Reviewed by Dr. Neha Narula, BPT, MPT (Neurology), McKenzie Certified
Doctor’s Clinical Note
Pre-habilitation can assist patients to better prepare themselves physically and mentally for the surgery through the strengthening of physical fitness including strength, flexibility, balance, proprioception, and exercise familiarity prior to the surgery. A properly designed pre-operation program can assist patients to become prepared mentally and physically for the upcoming surgery.
If we speak about joint replacement or ligament surgery, we always think about the day of the surgery itself. We spend much time talking about the surgery itself, organizing hospitalization, planning our future life after the surgery. Physiotherapy appears in our mind only after the surgery itself.
However, rehabilitation need not always take place post-surgery.
It can even take place prior to the surgery itself. This method is referred to as prehabilitation or prehab for short. Prehabilitation refers to physiotherapy done before the operation for the purpose of helping the patient prepare for their recovery period.
At StepUp Joints in Lajpat Nagar, South Delhi, prehabilitation programs may be conducted prior to the 2 to 4 weeks of surgery. The program takes into consideration the type of surgery that will be performed, the mobility of the patient, and the environment at home.
What Is Pre-Habilitation?
Pre-habilitation is a specific physiotherapy treatment performed prior to joint replacement or ligament reconstruction surgery.
It can be recommended to individuals undergoing knee replacement, hip replacement, or ligament reconstruction surgery, for example, ACL surgery. Instead of coming into the operation weakened physically and beginning to work on rehabilitation, the patient has an opportunity to work on some areas of physical strength ahead of time.
That is why pre-hab differs significantly from postoperative rehabilitation.
Postoperative physiotherapy is concerned with the restoration of bodily functions after an operation. Pre-habilitation, in its turn, aims to prepare the body for this process.
The principle is quite straightforward: the more prepared the body is before the operation, the more prepared it will be for rehabilitation afterwards.
But pre-habilitation is not about pushing the body to its limits before the operation. It is about undergoing a specific physiotherapy program tailored to the individual’s situation and planned operation.
Why Consider Pre-Hab Before Joint Surgery?
Patients can feel weak, immobile, stiff, or less physically active before undergoing joint surgery. Pain and immobility can lead to changes in one’s gait or the way people carry out their day-to-day functions.
When surgery time finally comes around, some patients might already have been leading a life of immobility for some time now.
Pre-hab allows for the correction of these shortcomings prior to surgery.
According to StepUp Joints’ guidance provided, a proper prehabilitation regimen carried out 2-4 weeks prior to surgery can help aid in the recovery process by giving patients more strength, control, mobility, and confidence before they undergo surgery.
The aim is not to promise a certain time of recovery but to create a better base to start recovery on.
Pre-Habilitation Exercises Before Knee Replacement
For individuals undergoing knee replacement, pre-habilitation exercises prior to knee replacement may target the muscles and movement techniques that would be significant in terms of recovery after the procedure.
One of the primary areas where the focus could be placed in such cases is quadriceps.
Quadriceps play an essential role in terms of knee stability and the ability to extend one’s leg completely after surgery. Quadriceps strength is mentioned in the supplied material as one of the most important factors linked to post-operative knee function.
In addition to that, pre-habilitation exercise program may also cover some other muscles and movement systems that help with mobility, balance, posture and functional activities.
The important thing about them is that they should be selected in accordance with individual characteristics of the patient rather than being a standard package of exercises.
A person who is physically active may require something different from another one who had been inactive due to joint pain for a number of months.
Preparation for a knee replacement also has its own specifics and differs from preparations for hip replacement or ligament reconstruction.
How Pre-Hab Can Support Post-Surgical Recovery
1. Starting recovery with greater strength
After surgery, patients need to restore function and mobility even as their body is healing.
Those patients who come to the surgery with good muscular strength will be in a better position compared to those whose muscles were too weak before the surgery.
