Should we be left to our own devices? The beneficial effects of Pilates & Physiotherapy working together following post operative surgery.
As an established Chartered and State Registered Physiotherapist (www.info-physio.com). I would like nothing better than to state how good the NHS is regarding postoperative rehabilitation.
I have never been in any doubt that I am fortunate to live in a country where I can receive a healthcare service that is provided 24/7, and in many instances this is delivered to a high standard. It's also not my purpose to discuss the quality of that service as a whole, qualifications, experience and knowledge base that the NHS as a service provider delivers.
The concerns and issues (which are of my opinion) are directed towards the following - post surgery variables that restrict or hinder patients from full recovery.
* The limited time availability health care professionals are given to administer therapies
*Poor systems in place
* Poor verbal and administrative communication
* The increasing volume of population attending hospital
* People living longer and associated age related conditions
* The dictation of finance creating what seems a bigger priority than health
* The lack of programs and systems that give patients clear detailed guidelines on the do's & don’ts that they need to follow postoperative surgery
* Clear detailed exercise regime that they can follow, which has been clearly demonstrated and explained, and more importantly, fitted around their surgery and them as an individual.
I often hear the phrase 'best practice', surely this means best practice at this moment in time or as far as we know? It’s of my opinion related to many the above reasons, and from speaking to numerous patients who are dissatisfied with their postoperative rehabilitation package, or should I say the lack of one, the quality of aftercare suffers. In fact, on many occasions has ceased to exist, and I wonder have we now got a ‘health’ service or a 'medication prescribing service’, when surely the answer is activity, correct movement and motivation.
When a person leaves hospital after a surgical procedure the post-operative care, in my opinion, should address the full biopyschosocial aspect of recovery. To have the patients’ full body and systems fully functioning to as close to what normal is for them. To discuss this in depth would take far too long, so I want to focus on one aspect, "the beneficial effects of Pilates working alongside physiotherapy in the functional rehabilitative phase".
May I point out that I'm not a Pilates teacher, nor do I practice it myself, however, I do see the significant beneficial effects that Pilates gives to enhance patient recovery, when delivered in conjunction with physiotherapy.
As an experienced healthcare professional in sport, working as 1st Team Physiotherapist in the Premiership for many years, and with sports teams abroad. I also have extensive experience in setting up and running courses and programs for patients with MS, spinal injuries, stroke recovery patients and cancer patients. You not only see injuries/illness from onset you also see the condition tested in their active daily living, or witness them being tested at a very high level on a continuous basis in sport, demonstrating the sustainability needed of the body part in question to cope with demands.
If we were just to look at the knee and hip joints on their own, so many times we witness a reoccurrence of problem or the patient reporting reduced functionality, or more so, another part of the body breaking down due to overwork, in particular the stress placed on the lumbar spine. Therefore the early intervention of Pilates exercises, working alongside the advice and rehabilitation plan of a Chartered Physiotherapist, makes sense.
Once the patient had been confirmed clear of the risk of any post operative infection or contraindications, and under the guidelines of the patients’ consultant/GP, we can then work through the phases of non, partial and full weight bearing exercise.
The main areas to be focused on being to;
*Establish full active and passive range of movement to the joint affected,
*Decreased inflammation and any post operative pain, I
*Increased elasticisticity of the musculature that is in contracture or spasm,
*Increased dynamic stability of the musculature around the operative joint,
*Increased neural pathways to the musculature that supports the joint,
*Increased patients functional movement, increase balance, coordination and proprioception,
*Recognition of atrophy (muscle wastage) to the specific muscles surrounding the post operative joint also the muscles working in synergy to work the joint or work as fixators to work the joint.
All health care professionals will realise that the above is not a full list but a good framework to build on.
We must remember the importance of re-evaluating the patient on every appointment or class, it shouldn’t be set in stone nor taken for granted, that a patients progress will go in a linear direction, and allowances should be made for the different and changing pathology as time progresses. We need to keep an awareness that patients need guidance, some will not have the motivation or the understanding that the exercise regime is a vital requirement, others through ignorance, may do too much. It should also be noted that along with, the consultant, doctor and Pilates teacher, they all work alongside the Physiotherapist to inform and educate the patient on what their trauma was, what was done and how they need to take on board responsibility for their future.
We need to remember the importance of good blood flow to the area, which brings oxygen to the tissue, the beneficial effects of hydration and nutrition, also body weight management and control, the psychological motivation and guidance the patient requires, hydrotherapy where possible, hence the need for a structured plan which has a full body measured assessment at the start, a goal to achieve at the end and structured measureable benchmarks along the way; to keep the patient, physiotherapist and Pilates teacher informed, bearing in mind any contraindications that might be present in the patients personal health.
I firmly believe, having worked with good Pilates teachers over many years, and researched the method in depth, that Pilates working with Physiotherapy can and does play a major role in a patients quicker, safer recovery with less chance of reoccurrence of re-injury.
Working with a Pilates teacher I would expect them to advise, educate and where needed, correct patients with their breathing techniques, body alignment, improved posture and control, to create a stronger framework and foundation. As well as instilling confidence, a better sense of well being, improving self-esteem, working towards reducing stress, anxiety and depression within the sessions as a result of increased activity. However, always remembering, as we all should, never to step beyond the level of their qualifications and experience, seeking the correct advice where applicable. The patient should as a result through participation, reduce isolation issues, and feel improved confidence physically and mentally. The Pilates teacher working with the patient within a supportive class setting or one to one, in a session that is structured and safe - where the patient feels listen to with care and empathy.
The Pilates teacher constantly creating an environment that motivates the patient, creating clear meaningful but objective plans, goals that are constantly being reinforced through demonstration, explanation and correction where needed.
As with all our articles, we must stress the importance of keeping close contact with the patients consultant or GP, so that nothing is left to risk and everyone is kept well informed. Once the program is completed always contact the patient 3-6 months following completion to establish how beneficial the service was, to gain vital information to help inform and enhance the ongoing program.
If you would be interested in finding out more about our Pilates and Physio post-op programs, please contact us.