A discussion on Postoperative Rehabilitation

    In the modern age what is often lost sight of is the fact that “nature has her own clock”.  In as much as I would like to facilitate immediate and speedy recovery with return to normality as soon as possible, as a surgeon I am limited by the time it takes for biological processes to run their course.  Any operation whether it be arthroscopic with small cuts and/or open surgery with larger cuts, will result in trauma.  The consequence of trauma to biological tissue is that it will undergo a normal process of reparative healing.  These very complex processes go through various phases and these processes need to be allowed to run their course.  You cannot have an operation and expect to have no pain and to be instantly cured and return to normality.  As surgeons we endeavour to minimise the trauma so as to facilitate less painful recovery and minimise complications by optimising the healing process.  In essence, I endeavour to put things into place so that nature can do her job well with the best possible outcomes.  Any surgery you have is exactly that and not to be thought of as a haircut.  There is ample evidence also that postoperative physical therapy rehabilitation and instructions as it relates to any particular procedure must be adhered to in order to facilitate optimal outcomes and minimise complication risks.  Surgeons cannot be held responsible for non-compliant patients.  A typical example would be smokers and not stopping smoking pre- and post-surgery for a period of time, or another similar example would be instructions with regards weight-bearing and placing full weight-bearing on a limb when told not to do so resulting in complications.

    In the scientific literature, there are many different, sometimes quite detailed rehabilitation programs written up for individual procedures.  However, the evidence for or against these programs is somewhat difficult to interpret simply because of the fact that there is a lack of uniformity.  In South Africa, as opposed to anywhere else in the world, we have a subgroup of rehabilitation specialists called biokineticists.  This group of individuals together with physiotherapists are responsible for postoperative rehabilitation in many cases.

    The essence of postoperative rehabilitation is regaining full range of motion of the joint and thereby normalising muscle activity around the joint while protecting any surgical repair that has been performed.  You cannot begin exercising or training muscle groups until the joint has a free full range of motion with good muscle coordination and healed tissue.  Muscle coordination is determined by numerous neural structures that send discrete messages to the brain informing the brain as to the exact position of the limb and the range of motion and/or the strength that is required to move the limb etc.

    This sixth sense, or joint position sense, otherwise known as proprioception is something which is essential to any movement process.  In general, most joints require a three month period during which full range of motion should be achieved together with good muscle coordination and proprioception.  Only after this, can one begin actively training muscles with regards returning to full fitness and as applicable, sporting endeavours.  Post three months  is the period we call “functional rehabilitation”.  In my practice, essentially physiotherapists are responsible for the first three months and then they would hand over to the biokineticists who are specialists in muscle training.  There is however a great degree of overlap amongst these individuals and their skills.  All surgeons have their own ideas with regards to the complexity of these rehabilitation programs, but in essence our lives are so busy that we tend to hand this over to our colleagues, i.e. the physiotherapists to manage as appropriate while providing oversite or guidance as needed.  Every patient is also very different in terms of their physical requirements and the level of motivation required in order to optimise outcomes.

    In order to assist with compliance you will be sent to a physio who practices close to home or work or with whom you have built up a good relationship.