‘This is my dodgy knee – it has never been the same since the operation’.
A common misconception exists among many patients who require surgery for an injury: That the joint or structure that is being repaired, will never be as good as before. At this point, I want to stress that THIS IS
This feeling can have such an impact on a patient’s approach to their recovery and rehabilitation, that in some cases, they will have already admitted defeat before their recovery has even begun. Many of the patients I treat have already planned to give up their main sport or hobby, in favour of something more sedentary and with less chance of further injury. For those who are self-employed, I understand that this may be a practical decision in order to maintain a steady income and avoid further time off work through injury. But for most, the idea of an imperfect outcome has gained momentum because of the stories of others who have had a less than perfect outcomes from their own surgeries.
Lets start on the operating table………….
The surgeon will look to repair what is broken or not functioning normally in order to provide the stability that was missing or reduce the pain following the injury. Once the surgeon has finished their work, yours will be about to begin. The operation can ‘fix’ your problem but cannot guarantee a good final outcome – only your full investment of time and effort into your rehab can achieve that. Regaining the flexibility and movement, building the muscle strength and co-ordination, rediscovering the balance and control of a joint and muscles after surgery requires dedication. As much dedication as training for a marathon, or building strength in the gym when you haven’t lifted more than your shopping bags for years. None of these things are easy, but if you feel that your injury is important enough to be operated on, then it should also be important enough to be rehabbed comprehensively.
Most surgeons have existing post-operative recovery timelines and rehab protocols, which are worth studying, so that you can be aware of and involved in the aims and progressions of your rehab programme. The more you can understand and buy into your programme, the greater chance of improvement as you work towards and achieve numerous short-term aims one after the other.
It is certainly true that following surgery, the repaired joint may require a lot of rehab and exercise to allow you to continue following your chosen fitness regime or sport after your recovery. The key to a successful rehabilitation experience is to integrate the programme into your normal exercise routine or set aside a specific amount of time each day to work on your rehab exercises. When you have managed that, the major requirement from there onwards is CONSISTENCY. Stick to the plan, work through it regularly, with a focus on the key points that your physio has made when talking through each exercise.
That is your part of the bargain. Your physio’s responsibility is to provide you with an interesting, effective, manageable and progressive rehab programme that allows you to see progress on a week to week basis. It should also be specific to your exercise choices (or sport) and your personal needs.
A second common misconception among amateur sportsmen and women is that professional athletes have different or better exercises than the ones you would have for the same injury. Again this is also NOT TRUE. Having worked for many years in professional sport and now in private practice, I prescribe the same exercises and programmes for amateur athletes and gym-goers as I did for top-level professionals. The only obvious difference is how advanced the rehab becomes in the latter stages – but again this will depend on the needs of the individual and can be tailored accordingly.
It is also wise to expect bad days, where the joint may feel like it has regressed rather than progressed. I usually tell patients to expect 1 bad day for every 4 or 5 good ones. That way, the patient is more realistic about the fact that rehab isn’t easy and there will be times where progress is faster and other times where it is slower.
Towards the very end of a rehabilitation programme, the biggest mistake that many patients make is failing to complete the final stages of high-end strengthening, agility and fine-tuning of movement control etc… This is usually because they feel that they are ready to return fully to sports and exercise, with the pull being almost irresistible. Fully completing your rehab programme can be the difference between a successful, niggle-free return to activity or a sporadic, injury-affected participation. Not even the best athletes in the world can perform well if their strength and confidence levels after surgery are below par. Most others will not be able to perform at all.
The final piece of the puzzle in completing your return from surgery is once you have regained the optimum strength, flexibility and proprioception of an operated joint, you must continue working to keep it that way. Once you have completed your rehab programme, it becomes your Prehab programme – selected exercises from the original plan performed in smaller amounts to keep everything topped up. If you can merge these exercises into your daily routine and stay at the high levels you have achieved, then what was once your weakness, will become your strength.
I’ll finish with some advice that my father has given me on many occasions:
‘If you’re going to do something, do it right’.
This advice applies to most things in life, especially the rehabilitation process!
Below is an example of an early stage of a rehab programme for a patient with a low-grade calf tear. As previously stated, there is no difference in the exercises that can be selected from for a professional athlete or an amateur and will depend only on the individual’s strength and flexibility at that point following their operation. The patient would usually perform 4 sessions of this stage before progressing onto the next, more advanced stage. The progressions, in some cases may be very minor, but small, regular progressions are the key to maintaining interest and keeping sight of the light at the end of the tunnel.
Insert video here.
As with all exercise programs, when using our exercise/rehabilitation video, you need to please use your discretion. To reduce and avoid injury, please check with your own Doctor or Physiotherapist before beginning any exercise/rehabilitation program. By performing any of our video exercises, you are performing them at your own risk. ProPhysio UK Ltd or ProPilates Ltd will not be responsible or liable for any injury or harm you sustain as a result of carrying out the exercises in our Rehab programs, online fitness videos.