PT before surgery: is it necessary?
“My orthopaedist wants me to do physical therapy before surgery. Is this really necessary?”
“A friend of mine did physical therapy before her knee surgery. Why would I need PT if I’m having the surgery?”
These questions and other related versions come up regularly. I love having the discussion because it indicates that someone is being proactive with their health. Preventative care is one of the many reasons I got into the PT field and these questions fall right in line with that. Since it is such a frequent question, I figured I’d cover this topic in a bit more detail.
To understand my answer to this question, we need to first appreciate what tends to happen to the musculoskeletal and nervous systems when we undergo a surgery. When the tissues get cut, pulled and pinned aside and internally manipulated, the nervous system tends to react in ways that then influences muscle function. There are a couple of things that commonly occur…
1. The nervous system-muscle connection becomes interrupted. This results in decreased muscle activation, strength and overall functionality.
2. The trauma of the surgery signals a “guarding response” to the affected area. This means that even though the area might by physically capable to moving more normally, it guards and locks up the movement as an overactive response to protect the area (even when protection might not actually be necessary).
In addition to the nervous system influences, there are circulatory system consequences to surgery.
The circulatory system is your heart and blood vessels. During a surgery, some blood vessels are totally cut (normally just the smaller ones) and bigger ones are moved aside. Regardless, this impairs the function of this system when things get sewn back up, resulting in decreased efficiency of the good things being brought to the area and the bad things being removed from the area.
So how can physical therapy help counter these inevitable side effects of surgery? There are a few ways…
FIRST, activating the involved muscles properly will help to restore and strengthen the nervous system-muscle connection.
In turn, the connection tends to return more easily post-op. Of course you could exercise on your own but oftentimes individuals feel like everything they do causes irritation to the area. An expert PT will be able to prescribe exercises that achieve what needs to be accomplished while minimizing any irritation or over-training to the vulnerable area.
SECOND, moving the affected area in a healthy way “normalizes” that movement to your nervous system thus decreasing the guarding response post-op.
Essentially you are desensitizing your nervous system to those movements, telling it that they are safe and healthy.
THIRD, assuming you do enough weeks of PT, your circulation in the area will be boosted thus improving the circulatory recovery post-op.
This means swelling tends to be more controlled and thus movement can occur a bit more easily.
So is physical therapy necessary pre-op? If you are looking to have the best recovery possible, then yes.
This doesn’t necessarily mean for just musculoskeletal surgeries either. It can apply to any surgery. I’ve witnessed the difference between those who do and do not do pre-op countless times and can say with confidence, it is absolutely worth your investment.