Kristin Prentiss Ott, M.D.

6 Tips to Optimize Recovery After Orthopedic Injury/Surgery (Guest Post)

Carolyn and I met 11 years ago when Mickey and Carolyn’s husband worked together as residents. Our paths diverged, but thanks to Facebook, we are still in touch and I am happy to offer you some of her expertise!

Carolyn has LOTS of letters after her name including a doctorate of physical therapy. She owns Spine Orthopedic Active Rehab (SOAR) and has written a soon-to-be published book on health, wellness, and disease prevention. In addition to running her own business, and working as a physical therapist and holistic health provider, she is a thriving mom to three kids and makes time to blog at www.renoSOAR.com. You can also follow her on Facebook.

She has an incredibly soothing voice and demeanor. Think of her as your personal physical therapist when you read this!


6 Tips to Optimize Recovery After Orthopedic Injury/Surgery

 

My past work experience has included years working in the hospital including the surgical wards. Now, I specialize in outpatient orthopedic physical therapy. I see mostly patients who want to avoid surgery. I am a proponent of keeping the body intact whenever possible.  However, there are times when accidents happen or it is necessary to have surgery in order to get back to living life.  Sometimes it happens.

You take good care of yourself and exercise regularly, but then you fall skiing and tear your ACL. Often, to keep up that same level of activity, the ACL will need to be surgically repaired.

Or you may have been a college athlete that played football and now have severe hip arthritis in your 60s that requires a total hip replacement.

Like I said, sometimes it happens.  And if you are going to have surgery planned or not, here are a few tips to help you to optimize recovery, not faster, but optimally.

1. Move whatever you can, often and safely.

Start with moving the body parts that didn’t have surgery. If you had knee surgery, start with moving your arms, then hips, opposite knee, then ankles. You need to move the surgery site, but only when your surgeon says it is safe. Sit up and take deep breaths. Stand or walk when you are safe and breathe.

Move whatever you can, whenever it is safe and don’t stop. The movement helps keep the blood pumping, the lymph draining, and the muscles contracting. My general recommendation is: every hour you are awake, move your body some way, some how – any way, any how as long as you are following surgical precautions. This may require help (see #2).

2. Call in the troops.

Don’t be shy about asking for help.

  • Ask for friends to help take the dog for a walk.
  • Ask family to prepare a few meals for you.
  • Ask your doctor for a physical therapy referral to help you get moving safely sooner than later.

Don’t wait until you are struggling. Ask for help. Really. We are all here on this earth to help each other in times of need. Be gracious and say thank you a lot, but do not feel guilty. Remember what goes around comes around, and when it is your time to help another, you will be willing to do what you can.

3. Drink bone broth.

Yes, this is what your grandmother used to make when she made homemade chicken soup. Specifically, using long bones from beef allows for additional bone marrow, which is wonderful for healing as well as calcium from the bones that is readily available to absorb (so long as you get some vitamin D, see #5) for your body to use to help heal that fracture. The bone broth is easy to digest and soothing on the stomach especially after anesthesia. Making homemade bone broth is simple to do.  Here is a recipe.

4. Eat real food, including protein.

It is always best to eat real food whether you are having surgery or not. But for certain, the best way to get important vitamins and minerals that are bioavailable to assist in the healing process is from real food. That means foods that are as close to nature as they were intended. Whole food. Nutrient rich foods like salmon, broccoli, spinach, berries, etc. It is NOT food in packages. Those foods are often heavily refined and processed in a way that renders them nutrient deficient and in fact require your body’s stored nutrients to process them and you get nothing in return. Not to mention prepackaged food and drinks often include a host of things that hamper healing like sugar, trans fatty acids, and additives.

Specifically, in the case of an orthopedic surgery, it is important to include healthy protein. Protein is the only source of a complete amino acid profile that our body requires for structure (tissue, bone, teeth, skin), movement (muscles, ligaments, tendons), protection (skin, immune system), energy (glucose), transport (across cell membranes), communication (hormones and cell signaling), and regulation of fluid balance and pH. Every single one of those bodily processes has an important impact on your ability to heal from injury and especially surgery.

