Functional Health see a lot of patients for Physiotherapy Before & After Surgery at both our Biggera Waters and Broadbeach Practices. Rehabilitation following hip, knee or shoulder surgery is one of the most common things that our Physiotherapists and Exercise Physiologists at Functional Health see on a day to day basis. We have seen a large increase in our Biggera Waters practice of late. Getting effective rehabilitation after surgery is critical to helping patients optimise their recovery and get as close to their pre-surgery level of functional as possible. Rehabilitation programs are different for every person depending on their condition, surgery, level of function and goals, but generally involve returning to having full range of motion at the joint, improving the strength and endurance of the muscles around the joint, and to improving the stability of the joint. However rehabilitation shouldn’t just be something that starts after surgery, it should be an integral part of the preparation for surgery as well. The term ‘pre-habilitation’ refers to the progress that is made towards these same goals (e.g. improving strength and range of motion) prior to having surgery and can make a significant impact on subsequent post-surgery recovery times.
The diagram below comes from an excellent medical textbook by Parveen Kumar and Michael Clark 1 and describes the relationship between your baseline level of function and how this can predict the likelihood of suffering some sort of disablement during life. The ‘threshold of disability’ is the point at which we begin to experience negative effects due to poor levels of function that can impact our day to day life. This can include our ability to work, perform usual tasks around the home or even mobilise. When we are faced with situations that place our body under stress, such as illness or surgery, it can lower our functional capacity so that we become closer to this ‘threshold of disability’. In young healthy individuals the stress of surgery may not be enough to cause issues. However for those that are a bit older or have existing health issues, the added stress of surgery can be enough to push them below this line and cause significant functional problems.
But as you can see from the graph, there is plenty of variability in our levels of function between the red and green lines. This can subsequently impact how far away from the ‘threshold of disability’ we are. By improving our function and moving closer towards the top green line, there is a lower risk that a stressful event may cause significant issues, or that the dip below this line may be reduced so the effects are not quite as severe. This is exactly what we try to achieve with pre-surgical patients throughout a pre-habilitation program.
For example, hip or knee replacement surgery can cause a significant loss of strength in the muscles surrounding these joints due to the recovery time and gradual progression back to weight bearing. But improving the strength of these muscles prior to surgery can mitigate or offset some of this loss of strength meaning that the recovery time following joint replacement may be less likely to cause significant issues when returning to activities of daily living.
This principle is not limited to just surgery either. Improving our general fitness levels and level of function through regular exercise and physical activity can help to slow the decline in function that happens as we age, and also how we are able to tolerate stressful events such as sickness and illness.
If you know that you have upcoming surgery and would like to get a head start on your rehabilitation, consider giving us a call at Functional Health to make an appointment with one of our expert Physiotherapists and Exercise Physiologists.
1. Kumar, & Clark. (2012). Nutrition and ageing. Figure 5.10. Kumar & Clark’s clinical medicine (8th ed..). Chapter 5, p. 227. Edinburgh ; New York: Saunders/Elsevier.