WA News Guest Opinion / Editorial From Rehab to Prehab?
From Rehab to Prehab?
Written by Mr Adam Spiroff
Friday, 31 March 2017

201704-exercise-rehab-crutches-physioIf you hang out your shingle as a musculoskeletal physiotherapist it’s a fair bet that a significant number of your patients will be coming through the door needing some form of post-surgery rehabilitation. It’s also pretty likely that their recovery will be hindered, to a greater or lesser degree, by limitations in movement linked with pain and a healthy dose of apprehension.

And along with all that pain and fear comes avoidance strategies, which can slow recovery rates significantly.

So a couple of questions regarding exercise prior to surgery are well worth considering. Might these patients have benefited from some form of structured program prior to surgery? Might it have better prepared them for the rehabilitation journey, both physically and mentally?

One of my patients had a total knee replacement, an increasingly common procedure in our ageing population. This can be pretty invasive surgery in which muscles, tendons and ligaments are stretched or replaced. And the duration of post-surgery stays is being relentlessly reduced - patients are often discharged when they can walk a predetermined distance and are self-mobile across a range of basic activities.

However, they often have strength and mobility deficits in their hips, ankles and knees combined with an altered cognitive ability to ‘switch on’ required muscle areas. This can translate into an increased risk of falls.

Many patients feel that surgery is a fast-track solution to a diminishment of symptoms and the structural improvement to the joint is the whole point of the procedure. Nonetheless, proprioception, strength and stability are usually markedly deficient in these patients. And that’s where a ‘Prehab’ program can make all the difference.

The onset of pain is often linked with a specific movement or weight-bearing activities that bring a joint into its ‘end range’ of motion. Prehab involves a series of structured exercises that builds strength without aggravating the injury and prior to any inflammation linked with surgery. Patients are then able to move much more freely and autonomous activation of the muscles is easier because nerve fibres haven’t been interfered with.

Incidentally, I practice what I preach. My shoulder surgery was preceded by a structured twelve-week program that gave me increased muscle activation and a much better pattern of biomechanics that allowed me to return to normal activity within a relatively short period. That gave me more confidence during post-surgery rehabilitation to better use the muscle groups and stabilise the shoulder joint.

The road to recovery after surgery can be a tough one. Many physiological changes occur post-surgery and some of these can lengthen recovery times. Before a patient goes under the knife ‘Prehab’ exercises, where applicable, can be an integral part of the surgical plan.