By Tash Barry – Physiotherapist
You might have seen the word ‘prehabilitation’ before and thought it was a typo. But it is not, there is a difference between PREhabilitation and REhabilitation, and we think you should know about it.
Rehabilitation is a specific program, undertaken with a Physiotherapist or Exercise Physiologist’s guidance after an injury has occurred. A personalised assessment is carried out, and a specific set of exercise protocols are designed to train you to your maximum potential allowing you to recover. It aims to:
- Reduce pain and dysfunction
- Improve mobility
- Improve balance
- Improve strength through range
- Improve core stability
- Help you return to your usual daily activities, exercise or sport
- Improve your fitness, endurance or skill
Prehabilitation on the other hand is beginning your rehabilitation before a surgery or injury has occurred. It is employed with one simple goal: to prevent an injury or prepare you for surgery.
Prehab for Surgery
Prehab is commonly used prior to a surgery, to improve cardiovascular, respiratory, muscle strength and function to optimise surgical outcomes. It is very effective in increasing a patient’s ability to perform daily tasks, increasing the success of surgery, facilitating an earlier return to functional capacity or pre-injury level, and reducing the time between surgery and returning to exercise or sport.
Surgery places a lot of physiological stress on the body, and certain lifestyle and behavioural factors can add to this, including inactivity, poor fitness, smoking, drinking, malnutrition, and psychological conditions. On a study done in the UK, postoperative complications were reported to affect 15–40% of patients. Not only does this add to the increase in hospital length of stay, number of hospital admissions and cost on the healthcare system, but it leads to many surgical patients failing to regain their preoperative level of function and independence.
Many injuries, especially chronic (lasting 3 months or more) cause a decrease in exercise tolerance, loss of muscle strength and general deconditioning. Lengthy waitlists for elective surgeries can also result in long terms of deconditioning as patients wait with often debilitating and deteriorating conditions. The surgical stress response increases the need for oxygen around the body and to vital organs, therefore aerobically ‘unfit’ patients are at a higher risk of an adverse outcome. Prehab aims to improve your general health and wellbeing prior to surgery, improving your body’s ability to withstand the physiological stress and recover from surgery quicker and without complications. This has proven to be true for a range of elective surgeries including joint replacement, cancer resection, and abdominal surgery.
A prehab program combines aerobic with resistance exercise to improve your aerobic capacity and develop lean muscle mass. On your assessment with one of our trained health professionals, you will undergo a series of tests including a 6-minute walk test to determine your aerobic capacity, muscle strength testing, functional tests and depending on your surgery we may also assess specific joint mobility. An individualised program is then prescribed to improve your baseline fitness, joint mobility, and strength. At Higher Function we have many classes available for you to join, or independent gym sessions for you to carry out your program. Clinically, a prehab program has even helped some patients avoid orthopaedic surgeries (such as total hip or knee replacements) all together due to a complete restoration of function during their program.
Along with a prehabilitation program under your health professional’s guidance, we may also recommend you consider implementing:
- Coping strategies to reduce anxiety. Including relaxation exercises, breathing, meditation or referral to a psychologist where necessary
- Nutrition intervention with a registered dietitian
Prehab for Sport
Athletes of all levels should include a prehab program as part of their training. In order to achieve optimal injury prevention, we must first determine areas of instability, weakness or loss of mobility through an individualised assessment. Here we may look at joint mobility, muscle strength, movement quality when completing functional tasks, balance, stability and sports specific movements where relevant. We understand that every single person is different, and factor in things like age, injury history, type of sport, current fitness level, and daily activities when designing your program.
A prehab program is functional, progressive, sport or activity specific, re-evaluated periodically and aims to address any underlying factors highlighted in the assessment which might contribute to sustaining an injury. Our physios can also identify likely injuries sustained from specific sports and screen for, as well as tailor a program, to prevent these injuries. It addresses imbalances that will likely lead to injury or strain, and includes stabilising exercise for the trunk and pelvis, shoulder, hip, knees and ankles, as well as strengthening exercises through range, coordination, proprioception, and biomechanical advice.
At Higher Function, we offer a range of classes to assist you in your prehab or rehab journey, or you can have an individually tailored gym program made to suit your specific goals.
Get in touch with us today to book a consultation with one of our highly trained health professionals to start your prehab or rehab journey.
References
- Ditmyer M, Topp R, Pifer M. Prehabilitation in preparation for orthopaedic surgery. Orthop Nurs. 2002;21(5):43-54.
- Quinn E. Athletes Can Avoid Many Sports Injuries With Prehabilitation [Internet]. Verywell Fit. Verywellfit; [cited 2019Mar1]. Available from: https://www.verywellfit.com/prehab-to-avoid-rehab-3119272
- SA Health. Models of Care for Orthopaedic Rehabilitation. Adelaide: Government of South Australia; 2011.
- Durrand J., Singh S. J., Danjoux G. (2019). Prehabilitation. Med. (Lond). 19, 458–464.1. 10.7861/clinmed.2019-0257
- Cabilan C, Hines S, Munday J. The effectiveness of prehabilitation or preoperative exercise for surgical patients: a systematic review. The JBI Database of Systematic Reviews and Implementation Reports. 2015;13(1):146-87.
- Lemanu D, Singh P, MacCormick A, Arroll B, Hill A. Effect of preoperative exercise on cardiorespiratory function and recovery after surgery: a systematic review. World J Surg. [Review]. 2013;37(4):711-20.