5. Get outside in the sun as soon as possible.

Vitamin D is converted from the cholesterol in your blood in the presence of full spectrum sunlight. Vitamin D is not only critical for calcium absorption, but it is also important for joint health, metabolic health and even your brain. Deficiency of vitamin D has been linked to osteopenia (bone loss), osteoporosis (severe bone loss resulting often in fracture), cancer, Type 1 Diabetes, Multiple Sclerosis and even cardiovascular disease.1,2

Early inflammatory arthritis, osteoarthritis of the knee and autoimmune diseases have also been linked to vitamin D deficiency.3-6 Although eating foods high in vitamin D like fatty saltwater fish is helpful, it is still important to get sun. As a safe rule spend time in the sun, but don’t burn. Three 8-minute stints is usually adequate. If you have had surgery, it is important to keep your wound or scar covered. This new skin is more sensitive to the sun’s rays and you don’t want to promote scar tissue formation. As an added bonus, sun exposure will also help with your circadian rhythm, which helps with sleep-wake cycles (see #6).

6. Sleep when you are tired.

Rest is critical for recovery and repair. Yet, when we are limited or recovering from surgery we are doing things that negatively impact our normal sleep cycle. Moving often and getting sunshine will help regulate the circadian rhythm. Watching endless TV and computer screen time is like looking at the sun and has effects on our sleep-wake cycle.  So, go to sleep when it is dark. Move your body when it is day-time. Turn off screens 2 hours before bed. Don’t watch TV in bed. Make a schedule and a routine to optimize your rest.

In the end, having a plan for recovery will lead you to optimal healing.

Remove. Replace. Restore.

Remove stagnancy and helplessness. Remove refined and processed foods, especially sugar. Remove excessive screen time to fill your day.

Replace with movement any way you can safely. Replace with help from family, friends, or a physical therapist. Eat nutrient rich whole foods including protein and bone broth. Get safe sunshine. Go to bed when it is dark.

Restore optimal healing and recovery from injury or surgery.

Eat well. Move well. Sleep well. Thrive on.

-Carolyn Dolan, PT, DPT, Cert MDT


 

1. Baggerly CA, Cuomo RE, French CB, et al. Sunlight and vitamin D: Necessary for public health. J Am Coll Nutr. 2015;34(4):359-365.

2. Lieberman S, Bruning N. The real vitamin and mineral book. New York, New York: The Penguin Group; 2007.

3. Park YE, Kim BH, Lee SG, et al. Vitamin D status of patients with early inflammatory arthritis. Clin Rheumatol. 2015;34(2):239-246.

4. Sanghi D, Mishra A, Sharma AC, et al. Does vitamin D improve osteoarthritis of the knee: A randomized controlled pilot trial. Clin Orthop Relat Res. 2013;471(11):3556-3562.

5. Broder AR, Tobin JN, Putterman C. Disease-specific definitions of vitamin D deficiency need to be established in autoimmune and non-autoimmune chronic diseases: A retrospective comparison of three chronic diseases. Arthritis Res Ther. 2010;12(5):R191.

6. Park KY, Chung PW, Kim YB, et al. Serum vitamin D status as a predictor of prognosis in patients with acute ischemic stroke. Cerebrovasc Dis. 2015;40(1-2):73-80.

 

Photo credit: Flikr, Roger Mommaerts, creative commons license.

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Kristin Prentiss Ott, M.D.

Author of the viral post: 10 Things to Know Before Your Next Visit to the Emergency Department. Board certified emergency medicine physician, wife, mother, aspiring novelist.
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14 Comments

  1. Jordan

    Some very important tips here that I think many people should read! Hopefully it can help those having to go through recovery and therapy to do the best things for their health.

