Rehabilitation after surgery at home: a guide for patients

After surgery, the joint and the muscles around it are stiff, sore and weak, because they were spared before the operation and in the first days. Without rehabilitation, stiffness can set in and recovery is slower or incomplete.

The physio helps you move at the right pace: enough to make progress, without straining what the surgeon repaired.

The surgeon decides. Depending on the operation, rehabilitation can start very early, sometimes within the first days, or after a period of rest for the joint. The surgeon gives you a physiotherapy prescription with the number of sessions, and often precise instructions: what you can do, what to avoid, and whether you can put weight on the leg.

Give these instructions to the physio at the first session, and follow them even if you feel better. If in doubt, the physio can contact the surgeon.

The physio starts with an assessment: range of movement, strength, pain, swelling, walking. They set concrete goals with you, such as climbing the stairs or bending the knee to a certain angle. They can, for example:

• ease the pain and reduce swelling with suitable techniques;
• restore movement in the joint, with gradual exercises;
• strengthen the muscles step by step, within the limits the surgeon has set;
• teach you to walk again, with or without crutches or a walker, then the stairs;
• work on balance to reduce the risk of falling;
• care for the scar once it has closed and the surgeon agrees;
• give you exercises to do alone between sessions.

Every operation has its own stages. The surgeon and the physio adapt the programme to your case. Here is what rehabilitation most often aims for:

• knee or hip replacement: walking again, bending, and managing stairs safely;
• knee ligaments: regaining movement, then strength and stability;
• shoulder (for example the rotator cuff tendons): gradually getting the arm moving again, with plenty of patience;
• fracture, with a cast, screws or a plate: restoring flexibility and strength to the area that was immobilised;
• back surgery (for example a slipped disc): getting back to everyday movements while protecting the back.

A session usually lasts between 30 minutes and an hour. The physio brings the small equipment they need. A bit of clear space and a stable chair are enough. At home, they can train you on what really awaits you: getting out of bed, going to the toilet, climbing your own steps.

The rhythm is set with the surgeon and the physio: often several sessions a week at first, then further apart as you improve.

What you do every day matters as much as the sessions:

• do your exercises a little every day, rather than a lot once a week;
• walk regularly, in short trips, as the surgeon’s instructions allow;
• respect the limits you were given: don’t push to go faster, pain is a signal to listen to;
• for painkillers, follow what your doctor prescribed, and ask before changing anything;
• make the house safe: remove slippery rugs, clear the walkways, light the way at night, and if possible fit a grab bar in the bathroom;
• don’t skip your check-ups with the surgeon.

If you have chest pain, sudden difficulty breathing or cough up blood, call the emergency services immediately (15 or 141): it could be a pulmonary embolism, an emergency. Don’t wait for the physio session.

Tell the surgeon or your doctor quickly if you notice: a swollen, red, warm or painful calf; a fever; a scar that is red, warm, leaking or opening; pain that gets worse despite treatment; numbness, or a foot or hand that is cold or pale; or after a fall. The physio can also point you in the right direction if they notice any of these during a session.

A home physiotherapy session usually costs between 200 and 600 DH, depending on the situation. When prescribed by a doctor, physiotherapy may be covered by AMO (CNSS or CNOPS) or by your private insurer, depending on your cover. You need the prescription and a care sheet filled in by the physio. On Kinezy, physios who provide one say so on their profile.