Prehabilitation is a newer buzz word that is used often in the healthcare industry, in particular, more amoungst physical therapy providers like chiropractors, physiotherapists, occupational therapists, athletic therapists, massage therapists and some orthopedic surgeons. By definition, Rehabilitation (according to Oxford dictionary) is “the action of restoring someone to health or normal life through training and therapy after imprisonment, addiction, or illness”. Prehabilitation can be defined as “the process of care, initiated before surgery, whereby patients’ physical, nutritional, medical and mental conditions are strengthened while waiting for surgery in order to face the surgical insult and facilitate postoperative return to preoperative conditions” (McGill perioperative program). The difference really only is the timing. Prehab occurs prior to surgery or other intervention, while rehab occurs post surgically or following an injury.
Why prehab? There are multiple benefits of a prehabilitation program including: increase cardiovascular function, strengthening areas around the injury, develop stabilization, increase range of motion in other body areas, modification of medication to prevent interactions or address surgical anxiety and address nutrition and diet to prepare tissue with nutrient dense foods to speed healing and prevent the loss of lean body mass. Many hospital prehab programs will address multimodal aspects of surgery preparation.
Research has found that those patients who receive a targeted pre-surgical exercise program prior to knee or hip replacement surgery can decrease the odds of needing inpatient rehabilitation by up to 73 per cent, with significant improvements in functional status and muscle strength (Rooks, 2006). For our focus, we will discuss only the exercise component.
When developing a prehab program, there are several components to consider. These include:
- Injury history.
- Future movement/athletic goals.
- Current movement abilities and limitations.
- Prehab exercise with progression.
An understanding of the clients injury history is important to consider as past injuries may be responsible for some of the limitations that currently present. In addition, the current injury requiring surgery needs to be addressed in order to prevent further injury and determine if there are any contraindications. Are there medications that may have side effects on their own or in conjunction with your exercise program. Is the surgery going to enable further physical activity or potentially limit activity level? The goals for future activity may vary drastically from being able to walk without pain to competing in a triathlon event. Some high level athletes need the surgery inorder to get back to competing. There are several ways to assess the current movement abilities. Personal trainers, physiotherapists, family doctors and chiropractors may all have their own methods of determining the physical capacity of their clients. When looking for someone to develop this program, you want them to be able to take you through a series of movements to assess general motion. Some clinics or services will even assess cardiovascular function with treadmill tests and VO2 max calculations.
At MMD Chiropractic, we utilize the Functional Movement Screen (FMS), which consists of 7 movements which address mobility, stability and functional movement while changing your centre of mass. From here we can individualize exercise to meet the clients movement skills. An important component with a prehab exercise program is to have progression. As a client cycles longer, increases weights or performs more complicated movement exercises, overall functioning is improving. Not only is this a sign of physical improvement, but it also helps in the mental preparation for surgery.
We like to think of prehabilitation as a preparation phase, to reach the best possible outcome post surgery . Next in our series, we will look at the process of rehabilitation. Is it really necessary? Does rehab have to be guided by healthcare providers?