be the first approach to your “bone on bone” problem. Here
are some considerations prior to opting for surgery:
1. You may not need surgery. Physical Therapy (PT) for mild
to moderate osteoarthritis has shown to be very effective,
and may extend your ability to remain active prior to
needing surgery. Just because you are “bone on bone”
doesn’t necessarily mean you need surgery. Try PT first
and then reassess your options.
2. Maximize your fitness level by doing Pre-Hab PT to
increase your strength, mobility, flexibility and motor
control. All these will put you ahead of the curve for when
you have surgery. The more fit you are before surgery, the
better you’ll come out of it, making your post-surgery
rehab more successful.
3. Joint replacement rehabilitation is not easy. The
surgery is just the first step. If you plan to continue
playing pickleball, be prepared to work hard following
your surgery. If you’re not willing to commit to your rehab
program and work through some pain following surgery,
this may not be the best option for you.
4. While joint replacements aim to decrease your current
pain, please know there will be pain following the surgery.
This will decrease over time, but can take three to six
months (sometimes a year) to resolve. Most people will
get back to playing pickleball at six months post-op, but it
can take up to a year to fully regain the necessary
strength and motor control to play your best pickleball
without pain.
I often treat patients who have expectations for their total
joint replacements that are not necessarily realistic. It’s
important you know what you’re getting into and understand
that surgery is just the beginning. The following is based on
my experience as a Sports Physical Therapist:
Total Hip Replacement
Overall, this is probably the best joint replacement in
terms of outcome. The hip is a very stable joint, and the
advances in surgical techniques have made this procedure
very successful overall. However, it’s a major procedure.
The head of the femur is displaced out of the socket, then
the head of the femur is cut off and a metal rod (prosthesis)
is inserted inside the femur. A new joint socket is then
placed before relocating the head of the femur back in place.
Patients are usually walking within the first day or two, and
will start physical therapy as soon as possible. The pain is
not as bad as a knee replacement overall. A thorough hip
strengthening program, as well as extensive mobility and
flexibility work, is crucial in order to return to playing sports.
Total Knee Replacement
This is the most common procedure, and the outcome
varies for each person. Being diligent with your
rehabilitation is a must if you wish to get back to playing
pickleball. Again, this is a major surgery, with both the
femur and tibia being cut, as well as the undersurface of
the patella being scraped. Recent advances are making it
possible to retain internal ligaments of the knee (ACL and
PCL), which may improve the function of the knee in the long
run and provide increased stability. Patients should be ready
to endure a fair amount of pain following surgery. Working
on range of motion and regaining full extension is vital for
this procedure and for normal function. Patients can expect
to be back on the court within six months (not 100 percent),
and back to normal after about a year.
Total Shoulder Replacement
Overall, shoulder replacement seems to leave people a
bit disappointed. When pain is taking over your life and the
shoulder is just not usable, then a shoulder replacement
may be beneficial. However, I’ve seen people struggle
with the rehabilitation after this procedure. It’s difficult to
get full range of motion back, which can affect your ability
to play pickleball. It works well for some people, but be
prepared for a difficult rehab. Once again, focusing on
motion, flexibility and mobility is key in the first few months
to ensure you can move through the entire range of the
shoulder. Reverse total shoulder replacement is another
procedure that’s usually used when someone has little or
no rotator cuff stability. It’s not ideal for getting back to
pickleball.
Total Ankle Replacement
This is not as common, and overall appears to be
restrictive in terms of motion following surgery. A difficult
rehabilitation is ahead, and I wouldn’t rush into this
procedure unless you have to. The ankle is a joint that
requires good stability and mobility, which can be very hard
to get back.
If you have any questions, you can contact the Pickleball
Doctor at [email protected]. •
Noe Sariban is a Doctor of Physical Therapy, Certified Pickleball Teaching
Professional through the IPTPA, and a USAPA-rated 5.0 player sponsored
by Engage Pickleball. Please visit www.thepickleballdoctor.com for more
information on injury prevention and rehabilitation tips. Noe started his
website to provide pickleball players around the world with a reliable and
free source of information. Please like his Facebook page, www.facebook.
com/pickleballdoctor, for updates and new information.
MARCH/APRIL 2019 |
MAGAZINE
81