The Australian Government temporarily suspended elective surgeries a few weeks back to ensure adequate hospital capacity was available to respond to the COVID-19 outbreak. Recently some of these restrictions were eased, with many elective surgeries now allowed to recommence incrementally. The period of time during which the suspension occurred meant that many surgeries were cancelled or postponed. Now, with some surgeries allowed, the waiting period for surgeries such as joint replacements, ligament reconstructions, arthroscopies etc has increased dramatically.
This has left many people in limbo as to when and if they will go under the knife, albeit while they are still experiencing significant pain or other symptoms. Rest assured, there is still plenty that can be done to help without the necessity of surgery. Physiotherapy before and/or after surgery has been proven to improve surgical outcomes such as symptoms, reduced return to work or sport time, functional capacity and quality of life. In some cases, pre-habilitation (physiotherapy before surgery) has improved symptoms and functional capacity to the point where surgery was no longer required.
So what exactly is pre-hab and rehab? And is it for me?
What is it?
Pre-habilitation is the process of improving and individuals’ functional capacity with the aim of preparing the person for the inactivity that follows after physiologically ‘stressful’ event such as surgery. It can also be utilised preventatively to try and minimise a persons’ risk of injury. All pre-hab is performance enhancing and can be undertaken by any person at any level of performance or injury. Pre-hab has been proven to reduce recovery times post surgery with a vast range of different surgeries. From ligament repairs or joint replacement to cardiothoracic and cancer surgeries – all of these benefit from pre-hab and this is backed up by a strong body of evidence.
What does it involve?
A pre-hab program should ideally be performed for at least 6 weeks prior surgery to see more significant benefits, but even a week of pre-hab can helpful. The content of the pre-hab program will differ dependent on the surgery that is planned and the injury or illness in question. Someone preparing for an ACL reconstruction, knee or hip replacement would likely be focussing on hip and knee strengthening and control. Someone in line for abdominal surgery may be trying to increase their core strength for example. There is a broad spectrum of pre-hab and it should be initially planned and instructed with the guide of a physiotherapist in conjunction with the surgeon.
In a nutshell a pre-hab program will incorporate a component of strength and conditioning, target motor control of the necessary joints and look to improve the individual’s proprioception (or body awareness). Education is an important component of the pre-hab plan and will aim to inform the person on a number of factors such as;
- The likely deficits and symptoms that may occur because of the surgery.
- The initial recovery phase (first 1-2 weeks).
- Address gaps in the person’s knowledge of what the surgical procedure involves both from a surgical method and anatomical stand-point.
- The rehabilitation that will be required post-op – both the length and components of the rehab.
- Address personal factors and goals in relation to the individual such as when they might return to sport, work or their normal lifestyle.
Why does it work?
After most surgeries there is (hopefully) a short period of rest and recovery while tissues repair and get used to the internal changes that have occurred. During this time the muscles around these areas aren’t functioning as they were before and as a result of this inactivity they become weaker. This process happens quite quickly, with changes occurring in the first few days. Pre-hab helps in increasing the muscle strength of the primary muscle groups involved in the surgery so that they have a head start of sorts when it comes to recovery. Pre-hab can also be used to target other areas of the body that will be relied upon more heavily during recovery. For example, someone undergoing a knee replacement surgery will be required to use crutches for a period of time so improving their upper limb strength in preparation for the surgery will make it much easier to get around of the crutches while they’re unable to fully weight bear on their operated leg.
There is a neurological process called ‘pain inhibition’, which can cause muscles in the surgical area to effectively ‘shut down’. This is the body’s protective response to a perceived ‘injury’ and it aims to reduce the perception of pain. However with the muscle effectively ‘shut down’, the effected muscles weaken quickly. Some muscles have to be incised or cut to perform particular surgeries, which can cause significant weakness as well. Pre-hab can assist in the ‘reactivation’ of these muscles by training an individual prior to the surgery on how to contract or activate them, so that when it comes to doing this post-surgery, it is already a learnt activity which can be more quickly retrained and strength regained.
Rehabilitation is the process of improving an individual’s level of function, whether that be physical, cognitive or mental – often a combination of all of these. It occurs after an illness or injury where the person’s function, independence or quality or life has been affected. Rehab can be ongoing, long-term or relatively short depending on the degree of deficits that the particularly event induced or the significance of the surgery.
Pre-hab and rehab are essentially the same in terms of the goal being to improve function, quality of life and independence. The main difference is that rehab is after the surgery and is often a longer term procedure than pre-hab (depending on surgery waiting lists/time). Rehab may, and in most cases should, involve a multidisciplinary team of health practitioners all working towards the persons’ goals. This can include a GP, the surgeon, physiotherapist, psychologist, dietician, osteopath, podiatrist, rheumatologist or others depending on the presenting needs of the individual and the type of surgical intervention.
It is important to know that the longer a person participates in pre-hab the shorter their rehab in most cases. With the increase demand on our health system due to COVID-19 and potentially long surgical waiting lists, now is a great time to start your pre-hab if you are waiting for an elective surgery. With the right guidance, determination and attitude surgery may be able to be avoided altogether.
If you are a surgery candidate or have recently gone under the knife and would like to discuss your pre-hab or rehab, book in to see a Physiotherapist or Exercise Physiologist at Back in Motion Aspendale Gardens here.