Physical therapy typically plays a key role in the recovery process after joint surgery, even for patients treated with minimally invasive solutions. But for those unfamiliar with physical therapy, patients may be unsure what to expect. What will progress look like? What questions should they be prepared to ask and answer?
Anika Therapeutics, a global joint preservation company, recently met with Andrea Schleibaum, licensed physical therapist and owner of Belle Pelvic Physical Therapy, to learn more. Andrea is a board-certified Doctor of Physical Therapy licensed to practice in Massachusetts. She has over ten years of experience as a physical therapist, including in general orthopedic care.
As physical therapists, our goal is to help you achieve a return to function and pain-free mobility. Your first visit with a physical therapist (PT) is your initial evaluation. You can expect to answer common questions like what your function prior to the injury or surgery was, what have you done thus far to start the rehabilitation process, does your doctor have any specific protocol or recommendations for you, what is your pain like and what is your current level of function. Notably, you will also be asked about your goals and what the end-result of “successful therapy” looks like for you. Everybody has different goals and expectations—some people want to hike, some want to run marathons and some simply want to be able to drive and pick up their grandchildren. Physical therapy caters to your unique needs and so, for an initial evaluation, we’re asking a lot of questions with the goal of getting to know you better.
A great way to find the right PT for you is through word-of-mouth. Word travels fast and if you know someone who’s established a relationship and rapport with someone who treats what you would be going to PT for, that’s a great place to start. Another option is to ask your doctor who they recommend. If your doctor typically refers to a certain PT, great communication is likely already established which can help make your treatment run more fluidly. Lastly, I would encourage patients to consider the setting in which they will be receiving their therapy. Would you prefer a larger clinic where multiple PTs work in an open setting, or would you be more comfortable seeing someone one-on-one? I would recommend thinking about where you’d be most comfortable and what type of environment would suit you best.
One question I’m typically asked is how long will I need to come to physical therapy, which is patient-specific. This is important, though, because it allows us to set expectations and give you a better idea of when you’re going to be back to your old routine. It’s important to note that physical therapy is not just a cure-all that will get you back to 100% right away. I’d recommend asking your PT about whether you should be doing exercises at home outside of sessions, because our answer will almost always be yes. And on the other side of that, I’d encourage people to ask their PTs what not to do because it can be surprising. If you’re going to the gym and doing overhead pressing, for example, your PT might advise against it.
One of the main differences between outpatient and at-home physical therapy is that we base a lot of our evaluations around how you function in your own home, especially for patients who are “homebound” and not able to drive. For example, we will need to see that you can get up the stairs or out of bed safely. We utilize what’s available and will often do a lot of exercises on the couch or the bed and use the kitchen counter for standing exercises. Of course, there’s a lot of stretching too, so we may lay patients down on their beds and do some mobility work. Ultimately, our goal is to make sure you’re safe in your own home, while returning you to a functional baseline.
I tell people all the time that you can’t get better if you only come to see me one or two times a week—physical therapy really needs to translate into your regular routine. One piece of advice that works like magic, believe it or not, is stretching in the shower. It’s warm, it’s a relaxed setting—shoulders start to loosen up—and it’s a great way to start a gentle range of motion exercise. Another idea is to stretch around mealtimes. The key here is to set aside some time for yourself to commit to the routine that will get you back to function.
Of course, high impact activities have increased impact on your joints so that needs to be taken into consideration, but so does quality of life, passions and goals. I like to find a balance where patients feel they can still pursue their passions although if their joints are demanding a lower impact version, I like to come up with a way the patient can still feel good about the activities they are pursuing. For example, if running hurts, let’s try an elliptical. That said, one exercise I tell everyone to try is swimming. People feel so good in the water regardless of whether they’re recovering from a joint replacement or dealing with arthritis. If you have access to a pool, go swimming!
Doctors often want patients to already be set up with a PT prior to their surgery so they can get in exactly when they need to be to begin the rehab process. Typically, the protocol is sent over to the PT so there are clear instructions on when, how much and in what direction the PT can begin to get the patient’s joint moving again. Oftentimes, PTs will see patients in the first few weeks after their surgery and be with them until they have returned to an acceptable functional baseline.