General Rehabilitation in Physiotherapy

What is involved in rehabilitation?

Your rehabilitation program may include a combination of the components described below. Note however that these will not always be appropriate, and your physio will determine an inidividual program that is tailored to your needs.

Initial Assessment

You may see a physio 6 weeks after your operation for a check-up. This may include: 

  • Review of history - your physio will ask you to describe your symptoms and history and what led you to seek out treatment. They will also ask about your surgery, what you understand about your diagnosis and ongoing treatment and then discuss these further with you. In addition, your physio will get a sense of what your expectations of functional outcome are, for example if you need to walk up and down lots of stairs for work. This is an important stage in your treatment - you should take the opportunity to discuss what may or may not be possible for you, and ask about the probable timeline for return to function, as sometimes physio will have a greater understanding of patient experience than your surgeon.
  • Discussion of surgical plan - your surgeon will have determined a plan of when you should start moving your injured limb and when you can begin weight-bearing. This is critical in determining the rehabilitation program, so it's useful if you clarify this aspect of management with your surgeon before seeing the physio.
  • Management of Symptoms - at this point, your physio may be able to give you tips on managing your current level of pain, stiffness, dysfunction, swelling etc. This may include some exercises, suggestions for painkillers etc.

Exercises

The number and type of exercises used in your rehabilitation program will vary depending on your condition, however some possible exercises include:

  • Range of Movement (ROM) Exercises - ROM exercises aim to improve flexibility and strength around a joint. This is important in situations where the joint has been immobilised for a while (eg in a cast) as long periods of immobilisation can lead to muscle shortening / weakening and joint capsule fibrosis. 
  • Strengthening Exercises - strengthening exercises are designed to build up the muscles around joints. Physio-designed strengthening exercises are specially designed to maintain the balance between muscle groups around a joint (agonist-antagonist muscle groups like biceps-triceps). 
  • Proprioceptive Training - in some situations, proprioception is disturbed by injury or surgery. Proprioception is very important in walking normally and preventing further injuries, so exercises designed to improve proprioception, like standing on a wobble board, may be indicated. 
  • Gait Retraining - when you have injured your hip, your pattern of walking may be disturbed. This can be because you have learnt to compensate for weakness or pain, or may simply be due to immobilisation. As part of gait re-training, your physio may be involved in progression through the different gait aids, for example a walking frame to crutches to independent walking. 
  • Functional Training - functional training is often only necessary for specific situations, eg if you wish to return to a sport. Functional training can involve jogging, hopping, kneeling or squatting exercises. The aim is to help you perform these tasks safely, with little risk of re-injuring your joint. Functional re-training can sometimes be used to help you return to work, however this will be discussed at your initial assessment. 
  • Manual Therapy - manual therapy like massage is often not appropriate in the rehabilitation setting. However, your physio may use massage to help reduce swelling, particularly in older patients where swelling is a severe, ongoing problem. In other patients, stiffness may also be addressed through manual therapy. 
  • Hydrotherapy - hydrotherapy is a specialised form of therapy used in a specific group of patients. The aim of hydrotherapy is to perform strengthening and ROM exercises without placing weight on the joint. Furthermore, the warmth of the water can help with pain and swelling. Hydrotherapy is available at Sunshine Hospital, but is also available in Footscray through a private clinic hired by the Western Hospital Footscray.
13 October, 2011