When it comes to physical therapy, many people think of its usefulness in recovering from surgeries. For some, it can even be used as an alternative to surgery, providing them an opportunity to heal their body without having to undergo an operation. But even if you still have to go under the knife, did you know of its usefulness in preparing your body for what comes after?
Pre-surgical rehabilitation, also known as preventative rehab or “prehab”, is quickly becoming the standard for elective orthopedic surgeries. Many patients facing major orthopedic surgeries like hip and knee replacements are prime candidates for this specialized form of physical therapy. But what exactly is it, and why do you need it? Let us explain:
What is prehab therapy?
To put it simply, prehab is preventative rehabilitation. Following most orthopedic surgeries, patients are prescribed a series of physical therapy visits to help restore their lost strength, balance, and range of motion. In contrast, prehab therapy works on improving your movement, flexibility, and strength before your surgery.
Prehab therapy is known as a proactive approach, geared towards setting your body up for a successful recovery after surgery. During your prehab, our physical therapists will assess you for any deficits in strength, stability, range of motion, and balance that may impede your ability to recover from surgery. We use a whole-body approach, as a balanced body will be able to recover more efficiently. They will then teach you exercises that address these issues, many of which you will later perform during your rehabilitation after surgery. These exercises provide two very unique benefits:
Your body will be stronger going into surgery, which means it will also be stronger coming out of surgery and better equipped to handle it
Your body will retain muscle memory of these movements, making the rehab process a smoother transition
Why is prehab therapy so important?
Prehab provides the opportunity for you as a patient to have a role in controlling your recovery. While we cannot know the outcome of any surgical procedure in advance, we do know that patients who move better, feel better, and are stronger, tend to do better.
Studies have shown the positive effects of prehab in patients undergoing artificial hip and knee replacements. “Much like people wouldn’t run a marathon without training for it, you should train your body ahead of surgery so that it can excel in its recovery,” says Dr. Randall Peyton, a fellowship-trained joint replacement specialist at Arthritis & Sports. “Joint replacement surgery is by no means an easy procedure on the body, but is necessary for so many people to return to their active lives. Whatever a patient can do to prepare themselves ahead of surgery – both physically and psychologically – will have very positive outcomes on their recovery.”
Numerous studies have shown that patients who complete strength, aerobic, and flexibility exercises before joint replacement surgery are less likely to need inpatient rehabilitation and typically recover faster. The rewards of prehab can show in as little as 24 hours after surgery, with patients achieving major milestones that allow them to return home faster than those who did not complete a prehab program.
Not only does prehab prepare your body for surgery, it also helps prepare you mentally for what’s to come. Prehab is an opportunity for you to become acquainted with those that will be guiding you through the rehabilitation process after surgery. It also provides you time to ask questions about the recovery process, increasing your confidence in achieving a full recovery.
“Patients that undergo prehab gain a better understanding of what’s to come after surgery, which often decreases their anxiety about the procedure,” says Diane Husick, MPT, one of Arthritis & Sports physical therapists. “Improving your range of motion and strength prior to surgery can be incredibly beneficial, but sometimes the mental component can be just as important.”
While some patients may opt to go online and find a program to follow, this may cost you in the end. Although these protocols can be beneficial, they don’t take into account any previous surgeries or any injuries you may have. "We don't want to aggravate the joint and muscles before your surgery, but make them stronger and more flexible," says Maude Bertovich, DPT, another physical therapist in Sterling. "Your therapist will work with you to modify any exercises so that they are effective and painless at the same time. Even a small change can make a big difference."
For patients worried about saving their insurance-covered PT visits until after surgery, we have you covered – our therapists will customize an exercise program just for you that can be completed at home, saving your visits for when you need them most.
While prehab is a relatively new process, the benefits are substantial. Not only does it prepare your body for your upcoming surgery, it also gives you an opportunity to prepare yourself mentally and put your mind at ease when it comes to surgical outcomes. Instead of making the choice to go into your procedure with little to no knowledge of what’s to come, allow our therapy team to give you the help you need to get through this difficult time. For patients that are interested in learning more about the benefits of prehab, reach out to your surgery team and ask them if prehab is right for you!
Randall Peyton, MD, is a board-certified total joint specialist who sees orthopaedic patients in Sterling, VA. Dianne Husick, MPT, is a licensed physical therapist in Sterling, VA. Our clinic also provides physical therapy in South Riding, VA.
Snow R, Granata J, Ruhil AV, et al. Associations between preoperative physical therapy and post-acute care utilization patterns and cost in total joint replacement. J Bone Joint Surg Am. 2014;96(19):e165.
Brown B, Brosky JA, Topp R. Lajoie, AS. Prehabilitation and quality of life three months after total knee arthroplasty: a pilot study. Perceptual & Motor Skills. 2012;115(3):765-774.