The Importance Of Prehab Before Any Surgery

What is Prehabilitation and how can it be helpful?

Should one train before running a marathon?
Do we need water to survive?
Is Guy Fieri’s hair out of control?
Is Cynergy Physical Therapy the place to go for your PT/OT needs?

The answer to all is YES!

Let’s think of orthopedic surgery and recovery as running a marathon. One does not simply decide or choose to run a marathon without specific training or practice. You could technically run a marathon with no experience or preparation, but it will certainly be more difficult. It will also put significantly more stress on your body and mind and it‘ll also take longer to recover. Many first-time marathon runners will tell you how surprised they are at the level of soreness and fatigue they experience. Some are also surprised with how difficult it is to complete basic tasks like getting up from a chair or walking for a couple days afterwards.The body is pushed to a new limit that it’s not familiar with.

The time spent training and preparing before a marathon can be compared to the use of prehabilitation before a surgical procedure and the recovery afterwards. The goal of prehabilitation is to maximize the health, strength, and function of a specific body part. The more strength, range of motion, and function you have going into surgery, the more you will have coming out of it. Prehab can start the day after an injury or up to a week later to help prevent or improve swelling, ROM (range of motion), and pain. Research has shown that prehabilitation can decrease time spent in rehab and improve functional outcomes as compared to those who do not use it. Prehabilitation is more than just physically preparing one’s body for the surgery and recovery, it also helps with the mental and emotional variables at play.

Going through surgery, whether it’s your first time or not, is always a complex experience. There are aspects of the recovery that some people may find stressful. If the patient is confused or stressed about any aspect of the surgery or recovery, prehab is the best time to ask questions so there is no confusion or added stress. Feeling comfortable asking questions and opening up to your therapist also helps to build a strong relationship going forward.

Let’s use the example of an individual getting an ACL repair surgery. There is a post-operation guideline that needs to be followed in order to protect the knee and the ACL. Doing so will guarantee that the patient has a successful recovery. Understanding the timeline of recovery and what is expected can help decrease stress and anxiety. If the patient wants to know what exercises will be done post-operation, they can review them with their therapist. This will help them gain a good understanding of not only how to perform the exercises but why they are important. If the patient has never used crutches before or is worried about how to move around in a leg brace with their knee extended, they can practice ambulating with crutches or standing up with the leg in a brace during prehab.

An important factor that is addressed during prehab is neuro-muscular (re)education.  This is the process of training your muscles, nerves, and brain to work together to improve movement, strength, balance, and function. Following ACL surgery, there is swelling in the leg which impairs the activation of the quadriceps. One of the first steps in this kind of recovery is to regain quad activation, strength and control. In prehab, the patient can work with their therapist and learn how to isolate the quad specifically. One can then go onto more specific training of the quad like concentric and eccentric strength, as well as functional strengthening. The more motor control and strength you have at the quad before surgery, the more ease you will have regaining quad control after. As a result, less time will be spent on how to isolate, reactivate and control the quad post-operation. This will allow the patient to start on other aspects of their rehabilitation protocol that are initiated later in the program, hence speeding up the recovery process.

As a physical therapist, I want my patients to live their best lives, without injuries or impairments holding them back from doing what they love. It’s important to stay in a good  physical, mental, and emotional state. Prehab is just another tool at your disposal to help you be the best YOU. It can ultimately speed up your recovery time, improve functional outcomes, lead to less visits to the physical therapist, and help patients.

In good health,
Aaron Lentz, PT, DPT

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