Prehab/rehab

By DiAnne Crown

November 12, 2013 4 min read

Rehabilitation therapy following a major orthopedic procedure such as knee or hip replacement has been standard for many years. But the latest trend to reduce postoperative recovery time and improve the quality of the recovery overall is preoperative physical therapy, or "prehabilitation."

Physical therapist and certified athletic trainer Ryan Schallenberg is a proponent of prehabilitation, and not only with his fit, young patients, but with seniors, as well.

"The goal is to get as much motion, strength and function as you possibly can before surgery," Schallenberg says, "and to learn as much as you can about managing the condition after the surgery," such as how to safely use crutches or a walker.

Prehabilitation is part of an overall training and education experience offered at various hospitals, clinics and centers that address orthopedic issues. Information may be introduced in a group class led by a physical therapist or other health professional. Then individual sessions may be offered with the physical therapist. And depending on the location, procedure and insurance coverage, postoperative therapy is offered either during or after the hospital stay.

Sometimes prehabilitation stretching and strengthening exercises actually help avoid surgery, says Schallenberg. But if not, before a scheduled surgery, patients usually will come for two to four weeks, once or twice a week, for 45- to 60-minute sessions of combined manual therapy that includes the physical therapist's hands on the patient (stretching legs, for example, to extend range of motion) and strengthening exercises that also can be done at home. The exercises are designed to increase range of motion, strength, body awareness, balance and function.

"Prehabilitation is not a bad thing for anyone going through a major procedure, but especially when it's the first time, such as the first knee or hip replacement. I strongly recommend it," says Schallenberg.

According to the American Physical Therapy Association's website, http://www.apta.org, "the better physical shape you are in before total knee replacement surgery the better your results will be (especially in the short term). Before surgery, your physical therapist will teach you exercises and show you how you will walk with assistance after your operation. Your therapist also will discuss precautions and home adaptations," such as removing loose rugs and more.

Barbara Stanton, age 79, has had the benefit of pre- and postoperative physical therapy and believes this is one of the main reasons she can walk nearly pain-free today. Six years ago, Stanton's story was very different. She had so much pain from bone-on-bone arthritis that her doctor recommended hip replacement surgery.

Since then, Stanton also has had the other hip and both knees replaced, and before all but that first surgery, Stanton did presurgery exercises to ensure her recovery was as smooth and effective as possible. She's glad she did.

"I did leg lifts and knee bends lying on my back on the bed before the knee replacement surgery," she says, and she did leg lift exercises lying on her side before the hip replacement. Stanton then followed up with additional physical therapy after each surgery.

"I think it helps a lot. It's strengthening and even helped my recovery go a little faster," she says.

Stanton encourages anyone suffering with that kind of pain to consider replacement surgery, and everyone to do preoperative therapy, or prehabilitation. Don't wait until your doctor tells you you're too old, she says. But also "be sure to check with your insurance company beforehand" so you know what is covered.

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