To move or not to move


Whether you are a specialist performing surgery, a GP seeing a patient complaining of pain or a physiotherapist

or occupational therapist rehabilitating a patient after an injury, what is the first question most of us are asked?

When can I … start walking, go back to work, drive again, return to sport, play my next game?


This normally gives me so many headaches, because I want to get this person back to their “normal” life as soon as

possible, but in such a way that they do not end up doing more damage. Sports people are my biggest challenge,

because you must factor in their, probably, very competitive nature and their “mind-over-matter” attitude, not even

to mention the “no-pain-no-gain” philosophy.


Let me start off by saying: After surgery or injury, there are prescribed periods in which the tissues affected need

time to heal. This time will depend on the type of surgery performed, the specific tissue that was damaged and the

risk for relapse post injury or surgery. Each person is different, heals at a different rate and has different pre-injury

factors influencing their recovery. It is, therefore, vitally important to follow a team approach, where communication

between the different team members involved in the recovery is of utmost importance.


Having said all of that: The body was made to move…


If we go back to the time before the wheels of the bus went round and round and before we learnt to domesticate

animals to provide us with easy transport, how did we get about? In the time before pully systems were devised to

make heavy lifting easier and before machinery started doing the work for us, how did we do it? We did it with our

bodies. You just have to look at the joints of the spine, the mobility in the joints of the hips and shoulders and the

design of our feet to realise that the body was not made to be stationary.


To illustrate this: Pick your most comfortable position, in a chair or in bed – even standing if that is your choice.

How long can you hold that position without starting to feel uncomfortable and feeling the need to move? Exactly!

So, keeping all rational precautions in mind, how soon can our patients start moving? In my opinion – immediately.

There is always some form of movement that can be done, even if it is just ankle rotations for circulation or

pendular exercises for an injured shoulder.


Again, I want to mention the team approach. The information the patient is given before the surgery by the surgeon

and physiotherapist or occupational therapist, the treatment the patient receives directly post-surgery or injury and

the follow-up from there, all need to come from the same book.


There are movements that can be done and should be done after every surgery or injury. This, forgive me fellow therapists,

is where physiotherapists get the nickname “Physical Terrorist”. Who is, practically, the first person the patient sees after

waking up from surgery? The physiotherapist telling them to move or walk. We take this abuse gladly because we know the

importance of this. For tissues to heal it needs circulation and one of the only ways to provide that tissue with blood flow is

through movement. That is without mentioning the preventative aspect of movement with regards to blood clots,

pressure sores, chest infections etc.


This is such a vast topic and I can write a whole book discussing the advantages and disadvantages of RICE

(Rest, Ice, Compression, Elevation), strapping and bracing. The topic of the psychological impact of the words we use when

talking to our patients (that can very easily create fear of movement) is a whole different subject. Consider the words

support vs stability, protection vs immobilisation and physical challenge vs disability?


I will sign off with these questions: A day in bed for a person without injury or pain sounds fabulous – how many of us can

sustain that without discomfort? How many of our patients can benefit from a regulated, well thought out movement program

as early as is medically possible?