Postoperative Physical Therapy at Your Home or Office in New York City

When Can I Start Physical Therapy After Surgery? 

First a word on immobilization.  Physical therapy after surgery or “Post-operative physical therapy” and immobilization, using methods like casts or slings to protect the surgical site, are intertwined in the first step of the recovery process. It’s important to balance both with the guidance of a physical therapist for a smooth and successful recovery. 

Think of it like this:

• Immobilization is like hitting the “pause” button on movement to protect the injured area and allow tissues to heal and inflammation to subside.  It’s important immediately after your surgery but too much rest or having things on “pause” can lead to stiffness, weakness, and slower healing.  

• Physical therapy is like pressing “play” on gentle and safe movement centered on targeted exercises and techniques to restore strength, flexibility, and function.  Physical therapy can prevent complications from inactivity and facilitate a speedy recovery.

Balancing immobilization with controlled movement after surgery is essential for the best recovery possible. While immobilization protects the surgical site, early movement, guided by a physical therapist, promotes blood flow, reduces stiffness, and helps regain strength and function. This approach can also help manage pain and reduce the risk of complications like blood clots.

By gradually introducing controlled movements and exercises after a surgical procedure, physical therapists help patients recover faster and more completely. They assess individual needs and tailor treatment plans to ensure safe and effective rehabilitation, ultimately leading to a quicker return to normal activities and improved quality of life.  Generally speaking, when you can begin your post-surgical physical therapy, assuming all goes smoothly, depends on a few things starting with the type of surgery.  Here are 3 examples that give you a glimpse of how far things can be pushed out, keep  in mind this is an average and your surgeon will give you personalized forecasting:

• Rotator Cuff surgery to repair torn muscles and tendons in the shoulder needs time for the tendon to heal securely to the bone and may involve wearing a sling for several weeks to limit movement before starting gentle range-of-motion exercises. The immobilization period after rotator cuff surgery can vary depending on the extent of the repair, surgical technique, and individual factors. However, on average, people can expect to wear a sling and have limited arm movement for about 4-6 weeks before starting more active physical therapy.

• Surgery to fix a broken bone or fracture may involve plates, screws, or rods and the bone needs time to repair and heal and can involve a cast or splint for several weeks, followed by a gradual return to movement and physical therapy. The immobilization period after surgery for a broken bone or fracture can vary depending on the extent of the repair, surgical technique, and individual factors.  However, on average, people can expect to be immobilized for around 6-8 weeks before starting more active physical therapy.

• Spinal Fusion surgery joins vertebrae in your spine together, using bone grafts and often metal hardware, to stabilize a segment of your spine and it takes time for the bones to fuse solidly and you might wear a brace for several weeks or months before starting more active physical therapy. The immobilization period after spinal fusion surgery varies, but on average, people can expect to be relatively immobile for about 6-12 weeks before starting more active physical therapy.

For many surgeries, you’ll likely have your first physical therapy appointment within a week of the operation.  Here are 3 examples that give you a glimpse of how soon you might start physical therapy after these surgical procedures, keep in mind this is an average and your surgeon will give you personalized forecasting:

• Laparoscopic Cholecystectomy (Gallbladder Removal): Often within 1-3 days. You might even start walking around the same day as surgery.

• Arthroscopic Knee Surgery: Usually within 1-7 days, depending on the specific procedure and your individual recovery.

• Carpal Tunnel Release: Typically within 1-2 days. Gentle hand and wrist exercises can often begin very soon after surgery.

These surgeries are generally less invasive, meaning smaller incisions and less tissue disruption. This allows for quicker healing and earlier mobilization, which helps prevent stiffness, reduce swelling, and improve blood flow to the surgical area.

Beyond the type of surgery determining how soon you can start postoperative physical therapy, also considered is: 

• Your overall health and if there are other conditions that have to be considered
• Your surgeon’s recommendation   

Early Mobilization Physical Therapy after Surgery

Increasingly something called “early mobilization” is being adopted for some surgeries like hip or knee replacements where our physical therapist might start working with you in the hospital within a day or two of your surgery.  Examples are for:

• Cardiac Surgery: Early mobilization after heart surgery, including bypass surgery or valve replacement, is crucial to prevent complications like pneumonia and blood clots. Physical therapists help patients with breathing exercises, walking, and gradually increasing activity levels.

