It helps restore
your mobility after
joint replacement
By Ann L. Rappoport
If you're undergoing joint replacement, physical therapy may be as important as the surgery itself.
"It helps restore normal biomechanics and motion," says physical therapist David Bull, manager of an outpatient therapy site at Rothman Institute. "It's about proper posture and position, re-learning how to move most appropriately."
Physical therapists guide you in practicing walking, bending, lifting, climbing (and descending) stairs and ramps to re-develop strength, balance and endurance.
"Increased independence" is one of the goals of post-surgical rehabilitation, Bull says.
It is to help you return to work, family and leisure activities that had been limited by the joint problems.
Measures progress
If you want to be able to ski, or play golf or tennis again, therapists tailor the program to your needs.
Sue Miller, clinical manager for MossRehab, explains that patients going to outpatient physical therapy there see the same therapist two or three times a week. The therapist becomes a "barometer" of progress.
For instance, if your pain is interfering with progress, Miller discusses this with you, finding out, for instance, how you are reacting to prescriptions. If you experience side effects or the medication is not controlling the pain, she'll encourage you to discuss the symptoms with your doctor. Therapists occasionally contact the doctor about other post-surgical conditions.
Physical therapy also may increase circulation to the affected areas and reduce the build-up of scar tissue.
Many surgical offices help prepare you for joint replacement by providing information about the process. A booklet may be issued or a seminar presented to acquaint prospective patients with the routine and expectations.
Preparing for surgery
Some conditioning exercises are often suggested for before the operation to support your post-operative transfer from bed to chair or to help with using a walker.
Your particular surgery, insurance and situation will determine where you spend your first weeks "post-op," explains registered nurse April Smith. Most insurance will cover a period at an inpatient acute rehabilitation hospital (such as Magee, Bryn Mawr and MossRehab) for double joint replacements (bilateral). For single joint replacement, if you cannot go directly home, insurance might cover some time in a sub-acute rehab or nursing home. Most single-joint replacement patients go home and receive in-home nursing and physical therapy services through a homecare agency.
Your social worker and/or case manager review your circumstances and preferences within a day or two of your surgery and arrange for your hospital discharge.
Tell your healthcare team
"Be sure you tell them about your status at home," urges therapist Greg Nolan at Rothman. For instance, if there are eight steps up to your entrance, or if your spouse is not able to assist you, it's essential to tell your healthcare team.
Some hospitals have skilled nursing facilities on campus, and eligible patients may be able to select those for convenience and continuity of care.
Typically, after about three to six weeks, depending on your other health conditions, the surgeon will write a prescription for outpatient physical therapy.
What to look for
You can ask for a tour of physical therapy centers, Miller points out. Look for ease of accessibility, cleanliness and a friendly, professional atmosphere, she suggests. You also want a site convenient enough to ensure that you'll show up two or three times each week.
There's more to a therapist than great credentials. You want one who listens, who assesses and reassesses.
And remember: You must also perform the home exercises conscientiously. "Challenge yourself in ways that support the rehab process," Miller encourages.
After your outpatient physical therapy is complete, experts urge you to join a group exercise program or a gym, and continue to be as active as possible.