March 13

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Rehab after Surgery with Iyad Salloum

By Wil Seto

March 13, 2023

rehab after surgery

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Iyad Salloum of Insync Physiotherapy in North Burnaby. We're gonna talk about rehab specifically after surgery. How you doing Iyad? 

Iyad: I'm great, Mark. Thanks for doing this. How are you? 

Mark: I'm good. Is this something that you guys see a lot? People come in for help from a physiotherapist after they've had surgery?

Iyad: Yeah. A lot of orthopedic surgeries and even some neurological surgeries will involve a fair amount of rehab afterwards. Sometimes in the hospital, even like if somebody has like abdominal surgery or whatever, you'll see a physio involved. Unfortunately, what tends to happen is when people go home, they're discharged from the hospital, they're kind of left to their own devices sometimes, and then they have to figure out what to do.

Now, in some cases, you're lucky and you have some kind of instruction that's given post-surgically, like, you know, like a protocol of some sorts to follow. So that kind of helps a bit. Especially if the person has some exercise background. But often we see a lot of people kind of leave it be for a while and then they come in maybe a bit too late sometimes, and then they're like, oh, I wonder why it hasn't changed in the last month or so. It's because maybe they're not progressing their tolerance activity as well as they could have. 

And then in other times where people are told right away by the surgical team, we need you to kind of rehab this so, you know, consult a physiotherapist and work with them. So that's where we'll see them from the beginning and we take them along their journey and we work from anywhere from the adolescent kid who has a knee surgery after a ligament tear of some sort. All the way up to, let's say multiple traumas where somebody has like several fractures and they get, you know, potentially some hardware put into their legs and then all the way up to hip and knee replacements, which will happen typically in their like older group.

Not necessarily, but most commonly will be in the older group where people have had a long bout of arthritis, either the knee, a hip, and then they get the surgery and we'll help 'em come back to whatever level they need to come back to. 

Mark: So what's important about this in terms of changing the healing for someone? 

Iyad: It's actually really interesting. I was talking to one of our surgeon colleagues, and he labeled it as an interesting thing. He says, like, you know, to heal from a surgery perfectly, it's a three-way dance. So there's the surgery itself, and there's what the therapist recommends and there's also what the patient does.

So it kind of ends up being influenced by the three things. So obviously, like the surgery itself going well or not going well, it's gonna matter. But then also the rehab program has to be tailored for that person. Like for example, if you have a soccer player who wants to get back to high level soccer, and they had an ACL reconstruction, that program needs to prepare them for a return to play to soccer. Not necessarily just running in a straight line or just being able to do a squat, cuz that's great, but probably not enough for that person. 

And then the other thing that comes down to it is, you know, unfortunately as in a perfect world, you'd have supervised exercise day and night. But then some people are gonna need to do some of the home programs on their own, which usually we coach them through it and like, again, most surgeons are quite supportive of that, and they'll try to emphasize the importance of them doing the stuff at home. So we'll see that kind of emphasis on like some home program, but where it affects healing is in function.

So the way I kind of describe it to people, I'm like, okay, yeah, you had an ACL reconstruction, the surgery fixed the structure. So now that you have something that's restricting that shin from moving in let's say, abnormal way, well now it's up to you to make that knee work for you. And the way it works is like, you know, you gotta expose it to early phases, it's a lot of range of motion. Just to get over the stiffness and the swelling and all those things. And then you progress strengthening you know, there's flexibility in strengthening and there's a whole bunch of stuff including coordination. Control exercises that we would kind of work the way with.

And then, you know, I find it the most helpful also for people who tend to be a little more on the cautious side. So you see a lot of hesitation. People do a little less than they should sometimes. Obviously there are people who do too much. But honestly, for the most part, I see people who tend to under, let's call it underload themselves and under stress it because they're worried that it could, for example, harm the surgery or harm the knee or harm the hip or harm the ankle, whatever surgery they've had.

And I think this is where, you know, we work really closely with the surgeons to kind of give them the appropriate dosage of movement so that they're not under moving, but also not going overboard at the same time. 

