Having surgery? Seeing a physical therapist can help ensure optimal recovery

Dr. Paula Ludewig explains shoulder anatomy to a student.

Patients who have recently undergone surgery – or are preparing for surgery – can benefit from seeing a physical therapist. Thanks to a three-way partnership with the patient, the therapist, and the surgeon, physical therapy can help post-operative recovery happen safely and effectively and can help strengthen and prepare a patient for surgery.

Physical therapy helps you regain movement and function, reduces your dependence on pain medication, and gets you back to doing the things you love (or back to work).

What was done?
Dr. Paula LudewigThe first thing a physical therapist keeps in mind when working with a patient post-surgery is what was done during the procedure, according to Professor Paula Ludewig (pictured at left), PhD, PT, Physical Therapy Division Director. “We must know about different surgeries and the approaches that are taken because different approaches will have different restrictions,” she explained. “If it was a shoulder dislocation, for instance, the surgeon generally has to repair the front portion of the shoulder. That means there are certain motions we definitely need to minimize or avoid.”

It’s a matter of getting the correct balance. “What we want to do is impose just enough stress on the tissue to help it heal properly,” Ludewig said. “We want to get you moving and functioning again without overdoing it.”

Coaching patients
Physical therapists often have to be their patients’ coaches through the recovery process. “Patients don’t care specifically about how much their tissue is being loaded, they care about getting back to normal,” said Ludewig. “There is a huge amount of education, reassurance, and guidance that goes into helping them progress, which enables them to stay within the guardrails that ensure a good outcome.”

When Ludewig thinks about the education she provides her patients, she is primarily concerned with helping them understand the procedure they underwent. “They need to know how to control the situation for better or worse,” she said. “Often, patients can do more than they think. We help them understand that it’s safe to move again.”

Reasonable expectations
It’s also important for physical therapists to give their patients a reasonable expectation of outcomes. “That is a huge motivating factor,” said Ludewig. “It’s important to set realistic goals for what they do and don’t want to do and help them understand the timelines within which they can reach those goals. We emphasize that they are going to get better…their body will help them recover.”

The physical therapist can only do so much, however; the patient must take an active role in their recovery. “It’s up to them,” said Ludewig. “We want them to make sure they’re thinking about how they’re moving throughout their entire day, not just during their exercises. Physical therapy is physical, after all. You can’t just take a pill and everything goes away.”

Physical detective
Although Ludewig is much more involved in research than clinical care these days, she still loves interacting with the patients who come to her with shoulder issues (her specialty). In a way, she plays the role of a physical detective. “Some of our patients come in with pain pre-surgically and we help them figure out what’s going wrong and what they should do differently,” she said.

One of the biggest frustrations for Ludewig is when she sees a patient whose shoulder is completely blown out. “If we had seen them years earlier, we could have helped them delay the progression,” she said. And there are occasional patients who just want the therapist to fix what’s wrong without doing what they need to do. “It doesn’t work that way,” Ludewig said.

Positive impact on lives
She believes that her physical therapy work has a positive impact on her patients’ lives, and the work is constantly stimulating. “You see different people all the time, making each case unique,” Ludewig said. “Even though I focus on shoulder issues, there is still a lot of breadth in that. It’s super rewarding to see people reach their goals.”

There are some new trends in physical therapy that Ludewig is excited about. One is a notion called prehab, as described earlier. “When a patient knows they’re going to have surgery, their doctor may have them see physical therapy first to be able to strengthen them a little more and enable the best possible outcome post-surgery,” said Ludewig.

Exercise is medicine
With the push to minimize opioid use, the notion that exercise is medicine has been reinvigorated. “There are ways to use movement to reduce pain,” Ludewig said. “Science has really advanced in that area to help ensure that people are moving correctly to minimize their pain.”

Surgical techniques are also continuously changing. “Some of the most cutting-edge treatments use tissues that have stem cells implanted in them to help regenerate tissue,” said Ludewig. Deep brain and spinal cord stimulation are also helping people reduce pain and improve function. “These procedures have the potential of being lifechanging,” said Ludewig. “Keeping up with all these advances keeps things fresh for me.”

Her own research is helping move the practice of physical therapy forward. “We’re trying to understand the mechanics of how abnormal movement can contribute to the development of rotator cuff problems,” Ludewig said. “We want to create treatments for intervening much earlier to help prevent these issues.”

Learn more about Ludewig’s research.

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