  2. padrooga

    Please spread the word to all the people that are still telling women not do anything post axillary node dissection! Anyone with the slightest understanding of anatomy would know that NOT exercising will cause/contribute to/worsen, lymphedema. Exercise is important to being human! Research is finally proving the medical wives’ tale wrong, but I laugh when folks say they require “evidence based medicine” to undo the “precautions”. I then ask, what evidence based medicine put them in place? Seriously though, research has shown that exercise is good. Movement is good. The message is not getting through to the surgeons and oncologists though. If I meet one more woman who said their doctor told them not to do any repetitive motion with their arm since their mastectomy, I’m going to scream loud enough for you to hear me. I have put together a list of do’s and don’ts that I give women when I speak to support groups, but I definitely see that the word has not gotten out yet to the people that need to be most informed. Of course, there’s lots of research about how women treated for breast cancer seem to mysteriously gain weight during and after chemo. Let me get this straight, you give a woman a cancer Dx, then tell them NOT to exercise… what do people expect to happen?

    1. Carolyn Dolan

      I am sorry to hear that you have had a bad experience either personally or with a loved one.

      “Evidence based medicine” is still a standard we should try to adhere to. However, we also need to simply apply basic rules of physiology and anatomy when treating most conditions. In the case of lymphedema, movement is key as you described. In fact, there are physical therapy specialist in lymphedema and the manual techniques of lymph drainage.

      One of my goals as a blogger and clinician is to empower the patient and consumer of health care to know how to have a positive and collaborative conversation with his/her healthcare provider. I also want to continue to share information with healthcare providers on the current evidence to support many of the simple treatments available, including physical therapy.

      1. padrooga

        Not only physical therapists. OT’s nurses and massage therapists get lymphedema certs as well. My point about evidence based medicine does have to do with the fact that common sense about anatomy was not invoked in creating those outdated “guidelines” and it is sad that common sense could not remove them. Additionally, I can’t believe it is still not standard practice to send someone to PT after a mastectomy for initial baseline evaluation, and to maintain mobility etc… I know many woman who don’t even know they should/could ask for this. The doctors do a very poor job of getting the word out. A woman doesn’t even get to PT unless someone lets her know it’s an option. I advocate for people in that regard. I ignored the guidelines from the start because I saw how they were wrong, from a physiology standpoint, and were merely patronizing and condescending notions having to do with the fact they didn’t expect that a woman needed to be able to function. Not to mention the fact that they contradict themselves.
        Keep up the good work.

        1. Kristin Prentiss Ott, M.D. (Post author)

          Thanks for sharing your experience and advocating for women’s health!

          1. padrooga

            http://southgeek.blogspot.com/2011/01/heroes-and-tigers-and-saints-oh-my.html

            This may explain my “fervor”. I’ll sit down and hush up now.

        2. Carolyn Dolan

          Thank you for sharing your experience! And you are correct, many healthcare providers can be trained and perform lymph drainage, not just physical therapy.

  3. Aletha Cress Oglesby, M.D.

    Thank you Kristen and Carolyn. This is wise and solid advice for recovery after any injury, illness or surgery.

    1. Carolyn Dolan

      Yes it is! We all inherently know this, but we simply forgot. Simple principles can help you recover AND stay healthy.

  4. smitty

    Thank you Kristin for posting this ‘healing’ information and to Carolyn for writing in such an accessible and applicable manner. It’s hard to believe that although I’m an informed 67 year old, I’ve never heard some of this practical advise. You are both outstanding doctors — and educators!

    1. Carolyn Dolan

      Thank you. This ‘healing’ information is applicable to everyone, all stages of life, and nearly all medical conditions. Like Dr Kristin Prentiss Ott says, “Blog Therapy; Because writing and relating are good medicine.”

  5. padrooga

    Nice to see they are finally telling people to move. Now make sure folks who have axillary node dissection for breast cancer surgery get the message too. The “precautions” that were in place for too long were horribly wrong. Word is out, but it is taking too long to trickle down. Telling women not to move or use the “affected” arm ever again for anything “strenuous” is the exact opposite of what they should have been doing all along and causing more lymphedema than they hoped to prevent.

  6. Kassi

    Carolyn, I wish I had read this before I tore my meniscus. But, even unrelated to that, you have just written a simple guide for EVERYONE! Every day, all of need to follow this. I’m going to print it out and take to my 93 year old mother.
    Great article!

    1. Carolyn Dolan

      I am sorry about the timing, but I am glad that you have it for the future and for sharing!

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