Physical therapists strive to enable people to reach their goals without surgery or pain killers, however, there are instances in which surgery is appropriate and indicated.

While I am never advocating for surgery first, I do want to ensure any patient has much information as possible to make decisions about their health.

It has been my experience that patients sometimes don’t receive adequate information regarding their surgery and recovery prior to their operation. This article is to help provide further clarity on what to expect when you’re expecting surgery.

As a physical therapist, what do I know about surgery?
Before going to PT school, I worked as a surgical technologist in the operating room for several years. I figured I would use the knowledge I’ve accumulated over that time to share some insight into what you may expect before, during and after your procedure and set some expectations during your recovery and healing process.

Before Surgery

Drive past the hospital or surgery center. This reduces the stress you have for the day-of surgery because you know where you are going. If it’s a big hospital, I suggest even going in and asking the front desk to point you to whatever wing you may need to go to to check in for those expecting surgery.

If you feel like you still are unclear about aspects regarding the surgery, create a list of questions to ask your surgeon’s office. Call them two to three weeks ahead of time to ask the medical assistant to relay them to the surgeon or their staff. They may need time to respond, so make sure you are reaching out in plenty of time before your surgery.

Ask for a prescription for physical therapy. For many procedures, it is even helpful to participate in “prehab” - physical therapy prior to surgery. Research shows that patients who participate in prehab before their total knee operations demonstrate improved strength prior to surgery, which can improve post-operative outcomes. Studies also show patients who participated in prehab reported improved confidence going into surgery. Asking for a recommendation or prescription (if needed by your insurance) ahead of time decreases wait times and allows you to get on the road to recovery as soon as possible.

Limit smoking, alcohol and sugar intake. All of these things are inflammatory substances, which causes increased irritation of tissues. The idea is to stack the deck for your body to heal as well as possible after surgery! Additionally, smoking causes restriction of your blood vessels to your tissues, causing decreased wound and incision healing.

Clean your belly-button. Yup, I know this sounds like silly advice. And it pertains to abdominal surgeries, mostly. (While I am a physical therapist, this advice is for ALL surgeries, as I have experience in everything from vascular surgery to gynecological surgery.). Most laparoscopic procedures go through the belly button, and the cleaner it is, the less risk of infection (and I’ve seen some very unclean belly buttons in my lifetime). It’s a place that deserves a little extra care when expecting surgery!

Day of Surgery

Unless otherwise indicated by your surgeon, take a shower with antibacterial soap. Our skin loves to be home to a whole host of bacteria, so the more you can rinse off before surgery, the better!

Typically, you are not able to eat or drink anything 12-24 hours before surgery. Check with your provider to know their requirements.

Ensure you have an up-to-date list of all medications you are currently taking (with dosages), prior health history (hospitalizations, illnesses), and allergy list. Yes, the hospital should have all of this on file. But having everything in one place will be helpful on the off chance they are missing some bit of information.

After Surgery

Pain is scary. Especially if we just had surgery to just help address whatever pain we were having. It is useful to have a good understanding of what the tissue healing process may look like after surgery.

Our body has several healing phases: the inflammatory phase, the proliferative or reparative phase, and the remodeling phase. It is important to have reasonable expectations on what healing after surgery will look like. Let’s break these phases down.

1. Inflammatory phase

This can last anywhere from 3 days to 3 weeks. During this time, your body is working on bringing a whole host of healing factors to the surgical site. You may experience swelling and pain. While you most likely will have some meds to help with the edema, swelling is actually a normal sign of your body working on healing - we need a rush of chemical and vascular factors to the incision in order to help it heal.

2. Proliferative and Reparative Phase

This phase lasts from a few days to 6 weeks. During this time, specialized cells for the tissues (fibroblasts, myotin, collagen, osteoblasts) begin to accumulate and organize in the area of injury. These are the building blocks for whatever tissue your body is trying to repair - ligament, muscles, tendon, and bone. When surgeons order x-rays after orthopedic surgery, this is when they are looking for the formation of a “callous” in the bone. During this time, you will continue to experience some swelling, pain, and decreased mobility.

3. Remodeling Phase

This phase can take from 6 weeks up until one year. This is when the tissue itself matures, continues to organize, and strengthens. This is when scar tissue forms. This is the time in which it is important to begin appropriately loading tissue, improving mobility, and increasing joint load and tolerance.

Regardless of the surgery, it is important to receive physical therapy afterwards for several reasons:

When tissue heals, it has the tendency to form scar tissue, which is not as strong as the tissue it is replacing. Physical therapists can assist in ensuring maintaining mobility and strength as you heal.

Orthopedic surgery, especially spine and hip surgery, is often performed to address symptoms that have occurred due to poor movement patterns or compensatory motor patterns. It is imperative that after fixing the symptoms, the movements that may have caused the pain in the first place are addressed.

Physical therapy can address the swelling, decreased tissue mobility, and pain that can come after surgery. While it may not feel like it, oftentimes movement after surgery is the best way to decrease post-operative pain. It is important to have a skilled doctor of physical therapy evaluate you after surgery to ensure the best possible results and recovery following surgery.

Have further questions regarding surgery, prehab, or how physical therapy may help you avoid going under the knife all together? Join my newsletter as I cover aspects of physical therapy, movement, and often toss in a surgical gem or two!