Postoperative rehabilitation
Postoperative rehabilitation constitutes a distinct clinical entity in itself in the rehabilitation of musculoskeletal problems.
It has its own qualitative characteristics and differs from a simple musculoskeletal problem due to degenerative or traumatic causes.
Many times after surgery, we happen to have various contributing factors that create delays and complications in postoperative recovery.
For example, one of the factors that creates difficulties in the speed and effectiveness of recovery from surgery is the development of edema.
The effectiveness and success of the rehabilitation of surgical cases at our center lies in the fact that there are specialized colleagues for the individual functional systems of the body.
Therefore, another therapist will take care of the removal of edema (swelling) and another will take care of musculoskeletal integrity in the postoperative period.
Of course, all of this is included in a pre-planned and pre-calculated treatment plan. Therefore, from the beginning you will know what the duration, stages of recovery and treatment expectancy will be.
Our treatment plan is guaranteed from the first appointment and if for any reason it deviates from the agreed duration or number of sessions, our center will cover the additional cost.
After consultation with the treating physician and surgeon of the case, the surgical rehabilitation treatment plan is formulated, which is usually divided into three phases.
Phase I: Postoperative Edema Rehabilitation
In the first phase the main objectives are:
- Decongestion of postoperative edema
- Pain reduction | analgesic therapy
Why does postoperative edema form?
Every surgical procedure essentially constitutes a new injury to our body, resulting in our body immediately activating its healing mechanisms.
The creation of local edema in the operated area is the most characteristic image in the initial stage of healing and it is normal for it to remain for the first twenty-four hours after the operation.
Our lymphatic system, being responsible for the drainage and management of edema in our body, has been directly injured by the surgical intervention, while in addition the pain stimuli drastically reduce its functionality. The result is the formation of edema (swelling) in the area, e.g. in the knee
What causes prolonged postoperative edema?
The normal duration of postoperative (aseptic) edema can reach up to 2 weeks, however, it burdens and delays the healing mechanisms.
Specifically:
- It reduces local blood flow, resulting in prolonged recovery of the area.
- It presses on the injured tissues, increasing painful stimuli.
- It greatly limits the mobility of the area.
- The risk of developing fibrosis and tissue damage increases, which will reduce range of motion in the long term.
We therefore understand that the immediate and correct treatment of postoperative edema plays an important role during rehabilitation as it directly affects the duration and quality of its results.
What does physiotherapy intervention for edema include?
The therapist's intervention to treat edema begins immediately, even on the same day of surgery if possible, and includes:
- Special techniques for activating the lymphatic system (Manual Lymph Drainage)
- Bandage
- Cryotherapy
- Suction position
Compression bandage helps control swelling
Special techniques for activating the lymphatic system can be applied from the first postoperative hours as they are painless, pleasant for the patient and are performed peripherally from the surgical area.
In addition to the lymphatic network, they also affect the autonomic nervous system, reducing painful stimuli.
Then, a bandage is applied with special materials (hypoallergenic bandage substrates - low-elastic bandages) that stabilize the area, offering a sense of security, while allowing movement.
The combination of the above interventions pushes the edema to areas where the lymphatic system can manage it while at the same time the functional dressing ensures that the edema does not return. At the same time, by applying cold compresses and placing the area in an inverted position (higher than the level of the heart) we have a comprehensive management of postoperative edema.
Duration and frequency of treatment
As we mentioned, in cases where there are no postoperative complications (e.g. infection) the treatment plan can begin immediately, even on the same day of the operation. Treatments are performed on a daily basis (even 2-3 times per day) and last up to 5 days depending on the severity of the symptoms.
During this time, we manage to drastically decongest the area, helping the natural healing process.
Results of edematous treatment
Immediate treatment of postoperative edema ensures
- Faster recovery and return to professional and athletic obligations.
- Avoiding complications from prolonged edema (fibrosis, future limitations in range of motion)
- Immediate pain reduction
Gradually, as the edema subsides and as we move into the middle of the healing process, the therapeutic intervention increasingly aims at mobilization and retraining.
Phase II: Return to Normal Movement in Post-Injury Rehabilitation
In the second phase of rehabilitation, the process of regaining mobility and functionality continues.
After the swelling of the operated area has been relieved, the effort to restore normal movement and function is intensified.
The therapeutic approaches used are mainly:
- Manual Therapy
- Myofascial Release Techniques
- Neurodynamic concept
- Acupuncture (Western European style, dry needling)
- Therapeutic exercise (therapeutic exercise, pilates for injuries, retraining)
- Various physiotherapy machines (analgesia, accelerated healing, etc.)
What is Manual Therapy and what is its place in the therapeutic plan?
Manual Therapy is a comprehensive rehabilitation method based on clinical reasoning. The specialized therapist has all the diagnostic and therapeutic techniques that are accompanied by a thorough and detailed history taking and a specifically justified therapeutic plan.
With manual therapy, the specialized therapist, knowing the individual movements of the joint, can increase its mobility without causing excessive pain to the patient.
Especially in postoperative rehabilitation, targeted and pain-free mobilization is extremely important.
This is the biggest difference compared to the classic method of regaining joint mobility, in which the patient is subjected to a very painful procedure that creates denial and fear in the patient.
Our center applies the most complete Manual therapy method – Maitland Concept.
Special mention should be made of the importance given to the psychosocial component in any phase of rehabilitation.
The modern approach is person-centered and wants the patient to play an active and meaningful role in the rehabilitation process.
Under the light of this philosophy, any therapeutic peritoneal release techniques (dry needling, FDM, IMTT) are applied, as well as neurodynamic mobilization techniques that concern the mobilization of nervous tissue.
The various physical therapy machines also have their role, where there is a reason for their application.
The difference in the modern approach is that physical therapy machines, and their passive application, constitute the least important part of rehabilitation, while for many years they were considered the exclusive and only method of rehabilitation.
This is of course no longer the case these days, and a program based primarily on machines is considered a priori unsuccessful and incomplete.
From the second phase of rehabilitation, the implementation of therapeutic exercise begins, always adapted to the needs and any particularities of the surgery.
A successful therapeutic exercise plan is ultimately what most of the time will determine the entire course of rehabilitation and, above all, the maintenance and improvement of the therapeutic outcome.
Any treatment without exercise is incomplete and puts at immediate risk whatever has come before, no matter how effective it may have been.
The end of the second phase of rehabilitation after surgery is considered the time when the patient has regained full range of motion of the involved joints. In addition, the strengthening, proprioception and coordination of movements should be at such a level that the patient can self-serve and carry out all his basic daily needs.
Phase III: Perfecting Postoperative Rehabilitation with Exercise, Biomechanical Correction and Ergonomics
In the third and final phase, rehabilitation shifts even more towards the patient's active participation and therapeutic exercise.
The ultimate goal is now to maintain and further improve the therapeutic effect through strengthening, ergonomic retraining, and correction of biomechanical deviations and incorrect movement patterns.
Throughout the rehabilitation process, the role and guidance of the physiotherapist plays a crucial role in a successful therapeutic outcome.
The road to post-operative rehabilitation often has difficult phases and obstacles. The patient should be properly informed at all times and receive the support of the therapist.
Patience, consistency, and the full cooperation of the patient and therapist are considered necessary conditions for achieving the ultimate goal.
At our center, knowing the uncertainty that a patient experiences after surgery regarding the time and cost of rehabilitation, we provide an accurate financial plan for comprehensive postoperative rehabilitation from the beginning.
