How to Optimize Surgery

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How to optimize your surgery

By Juliana Gildesgame, PT, DPT

I feel lucky when I am given the opportunity to evaluate a patient prior to a major surgery because I know physical therapy can complement their surgery. The best indicator of a surgical outcome is the patient’s functional level prior to the surgery. My patient Sharon is a good example of how becoming stronger and more flexible before surgery can improve surgical outcomes.

Sharon started physical therapy because she wanted to avoid knee replacement surgery. She was an active lawyer, grandmother and tennis player. “I hate everything there is to hate about the idea of surgery,” she told me at our first appointment. She didn’t like the idea of general anesthesia, having a synthetic joint or a long and likely painful rehab. So Sharon and I set out to optimize her hip stability and her balance strategies. She improved her range of motion, she decreased her pain and was able to play tennis twice per week without flaring up.  “The only thing I can’t do is run after my 2 year old granddaughter. I can’t walk around on my knees, I can’t stay on the floor with her for long periods of time.” So Sharon decided to have the surgery. She wanted to keep up with her granddaughter and her grandson who is on the way.  Ultimately, Sharon’s rehab was smooth and successful. She went into the surgery strong, with good range of motion and aware of how to integrate self-care skills into her lifestyle.

Patients who participate in rehabilitation before surgery have better outcomes because:

  1. They are mentally and physically prepared for their surgery. 
  2. They understand why they are having the surgery.
  3. They know how to stay appropriately strong and flexible to maximize surgical results.

Patients who participate in “Pre-habilitation” or  “prehab” optimize their surgical outcomes for several reasons. 

  1. Prehab patients have informed expectations. There is peace of mind associated with feeling clear about the need for surgery and the likely surgical outcomes. The surgery itself is inherently a passive experience, but mentally and emotionally preparing yourself for what to expect is a way to assert yourself in your surgical procedure. 
  2. Prehab patients work with their movement patterns throughout the body. Our bodies adapt to our injuries with varied alignment modifications and movement patterns. Patients who participate in pre-habilitation start to understand compensatory patterns before they materialize into secondary injuries. 

Patients who participate in prehab optimize their surgical outcomes because:

  1. They are stronger going into rehabilitation. After surgery, there are certain muscle groups that typically weaken. If you start with increased muscle mass presurgically, you will have a better reservoir of strength to draw upon after surgery. Studies show that patients who undergo total joint replacement have improved strength post-surgically compared with patients who did not participate in prehab.1 Athletes also benefit from presurgical strength. A 2013 study showed that athletes who participated in 6 weeks of preoperative physical therapy prior to ACL reconstruction had improved quadriceps strength and functional outcome tests at 12-weeks post-operatively. (2)
  2. They know how to respond to their pain. Stiffness, swelling, sharp pain, achiness… there are so many ways your body can feel cranky! In prehab, physical therapists will help you interpret the myriad of ways your body communicates and help you to respond appropriately. Give yourself the advantage of prehabilitation before your surgery.

Consult with the physical therapists at Century City Physical Therapy about how to prepare your body to maximize your post surgical recovery and be proactive in your rehabilitation.  

References:

(1) Rooks DS, Huang J, Bierbaum BE, Bolus SA, Rubano J, Connolly CE, Alpert S, Iversen MD, Katz JN. Effect of preoperative exercise on measures of functional status in men and women undergoing total hip and knee arthroplasty. Arthritis care and research. Oct 2006; 55: 700-708.
(2) Shaarani SR,  O’Hare C,  Quinn A, Moyna N,  Moran R, and O’Byrne J. Effect of Prehabilitation on the Outcome of Anterior Cruciate Ligament Reconstruction. Am Journ Sports Med. Sept 2013;1(9):2117-27.
(3) Snow, R, Granata J, Ruhil A, Vogel K, McShane M, Wasielewski R. Associations between preoperative physical therapy and post-acute care utilization patterns and cost in total joint replacement. J Bone Joint Surg Am.  Oct 2014; 19.