According to the information provided, patients with muscles that are stronger prior to the surgery can have an easier time working towards functional goals like walking independently and using the stairs without regaining their strength in the first place.
That is one way through which pre-hab is effective.
As opposed to looking at surgery as the beginning of the process of rehabilitation, patients can establish their physical base before surgery.
2. Improving neuromuscular control
In order to perform movement, muscle strength alone is not enough.
The nervous system needs to coordinate muscles that stabilize and perform movements. Prehabilitation can assist patients in gaining neuromuscular control and therefore enabling the stabilization muscles to activate effectively.
This is especially important in the initial post-operative phase where even normal daily movements are strange and unfamiliar.
Practicing movement control before surgery helps patients know how their body is supposed to perform when exercising and performing other movements.
3. Supporting mobility and reducing stiffness
Problems with joints can cause a decrease in mobility.
If there is a lack of mobility prior to surgical operation, then the patients will become less mobile and experience further stiffness. As explained in the given guidance, enhanced circulation and mobility of the joint prior to surgery can result in lesser stiffness after surgery.
This is not to say that the joint should be forced to move if it is in pain.
It just means that the exercise chosen should suit the abilities of the patient.
4. Building confidence
Surgery is a life-altering moment in many ways, especially for those involving a part as essential as being able to walk or ascend stairs.
Some are concerned about their future and try to figure out how they would move about, which exercises they would have to do, and how long it would take them to get used to doing things again.
Pre-hab would allow them to practice some movements and exercises in advance.
According to the above material, patients who have already practiced their post-surgical exercises through pre-habilitation might better understand and adhere to their rehabilitation program.
Which Muscle Groups Are Typically Included?
Prehabilitation programs are specific and not general.
Depending on the procedure that will be performed, as well as the requirements of the particular individual, different muscle groups can be exercised.
Quadriceps
If knee surgery is scheduled, then the condition of the quadriceps muscles will be crucial.
The quadriceps are responsible for knee stability and leg extension, and pre-surgery strength training can serve as a helpful preparation for rehab.
Gluteal Muscles
Gluteus medius and gluteus maximus muscles ensure the correct alignment of the hip and knees when walking.
These muscles are crucial for controlling movement and can be included in a pre-hab program.
Core Muscles
Stability and coordination in the post-operative phase are facilitated by the core muscles.
Functional movements such as sitting and standing, as well as stair use, all require coordination and stability; therefore, the core is an integral part of physical preparation for the post-operative phase.
Calf and Ankle Stabilizers
Additionally, calf and ankle muscles provide gait and balance.
This area can be incorporated into the program in order to support gait and prevent falls while the patient is mobilizing and using either a walker or crutches.
Pre-Op Mobility: Why It Matters Before Surgery
Pre-operative mobility is a description of a patient’s ability to move prior to surgery.
It goes beyond just walking and may include getting into and out of chairs and vehicles, standing without falling, balancing, stair negotiation, and ambulating around the house.
A patient may have learned to live with the effects of pain or stiffness over a prolonged period of time by adapting their movements. For instance, they may have adapted the way in which they load a limb when walking.
Pre-operative physiotherapy is an opportunity to address these functional activities within the limitations of the patient.
The aim of pre-operative physiotherapy is not to ensure that the patient is completely asymptomatic before the surgery takes place. Instead, it is to maximize their mobility to the best extent feasible.
Home Rehabilitation Physiotherapy South Delhi: Why the Home Environment Matters
Rehabilitation is not done in the clinical setting alone.
Much of what the patient does to recover takes place at home and therefore the home setting can be an essential component in designing the physiotherapy program.
Patients who want home rehabilitation physiotherapy in South Delhi should focus on more than just the list of exercises.
A good rehabilitation program will include considerations of how the exercises and mobility techniques are incorporated into daily activities.