• Abdominal Surgery: For procedures like laparoscopic colon resection or hysterectomy, early mobilization helps improve circulation, prevent blood clots, and promote healing. Physical therapists guide patients with gentle movements, deep breathing, and walking. There is research outlining the positive outcomes of early mobilization physical therapy as soon as 2 hours after abdominal surgery, click here.

• Total Joint Arthroplasty (Hip and Knee Replacements): As mentioned, early mobilization is now standard practice after hip and knee replacements. Physical therapists help patients get out of bed and start walking with assistance within a day or two of surgery.

The benefits of early mobilization include:

• Reduced pain and swelling
• Improved circulation & prevents stiffness
• Faster healing & regaining of strength and function
• Reduced risk of complications
• Shorter hospital stays
• Quicker return to normal activities

“Early mobilization reduces the risk of postoperative complications, accelerates the recovery of functional walking capacity, positively impacts several patient-reported outcomes and reduces hospital length of stay, thereby reducing care costs.” – Source: Early mobilization in enhanced recovery after surgery pathways: current evidence and recent advancements click here.

Early mobilization after surgery is the initial phase of a comprehensive post-op physical therapy program. It involves a physical therapist guiding you through gentle movements and exercises soon after your operation, even while still in the hospital. This helps jumpstart recovery, prevent stiffness, and reduce complications.

As you heal, this early mobilization seamlessly transitions into a more structured post-op physical therapy program. The therapist will gradually increase the intensity and complexity of exercises, tailoring them to your individual needs and progress. This ongoing rehabilitation helps you regain strength, flexibility, and function, ultimately leading to a faster and more complete recovery.

Will Postoperative Physical Therapy Be Painful?

While everyone experiences pain differently, one of the objectives in physical therapy is to help you manage and reduce your pain, not have it linger and certainly not have it increase.   One of the ways we achieve this is with our “preoperative or prehab physical therapy” component of our overall program.  

Preparing for surgery is similar to training to run a marathon and requires building physical stamina and endurance to handle the demands of the operative procedure and recovery process. Both involve strategic preparation covering stretching, exercise, nutrition, and rest, to fortify your body’s ability to withstand stress and heal efficiently. Just as for a marathon runner, preparation or pre-surgery conditioning best positions you for the challenges ahead and realizing the best possible outcome.

Preoperative physical therapy, or prehab, improves your strength, flexibility, and endurance so you can tolerate the stress of surgery, reduce the risk of complications, and accelerate recovery. Studies show that just a single preoperative physical therapy visit improves key outcomes, both clinically and financially. Specifically, overall care costs are lower and patients’ report they feel in better control over their post-surgical pain and accelerated recovery if they’ve had preoperative physical therapy. (study, study).

We prioritize minimizing your pain through creating a personalized exercise plan, education on the surgery and recovery process, and teaching you how to use any necessary assistive devices (crutches, canes, etc).  While there might be some discomfort along the way, the goal of physical therapy is to help you heal and regain your function, ultimately resuming your full life.

What Will I Do in Postoperative Physical Therapy Sessions? 

Physical therapy after surgery can vary broadly depending on the type of procedure you have and your individual needs.  Nonetheless in general you might expect starting off with careful stretches to get your joints moving and prevent stiffness. Since you might have pain, weakness, or limited mobility, simple things like deep breathing or assisted range of motion exercises are a prudent starting point. 

We’ll gradually increase the intensity and complexity of your exercises as you get stronger introducing strengthening and balancing activities and perhaps hands-on techniques to improve your joint mobility, reduce pain, and release muscle tension.  General functional training will soon follow where you will regain your ability to do your everyday tasks, like dressing or ergonomic concerns if your job involves using a computer as returning to work can be challenging if your surgery involves your upper body or core.  In a nutshell and some quick examples, if your surgery involves:

• Knee replacement; expect to focus on regaining range of motion, strengthening your leg muscles, and improving your walking.
• Shoulder surgery; expect to focus on restoring shoulder mobility, strengthening your rotator cuff, and improving your ability to reach and lift.
• Spinal surgery; expect to focus on core strengthening, improving posture, and regaining safe movement patterns.

The underlying overall goal is to help help you regain your strength, mobility, and function as swiftly and safely as possible so you can return to your normal activities.  Together we’ll create a personalized plan and guide you through each step of your recovery.

