Getting In Shape Prior to Surgery Can Make Recovery Easier
Most people facing the need for surgery do their homework first to pick their surgeon, read up on their surgery and speak to others who have undergone a similar intervention. Some may still feel nervous or worried as to whether or not they will bounce back quickly or struggle to get back on their feet. To ensure a speedy recovery, in addition to finding a skillful surgeon, you would benefit from getting into shape with “pre-hab” prior to your surgery.
What is pre-hab? In short, it’s an individualized physical conditioning program to improve strength, endurance, and range of motion prior to surgery. It requires teamwork between the patient, surgeon and physical therapist to maximize the benefits of their surgery and minimize the challenges that come along after surgery like a total joint replacement.
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More than a million Americans undergo a total or partial joint replacement every year according to the National Institute of Arthritis. The Journal of Arthritis Care and Research reports that patients who participated in a pre-surgical exercise intervention reduced their odds of requiring post-surgical discharge to an inpatient rehab facility by seventy-three percent, regardless of which joint was replaced.
“Pre-hab makes a huge difference in our patients’ outcomes,” reports Hal Crane, MD and founding medical director of the Rose Institute for Joint Replacement in Denver.
For most people, two to six weeks is ideal for physical preparation, however, those people with additional problems such as obesity, deconditioning, multiple joint problems and/or cardiovascular disease may benefit from six weeks or longer. Ideally, pre-hab programs are unique to each individual patient. “Even in a fairly brief time period, the exercise paid off for the participants,” said lead author Daniel Rooks, PhD, assistant professor of medicine at Harvard Medical School. “The benefits of exercise before surgery are very clear: the more you can do for yourself physically before surgery, the better off you will be.”
The best approach to pre-hab is having individual sessions with a physical therapist, but this may be costly. Despite the proven benefits of pre-hab, not all insurance companies pay for it. It is recommended to exercise three times per week after educated in a proper program, with infrequent supervision from your physical therapist to modify and enhance your program appropriately. It often includes 1-4 formal physical therapy sessions for ongoing guidance and education from your physical therapist. If your insurance does not cover pre-hab, speak to your doctor. Some physical therapy offices provide a free or low cost program for you to perform up to the date of your surgery.
Exercises may include isometrics, low impact muscle toning, stretching, and aquatic exercise classes. The goal is to strengthen and improve motion with as little pain as possible. An aquatic/pool setting may be ideal if you struggle with weight bearing pain. This setting allows for strengthening, balance and endurance training with minimal joint loading.
Almost all joint replacement patients can benefit from pre-hab. Pre-hab can also deliver benefits like changing negative attitudes and fears as well as providing some of the mental and emotional confidence needed to succeed in the post-surgical programs and physical therapy. Vonda Wright, MD, assistant professor of orthopedic surgery at the University of Pittsburgh’s Center for Sports Medicine reports “Fifty percent of outcome success is due to the surgeon, and the other fifty percent is due to the patient’s commitment to recovery- starting with pre-hab.”
Surgeons may not regularly advise pre-surgery physical therapy so you may need to speak up and ask him/her to put you in touch with a physical therapy program familiar with pre-hab programs. Returning to the same therapist for post-surgery care will create an even more seamless and efficient program to get you back in to shape sooner, stronger, and with more confidence.
—Laura Markey, PT, DPT, FAAOMPT
