For many of us, the reality that we will need a joint replacement or a surgical procedure in the future or near future is inevitable. Injuries can happen for any number of reasons. Some injuries may be sport related, others caused by falls or car accidents, and yet some injuries come from aging joints and arthritic changes. However the injury happens, there are several steps that should be considered prior to undergoing a surgical procedure. Many understand the importance of rehab after an injury, but fewer know the benefits of prehabilitation before a surgery.
The very thought of having surgery can be terrifying. With the rising cost of healthcare, many of us are faced with high deductibles and hefty co-payments. When we multiply this cost over multiple visits, it can add up and force some of us to deal with the daily pain until function is lost. What if there was a way to shorten the duration you were in therapy? What if, by performing what is known as prehabilitation, you could ease the entire process and improve your outcomes after and even before surgery?
Prehabilitation, or prehab, offers several benefits for patients who are faced with injuries and planning to have a surgical procedure. It is a chance to regain control and improve your quality of life. According to several studies, people who participate in prehab can shorten hospital stays, decrease overall rehabilitation duration, and improve outcomes. In addition to these benefits, prehab can also have emotional benefits: patients will improve their understanding and knowledge of what to anticipate after their surgery is performed.
In prehab, patients are given a variety of exercises that will improve function. Some exercises will increase range of motion. By increasing the joint range of motion prior to a surgical procedure the restricted capsule of a joint becomes more tolerant of movement and the surrounding tissues will lengthen, allowing the joint to move more freely. When the body is prepared prior to surgery to move as it should, it will be more prepared for movement once the procedure has been performed. Strength and flexibility are also emphasized during prehabilitation. After surgery, muscle mass and function are lost. When patients perform exercises that improve function prior to having surgery, their ability to regain that function is typically greater after the procedure.
Typically, prehab can range anywhere from two to six weeks and may even be requested by your surgeon. Depending on the patient’s availability and needs, a home exercise program may be prescribed after exercises are established and you are able to perform them properly. Performing exercises before the surgical procedure will not only improve outcomes, it can drastically improve a patient’s pain during the healing progress.
In addition to exercises, your therapist can give you guidelines to help improve the healing progress through diet and habitual changes. It may come as no surprise that eating healthier — by adding vitamins and minerals into your diet — will aid your body in healing itself. Simple diet changes, such as eating foods higher in protein to supply your body energy to increase the healing progress, will also help. Changes in habits, such as smoking, can also aid the body in recovery and lessen the chances of infection. Smoking may delay wound healing or contribute to acute vascular diseases that can complicate post-surgical outcomes.
Prehab before a surgery is similar to rehab for injuries; a physical therapist walks you through an individualized exercise program designed to help strengthen and heal. Prehab gives you the ability to improve your post-surgical outcomes and decrease your overall time spent in therapy. Make an appointment to find out how we can help ease the stress and worry you might have about an upcoming procedure.
Brown, Kent & Topp, Robert & Brosky, Joseph & Lajoie, Scott. (2012). Prehabilitation and quality of life three months after total knee arthroplasty: A pilot study. Perceptual and motor skills. 115. 765-74. 10.2466/15.06.10.PMS.115.6.765-774
There is a lot of talk about a newer treatment being utilized in strengthening and in rehab settings called Blood Flow Restriction (BFR). Essentially, BFR is taking a device such as a cuff or wrap and placing it around a limb to occlude partial blood blow to the affected area. When placing the cuff around the limb, blood flow is restricted by limiting arterial flow and venous return. By restricting the blood flow, higher levels of metabolic stress is created. Both metabolic stress and mechanical tension are associated with increased muscle growth. Because BFR can create this metabolic stress, exercises can be performed with low-load resistance training and achieve the same if not better results than traditional strength training.
For many patients, performing high intensity workouts is not an option.
Significant atrophy of muscle or injury can prevent people from loading joints and muscles without pain or risk of re-injury. Traditionally, patients coming into post-operative physical therapy are limited and unable to strengthen muscles for several weeks during the initial healing phase. BFR allows the physical therapist to strengthen a limb or joint without the risk of injury. BFR also has systemic effects which means with the use of BFR, a patient can achieve global gains in strength which can be important for patients who are deconditioned in more than one area. Another benefit of BFR is its ability to accelerate bone healing. Bone will adapt to the load which is placed on it. The external forces the BFR creates can help improve bone density and its ability to regenerate after injury when used correctly.
Rest assured blood flow restriction is safe when used properly.
Initially, many patients are a little skeptical of the safety of BFR. Every patient in our clinic is assessed for their appropriate level of restriction. Limb occlusion pressure is taken using a specialized doppler which allows the physical therapist to determine exactly when full blood flow occlusion is been attained and treatment is determined thereafter. BFR also does not cause blood clots. In fact, many case studies conclude that BFR can produce the release of anti-coagulating hormones when the cuff is released. BFR is not recommended for patients with uncontrolled blood pressure. However, if blood pressure is controlled, BFR has been shown to cause less stress on the cardiovascular system compared to high intensity training and weight lifting.
BFR can be used in a variety of ways and adapted to patients’ tolerance to improve outcomes in therapy as well as accelerate the healing progress. So who can benefit most from BFR? It is safe to use on most patients. BFR can be used on elderly, post-operative patients, athletes, patients with co-morbidities and most people who want to see faster, more effective results in strengthening. It is recommended to use blood flow restrictions under the guidance of a practitioner as exact limb occlusion pressure will be assessed with each individual patient. A detailed exercise programs will also be designed for the patient to ensure the most effective outcomes.
If you are coming out of surgery and/or looking to increase muscle growth due to atrophy and think BFR is right for you, schedule your free Rapid Recovery® Injury Assessment and our physical therapists can determine the right cause of action for you.
Clients often believe the key to fitness is repetition—relying on the same exercises, or types of exercise, to stay in shape and challenge their bodies. However, could the key to unlocking improvement and increasing your fitness level be the very opposite of what most of us do?
Cross-training is a concept in exercise therapy that breaks this repetitive behavior by exercising other parts of the body to supplement those engaged by your favorite activity. For example, cross-training for a runner might involve cycling, swimming, or strength training.
Whether you are a weekend warrior who is up for the next Spartan race, an avid runner, a college baseball player, or just the average Joe out at the gym, many of us forget the importance of training the body as a whole. For example, let’s break down a task as simple as walking. It causes a chain reaction from the foot to the knee, hip, and then spine. If at any given point in this movement there is a weakness or trauma, the proper mechanics of the chain reaction are susceptible to a breakdown.
Simple activities like adding more weight, or increasing the resistance and speed of the activity reveal that we are all much closer to injury than we might think. The same rules apply for those activities we enjoy. Our movement patterns cause a chain reaction in the body, which is why cross-training can help avoid future problems.
Cross-training does not imply hitting the gym and pumping out 20 reps of biceps curls, knee extensions, and crunches—quite the opposite actually. When training or preparing our bodies for a particular activity, the training will mimic aspects of the activity itself. For instance, let’s examine our running patients. We often see runners come in with chronic or reoccurring knee injuries. Many of these athletes are strong overall, but lack strength and control at some specific point in the chain.
So where do you start? If you are currently experience a problem or injury, talk to one of our knowledgeable physical therapists on staff and request an appointment to see if exercise therapy is needed. If you are an athlete looking to enhance performance, or someone looking to improve their form, come in and work with our FAST Trainers. They can build a program specifically for you, tailored to any athletic ability, and help make you stronger and more successful in the activities you love.