Some of the things that a rehabilitation program will need to consider are:
- Available room at home
- Patient’s walking needs
- Home design
- Use of stairs
- Mobility level of the patient
- Nature of the surgery that will be performed
- Ability of the patient to perform exercises
The StepUp Joints materials have clearly indicated that pre-habilitation and home rehabilitation programs are designed around the patient’s surgery, mobility level, and home environment.
Is Pre-Hab the Same for Every Patient?
No.
One of the most vital aspects of pre-hab is the process of individualization.
Two patients could go through identical surgery and yet possess extremely varying strength and mobility levels prior to that.
For example, one may walk without any assistance while another may already be experiencing difficulty in carrying out day-to-day tasks.
Thus, their pre-habilitation process may also be quite different.
In a similar manner, the demands for knee, hip, and ligament rehabilitation are different.
Thus, a pre-hab program must be based upon assessments and advice from physiotherapists.
When Should Pre-Hab Begin?
The StepUp Joints provided literature explains that pre-hab exercises are used in the two to four weeks prior to surgery.
The specific time and exercises involved in pre-habilitation will differ from one patient to another, depending on the individual’s situation and the surgery planned.
It is useful to start the preparation prior to the surgery to give the patient time to familiarize themselves with the exercises and what the early rehab process involves.
This is especially important for patients who are anxious about the post-surgery process.
What Patients Can Learn Before Surgery
Pre-hab offers one benefit of preparing oneself beyond muscle strength.
They will be familiar with:
- The exercises prescribed to them
- Correct movement patterns
- Functional movements
- Balancing and mobility skills
- The need for doing rehabilitation exercises in a proper way
By acquiring all of this knowledge prior to surgery, the patients do not have to deal with everything involved with their rehabilitation for the very first time while recovering from the procedure.
Pre-hab thus becomes an educational experience as well.
Pre-Hab and a More Confident Recovery Journey
Joint surgery recovery is a process that involves cooperation from the patient.
Surgery takes care of the problem of the operation, but rehabilitation plays an integral role in the restoration of motion and function.
A person who has knowledge about the process before the surgery is likely to be more ready to engage in the rehabilitation process.
Prehabilitation can offer such an opportunity for gaining knowledge about the process.
In addition, it enables patients to go into the surgery having already known what exercise and movements they would have to do during their rehabilitation process.
According to the reference provided, this sort of preparation helps with understanding the rehabilitation process.
Preparing for Joint Surgery in South Delhi
If a person in South Delhi is going to undergo joint replacement or ligament reconstruction surgery, pre-operative physiotherapy may be an essential part of the preparation process.
At StepUp Joints, Lajpat Nagar, we can design programmes based on individual patient’s surgery, movement, and living environment.
It is aimed at helping the patients know what their body requires before the surgery and how they can prepare for rehabilitation after that.
Instead of thinking of the post-surgery physiotherapy requirements after the surgery, they can discuss them even before that.
Final Takeaway
While joint surgery may happen all at once, the process of rehabilitation continues long after it happens in the operation theatre.
Prehabilitation helps patients prepare themselves for the journey through rehabilitation prior to surgery.
Exercises during prehabilitation in knee replacements may help establish strength and mobility skills that will be needed in post-operative rehabilitation. Exercising the quadriceps, gluteals, core, calf, and ankle stabilisers may provide the patient with the foundation of mobility skills through appropriate inclusion in the individualized treatment programme.
Simultaneously, increased preoperative mobility and understanding of rehab exercises can increase confidence in the coming journey.
Patients who would like to pursue home rehab physiotherapy in South Delhi may benefit from a personalized treatment programme based on the surgery, mobility and the patient’s living conditions.
The process of prehab is not about doing something more for the sake of it. It is about doing the appropriate preparation before surgery in order to start the rehabilitation from the optimal functional base.
At StepUp Joints, Lajpat Nagar, patients scheduled to undergo joint replacement or ligament surgery may discuss the possibility of a personalized programme for pre-operative mobility and prehabilitation prior to their surgery date.
