Total Joint Replacement: Physical Therapy “More Than Just Exercise”

By John R. Mishock, PT, DPT, DC

Our body has over 360 joints. All joints (where two bones meet) have cartilage at the bone’s ends which helps to reduce friction and provide shock absorption. With aging, this cartilage wears out, leading to pain, swelling, joint deformity, weakness, and altered function. Nearly 70 million Americans have some form of arthritis or chronic joint symptoms. (CDC, 2021) In the early phases, physical therapy effectively reduces pain, increases strength, and improves function. However, if the cartilage wears excessively and becomes “bone on bone,” a total joint replacement can be performed.

Approximately 2.5 million patients undergo joint replacements of the knee, hip, shoulder, ankle, and hand annually. (AAO, 2020) In the past, it was standard of care to have physical therapy before and after total joint replacement; however, some surgeons opt out of having their patients have physical therapy following total joint replacements.

The main driving force behind eliminating physical therapy following joint replacement is cost, even though research shows that physical therapy is a cost-effective post-surgical treatment. In some cases, those who do not have physical therapy following surgery have poor outcomes.

Eighteen percent of patients undergoing joint replacements are unsatisfied with the postoperative outcomes (Anderson et al., 2021). Beyond this, more than 1 in 5 patients do not regain their physical function after joint replacement. (Wieczorek et al. 2020) Many factors could lead to poor outcomes following surgery. However, a scientifically based physical therapy and rehabilitation program is critical to optimizing recovery.

Below is what to expect following surgery and why physical therapy is “more than just exercise.”

Physical therapists are doctorate-trained healthcare providers who can make a diagnosis, treat pain, improve function, enhancing the individual’s quality of life.

Thorough Evaluation: The physical therapist would perform a comprehensive history and physical exam. This evaluation would determine the cause of pain and the functional deficits leading to poor quality of life at home, work, or recreation.

Patient education: At Mishock Physical Therapy & Associates, we explain how post-surgical impairments lend to poor function. Our physical therapist will educate the patient on the cause of pain or movement dysfunction. We will address faulty body mechanics and ergonomics lending to the problem and create a plan for return to the desired activity. The physical therapist will manipulate the volume (how much), intensity (effort), and frequency (how often) while hedging rest and recovery guidelines to return the individual to back to their highest quality of life. We will address proper nutrition and its importance in recovery and disease prevention. The physical therapist will coach them through the psychological barriers to healing, such as fear avoidance, anxiety, and depression associated with pain and limited mobility. The PT would refer to the appropriate individual as needed.

Manual therapy: Mishock Physical Therapy & Associates uses a wide variety of manual therapy techniques (myofascial release, joint mobilization/manipulations, Active Release Techniques, trigger point therapy, acupressure, proprioceptive neuromuscular facilitation, cupping, Maitland, Mulligan, Cox Flexion Distraction, chiropractic, and others) to help relieve pain, enhance soft tissue healing and improve patient function. The manual therapy will significantly improve soft tissue healing, reduce pain, improve swelling, and optimize the range of motion following surgery.

Therapeutic Exercise: Therapeutic Exercise is not exercising like “going to the gym.” Therapeutic Exercise is used in a specific functional manner based on the deficits found during the examination. Certain types of exercise (isometric and eccentric exercise) can reduce pain. Other types of exercise are used to improve strength, endurance, power, motor control, balance, and flexibility. All exercises are done in a controlled, graduated fashion based on the best available science to help the individual return to function. The physical therapist will use some of these exercises to create a home exercise program that will be performed daily.

Physical Therapy Modalities: Electrical stimulation, cupping, vasopneumatic, and Vibratory are used with hands-on soft tissue and joint treatments to enhance tissue recovery.
Ultimately the goal of

Physical therapy following joint replacement surgery helps the patient achieve optimal function and quality of life faster with fewer limitations.


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Dr. John Mishock is one of only a few clinicians with doctorate level degrees in both physical therapy and chiropractic in the state of Pennsylvania.

He has authored two books; “Fundamental Training Principles: Essential Knowledge for Building the Elite Athlete”, and “The Rubber Arm; Using Science to Increase Pitch Control, Improve Velocity, and Prevent Elbow and Shoulder Injury” both can be bought on Amazon.

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