How Long Will I Need Physical Therapy After Surgery?

The length of post-surgery physical therapy varies greatly depending on the type of surgery, individual factors loom large as do recovery goals. However very generally speaking free of any extenuating circumstances, here’s a glimpse using three common surgeries as examples:

Knee Replacement:  Average physical therapy duration is 2-3 months of consistent sessions.  This covers an initial phase (weeks 1-4) focusing on reducing pain and swelling, restoring range of motion and a later phase (weeks 5-12) of strengthening exercises, improving balance, and gradually returning to higher-level activities.

Rotator Cuff Repair:  Average physical therapy duration is 3-6 months of consistent sessions.  This covers an initial phase (weeks 1-6) of protecting the repaired tendons with limited range of motion that gradually increases in a later phase (weeks 7 onwards) of strengthening the rotator cuff muscles, improving shoulder stability, and gradually returning to functional movements.

ACL Reconstruction (knee):  Average physical therapy duration is 6-9 months, and in some cases of pro athletes returning to work even longer. This covers an initial phase (weeks 1-4) reducing swelling, regaining range of motion, and protecting the surgical graft.  An intermediate phase (months 2-6) follows focused on strengthening leg muscles and improving balance, followed by a later phase (months 6+) with advanced exercises and agility training. 

It’s important to note that these are just averages, and your individual needs may vary and stay mindful, more complex or invasive procedures generally require longer postoperative physical therapy.  While infections or other complications can extend healing – age, overall health, and pre-surgery fitness level all influence recovery duration. 

How Often Will I Need to Go to Physical Therapy After My Surgery?  

First of all remember, we come to you and on your schedule, and that is going to make a tremendous difference in all aspects of your wellness journey.  After surgery the frequency of physical therapy sessions depends on several factors, but here’s some general guidance.  Initially or in the first few weeks to ensure you’re progressing properly expect about 2-3 sessions per week.  In some cases, like after a major joint replacement, it’s possible initial sessions may be required daily.  As you regain strength and function, the frequency of sessions can be dialed down to 1-2 sessions per week with the understanding that you’re able and doing prescribed exercises independently.  Your healing rate, overall health, and specific goals will indeed influence the frequency of sessions.  Do know the personalized treatment plan we create at the start or your postoperative physical therapy journey is ‘agile’, meaning it allows for flexibility and can be adjusted more or less – all depending on how things are going.

Things About Postoperative Physical Therapy No One Tells You

Post-operative physical therapy is an essential part of recovery after surgery, but there are things patients often aren’t fully aware of until they begin the process. Here are some insights from our perspective:  

Postoperative Physical Therapy is More Than Just Exercises:  Physical therapy isn’t a one-size-fits-all set of generic exercises like an exercise machine at a fitness gym.  Just as a dentist faces unique circumstances with each patient, so too does a physical therapist and a personalized treatment plan produces faster and better outcomes.   The benefits of one-on-one focused attention shine when it comes to being on the receiving end of hands-on techniques to improve joint mobility, reduce pain, and release muscle tension for example.  And as you go about this holistic approach with us focused on your ‘whole’ recovery, you receive a comprehensive education on your body mechanics and how to keep them tuned and in shape going forward.

Postoperative Physical Therapy Can Be Challenging: While the goal is to reduce pain, some discomfort is normal and expected as you regain movement and strength.  Active participation in exercises and instructions goes a long way on the road to recovery.  There may be a few bumps along the road – that’s okay.  Recovery is a gradual process, we’re going to prepare you to handle those bumps, it’s important to be patient but persistent in working through any tough moments that may arise with your treatment.

Postoperative Physical Therapy is More Than Just Physical Recovery: Postoperative physical therapy is a holistic approach that takes into account the whole person you are, not just your physical recovery from surgery. While it’s natural to feel emotionally and mentally drained after surgery, postoperative physical therapy can be an unexpected boost to improving your overall well-being. Beyond helping you regain physical strength and mobility, the pain reduction coupled with the gains can significantly energize your mood and reduce anxiety. The exercises release endorphins, natural mood boosters that can help combat stress.  Preoperative physical therapy helps you regain a sense of independence and control, fostering a more positive outlook and reducing feelings of helplessness.  Hence if you feel at any point as if you’re in a ‘tunnel’, trust us, there is light at the end of that tunnel and we’re committed to seeing you thrive in your daily life once again!