What is Prehab?
Prehab is a stint of therapeutic exercises prior to undergoing a surgical procedure. Prehab is typically shorter than a course of rehabilitation and the goals differ. In rehabilitation, you are focused on returning to your pre-injury level, and perhaps being even stronger as you address underlying concerns that caused the initial pain, dysfunction, or both. With prehab, the goal is to improve your strength and endurance to the greatest degree possible prior to surgery to minimize the negative effects of the procedure.
For many surgeries, there are unavoidable musculoskeletal side effects. The primary negative outcome following surgery is muscular atrophy or muscle loss. If a body part is immobilized and restricted of movement, a muscle is cut, or a muscle’s nerve or blood supply is interfered with, muscle size could decrease rapidly. This reduction in muscle size impairs a person’s strength, endurance, power, and balance. If you have not experienced this personally, it is likely you have seen someone’s arm after if was removed from a cast, or a leg after a prolonged period in a walking boot, or a thigh after an ACL surgery. In all three cases, the muscle size decreases significantly.
While prehab will not prevent this atrophy from occurring, it will limit the severity. Prehab can lessen the decrease in muscle size, the loss in strength and power, and mobility. Furthermore, by training specific movement patterns, you can improve your skill development which will suffer little, if any, reduction following a short layoff. Even strength and power will return more rapidly in someone with more recent training. The ability to quickly regain any lost skill, strength, or power is known as the reversibility principle and it can rapidly expedite your subsequent rehabilitation.
Why is prehab effective?
When rehabilitating from surgery, there are three primary limiting factors for progression of rehabilitation: tissue healing, pain, and functional performance. While tissue healing can be improved through patient controlled interventions – such as sleep hygiene, nutrition, activity level – and pain can be reduced by treatments commonly received in physical therapy – such as soft tissue mobilization, joint manipulation, and therapeutic exercise – we want to focus specifically on functional performance issues. Functional performance refers to strength, power, and mobility. All three of which can be enhanced through prehab.
In addition to the specific changes covered, we see a reduced number of post-operative treatment sessions and overall cost of care when adding a bout of prehabilitation. Patients have also reported feeling more prepared for surgery and have a positive outlook when provided prehabilitation. Even if the prehab consists of only a single session, it provides an opportunity to build an initial rapport with the physical therapist, set expectations, and obtain a home exercise program (HEP).
Which types of surgeries require prehab?
Any surgical procedure can benefit from prehab, especially if the surgery will result in immobilization or a change in weight-bearing status. This list is not exhaustive but contains the more common surgeries that utilize and benefit from prehab.
- ACL reconstruction
- Total Knee Arthroplasty
- Total Hip Arthroplasty
- Total Shoulder Arthroplasty
- Rotator Cuff Repair
- Spinal surgery
A key to success is combining prehab with post-op care. A home exercise program (HEP) alone will be insufficient as it cannot account for all the variables. HEPs require consistent updating and many treatments are more effective under therapist supervision. Prehab sets the stage and allows for a smoother transition from surgery to rehabilitation and may lead to a quicker resolution of symptoms and subsequent discharge.
Occasionally, prehab negates the need for surgery altogether. Patients often experience substantial improvements during prehabilitation and it is determined that surgery is no longer necessary. Sometimes the improvement results in a delay in surgery, but often times the surgery is never rescheduled. Your therapy sessions may uncover the underlying root cause of the pain, leaving the dysfunction to be treated exclusively through conservative care.