HLI Q&A Series: When can return to clinical practice after surgery?
When can I return to clinical practice after surgery?
Question from Lane:
Hi Ginger, I am an orthopedic PT scheduled for upcoming hip preservation/reconstruction. I came across your blogs in my scholarly and subjective research, they have been very helpful so far. I had a few questions for you regarding undergoing the procedure as a PT. First, my surgeon has suggested my time off work will be 8-12 weeks. Do you work in the clinical setting? If so, How much time were you away from the clinic? I work with a good deal of athletes and am concerned about coming back and having to perform squating, cutting, rotation, agility, etc. Second, You continually reiterate the importance of post-op PT, which I agree with. I have not scheduled formal post op PT yet, my thought was to do a lot of HEP (home expertise program) independently and at my community rec center, using my colleagues to assist with soft tissue more and mobilization when necessary. What did you find your needs for skilled PT being? I appreciate any unique insight you have, thanks for your time!
Response:
First, thanks for your query. Second, I am sorry you are entering this journey of hip reconstruction, but happy that you are finding the right help and have peace about it. Third, my blogs – glad you found them helpful. That ‘s the whole purpose. I will be posting 2 more hip posts over the next month – and I think you’ll find those very helpful as well.
Now, to answer your questions:
Time off – That is a doozy of a question and a VERY important one. Your surgeon is right. Unless you have someone to do ALL the heavy lifting and basically any movement, you cannot adequately perform your job duties. I had to go back to work at 3 weeks post-op, and it was very scary. I had some very bad days because of it, and I would never recommend doing it. I even stayed in my doctoral program that semester and was trying to turn in papers at just a few days post-op (also NOT a good idea ;).
Here’s the catch: I am a therapist’s therapist. I teach, travel, and write while also seeing patients as my schedule allows. I was able to have TA’s present at all my CE courses that season (August-December), and now still make it a point to have a TA at teach course. Those assistants drove me (I made a professional decision that I could not drive safely until I could walk safely, due to consideration of reaction time, etc.), took me to PT (and in some cases helped with PT), taught early morning sessions in my CE courses, such as meditation and movement therapy classes, and were there to do all the heavy work in lab (assisting students, making manual corrections, circulating through the room, even getting me glasses of water and fetching things I needed) because I literally could not do it.
For example, at three weeks post-op, I was still experiencing acute post-op pain and edema, so I literally had to teach while lying supine with my leg elevated. By the 4 month mark, I could get down on the floor, but it was tenuous and required careful and conscious movement. So my recommendation is, if you can, take the entire time off, at least through the first 12 weeks. You will thank yourself for that later. Trust me.
Post-Op PT
Hear me on this – you absolutely, positively need to schedule yourself for regular PT sessions, just like any other patient. I am fiercely independent and self-sustaining and have rehabbed myself through 2 rotator cuff tears, a glenoid labrum tear, DRA, and POP. All of those things are a walk in the park compared to HLI surgery. You will not even be coherent for the first month or so (at least – general anesthesia packs a wholloping punch which severely affects your cognitive state, and you won’t recognize it for some time). You will also be unduly tired from all the hip precautions and movement limitations, and you will experience some level of debility due to WB precautions. Polypharmacy in the post-op period (first 30 days) is significant, not pain meds mind you – you can come off of those relatively quickly -it’s all the other prophylactic meds for blood clots, chondral formation, etc.
Now, what kind of skilled PT do you need?
Pretty much ALL of your PT is passive – and should be – for the first month. If your tear is anterior (and most are), your muscles will likely, terrifically react to the surgery. Hence the reason for not firing the psoas for at least 2 weeks after surgery. Have you ever tried to shut your psoas off voluntarily? How about when you are in a post-op haze, which includes all the GI “fun” that polypharmacy and general anesthesia brings? It is not easy, and you won’t be in control of muscle spasms. I would recommend, and I never encourage med dependence, having some muscle relaxers in your arsenal of drug choices, for the simple reason that if your psoas decides to involuntarily contract, it can affect your surgical outcome. And, it also causes great pain at the repair site(s). Also, you like very likely need internal pelvic PT as well. Even if you had no PFM dysfunction before, the post-surgical period brings a second and entirely new set of functional impairments and deficits. (this is definitely not in the brochure). This means you’ll have your preoperative deficits as they are now (probably tendinosis in areas, tendonitis in others, weakness and NM patterning issues in yet other places) AND you’ll get a whole  new set of post-operative deficits. In conclusion – I cannot emphasize enough to hire your own PT for this – you cannot do this alone or with the “help” of colleagues.
My story:
I brought on two of my friends (one ortho PT and one pelvic PT) plus had my own knowledge base from specializing in this area (neither of the other two PT’s were HLI specialists). I saw my colleagues 2-3 times a week for 9 months (not 4). At the 6 month mark, I reduced myself to 1-2 times a week, but mind you, was still deep in my own integrated PT care, based on medical therapeutic yoga methodology.
The bottom line is – even if you are an expert, you must have help – and for the time required to recover, it’s just not fair to ask colleagues to pitch in here and there – it’s not fair to your hip or your colleagues. You need and deserve MORE care than that.
I hope my response has not just turned a fire hose on you when you only asked for a drink of water – but I’m also just speaking out loud, off the cuff – and if given more thought, the fire hose would definitely be turned up higher because HLI rehab is that important – and early intervention (and long-term rehab) is of utmost importance for optimal outcomes.
Hope this helps and best of luck to you on your surgery and recovery!
Best,
Ginger
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