Once your physical therapist has completed an examination, he/she will put together a treatment plan. The treatment plan lists the types of treatments that will be included in your physical therapy. It gives an indication of how many visits you will need and how long you may need therapy. It also includes the goals that you and your therapist think will be the most helpful for getting your activities done safely and with the least amount of soreness. Finally, it will include a prognosis, which is how your therapist feels the treatment will help you improve.

Physical Therapy Treatment

Easing pain:
Your therapist may choose from one or more of the following tools, or modalities, to help control the symptoms you are having from the surgery.

Heat:
Heat makes blood vessels get larger. This is called vasodilation. This action helps to flush away chemicals that are making your neck hurt. It also helps to bring in nutrients and oxygen which help the area heal. True heat in the form of a moist hot pack, a heating pad, or warm water whirlpool is more beneficial than creams that merely give the feeling of heat. Special care must be taken to make sure your skin doesn't overheat and burn.

Ultrasound:
An ultrasound machine produces high frequency sound waves that are directed toward the sore area. Passing through the body's tissues, these waves vibrate molecules. This causes friction and warmth as the sound passes through the tissue. The rest of the sound changes to heat in the deeper tissues of the body. This process helps flush the sore area and brings in a new supply of nutrient and oxygen-rich blood. Ultrasound treatments are a way for your therapist to reach tissues that are over two inches below the surface of your skin.

Electrical Stimulation:
This treatment stimulates nerves by sending an electrical current gently through your skin. Some people say it feels similar to a massage. Electrical stimulation can ease pain by sending impulses to the brain that are felt instead of pain. This is based on the Gate Theory. When you feel a sensation other than pain, like rubbing, massage, or even a mild electrical impulse, your spinal column will actually "close the gate" and not let pain impulses pass to the brain. In the case of electrical stimulation, the electrical impulses speed their way across the skin and into the central nervous system much faster than pain. By getting there first, the electrical information "closes the gate" to pain, blocking its passage to the brain. Once the pain eases, muscles that are in spasm begin to relax, letting you move and exercise with less discomfort. Other settings on the machine can be used to help your body release endorphins. These are natural chemicals formed within your body that behave like a strong drug in reducing the perception of pain for up to eight hours at a time.

Swelling control:
Massage, whirlpool treatment, or compression therapy may be used to control swelling by flushing the extra fluid away from the area.

Weight bearing progression:
Your therapist will check to make sure you are walking safely and with the right amount of weight on your foot. Until the x-ray confirms good attachment of the bone to the implant, you'll only be allowed to put the toes of the operated ankle down as you walk. If you had a cemented procedure, you'll be able to put as much weight down as you feel comfortable.

Improving range of motion:
Your visits to physical therapy will include range of motion exercises to help the ankle move safely in each direction.

Strengthening:
Your exercise program should also help improve strength in the larger muscle groups of the buttock and hips, thigh, and calf.

Endurance:
To help improve your overall endurance, exercises like stationary biking, lap swimming, or upper body cycling may be assigned.

Balance:
When you can safely put all your weight on the ankle, you'll be shown some ways to improve your balance, which has to do with the stability and control of your ankle. To help with this, your therapist may have you practice activities like heel-toe walking, side stepping, single leg standing, or even training on special balance equipment in the clinic.

Exercise progression:
As you continue to get better, your therapist may give you some exercises that mimic your day-to-day activities; like going up and down steps, squatting, raising up on your toes, and bending down. Eventually, you'll be challenged with activities that relate to your hobby, work, or daily activities.

Home program:
Once your pain is controlled, your range of motion is improved, and your strength is returning, you will progress to a final home program. Your therapist will give you some ideas to help take care of any more soreness at home. You'll be given some ways to keep working on the range of motion and strength, too. Before you are done with physical therapy, more measurements will be taken to see how well you're doing compared to when you first started in therapy.