Pre- and Post-Surgical Physiotherapy

When a person is about to undergo surgery, attention is often focused solely on the surgical procedure itself. However, the condition in which the tissues arrive at the operating room and how they recover afterward have a massive influence on the final outcome. 

Surgery represents a controlled trauma for the body. Although necessary and beneficial, it involves incisions, tissue manipulation, inflammation, immobilization, and biomechanical changes that affect muscles, fascia, skin, circulation, and the nervous system. 

That is why physiotherapy is not only important after an intervention. Pre-surgical therapy can also make a major difference in your recovery.

What happens to tissues during surgery? 

When the body undergoes surgery, the tissues go through a complex physiological process. 

During the procedure: 

Skin and fascia are incised, separated, and cut 

• Muscles can be manipulated or retracted 

• Inflammation appears as the body's natural response 

• Local circulation is temporarily altered 

• The nervous system enters a protective state 

• Tissues lose mobility and adaptability 

After surgery, the body immediately begins a repair process. This is completely normal, but without proper functional recovery, several issues may arise: 

• Fibrosis 

• Deep adhesions 

• Joint stiffness 

• Fascial restriction 

• Muscle wasting 

• Altered mobility 

• Hypersensitivity or persistent pain 

Inflammation: necessary, but controlled 

Inflammation is part of the healing and recovery process. The problem arises when there is excess stiffness, poor tissue mobility, or inadequate rehabilitation.

Inflammatory fluid, combined with immobilization and protective muscle guarding, can cause tissues to lose elasticity and glide. 

An important aspect: 

Deep tissues also need to regain their ability to adapt to movement, not just "close" the superficial scar. A scar can look good on the outside while still presenting internal restrictions that affect function, mobility, and pain. 

Pre-Surgical
Physiotherapy:
preparing the body before surgery 

Pre-operative physiotherapy aims to optimize the state of the body before entering the operating room. It is often assumed that treatment begins after the surgery, but preparing the tissues beforehand can help make post-operative recovery faster and more efficient.

Why is pre-operative care important? 

Before surgery, it is common to find: 

• Muscle stiffness 

• Accumulated tension 

• Inflammation and fluid retention 

• Fascial restrictions 

• Persistent pain 

• Loss of mobility 

• Muscle weakness 

• Biomechanical alterations 

If the body enters surgery already stiff, inflamed, or with poor functional capacity, the post-surgical recovery process is usually more difficult.

Objectives of pre-surgical physiotherapy 

Pre-operative care aims to: 

• Reduce inflammation and pain  

• Improve tissue mobility 

• Decrease muscle and fascial tension 

• Reduce stiffness 

• Optimize circulation and venous return 

• Improve muscle activation 

• Prepare the nervous and biomechanical systems for recovery 

Treatment: 

 Depending on the case, treatment may include: 

• Manual therapy 

• Myofascial release 

• Joint mobilization 

• Tailored therapeutic exercise 

• Lymphatic drainage and circulatory enhancement

An important point: 

 Even a gentle therapeutic massage before surgery can promote circulation, decrease bodily tension, and improve venous return, helping the body reach the procedure in better condition.

Post-Surgical
Physiotherapy:
helping tissues restore proper function 

 After surgery, the goal is not merely to "wait to heal," but to guide the tissue so that it regains mobility, elasticity, strength, and function.

Recovery does not only depend on the wound closing, but on how deep tissues heal and reorganize themselves.

What happens after surgery? 

Following surgery, the body initiates protective mechanisms: 

• Inflammation 

• Stiffness 

• Muscle tension 

• Decreased movement, 

• And loss of functional mobility. 

Without proper intervention, tissue can heal with restrictions. This may not be noticeable initially, but over time, these limitations can lead to dysfunction. 

What do we aim to avoid?

Post-surgical physiotherapy helps reduce the risk of: 

• Fibrosis

• Deep adhesions 

• Scar stiffness 

• Loss of mobility 

• Persistent pain 

• Muscle weakness 

• Compensatory biomechanical alterations

A scar is not just skin deep

One of the most common mistakes is thinking that recovery ends when the skin heals—when the external scar looks and "feels" fine. In reality, underneath the scar: 

• Fascia 

• Muscles 

• Connective tissue 

• Vessels  

• Nerves 

also need to regain mobility and adaptability. 

Important fact: 

When deep tissues lose their ability to glide and stretch, the body begins to compensate in other areas, generating tension, pain, or functional limitations even months or years after surgery.

Tissue adaptability: the key to a complete recovery 

Healthy tissue must not only be healed, but also adaptable. 

This means it must: 

• Glide properly 

• Tolerate load

• Move without restriction 

• Respond efficiently to movement. 

Physiotherapy helps guide this process so that the body regains functionality progressively and safely.

Post-surgical treatment 

Depending on the type of surgery and the phase of recovery, treatment may include: 

• Manual therapy 

• Scar mobilization 

• Myofascial release 

• Invasive Therapy 

◦ Neuromodulation 

◦ EPTE (Echoguided Percutaneous Electrolysis) 

• Instrumented Therapy 

◦ Radiofrequency 

• Lymphatic drainage and circulatory enhancement 

• Inflammation management 

• Progressive therapeutic exercise 

• Mobility and strength restoration 

• Biomechanical re-education 

• Neuromuscular and functional training