Surgeries generally follow a predictable pattern. The surgeon operates, removing or repairing the problem. The patient allows the incision site to heal, which can take a few weeks. Most of the time, you are recommended to see a physical therapist within a week after surgery - in some surgeries, even the same day! The surgeon will recommend physical therapy, sometimes as much as 6 months of treatment - which is when the real work of recovery takes place. Why is going to a physical therapist so important?
Physical therapy has several major benefits after a surgery:
Breaking Up Scar Tissue: If allowed to heal on it's own, a scar will often stick, or adhere, to the tissues underneath. By not allowing the skin to move freely over the muscles underneath, this adhesion can cause lingering pain and restrict movement. A physical therapist will work on the scar itself, making sure the skin moves freely and the scar ends up feeling just like the rest of the skin. If this goes untreated, the adhered scar can cause of domino effect of dysfunction.
Regaining Strength and Range of Motion: Regardless of the surgery, the body has a predictable, immediate response. Inflammation rushes to the site of the wound, working to repair the tissue damaged by the surgeon's scalpel. Recognizing the injury, the body immediately puts the area on lockdown, trying to ensure you don't damage the area any further. This is a life-saving reaction to an accident, but makes recovering from a surgery more difficult. The muscles and tissue surrounding the wound begin to waste away, or atrophy, within 24 hours after a surgery. That's why, in hospitals, a whole corps or PTs are on staff to help surgical patients back onto their feet immediately after a surgery. The sooner they begin moving and regaining strength and functional range of motion, the better the outcome and the shorter the recovery time.
Restoring Function: No matter what the surgery, physical therapy helps to restore normal function. For orthopedic surgeries - knee, shoulders, hips, ankles, etc. - physical therapy starts as soon as possible afterwards in order to help patients regain their full unrestricted function in order to walk or reach for a cabinet, for instance. In other surgeries it's important to restore healthy functioning after the trauma of the procedure and prevent the body from overcompensating, developing bad habits that will cause pain and dysfunction over time. Limping after a knee surgery for too long, for example, can cause hip, ankle and back pain if left untreated.
Surgeons know how important these benefits are for their patients; many work closely with physical therapists, and every patient leaves the operating room with a prescription for 12-24 visits of physical therapy - in every surgery - hip, knee, back, shoulder, ankle - every surgery ...
Except for pelvic and abdominal surgeries!
These surgeries are common in both women and men, and include C-sections, hysterectomies, prostatectomies, episiotomies, colorectal surgeries, bladder surgeries and others. These are some of the most invasive surgeries around - for example, a "routine" C-section involves making a cut all the way through the abdominal muscles, pulling the intestines from the body and out of the way, and then making a large incision through a major organ (the uterus).
Even a 'routine' procedure like an episiotomy during vaginal delivery cuts through important pelvic floor muscles. These surgeries affect a sensitive and vital part of the body; the pelvic area is responsible for everything from helping you stand to controlling your bladder to having sex. Even a "simple" pelvic or abdominal surgery can have significant effects on the tissues and core muscles around the entire pelvis, abdomen, and low back.
Yet, despite the fact that these pelvic and abdominal procedures are often incredibly invasive and have lingering effects on some of the most vital functions of the body, almost no patients are sent to a physical therapist after pelvic surgery! The importance of post-surgical care is recognized by every other surgical specialty, but pelvic and abdominal patients are left to recover on their own.
Often these patients end up seeing a pelvic physical therapist, but only years after the surgery when they are experiencing pain, incontinence, pain with sex, low back pain, difficulty urinating or another lingering complication from a pelvic surgery. A few visits with a PT after the procedure could likely have prevented these symptoms by providing the same post-surgical care that every other patient receives.
Any pelvic surgery affects the pelvic floor, low back, and lower leg muscles. Any pelvic surgery needs the same type of rehab that any other surgery needs -- function, strength, mobility, length of the pelvic floor, core muscles, and organs -- needs to be restored and assisted back to a new-normal and repaired state.
Laparoscopic Hysterectomy Scars
If you, or someone you know, is facing a pelvic surgery, you don't have to wait for your doctor to suggest pelvic physical therapy -- sadly, they probably won't. In most states you can call a physical therapist directly after your surgery. Even a few post-surgical appointments can prevent many of these complications and set you up for a more rapid and complete recovery.
Dr. Nicole Cozean is the founder of PelvicSanity physical therapy, Orange County's premier pelvic floor physical therapy clinic. One of only 270 PTs to be board-certified in the pelvic floor, and the first PT to serve on the ICA Board of Directors, Nicole is the author of the acclaimed and best-selling book The Interstitial Cystitis Solution (2016). She is an adjunct professor at her alma mater, Chapman University. The PelvicSanity blog focuses on presenting practical, positive information to help patients beyond the walls of Nicole's clinic.