Prehab – What is it, and why you should do it?

Written by Monika Dobrowolska – Chiropractor with Skelian Chiropractic Clinic

I imagine that nearly everyone has heard of rehabilitation (or rehab) after surgery or injury. Rehab is a vital component of recovery after any orthopaedic surgery including arthroscopies, shoulder surgery, meniscus repairs, fractures, and hip and knee replacements. Before graduating as a chiropractor and beginning work with Skelian Chiropractic, I myself have previously worked with a team of physiotherapists, as a physiotherapy assistant in an orthopaedic department, specifically with patients who had undergone knee and hip replacements. My role was to get patients up and out of bed, walking on their new replacements as soon as possible. The sooner we could get the patient up and moving, the better the chance of recovery. Whilst working in orthopaedics, one important factor, that separated those who made a very quick recovery from those who did not, was how physically fit they were going into surgery.

Studies, as well as my own personal experience, have shown that those with a better level of fitness prior to surgery made a significantly better and faster improvement compared those who lived a more sedentary lifestyle. Chiropractors and therapists alike are all familiar with the term ‘prehab’ which, as the name suggests, is the exercise you do before your surgery. As a chiropractor, I do see a lot of patients before they have their surgery. Frequently, we may be the individual initially identifying patients with conditions that may need orthopaedic referrals. At the Skelian Chiropractic Clinic that I work from, based in Cheltenham, our in-house physiotherapist is also trained specifically in musculoskeletal (MSK) diagnostic ultrasound scanning and is able to diagnose a range of conditions including rotator cuff tears of the shoulder, which may then need surgical intervention.  In situations where we can identify such conditions with patients, I am regularly stressing the importance to my patients about starting rehab (or prehab) before they go under the knife.

Prehab – In the lead up to surgery

The principles of prehab are to prepare a joint in the lead up to surgery. If for example, you are having a knee replacement or an ACL reconstruction, your post-surgical rehab will include a variety of different leg strengthening exercises. The prehab will be very similar, as it would certainly include a variety of leg strengthening exercises, but will be tailored to your ability and tolerance at that point in time.  As well as strengthening, I also give advice on some forms of exercises to improve cardiovascular fitness prior to surgery.  A meta-analysis study conducted a few years ago, found evidence to suggest that performing a range of general fitness and strengthening exercises would lead to a faster discharge time from hospital, which in turn reduces costs and frees up space for other patients.

Prehab isn’t just for orthopaedic surgery. In fact, improving your general cardiovascular fitness has also been found to reduce your length of stay in hospital after any surgery. Therefore, I would recommend that even if you’re going in for routine surgery, try and do a little bit of exercise in the lead up to it. Brisk walking is a good start if you feel that you don’t have any fitness at all.

Prehab – Injury Prevention 

Prehab is also used as part of your training in the lead up to an event. If you are training for a marathon or any running distance as an example, carrying out effective strengthening exercises alongside your training can significantly reduce your risk of injury. Common running conditions I see due to lack of strength include runners knee (ITB syndrome) and plantar fasciitis.  If your sport involves a lot of shoulder movements, such as in tennis or squash, performing shoulder strengthening exercises can help reduce the risk of common rotator cuff issues. Of course, you can never fully prevent all injuries from occurring, due to multiple factors that may be involved, but if you are strengthening appropriate muscle groups it may significantly reduce the risk.

Treatment and Prehab

Your chiropractic appointment can often include recommendations on prehab exercises (exercises to prevent injuries before they occur). Once we have gone through the initial phase of treatment and you are moving and feeling better, generally I then give considerably more exercises to do at home. These prehab exercises are how we go about maintaining what has been achieved through treatment. Professional athletes coming back from injury do not just stop their rehab once they are fully recovered. They will return back into prehab type exercise in order to prevent further injury. This is also why we sometimes recommend that patients come in for check-ups every few months to ensure that the exercises are being done correctly and so we can improve them if needed. Your chiropractor will most likely release any tight muscles or joints that would have tightened over this period in order to improve the function of the body.

In summary, the best way to prevent injury reoccurring or faster recovery from surgery is to keep active and always re-visit the exercises that are given to you. Many people feel they no longer need to continue with exercise, but, you will continue to progress and make significantly healthier changes to your body if you do. If you have an upcoming surgery or an athletic event that you want to feel your best, please do not hesitate to book in with one of our chiropractors who can advise you on the best forms of exercise for you.