The Importance of Physical Therapy in Enhanced Recovery After Surgery (ERAS)

Despite the advancements in surgeries and invasive treatment, some extensive medical operations are still associated with greater morbidity and prolonged in-patient stay. This is because a patient may experience functional limitations and persistent weakness even long after the surgery. Therefore, in order to improve the patient’s condition and help them gain functionality in the long run, there is a need to increase the awareness and involvement of medical assistance within the post-surgery setting. 

For this, several health care sectors have adopted Enhanced Recovery After Surgery or ERAS. It is a multimodal perioperative care pathway that is created for patients to achieve early recovery after surgical procedures. This is mainly done by maintaining preoperative organ function, improving mobility and reducing the profound stress response following surgery. 

The fundamental procedures of an ERAS protocol include the following.

• Preoperative counseling
• Optimization of nutrition
• Standardized analgesic and anesthetic regimens
• Early mobilization through physical therapy 

Physical therapy or physiotherapy is one of the most essential parts of the post-surgical recovery process. It significantly helps patients recover both physically and mentally from the injury and speeds up the process of getting back to normal life.

Why Should Physiotherapy Be a Part of Surgery Recovery?

Patients are often kept in an ICU or critical ward following elective major surgery. They may remain under medical assessment for a long time and could potentially suffer from physical, psychological, and cognitive issues. This is mainly due to the lack of movement or functionality in a hospital ward, forcing the patients to usually remain stable with limited motion. This condition could critically impact the patient’s return to function and especially the quality of life in the long run. Moreover, most hospitals do not permit trainers or external health specialists into the ICU, thus further limiting the patient’s options for physical exercise. 

On the contrary, physical therapists are part of the ERAS program and are permitted to enter the ICU or any other facilities to help the patient. Throughout the patient’s stay in an ICU, a physical therapist can be part of his/her regular treatment and thus accelerate the achievement of discharge criteria and subsequent return to function. 

Even after discharge, the patient might still feel certain functional limitations and persistent weakness, hence there is also a considerable need to increase the awareness and involvement of physical therapists within the outpatient setting. By being a part of a standardized rehabilitation program, which is often suggested by ERAS specialists, a patient can have long-term benefits in health and well-being even after discharge.

The Importance of Physical Therapy in Enhanced Recovery After Surgery (ERAS)

The goal of physiotherapy in Whitby is to help patients return to their pre-surgical level of function as quickly as possible. This is especially important if there was significant damage to the body or if a patient has suffered nerve damage due to surgery. 

Physical therapy is a vital part of the recovery process after surgery. In fact, it is one of the most important aspects of post-operative care. Physical therapists provide patients with exercises that help them regain their strength, flexibility, and balance. They also work to prevent further injury from occurring by strengthening muscles and bones that have been weakened by surgery or an injury. 

It is a safe and effective way to help a patient return to the activities of daily living. It can help patients reduce pain and stiffness, improve their range of motion and function, increase strength, and increase energy levels. Here are some of the few reasons why physical therapy is considered an essential part of enhanced recovery after surgery:

1) Physiotherapy Improves Mobility

As mentioned earlier, a patient may be admitted to an ICU immediately after elective major surgery. Any type of wrong movements or no movements at all can cause permanent damage to the body and could even result in severe chronic pain. But with the help of physiotherapy, the patient can gradually begin assisted movements and can focus initially on maintaining a range of joint motion. This can significantly help prevent contractures, and reduce the muscle loss that occurs due to immobility whilst a patient is in the ICU.

During this period, physiotherapists mainly focus on sitting, standing, and walking exercises that are custom designed based on the surgery or type of injury. This is critical in the surgery recovery stage as patients may quickly become weak, and the use of exercises, electrical stimulation and ambulation practice by a trained physical therapist can reduce muscle atrophy or joint stiffness that may occur during this stage. 

2) Physical Therapy Can Reduce the Amount of Scar Tissue From Surgery

During extensive surgeries, a surgeon probably has to cut through layers of skin, fatty tissue, connective tissue, and muscles. This leads to the formation of scar tissue and can cause inflammation and irritation around joints, muscles, tendons, and ligaments, thus making it severely difficult to move that particular area.

If left untreated, the scar tissue can solidify and make it all the more difficult and painful to relive. Therefore, the sooner a physical therapist can create movement in the affected area, the lesser will be the development of scar tissue. Physical therapists often leverage multiple treatment options such as massaging, taping, or stretching, to reduce scar tissue adhesions and formations so patients can restore their normal functional mobility.

3) Physical Therapy Can Improve Strength After Surgery

Physical therapists not only provide relief for pain but also leverage progressive resistance training to augment a patient’s hypertrophy, thus enhancing their strength, balance, and muscular endurance. Muscle-strengthening or core strengthening exercises are considered essential in bringing more blood and oxygen to the tissues around the surgical site. By improving blood circulation to the site of an injury, therapists can help reduce swelling and enhance recovery.

Patients under ERAS treatment can recover from surgeries and also improve their overall strength and mobility as well as manage pain without medication through physical therapy. 

For effective treatment, the physical therapist will use exercise machines and other devices, such as crutches and braces, to ensure that the patient is properly supported while building their strength. By strengthening the core muscles, the patient can further reduce the risk of future injuries and ensure that the muscles and ligaments in the injured area are strong. 

4) Physical Therapy Enhances the Effectiveness of the Surgery

Physiotherapy can be imperative for patients who are recovering from cardiovascular, thoracic, abdominal, and major joint replacement surgeries. Early physical therapy treatments and mobilization are fundamental to improving the health of the affected area. Regular exercises for cardio, joints, and muscles can not only reduce immobilization due to hospitalization but can enhance the effectiveness of the surgery. In some cases, it is even believed to reduce the rate of postoperative pulmonary complications, venous thromboembolism, and infection. 

Conclusion

The importance of physical therapy within ERAS and post-surgery rehabilitation is highly valued and will continue to do so in the future. Critical care physical therapists adopt treatment methods that assimilate strongly with fundamental ERAS principles, and they can play a pivotal role in ensuring that patients recovering from surgery undergo therapies to improve mobility whilst in an ICU.

These intense and custom-designed physical therapy treatments, along with the constant analysis of professional doctors and supported by a multidisciplinary team is a great way to improve recovery and help the patient feel better again.