Recently, I received a brief private message from someone who wanted to find out more about my profession as far as post-operative care and rehabilitation are concerned. Facing orthopedic surgery can be quite daunting. What can we expect? How long will it take for the recovery?

Some of my previous patients have admitted to having had great reservations about starting rehabilitation after surgery. “Because,” they would say, “I have a relative (or friend) that had this done, and they told me PT is torture.” Or, “They said it hurt like h…!”

With these unpleasant news from well-meaning loved ones with less-than-perfect experiences and the uncertainties of a new and necessary event looming, it’s no wonder that our apprehension and anxiety levels tend to rise when we face procedures like total knee or hip replacements, rotator cuff repair or other shoulder surgeries, back surgeries, etc.

However, there’s really no need to hyperventilate or to indulge in extra doses of Xanax. Instead, let’s take some sage advice from the Spanish novelist Miguel de Cervantes Saavedra (of Don Quixote de la Mancha fame), who said it right when he pronounced that “to be prepared is half the victory.”

First, take advantage of the fact that your surgeon really does want your experience to be a good one. Most surgeons will supply their patients with informational pamphlets, brochures, even videos explaining the selected procedure as well as some general path of recovery. If this information does not answer all your questions, ASK. 

Good surgeons know the research on patient need and satisfaction. Great surgeons are not only skilled with the scalpel; they also earn your trust by personally discussing with you questions and concerns you might have. 1 

Secondly, surgical pain management has come a long way in recent years. 2 You may want to ask the anesthesiologist and the nursing staff who will be taking care of you how they remain current with the latest guidelines for acute pain management. There is good evidence that uncontrolled acute pain results in various unwanted medical complications, including delay in wound healing. 2 Excellent research-supported guidelines exist that help the health care staff do a phenomenal job making your recovery as comfortable as possible. Look for providers who know and follow these guidelines.

​“What about pain with physical therapy and rehabilitation once I leave the hospital?” 

Again, we have learned a lot over the last decade or so about how pain works. The old adage “no pain, no gain” is actually rather antiquated when it comes to recuperating from surgery or injury. Rehabilitation after surgery may be uncomfortable, but it should not be painful, and most certainly never “hurt like h…”

To get the least painful post-operative rehabilitative care, you may want to look for a physical therapist that is trained in modern pain science. 3 

Lastly, how long will the recovery process take? There are many factors that influence recovery from orthopedic surgery or injury. Age, overall health and fitness before surgery, nutrition, and pain control, are some examples. However, outcome studies do help us make some general assertions of what a typical uncomplicated recovery looks like.  4, 5  

Rather than writing many words about studies like the ones I referenced above, here is an informative graph created by Rod Henderson, a practicing physical therapist in Texas. 6

​As you can see, the majority of the recovery (60-75%) happens in the first 12 weeks. What is important to remember is that the rest takes longer. If we know this from the beginning, it may keep us from getting discouraged on our road to recovery. It may also keep us from developing unrealistic expectations, which could lead us to become impatient and engage in activities that we’re really not ready for, risking potential re-injury.

Research has shown that in many cases a good course of physical therapy can actually prevent the need for surgery. However, if you find yourself in a position where that is not the case, I hope you’ve learned a thing or two that will help prepare you more adequately for the procedure and for the road of recovery that lies ahead.
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References
1. Hoermann S, Doering S, Richter R, Walter MH, Schüssler G. [Patients' need for information before surgery]. Psychother Psychosom Med Psychol. 2001; 51(2):56-61.
2. Vadivelu N, Mitra S, Narayan D. Recent advances in postoperative pain management. Yale J Biol Med. 2010; 83(1):11-25.
3. Available at: http://www.bodyinmind.org/resources/journal-articles/full-text-articles/reconceptualising-pain-according-to-modern-pain-science/. Accessed January 28, 2016.
4. Kennedy DM, Stratford PW, Riddle DL, Hanna SE, Gollish JD. Assessing recovery and establishing prognosis following total knee arthroplasty. Phys Ther. 2008; 88(1):22-32.
5. Vissers MM, Bussmann JB, Verhaar JA, Arends LR, Furlan AD, Reijman M. Recovery of physical functioning after total hip arthroplasty: systematic review and meta-analysis of the literature. Phys Ther. 2011; 91(5):615-29.
6. Thanks to the gentlemen over at thestudentphysicaltherapist.com for making me aware of the existence of this graph. If you’d like to read up more about the graph, please see here (http://www.thestudentphysicaltherapist.com/home/explaining-rehab-time-frames)

As we talked about in the last post, learning about pain is an important part of fighting it. The more we know about what it is we’re trying to manage and/or get rid of, the more successful we will be.

Chronic pain affects more people in America than diabetes, cancer and heart disease combined. Based on the latest calculations, 100 million Americans are in pain daily. That is about 1 of every 3-4 people! This translates into an estimated annual cost of more than $630 billion spent on medical care and lost productivity. And what about the personal costs – loss of function and quality of life? *

In its 2011 report, the Institute of Medicine emphasized the need for better understanding, assessment and management of pain, with an eye on prevention of chronicity and on promotion of patient self-management of pain. The call went out to train not only healthcare providers more thoroughly in the complex biological and psychosocial aspects of pain, but also to educate the public at large, and especially the patients.*

We already established that good science supports getting the brain involved in this battle against pain. (See the previous post here: http://www.vtsphysicaltherapy.com/did-you-know-blog/your-brain-is-ready-to-fight-pain). Throughout this month, I will post information to help you feel more empowered in your pursuit of a life that is not hampered by it. 

So, let’s get started with this 5-minute video produced by some kindred spirits from Down Under.

What is one thing you can try this week to help you begin your journey toward a healthier you? I would love to read your comments below. Do you have any questions you would like to address to me privately? Click here (http://www.vtsphysicaltherapy.com/contact.html) to send a private message. 

* Available at: http://www.iom.edu/~/media/Files/Report Files/2011/Relieving-Pain-in-America-A-Blueprint-for-Transforming-Prevention-Care-Education-Research/Pain Research 2011 Report Brief.