therapy for total joint replacements

Joint replacements are becoming more common surgeries.  This is likely due to a number of factors.  Individuals are participating in more activities that wear down the joints.  People are bigger, both in height and weight, than they were in previous generations and they are living longer.  Also, the surgical process has become very well perfected.  So whether you are a former baseball catcher, or have had arthritis for years you may be considering a joint replacement for your hip or knee.  Physical therapy is something that will be needed following the surgery.  Despite the often little attention given, physical therapy is a very important part of the medical process.  The operation is just the start of the process.  Physical therapy will take you the rest of the way back to your healthy active lifestyle in a safe manner.  Physical therapy usually begins within a few days to a few hours after the surgery.  You will receive physical therapy in the hospital, your home and in an out-patient clinic.  This article will describe what you should expect from physical therapy for your hip or knee joint replacement and why these things are so important.

Therapy Pre-Operation

Attending physical therapy pre-operation is become more common.  The surgeries themselves are traumatic on the muscles and surrounding joints.  Participating in physical therapy before the procedure will aim to accomplish two things:  It will prepare the muscles and other surrounding tissues to minimize the damage undergone during the operation.  It will also aim to improve muscle strength that will help with the recovery after the operation.  These two goals will be accomplished through stretching out specific muscles and joints, and strengthen muscles that may have become weak over years of little use.  Therapy can also include being trained to walk with an assistive device, like crutches, or a walker.  Being stronger and having stretched muscles will help you recover faster.  If you are planning on having a joint replacement operation, or if you are already scheduled for one, be sure to visit you doctor of physical therapy first to help set yourself up for success.

Therapy Post-Operation

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In the hospital

After the operation you will be in the hospital for about a week.  Physical therapists will be working with other medical staff like the nurses, occupational therapists, and surgeons to facilitate a safe and quick recovery.  After your operation you can expect to have some discomfort in the area that was operated, whether it’s your hip or your knee.  You will have, after all, just had surgery.  You will have some swelling of the area and bruising in the area is a normal occurrence.  The nurses will work to manage your level of discomfort.  The physical therapist will help you get up and take your first steps on your new joint, probably the same day as your surgery.  You will likely begin walking using an assistive device like a walker, and as you improve they will give you other equipment to suite your needs.  Walking seems like such a simple thing, but it really accomplishes a lot.  It helps you recover from the anesthesia of the operation, puts weight through the new joint increasing the strength of the joint, it helps move the fluid out of the legs and it helps minimize your strength loss from being inactive.  Physical therapy will also get you moving your new joint in the appropriate ways to reduce the swelling and improve your ability to move around.

The physical therapist will assist you during the majority of your activity because of the complex nature of the operation.  Depending on the hip surgery performed you may be at an increased risk for dislocating your replaced hip if you do certain movements.  The physical therapist will be there to help you move in the appropriate ways so you understand your abilities.  Knee replacements are utilizing something known as a nerve block to reduce patient discomfort for the first few days.  It is helpful in that sense, but it also means it is more difficult to walk.  The physical therapist will work closely with you to make sure you are safe as you move about.  Then before you know it, you are on your on your way out of the hospital, either to a rehab facility, or to your home.  That depends on what you and the hospital determine.

Out of the hospital

Once out of the hospital physical therapy will continue with all of the same things that were being worked on in the hospital.  This period depends on the individual but is generally short, 1-2 weeks.  They will manage the swelling, strengthen muscles to increase stability and increase the joints ability to move.  You will continue to recover, to make improvements and you will be able to get around better.  As this happens you will be referred on to outpatient physical therapy at a physical therapy clinic.

Outpatient physical therapy for your joint will pick up where the other physical therapist left off.  By this point you will have received care from many health care providers.  On the first visit to the outpatient physical therapist he/she will assess your physical condition and develop an individualized plan of care to help you achieve your goals.  They will progress your strengthening exercises, targeting muscles that are important in maintaining stability around the joint that was replaced.  They will stretch the joint capsule enabling greater motion in the joint.  They will improve your proprioception, the body’s ability to sense itself within space, which was damaged from the operation by developing challenging balancing activities.  They will perform tissue mobilization, manual therapy,  when appropriate to minimize the scar tissue build up, and to relieve muscle trigger points that may be causing increased discomfort.  They have numerous modalities like moist heat, ultrasound, and cold compression which they will utilize when appropriate to accelerate healing and recovery.  As you return to your former activities, and desired goals, therapy will talk to you about discharge.  They will give you final recommendations to advise you on self management, things to do, and not to do.  Upon final discharge you will be able to celebrate a successful knee or hip joint replacement.

Physical therapy is an integral part of the medical process for joint replacements.  Physical therapists are the experts of movement.  They will get you back to moving the way the body is supposed to.  This will minimize compensation of other parts of the body and eliminate the risk of developing other complications from the compensation, like back pain.  The physical therapists will work with you to meet your personal goals in a safe and efficient way.  Physical therapists are also educated to pick up warning signs of possible complications from the surgery.  They closely monitor your progress and help manage your recovery.  Physical therapy is an important part of successful joint replacements and so whatever stage you are at, work with your physical therapists because they are working for you.

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