Prehab—Why You Should Have Therapy Before Surgery

Aug 26, 2016

Brooke Dolberg

by Brooke Dolberg
PT, DPT | Old Town Scottsdale Location

Whether you’ve been suffering from chronic knee pain for five years or you traumatically tore your ACL during last month’s ski trip, one way or another you’ve found yourself in need of a surgical intervention.
You’ve been referred to an orthopedic surgeon whom you have never met, for a surgery you thought you would never need. After consulting your family, friends and the infinite knowledge on Google, your calendar is marked and the surgery date is set. Your neighbor volunteered to drive you to and from the surgery center, and a coworker has already brought over a mysterious casserole and some chicken noodle soup for your recovery. In spite of all this planning, you are still scared and unsure of what to expect in the days, weeks and months following your surgery.
Prehabilitation or “prehab” is when a patient seeks physical therapy prior to their orthopedic surgery. This approach improves the odds of a successful surgical outcome by combining knowledge and specific exercise. It’s also an opportunity to become acquainted with the office, staff and physical therapist that will be guiding them through the rehabilitation process.
Traditionally, patients are referred to physical therapy within 3-14 days after their procedure. During this time, patients can be in pain, under heavy influence of pain medication, and scared that physical therapy will hurt them. When a patient opts for prehab instead, she can establish a rapport with her physical therapist, and her PT can answer any questions she may have about using braces and walking devices after surgery. Answering a patient’s questions so she knows what to expect will increase her confidence in achieving a full recovery.
In addition to the emotional benefits of prehab, the primary focus is to establish an exercise routine prior to surgery, which makes recovery easier. Outcomes after surgery are determined 50% by the surgeon and 50% by the patient’s commitment to recovery before the surgery even takes place, according to Vonda Wright, Associate Professor of Orthopedic Surgery at University of Pittsburgh’s Center for Sports Medicine.
Studies have shown the positive effects of prehab in patients undergoing artificial hip and knee replacements. Those patients who complete strength, aerobic, and flexibility exercises prior to surgery are less likely to need inpatient rehabilitation and typically recover faster.
If your surgeon recommends it, prehab therapy is usually started six weeks prior to surgery. During this time a physical therapist will prescribe exercises to improve both strength and flexibility which helps jump start recovery. Under the guidance of a PT, you’re less likely to exacerbate current injuries and you can prepare as your surgery date approaches. Some patients are stymied when their insurance doesn’t cover six weeks of visits prior to surgery. In these cases, a physical therapist can teach the patient a land or water-based home exercise program that she can complete at home.
While in prehab, it’s important to consider adjusting your diet as well to decrease inflammation and help with the healing process. The reduction of inflammatory foods like unhealthy trans fats and saturated fats found in processed foods is a good first step towards cleaning up your diet prior to surgery. Limiting food high in sugar such as candy, soda, and pastries is also recommended. Patients can satisfy their sweet tooth with the natural sugars found in fruit. It’s important to eat healthy fats, protein, and fiber instead. For a healthy source of omega-3 fatty acids, try snacking on walnuts, chia and flax seeds, or cooking up some wild salmon for dinner—these foods fight inflammation that causes joint pain. Adding foods high in fiber is easy with the abundance of whole grains and dark leafy vegetables, available year round at your local grocery store. In addition to being high in vitamins and minerals, fiber can prevent unpleasant bowel issues like constipation that is a common issue postoperatively when patients are taking high doses of pain medication. Be sure to consume lean proteins like poultry, fish and other seafood, nuts, legumes and tofu, so your body is fueled to build healthy tissue during your recovery. Cleaning up your diet before your operation will drastically help your recovery in the weeks following surgery.
Prehab is an opportunity for patients to become proactive in their recovery, even before their surgery takes place. Be sure to consult your local Arizona physical therapy expert prior to your next surgery to establish a prehab program that is right for you!

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