It dramatically improves postsurgical results.
Joint-replacement surgery may be a good solution if your joint pain interferes with everyday activities.
Secret to getting better results: A targeted form of physical conditioning known as “pre-hab” can dramatically reduce the often-painful recuperation period that follows joint-replacement surgery.
Even though surgeons have encouraged pre-hab for as long as they’ve been doing joint replacements, not enough patients take advantage of it.
When performed for six weeks before your surgery, pre-hab can reduce your recovery time by up to 73% for common joint-replacement surgeries such as those for the knee and hip—and even less common replacement procedures, including those for the ankle and elbow.
What you need to know…
With pre-hab, a physical therapist coordinates an exercise program that helps build the physical “reserves” you’ll need to recover from surgery.
To accomplish this, pre-hab focuses on specific exercises that strengthen multiple muscle groups without stressing the affected joint…improves balance and flexibility…and increases stamina and coordination.
But is pre-hab really worth the effort?
Consider these facts: Pre-hab not only results in shorter hospital stays, but also shorter stints in inpatient and outpatient rehab…and a quicker return to the activities and lifestyle that had to be put on hold due to unbearable joint pain.
What’s more, there’s significant scientific evidence that supports the use of pre-hab for people undergoing joint replacement.
For example, participation in pre-hab has been found to greatly increase your chances of having a successful surgical outcome—that is, having little or no pain and regaining full joint mobility and functional capacity—according to research published in Physiotherapy Theory and Practice, Clinical Orthopaedics and Related Research and The Journal of Strength and Conditioning Research.
Although pre-hab is not a substitute for rehab that’s done after joint replacement, there are several advantages to strengthening one’s body before surgery. A faster recovery is perhaps the most important benefit.
Someone who undergoes a few weeks of pre-hab prior to a hip replacement, for example, might complete a postsurgery rehabilitation program in only five to seven days, while another person who hasn’t undergone pre-hab and isn’t in the best of health could require several weeks in rehab.
With pre-hab, you will exercise to strengthen the muscles around the joint that is going to be replaced. While this is done in several ways to avoid straining the joint, you may experience some discomfort.
If you’re planning to undergo a knee replacement, for example, you might do exercises that strengthen muscles around the knee, rather than flexing the knee itself. In rare cases, patients are in so much pain that pre-hab isn’t possible.
Helpful: Doing pre-hab at the same facility handling your rehab creates a seamless pre- and postsurgical “program.”*
WHAT TO EXPECT IN PRE-HAB
In general, the therapist will choose exercises that strengthen—but don’t overly stress—the affected joint. Pre-hab is usually done two or three times a week for 45 minutes to an hour. Patients are also given a program to do at home for 30 to 45 minutes on the days they are not in pre-hab.
- Straight-leg raises are often used for patients who are about to undergo a knee replacement. What to do: While lying down (with the pain-free knee slightly bent), the patient raises and lowers his/her painful leg. This strengthens muscles around the knee, such as the quadriceps in the thigh. Those who are preparing for joint-replacement surgery in both knees perform the exercise on each of their legs.
- Side leg raises are exercises commonly used for a hip replacement. What to do: While standing upright (and holding on to the back of a chair for balance), the patient slowly raises his leg out to the side, then slowly brings it back to the starting position. This strengthens side hip muscles.
- Isometric shoulder extensions help prepare patients for shoulder surgery. What to do: The patient stands with his back against a wall and arms straight at his sides. Keeping arms straight, he pushes his arms into the wall, holds for five seconds, relaxes and repeats.
Also useful: Pre-hab optimally includes exercises performed in a swimming pool, where there’s virtually no direct impact on joints and minimum pain during muscle strengthening and flexibility workouts. Since the body is buoyed, there’s better balance, too.
Important: Because some pre-hab exercises increase heart rate, anyone with high blood pressure, heart disease or other significant health issues should consult his physician before beginning this type of program.
WHO PAYS FOR Pre-HAB?
Pre-hab is usually covered by insurance, but you may be responsible for some out-of-pocket expenses. Your insurer may cover a specific number of sessions, which include both pre-hab and rehab.
Pre-hab can cost as little as $10 for a group class or up to $200 for an initial consultation with a physical therapist. Check with your insurer.
*To find a physical therapist or pre-hab program near you: Ask your surgeon…or check with the director of the rehabilitation clinic at the hospital where your surgery and/or rehab will take place.
Source: Karen Pechman, MD, medical director of the department of physical medicine and rehabilitation at Burke Rehabilitation Hospital in White Plains, New York. She is an assistant professor of rehabilitation medicine at Weill Cornell Medical College in New York City.