The term ‘PREHABILITATION (prehab)’ can refer to two therapeutic goals.
Firstly, it can mean maintaining or improving an individual’s fitness and functional capacity prior to a surgical procedure. The higher the functionality of joints and muscles before the procedure, the more likely the client will enjoy a swift and successful recovery. It’s aimed at mitigating the reality that any surgical procedure is followed by a time of enforced inactivity, muscle atrophy, and potential motor dysfunction in the affected area, and possibly the whole body.
Secondly, the term describes specific exercise programs prescribed to prevent injuries, usually for athletes. Prehab programs are therefore highly personalised, progressive and frequently monitored, whether they are pre-procedure plans or injury-prevention protocols.
The two uses of the term point to the populations using prehab: athletes and those with an injury or chronic condition that requires surgery. The number of hospitalisations due to injury has risen steadily in Australia since the early 2000’s, and now exceeds 46000 per year, with the groups most represented being women over the age of 65 and males aged 25 – 44. Most injuries are the results of falls and transport accidents, 10% of them are from sport.
This isn’t trivial stuff: injuries account for 9% of the disease burden in Australia, according to 2011 statistics from the Australian Institute for Health and Welfare. Anything that may help people get back on track post-procedure has to be a good thing.
Melbourne exercise physiologist Elizabeth Hewett says the term ‘prehab’ was not in use during her training 20 years ago. “Its definitely a last-10-year invention and I remember hearing it first in the footy clubs and the sports world where you do your prehab as part of your injury prevention. It was ‘What do you do to prevent an injury?’ but then its probably grown and extrapolated to ‘What do you do before treatment or surgery?”
The majority of clients who could be classed as ‘prehab’ for Hewett, who is also a clinical pilates instructor, are those that are coming up for surgery, and those who are prenatal. “Pregnancy is really the ultimate prehab, and so many pregnant women start Pilates then as the first time they have ever been interested in exercise.” She says prenatal clients are the bread and butter of the Pilates world, as they are “a classic case study of prehab: ‘How can I get my body fit and healthy to cope with the changes of pregnancy or the unknown of childbirth?”
As an exercise physiologist she sees a lot of older women who are scheduled for surgery, in particular, hip replacements and shoulder surgery. She stresses that most of her work isn’t classified as prehab or rehab so much as “using exercise and lifestyle management to help them cope and manage with a chronic condition for which there is no ultimate fixable curable treatment.” Clients book in with her directly or are be referred by their GP.
A recent case study is a woman in her 60’s who was seeing Hewett for exercise physiology in an attempt to postpone hip replacement surgery. “The muscle wasting and the atrophy she had around her hip and gluteal muscles was quite marked. We did what we could before surgery, but she had the classic muscle changes that people with severe osteoarthritis had – some of her glutes were bulky and built up and other areas were wasted and her hamstrings were doing more work than they should have. So if anything it was to delay any further deterioration and to keep her as mobile as possible. My goal was to set the ground work so that she understood the concepts of healthy posture, healthy movement, neutral pelvis, breathing, and abdominals, just to give the groundwork of healthy movement and then we built on it a lot after surgery.”
Her hip replacement surgery was “transformative” says Hewett, who worked with her post-surgery with clinical Pilates, using “gentle motor re-patterning work”. Her recovery was such that in January 2020 she went on a walking holiday with her son in Europe.
Can we prove that prehab will have a positive effect on your post-surgery outcome? Hewett emphasises: “It’s a tough one because when we see people really quite disabled and impaired by these conditions and then we see them after the surgery, it is hard to know how we helped them, but I feel that it’s not giving in, it’s trying to be proactive and to help yourself, and we do know from a science point of view that if you don’t move it you lose it.”
Whether you are pre or post-op, using exercise to generally maintain or improve your joint and muscle function is scientifically proven to be effective. You may want to think about what you wear to sessions. Look for easy to wear adaptive clothing that helps you move freely but wont risk re-injury. Look for women’s or men’s adaptive pants, tops, even boxers. Fashionable and stylish adaptive clothing for men and women has become increasingly available, whether it’s post knee surgery pants or tops for shoulder surgery.
Rehab or post surgery pants, or any adaptive dressing, have the added benefit of being easy access to your surgery site post-op, meaning you don’t have to take your clothes off when you have your post-op treatments – a pre and post-op clothing wins
For further information on exercise physiology see http://elizabethhewett.com/