Prehabilitation: It’s Effectiveness and Why It’s Worth Your Time!

By: Dr. Tyler Fallon, PT, DPT, CSCS

Everybody develops an orthopedic injury at one point or another. It is an unfortunate circumstance that all humans must deal with and it can often be very difficult both physically and mentally. Some injuries can be major, others quite minor depending on the situation. Surgery is an intervention that is not preferred by most initially and often acts as a last resort after conservative management has been tried. Surgery, however, can produce miraculous results that can be life restoring and allow people to live with a higher quality of life. Prehabilitation is the act of preparing for surgery or preventing injury through physical and lifestyle changes including strength and flexibility training, functional training, nutritional adaptations and emotional/stress management.

Prehabilitation plans prescribed by a licensed professional can vary greatly from patient to patient depending on each individual’s needs and the circumstances at hand, for example, preparing for a knee surgery versus an athlete looking to prevent common injuries of a busy and long athletic season. Significant research exists within the medical profession, proving that an implemented and consistent prehabilitation program can reduce post-operative pain / discomfort, speed up recovery, and result in accelerated returns to sport, work, and lifestyle. In general, if you can improve a person’s functional capacity before an anticipated surgery or athletic season, it is reasonable to infer that that individual will be able to rebound at a faster rate from an injury or surgery.

Let’s take an ACL injury that a young athlete may sustain, a common athletic injury, with over 150,000 ligament ruptures per year. Physical therapy is usually recommended by surgeons for about a month prior to surgery.  A prehabilitation program monitored by a physical therapist will focus primarily on four goals before surgery – 1. Reduce pain, inflammation, and swelling 2. Normalize range of motion 3. Comprehensive lower leg strengthening program 4. Education on expectations and the plan before and immediately after surgery, along with preparing the patient mentally for potential challenges they may face.  Undoubtedly after surgery, and even the strongest athletes in the world, will lose strength or atrophy primarily in the quadriceps, hamstring, gluteal, and calf muscle groups. Increased inflammation and swelling is experienced after surgery as the body recognizes a traumatic experience and attempts to heal itself. Inflammation and swelling can shut down muscle groups and cause them to atrophy or lose strength quickly. Many patients ask, “What is the point of strengthening a leg before surgery if you will lose the strength anyway?”  The truth is, if you start from a level of strength that is higher than previously, then recovery during the earlier stages of surgery will be faster as you lose less ‘net strength’.

The program given to a patient by a physical therapist will be specific to the person, their athletic goals, and current strength levels in order to maximize the amount of strength gained in the weeks leading up to surgery and facilitate a faster recovery time during the early stages. The hard work someone puts in prior to surgery makes a large difference, and I’ve seen that not only within my own practice clinically, but also within the medical research.

Therefore, a physical therapist is able to utilize a prehabilitation program in several different ways. If you sustained a musculoskeletal injury and are not sure what you should do, it is always best to seek advice from a medical professional. A physical therapist would be able to diagnose the severity and recommend any imaging that may be necessary, along with getting you started on the appropriate flexibility and strengthening program whether surgical intervention is needed or not. Secondly, if you didn’t sustain an injury but you are an athlete or active person, a physical therapist can perform a full body assessment to see if there are any areas of improvement or compensation. They would be able to implement a customized prehabilitation program that would be solely focused on injury prevention and enhancing your overall sports / activity performance.  With either scenario, a physical therapist would be able to provide the necessary education, care, and appropriate plan of action to ensure your absolute best possible recovery and outcome!

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