Updated: Aug 20, 2020
But really, can it?
The short answer...
I’m often approached with this question and clients explain that they sometimes struggle to get a definitive ‘Yes’ or ‘No’ from their provider of choice (MDs, chiropractors, massage therapists. The response they tend to receive is described as a shoulder shrugging “I guess you can go to Physical Therapy if you want to”.
This is sometimes awkward for the patient/client as their question isn't answered and the decision making is thrown back to them. As healthcare providers, people come to us for advice regarding all things healthcare. If questions are within your scope of practice, answer them! If they're out of your scope and/or area of expertise or you're simply uncomfortable answering some questions, refer to a provider that can help!
Often other healthcare provders are under the impression that Physical Therapy consists of:
Electrical Stimulation (EStim)
Little Baby Dumbbells
This is patently false. 30-40 years ago, those treatments may have been the best there was but research has shown time and time again that THOSE methods of treatment don't resolve any issues. Will they make you feel good? Probably. Will they resolve the source(s) of your symptoms/complaints? Absolutely not.
Surgery changes the game a bit. Tissue has been overloaded either gradually over time or with one giant incident and the tissue has failed. The failed tissue either needs to be repaired or replaced. This repair or replacement....read this part slowly....does not fix ALL things. It's not as simple as removing a broken brick from a wall and replacing it with a new brick.
Some clients who have recently had surgery and even some clients who had surgery years ago commonly ask the same question, "If it's fixed/repaired, why does it still hurt?"
Following surgery, the body does many amazing things. Healing is numero uno. But while healing, the body goes into overdrive to defend (protect) itself and it usually protects you too much.
Let's use an ACL repair (Common Knee Injury/Surgery) as an example.
To be clear, your body does not differentiate surgery from another type of knee trauma. It doesn't say "Oh that was surgery...everything is ok".
To the brain/body, trauma is trauma. Damage is damage. And a resulting cascade of healing processes takes place regardless of what created the damage.
Following surgery, common sense would make us immobilize the knee as it heals, which seems perfectly reasonable (duh, you just had surgery).
But, in fact, the opposite is true (in most cases). Early movement and slow, graded loading of the healing tissues causes an improved healing response. It makes the healing tissue and surrounding tissues more pliable and resilient to loading and movement. It also forces your brain to get over its overprotective mindset, allowing for more beneficial loading.
To be clear: THIS DOES NOT MEAN TO GO BACK TO RUNNING, LIFTING WEIGHTS, ETC. IMMEDIATELY FOLLOWING SURGERY.
The intent should never be to overload new, healing tissue. While it may be uncomfortable at times, your goal is to remind all of those tissues of their specific role within the system while driving them to get better at that particular role.
You may get the sense that your brain does not trust the knee and it will do everything to prevent you from loading it, even a little bit. This is where the skill set of your Physical Therapist makes or breaks the recovery.
We (Physical Therapists) have a unique role as a Provider which allows us to spend significantly more time with you during treatment and can offer more real-time knowledge and advice.
For instance, following an ACL replacement, the first 10 weeks (protection phase) after surgery are the most important but tend to be somewhat boring for the patient because of the necessary emphasis placed on protecting the repair. Typically, the important factors in the first 2.5 months are to restore and maintain knee extension (knee straightness) and bring the quadriceps muscle back online.
During the same 10 weeks, a lot of healing is taking place from the surgery alone; skin, bone, muscle, tendons, etc. are all healing at varying rates and based on the controlled load being transmitted through each of them.
Did you say tendon? I thought this was a ligament repair...
There are tons of variables that go into this that open the door for more nuanced discussion but for simplicity's sake let's assume the ACL was repaired with a donor graft (allograft). Typically a cadaver hamstring tendon (though other tendons are sometimes utilized) is used to replace the ACL that you were born with.
A tendon is not a ligament and a ligament not a tendon. The loads each type of tissue resists are different.
However, your body will remodel this newly installed tendon over the course of your recovery. This remodeling process alters the loading capabilities of the donor tendon and slowly converts it into a ligament. Neat, right?
Unfortunately, many clients are never allowed to be treated much beyond this point.
Often an enormous gap is created when therapy is ended at the 3 month mark. At this point, insurance views you as "functional"; meaning you can stand, walk, turn without significant pain and the knee is generally stable. The insurance company does not care one bit whether you can run, jump, squat or play your sport ever again. Once deemed "functional" they cut you loose which often leads to incomplete post-op recovery which can lead to further orthopedic injury or even reinjury of the repaired ACL.
For reference, the absolute minimum time for recovery from an ACL repair is 9 months. The ideal range is 12-24 months for full return to sport.
Avoiding this gap involves addressing your specific return to sport needs and goals. At Southeast Physical Therapy we specialize in a treatment approach of building/progressing strength, flexibility, endurance and agility which will allow to avoid the "gap" and return to full function and performance.
If you feel like you're beginning the slide into the treatment gap or even if you've been a resident there for some time, please call or text us directly at 678-640-4606. Let us help you along your return path towards whatever activity it is you love.