Physical Therapy Following Total Joint Replacement
Physical therapy is necessary following knee replacement surgery to regain functional range of motion and strength. It is usually initiated on the second post-operative day in the hospital with gait training, exercises to increase range of motion and pool therapy. Modalities such as heat, ice and electrical muscle stimulation are used for stretching, swelling and strength respectively. Upon discharge from the hospital, you will be referred to an outpatient physical therapy office or an in-home physical therapist depending upon your requirements and insurance benefits.
The duration of postoperative physical therapy is usually four to six weeks, three to five times per week. During the course of physical therapy, you will receive individualized (hands on) therapy in the form of soft tissue mobilization, heat for stretching, cold for swelling, and exercises consisting of range motion, stretching and strengthening. Various modalities are used to control pain if necessary. A home exercise program will be given to you to follow at home to maintain optimum range of motion and strength in your knee.
Primary hip replacement surgery usually does not require any physical therapy. Upon discharge from the hospital the patient is usually given a home exercise program which can be followed independently. Revision or secondary hip replacement surgery usually requires some physical therapy on an outpatient basis which usually begins after six to twelve weeks to strengthen hip muscles and improve gait pattern. The patient will use a walker or crutches for the first six weeks, maintaining weight-bearing status as determined by the physician at the time of surgery.
Usually, cementless hip and knee replacements must maintain touch down weight-bearing status for the first six weeks, which allows the porous coated anatomical (PCA) joint to heal with the bone. At the first post-operative visit (six weeks) after reviewing the x-rays, the physician will discuss your ability to progress weight-bearing on the operated hip or knee. Cemented hip and knee replacements can be weight-bearing to tolerance, but the patient must continue to use crutches or a walker until the post-operative visit at six weeks.
Amurvel Physical Therapy
Physical Therapy Following Arthroscopic Surgery
Physical therapy is usually prescribed following arthroscopic surgery depending upon the type and the extent of the surgery. With simple arthroscopic procedures, the patient is usually referred to physical therapy after the first or second week. With complicated arthroscopic surgeries involving repairs of muscles and tendons, ligament or bone repairs; the patient is usually referred to physical therapy after four to six weeks. The physician will advise the patient when to begin physical therapy. The only exception to the above criteria is a minor procedure performed to increase range of motion under general anesthesia, which is referred to as "manipulation." After this procedure, physical therapy is started immediately in the recovery room and then on a daily basis to maintain the range of motion of the involved joint. It is important before beginning physical therapy and immediately after surgery, to keep the swelling down in the operated extremity.
A Simple Rule of RICE is to be followed:
I.....Ice or cold packs.
C.....Compression, either with an Ace bandage or Ted hose.
E.....Elevation of operated extremity above your heart to
The five most important aspects of rehabilitation are:
- Proper body mechanics;
- Increasing strength of both upper and lower extremities;
- Maintaining a stable back and protecting the back in daily activities;
- Aerobic conditioning;
- Specific strengthening and stretching exercises for the abdominal, spinal and lower extremity muscles.
A regular exercise program will be provided by the physical therapist. Doing these exercises at home will be important in helping to maintain a healthy back. When the muscles have been sufficiently rehabilitated, activities, including athletics, may be approved by the physician. Under certain circumstances, rehabilitation may take longer.
The time frames mentioned above serve only as a guideline. If you have any questions at anytime during the post-operative period, be sure to ask your physician or physical therapist. If you have any doubts as to whether or not an activity is allowed, check with your physician or the physical therapist before you perform the activity. Remember, rest is an important factor in the healing process, as is exercise. The above suggestions are guidelines for you to follow during the early portion of your rehabilitation.
Certified Hand Therapy
Serious hand injuries and complex hand surgery frequently require specialized and highly focused therapy which is performed by certified hand therapists. These people come from both physical therapy and occupational therapy backgrounds and are required to do additional training specifically targeting the upper extremity, following which they must sit for a difficult certifying examination. Hand therapists perform extensive “hands on” treatment, guide their patients in setting up home exercise programs and frequently are called upon to fabricate a wide variety of specialized custom made splints and braces.
Although Dr. Hanlon utilizes the skills of many hand therapists throughout the greater Phoenix area, he most often sends his patients to the following facilities:
1) Amurvel (Brant Bermudez, OTR, CHT) in the Biltmore area and in Avondale.
2) Contact (Karen Thomas, OTR/L, CHT) near Hayden and Shea in Scottsdale.
3) Dynamic Rehab in Tempe, Gilbert/Chandler, and Mesa/Gilbert.
4) Industrial Hand and Physical Therapy in Gilbert, Tempe, West Phoenix and at Chandler Regional Hospital