Post-Surgical Physiotherapy in Pokhara: Rehabilitation After Orthopedic Surgery
Surgery creates tissue damage in the process of repairing it. An incision through muscle, manipulation of a joint, the implantation of a prosthesis — all of these produce post-operative pain, swelling, reduced joint movement, and muscle weakness that must be systematically rehabilitated before the patient regains full function. Without structured physiotherapy, many patients plateau far below the functional level that their surgery was designed to achieve.
Why Is Physiotherapy Essential After Orthopedic Surgery?
Physiotherapy after surgery serves several distinct and critical functions. It prevents joint stiffness from adhesion formation in the post-operative period. It restores muscle strength and motor control lost due to pre-operative disuse and the inhibitory effect of pain and swelling on muscle activation. It reduces the risk of deep vein thrombosis (DVT) — blood clots in leg veins — through early mobilisation and specific exercises. It restores proprioception (joint position sense) which is disrupted by surgery and tissue handling. And it provides a graded, safe progression back to full functional activity.
A patient who undergoes total knee replacement and does not receive physiotherapy will typically achieve 60–70% of normal function. The same surgery followed by a complete rehabilitation programme typically achieves 85–95% of normal function. The surgery is the same; the difference is rehabilitation.
In Nepal, where physiotherapy has been limited in availability and perceived as optional, many post-surgical patients have achieved poor outcomes that are attributable not to the surgery but to the absence of rehabilitation. A&B International Hospital’s integrated surgical and physiotherapy pathway addresses this directly.
What Are the Phases of Physiotherapy After Knee Replacement?
Total knee replacement (TKR) rehabilitation is divided into three phases, each with specific goals and progressions.
Phase 1 (0–6 weeks) begins immediately after surgery — physiotherapy starts on day one or day two post-operatively. Goals are to achieve adequate knee extension (full straight leg), achieve 90 degrees of knee flexion by discharge, reduce swelling, and restore the ability to walk with or without an assistive device (walker, crutches).
Exercises in this phase include ankle pumps (to reduce DVT risk by activating the calf pump), quadriceps sets (isometric quads activation), straight leg raises, and active-assisted knee bending. Patients begin walking with a frame within 24–48 hours of surgery. Ice packs are applied to control swelling. Compression bandaging supports the knee.
Phase 2 (6–12 weeks) focuses on strength, balance, and increasing knee flexion toward 120 degrees. Exercises progress to resisted knee extension, mini squats, step-ups and step-downs, and balance exercises on one leg. Gait normalises — the limp that characterised early walking gradually resolves as strength and confidence return. Patients typically transition from a walking aid to independent walking during this phase.
Phase 3 (3–6 months) addresses return to full functional activities — climbing stairs, walking on uneven ground, and for younger patients, return to recreational activities. Strengthening becomes more demanding: squats, lunges, and progressive resistance training. By 6 months, most patients have reached their functional ceiling.
What Does Physiotherapy After Hip Replacement Involve?
Total hip replacement (THR) physiotherapy shares structural similarities with TKR but has specific differences driven by hip replacement precautions — positions that stress the posterior capsule and risk dislocation in the early weeks.
Standard posterior approach precautions are: avoid bending the hip beyond 90 degrees, avoid crossing the operated leg over the midline, avoid rotating the foot inward. These precautions are enforced by the physiotherapy team and explained to the patient and family thoroughly before discharge.
Early mobilisation goals match TKR: walking with a frame by day one or two, independent ambulation by discharge, and progressive strength training through the phases. Hip abductor (gluteus medius) strengthening is the cornerstone of phase 2 rehabilitation and determines gait quality — weakness here produces the characteristic Trendelenburg gait.
What Is the Role of Physiotherapy After Spinal Surgery?
Spinal surgery — whether for disc prolapse, spinal stenosis, or fusion — requires a different rehabilitation approach from joint replacement. The principle is identical: restore function, but the specific goals and precautions differ.
After lumbar microdiscectomy (the most common spinal procedure for disc prolapse), early mobilisation begins within 24–48 hours. The physiotherapist teaches the patient neutral spine posture, safe movement patterns (how to get in and out of bed without spinal flexion stress), and gentle walking. Over 6–12 weeks, a progressive core stabilisation programme addresses the deep stabilising muscles (multifidus, transversus abdominis) that are disrupted by surgery and that protect the spine during movement.
After lumbar fusion, a longer, more conservative approach is required because the fusion mass is developing over 3–6 months. Heavy lifting and high-impact activities are restricted for longer. But early walking and gentle mobilisation are still essential for recovery and DVT prevention.
How Does A&B Coordinate the Surgical and Physiotherapy Teams?
A&B International Hospital’s model places the physiotherapist as a member of the peri-operative team, not an afterthought. Pre-operative physiotherapy assessment identifies physical limitations, educates the patient about what to expect post-operatively, and establishes rehabilitation goals. This pre-operative education is associated with better post-operative engagement and outcomes.
Post-operatively, the physiotherapist reviews the patient in the ward before discharge and establishes the home exercise programme. Outpatient follow-up physiotherapy begins as soon as the patient is mobile enough to attend.
For ECHS patients, all physiotherapy sessions that are part of the approved post-surgical rehabilitation pathway are covered under the patient’s entitlement. The hospital team ensures the paperwork for ECHS claims is completed accurately and promptly.
How Is Pain Managed During Post-Surgical Physiotherapy?
Post-operative pain is expected and must not be a reason to avoid mobilisation. There is an important difference between the discomfort of moving a healing joint and the sharp pain of damaging something. The physiotherapist teaches the patient to distinguish these, and designs exercise progressions that challenge the tissues appropriately without provoking injurious pain.
Analgesia — paracetamol, NSAIDs, and where appropriate, short-term stronger analgesics — is timed to allow adequate pain control before physiotherapy sessions. Ice packs applied for 15–20 minutes after exercises reduce post-exercise swelling and discomfort. TENS can be used as a non-pharmacological adjunct.
The physiotherapy team communicates regularly with the surgical team about pain levels, swelling response, and any concerns about wound status or range of motion progress. This integration ensures that problems are identified and addressed early.
A&B International Hospital
Pokhara-02, Bindhyaabasini Way to Sarangkot
Phone: +977 061-412512
Website: abinthospital.com
If you are recovering from orthopedic or spinal surgery, structured physiotherapy at A&B International Hospital ensures you achieve the full functional benefit of your operation. ECHS polycards accepted for eligible veterans and their families.
