We as Physios are pretty used to seeing people after surgery. Usually we see a few ‘post op ’ patients every day. We are pretty good at managing the physical part of the rehab. What to expect, weekly goals, protocols to get people back to normal life as soon as possible. But…. what happens when we are on the receiving end of an operation? We see the occasional things that can go wrong and probably worry unnecessarily. Things like infections can happen, blood clots, nerve damage to name a few.
With my surgery now a week ago and with a few spare hours and now out of the opioid fuelled first few days of looking like an extra on set of the walking dead I decided to jot down the things I see work clinically combined with research that has been shown to improve the healing process. Looking more holistically about what could be done.
This is my third shoulder reconstruction (poor sporting choices) and fifth orthopaedic procedure so I consider myself experienced on a personal level but also having seen thousands of patients who have had amazing outcomes and some that haven’t. With the benefit of age I have a bit more wisdom and with the fact I have two kids look after I am incredibly motivated to get better.
I am very grateful to Dr Alan Young of Sydney Shoulder Specialists. For complicated shoulder dislocators he performs a complex operation called a latarjet procedure. Allan spent a year learning this technique off Dr Latarjet in the south of France which is why he does the Swans and Waratahs shoulders so we are lucky to have him here in Sydney.
#1 Avoid infection
One of the things that can be incredibly devastating postoperatively is getting an infection. Once you open the skin those little bugs like staph can get into the underlying tissue. Unfortunately, it happened to me 10 years ago and put me back 3 months. 3 or 4 days before the op I buy and start using antibacterial soap and use it twice per day. I generally buy defence soap or gamophen soap. I buy a few bars to use after the operation also.
Exercise improves wound healing and reduces excessive inflammation. I try and ramp up my cardio 6 weeks out from the operation and as soon as you get the all clear from the surgeon you should be doing something active too. An exercise bike (I bought one on eBay and it arrived 2 days later), swimming (once the wound has healed) or walking are all low load good alternatives. It is important to have rest days and to not push through the pain. Make sure you ask your surgeon when, how much and plan this with your Physio. So exercise to improve wound healing.
#3 Have a session of lymphatic drainage before and after your surgery plus do your Physio
Whilst working in London I worked with a crazy German physio who did lymphatic drainage. I had a patient with persistent ankle swelling that I couldn’t settle. The swelling completely disappeared after one session of lymphatic drainage with the crazy German. It blew my mind and I regularly refer patients with swelling for it. I just so happen to work with one of the world’s best lymphatic drainage massagers Coby Du Preez whom also lectures on the topic.
It is incredible to see a patient who has had surgery and who has had a session before and after surgery. The difference is incredible. Less swelling means better muscle function leading to a happier healthier joint and faster recovery. I make sure I get a session before surgery.
I also make sure I have done as much Physio as possible preoperatively. The stronger I am and biomechanically optimal and the more settled my joint is the better outcome will be.
Stress has a negative effect on injury recovery. Stress has a massive impact on our immune system and after an operation, you need your immune system firing on all cylinders. Stressing to get ready for surgery is inevitable. You can, however, do what you can to minimize it. Yoga, meditation, running/walking/swimming and Epson salt baths work for me. I make sure I ramp these up in the weeks before surgery.
Have some time off work to recover!
Yes, you could go back to work 3 days after a knee scope but why? I’m sure your 70-year-old self would be grateful you took an extra week to recover. The amount of delayed recovery I see from those that went back and sat for 12 hours per day after a simple knee scope is ridiculous. Gross unnecessary swelling! Also, how do you work on endone? I just rechecked a couple of emails I sent the day after my operation and LOL
Not being able to exercise post-op turns me into an “ asshole ” according to my lovely wife who has been a very patient wife. Do what makes you relax for a couple of weeks afterwards. I have meditated twice per day, had daily Epsom salt baths and read John Ibrahim’s book the last king of the cross. Good read fyi but it means I’m spending more time in the parasympathetic nervous system response which is where we do our healing. I’ve also turned on my email autoresponder to try and reduce stress for a couple of weeks.
Get to bed earlier and if you have the luxury of a siesta TAKE it. The more time in the rest and digest nervous system response the better.
#5 Limit the booze
I’ve gone on a 3-month alcohol detox. I love a Pale Ale on a Saturday. I find that another 4 will follow that one though. 4 weeks out from surgery I stopped all alcohol consumption. I won’t touch a drop until 6 weeks post-op.
Clinical evidence and animal experiments have shown that exposure to alcohol impairs wound healing and increases the incidence of infection (Gentilello et al., 1993; Szabo and Mandrekar, 2009). Alcohol exposure diminishes host resistance to fighting infection. It also reduces your proinflammatory cytokine release meaning, decreased collagen production and shittier healing. Wounds heal over weeks to months. It has been shown to also influence wound healing weeks down the track. For the sake of a few weeks, I think it is worth it.
#6 Eat these foods
What should I eat?
Carbohydrates, Protein, and Amino Acids
Protein is one of the most important nutrient factors affecting wound healing. A deficiency of protein can impair a whole lot of processes that affect wound remodelling. A deficiency of protein also affects the immune system leading to increased susceptibility to infection (Gogia, 1995). Scar tissue creation also requires iron and vitamin C. Impaired wound healing results from deficiencies in any of these co-factors (Campos et al., 2008).
Vitamins, Micronutrients, and Trace Elements
Vitamins C ( oranges, kale, strawberries, blueberries, capsicum), A (carrots, dark leafy vegetables), and E (almonds, spinach, avocado) are potent antioxidants and anti-inflammatories. Vitamin C, A and E deficiencies result in impaired healing.
I make a morning nutribullet smoothie with the following
Carrot, kale, spinach, almonds, psyllium husk (stops painkiller constipation), strawberry, blueberries, half an orange, some coconut oil and some pea protein. I sip on that every morning and try and add the above into lunch and dinner.
#7 Listen to your physio
Post Operative physiotherapy is really important. We see a lot of cases and can make a huge difference to your recovery. It is disappointing to see the older surgeons telling people not to have Physio. It is really important, not just for the local tissues but the other parts of your body that have been compensating for the painful area.
So there you have it. If you want to give yourself the best possible chance to do well post op then this will certainly help! Let me know your thoughts. Anything I forgot?. Anything you would add? Hit me up
We see a lot of postoperative patients here. If you or a loved one need a Physio postoperatively call us 02 9365 0004