Mark: How often is getting that chain of movement that needs to happen, it's not just a knee that's involved in rehabbing a knee. How much is it, and if someone's had a not necessarily a traumatic injury, but maybe arthritis or something, how often is that a really key component for the healing? 

Iyad: Yeah, of course, of course. That's a really important thing. Like, it's really funny actually, sometimes we have people coming in with boots and they said their instructions are not to weight bear for six weeks.

What we are able to do is get people exercising in non-weightbearing conditions. So we could do a ton of different loading programs and even like cardiovascular programs that don't involve weight bearing on the foot, for example, or on the knee or on the shin or on the affected area.

And that's kind of like, I guess, where we get to be as creative as we wanna be and we 'd stress the person's body in a good way so that they don't lose their capacity in other areas. So imagine you had a foot fracture and then you're not allowed to weight bear. Well, we could still get people strengthening their quads and their hamstrings and their musculature. And that won't affect necessarily the healing of the foot, but then it makes it so that when they're allowed to weight bear, their function is a lot higher to start with. And then we don't have to kind of go back and rebuild on some of those areas that have just lost their tolerance and capacity to do what we need them to do.

And again, this is gonna depend on person to person, obviously. Like if you're doing stuff in your ultimate goal is to be able to walk around with your friends. And that's obviously gonna be a lot different than somebody who wants to get back to rugby or soccer or hockey or anything else like that.

So that's where we tailor it to the individual. But then, you know, early days, a lot of it tends to be education heavy, where we just tell people like, look, this is what you're allowed to do. We give people some parameters to function between,. And then also educate them on when it indicates that if they went too hard or didn't go hard enough, like, cuz you know, people are scared of pain sometimes and rightly so if you don't know what you're dealing with.

But if you at least understand what that pain actually means, or it doesn't. You're much better off psychologically, cuz you're gonna be a lot more comfortable and confident, you know going through the motions and then doing your rehab. 

Mark: Bottom line, is it fair to say that this is about getting you back to the activities that you want to be doing quicker and more the way you used to be able to do it before the surgery.

Iyad: Yeah. And then like a lot of it is removing uncertainty. I really wanna emphasize like that uncertainty is usually the killer. People just look around and wonder like I'm gonna try to run for the bus today. Like, that's kind of like how I've had people kind of tell me. Yeah, that's when I did realize I couldn't run anymore.

You know, after like three months full stop after an ACL reconstruction. So, you know, it's about being, and also accountability is a big part of what we do. Sometimes when you're consistently being followed by someone, you kind of are more on top of things. But yeah, it is about building you up to what you need to do, and it's about restoring your function as well as we can.

But also it's really important for troubleshooting. I find sometimes we're able to identify things that maybe weren't obvious in the early doors, but you know, you'll start to see something and you'll start to see if there's potential complications that happen afterwards. Just having that contact point, like last month we had somebody who had a routine knee surgery.

The surgery was successful, it was great. Unfortunately, one of the wounds got infected. The patient had no idea that it was infected. You know, after two minutes of looking at it, we referred them back to their family doctor. They were able to contain that infection. It was starting to kind of spread around their knee.

So it was, it was good that we kind of dealt with that pretty early. But like that's kind of another area where, you know, again, in a perfect world, you see your surgeon every day, but then unfortunately that's just not gonna happen in any way, shape or form. Just because of the workloads and also like the role description that we each have and how we kind of fit into this healthcare model. So like that's kind of where, again, most of the time, you can think of it as like coaching to get you back to where you need to go.

Mark: If you've had surgery and you wanna recover back to well full function of whatever that is. Whether that's gardening, running, professional level sports. And you're in Vancouver or North Burnaby, the people to see are Insync Physio. You can book online at insyncphysio.com. They have two locations, North Burnaby and in Vancouver. The Burnaby location, you can also call (604) 298-4878 to book. You have to call and book ahead or book online. They're always busy. Thanks, Iyad. 

Iyad: Thank you.

Wil Seto

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