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Pre/post-Rehab Considerations Following Joint Replacement Surgery: Living Inside the Arrow

Pre/post-Rehab Considerations Following Joint Replacement Surgery: Living Inside the Arrow

Tuesday, Mar 29, 2022

By Brian Reis, PT, DPT 
Gaylord Specialty Healthcare Physical Therapy

Can you picture this? It may not be hard to imagine. Perhaps you are the patient on the left, suffering from extreme knee pain that is limiting your day-to-day activities. Or perhaps you’re the patient on the right, who has rehabilitated from joint replacement and is back to your usual activity (and potentially beyond). Or perhaps you’re somewhere in the middle – living inside the arrow.

What does ‘living inside the arrow’ mean? Quite frankly, the ‘arrow’ is where rehabilitation succeeds or fails. The arrow is where the work is done, and the magic happens. In a perfect world, the patient on the left makes a slow, steady, and straight progression toward the patient on the right or life without pain. However, importantly, that arrow is not always straight. In fact, most of the time, the arrow looks more like a zig zag.

So, how do we make the arrow as straight as possible? The (not so) secret to success is simple:

  • Patience
  • Consistency
  • Hard work

As they say, nothing worth having comes easy.

In truth, my visual is a little flawed. You see, the arrow should start much sooner. Once the OR is booked, this shouldn’t be a free pass to ignore the hard work. Rehabilitation is just as important pre-operative as it is post-operative. And your chances of straightening that arrow are higher the earlier you get started.

If you’re the patient on the left, you’re likely thinking, “Brian, I’m in too much pain to exercise, that’s why I need surgery!” You aren’t the first to tell me this (and won’t be the last). Pain can be a major barrier to beginning and maintaining a regular exercise program. By working under the guidance of a trained physical therapist, it is possible to minimize pain while gradually progressing toward levels that provide greater mobility.

As long as pain levels are manageable, the research consistently tells us that high-intensity exercise and resistance training pre-op proves to be a strong predictor of outcomes at 1-year post-op. Why? Because pre-operative deficits are compounded by surgical intervention. This success is, of course, assuming that you continue the work while living inside the arrow.

Now, I wouldn’t be doing my job if I didn’t include some caveats to this:

  1. Strenuous exercise should be avoided during acute flare-ups
  2. Adequate warm-up and cool-down are essential for muscle repair
  3. A small amount of discomfort in the muscles or joints during or immediately after exercise is common and does not mean joints are being further damaged
  4. Pain more than two hours after exercise may indicate the intensity is too high at this time

Whether you’re the patient on the left, or somewhere in the middle, you will get to where you need to be. It will take time. And your patience, consistency, and hard work will pay off regardless of how straight your line is while living inside the arrow.

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