Remember those song lyrics "The knee bone's connected to the thigh bone, the thigh bone's connected to the hip bone"?
It's actually a good anatomical reminder about the importance of seeing an injured or arthritic joint as part of your whole body and not something to be treated in isolation. If you are limping or favoring a joint, more than likely other parts of your body are off as well. The whole body is connected in one way or another.
The joined-up skeleton is the reason why physical therapy is so important to the recovery process. A physical therapist can improve a patient's core strength and manually manipulate the joint itself, working on the soft tissue around it as well as working with the rest of the body, mobilizing the hip and the back and helping the patient to regain full range of motion and improve their gait. In our experience, soft-tissue manipulation makes a huge difference in how people heal, in large part by reducing swelling, inflammation and scar tissue. In some cases, physical therapy can help you avoid surgery altogether.
A smart physical therapist can look at a patient with an injury and figure out why they got injured, help the patient learn exercises and techniques to recover from the injury and guide and motivate them to work to improve (without fear of pushing too hard). Most people are unaware of their posture, of how they walk or how their feet hit the ground. They don't realize how loose or stiff their joints are or their back is. If you're hurt or in pain, a physical therapist can teach you about the mechanics of your gait and the mechanics of your sport, valuable information to help speed your recovery and protect you from further injury.
At my clinic, when we see people with a knee injury, the PTs teach them not only how to diminish the pain and recover from that knee injury, but how to train around the knee injury, so that if it requires a period of relative immobilization for the knee, we can train their hip joints, back joints, core muscles and upper-body program. We can get them on a well-leg bicycle, where they spin with one leg and rest the injured joint. We can come up with all kinds of creative ways to help people train while they are in recovery.
In my view, patients who undergo surgical procedures and do not have a great physical therapy program before and after surgery or who try to do all of the program on their own will recover more slowly than those who go through a physical therapy program. They'll also tend not to have as complete a recovery and certainly won't learn as much from the experience.
If you're injured or have arthritis, I would strongly encourage you to see a physical therapist in addition to an orthopedic surgeon, especially if it's likely that you'll need surgery. As a surgeon, I wouldn't want to work without a team of PTs. They have knowledge and skills that I don't have and together we're able to get a 360-degree picture of our patients and help them back to full strength.
First published in the San Francisco Examiner