As the population in the United States ages and the amount of joint replacement surgeries increases, more and more people are working with physical therapists to get back to what they loved doing before their joint stopped them.

According to recent numbers, there are over one million joint replacement surgeries performed per year in the United States and that number is expected to approach up to four million in the next 10 years! *(1-3)

In the event you or a loved one decides to undergo one of these procedures (hip, knee, shoulder, ankle etc), you will invariably find yourself sitting in front of a physical therapist soon after your surgery. As a team with over 50 years of experience seeing people after a joint replacement surgery at Par4Success, we can tell you that there are a wide range of outcomes and a wide range of treatment techniques and quality.

With that in mind, we have some advice!

Do not just go through the motions and sit there for your 30-60 minute appointment as a passive participant.

Be your own best advocate!

Give your best effort!

And above all, ask the right questions!

A good Physical Therapist wants you to ask questions because it shows us that you are engaged in the process and that you really want the best outcome for yourself.

We know the process of recovering can sometimes be intimidating, hard and frustrating.  So to get you started on your way to a quick and efficient recovery, we’re giving you the top three questions that you need to be asking your therapist on a regular basis.

So, without further ado…

 

Question 1: What should I be doing at home on a daily basis to get the most out of my rehab?

Often people take for granted that their physical therapist is telling exactly them what they need to know. However, take into consideration that your therapist is a human too and may forget to tell you something or get sidetracked on a busy day. We make every effort to avoid doing this at the end of every session, but we’d be lying if we told you that never once did any of us forget to give someone their instructions before they walked out the door or fully explain why what was given to them was important.

Asking this simple question at the end of EVERY appointment takes the guesswork out of getting better. After all, therapy is really only as good as the time you put into it when you are away from the clinic. So, if you don’t know what you should be doing, then you’re not getting the best results.

To take that a step farther, if you do not understand the reason why you are doing each and every exercise then you are losing too.  The more you understand the value and importance of squeezing your thigh, for example, to help you return to a normal walking pattern, the more likely you are to do the 200-500 quad sets each day.   This gets your quad control (thigh muscle working) quicker which is directly related to better outcomes which gets you back to doing what you love quicker!

 

Question 2: What should I NOT be doing at home to avoid going backwards?

As simple as this sounds, this is a huge question that is very often neglected in the physical therapy clinic. Therapists are very good at telling you what TO do, but often leave out the things to avoid because sometimes we forget that not everyone knows what we do and this can be worse than anything!.

With any joint replacement surgery (or any condition that you may be seeing a Physical Therapist for) there are things that we DON’T want you to do so that you do not re- aggravate the tissues that are upset. In our years we have found that sometimes the things we take away rather than the things we add to a person’s activities make the largest impact on you feeling better and getting back to normal activity.

One of the greatest examples of this is with total knee replacements and the idea that no matter how bad it hurts, you have to push, push push on the knee to make it straight.  This couldn’t be more false!

While there are extreme cases where this might be true, often times pushing nonstop on a joint just angers it and makes the pain worse.  By telling your therapist how the knee feels before, during and after the pushing you can give them amazing insight into what exactly you need.  No two joint replacements are exactly the same.

 

Question 3: How do you know that I am improving?

This is a big one. I mean a HUGE one!

Sometimes as a patient (which we have also been at times) we can be complacent to think, “I felt a little better after the treatment session, I must be getting better.” However, that can sometimes be a temporary treatment effect after interacting with someone and may have nothing to do with your objective progress.

Go back and re-read that last paragraph.

Over the years one of the most important things we’ve learned as Physical Therapists is that we MUST test and retest as frequently as possible. That’s the only way to know if we are making a true objective difference!  If you are not being objectively tested and retested and feel like you are not where you should be, it could be the fact that no one is measuring your progress in meaningful ways.

This doesn’t just mean how much bend does your joint have, we are talking about measuring your activity levels, your power, your strength, your sport and hobby activities, etc.  Don’t let a Physical Therapist just guess and rely on subjective opinions and reports to measure your progress.  Force them to measure and share the progress with you.  You will know how you feel and the things in your daily life.  But you need the Therapist to tell you what the meaningful measures are that will move the needle for you and how you are doing on those as well.

So, make sure your therapist is objectively measuring your progress before and after treatments. It could be as simple as testing your range of motion or strength in a certain movement and It may seem repetitive if we ask you to perform the same movement several times in a session, but that’s actually a good sign! That means your therapist is judging his or her treatments for effectiveness, and making sure you are improving!

If you are not improving or moving in the right direction for 2 weeks or more at any time this IS A PROBLEM! Speak with your therapist about it and ask them what they are going to do differently.

These three questions are so simple, yet so often overlooked and could make the difference between a good outcome and a great one. So do yourself a favor and ask these at some point in every session.

 

If you have any further questions about this topic or would like to visit us at Par4Success, please feel free to reach out by email anytime.

Ted Graham, DPT, SFMA, TPI Level 2 MP
Par4Success Physical Therapist

References:

1. Williams S.N., Wolford M.L., Bercovitz A. 2000. Hospitalization for total knee
replacement among inpatients aged 45 and over: United States, 2000–2010 key
findings. https://www.cdc.gov/nchs/data/databriefs/db210.pdf ;
2. Wolford M.L., Palso K., Bercovitz A. 2000. Hospitalization for total hip
replacement among inpatients aged 45 and over: United States, 2000–2010 key
findings. https://www.cdc.gov/nchs/data/databriefs/db186.pdf ;
3. Kurtz S., Ong K., Lau E., Mowat F., Halpern M. Projections of primary and
revision hip and knee arthroplasty in the United States from 2005 to
2030. J Bone Joint Surg Am. 2007;89(4):780.