What Is Prehab? Should My MD Recommend Physical Therapy?

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What Is Prehab? And Why Would My Doctor Recommend Physical Therapy Before Surgery?

Prehab Physical Therapy Before Surgery

This is a great question that we often get asked as physical therapists. Prehab is short for pre-rehabilitation, and it is defined as seeing a physical therapist or getting rehab BEFORE an operation or injury.  

Now, you may ask yourself, “Why would I go to PT before my surgery?” 

Prehab is beneficial as it allows us to take baseline measurements of your gait, strength, range of motion, joint mobility, and flexibility that we can use to set goals following your surgery. 

Prehab visits also allow you – as the patient – time to ask any questions about the surgery or recovery process to help ease your mind and decrease some of the stress associated with surgery.  

At Cardin and Miller, we strive to spend ample time with our patients explaining preoperative and postoperative expectations and potential changes you may need to make around your home including things you may consider purchasing to prepare for your recovery.  

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Prehab visits also allow us to work on improving joint mobility, muscle flexibility, and strength, as well as teach you strategies to reduce pain and inflammation prior to surgery.  

With prehab, we strive to maximize your range of motion (ROM) and flexibility to improve post-op recovery.  Just remember – better ROM before surgery leads to less discomfort and earlier mobility after surgery!

I like to say “The stronger you go into surgery, the stronger you come out.” What this means to me is the stronger you can get before your operation, the faster and easier your recovery will be!

The evidence also supports prehab! A large-scale study completed between January 1, 2001, and December 31, 2016, proved the ability of pre- and post-op physical therapy to reduce post-op opioid use following a total knee replacement (TKR).  

The study concluded that patients who received any amount of prehab had a lower risk of  long-term opioid use following a total knee replacement regardless of prior opioid use. 

To take this even further, the study showed that the sooner after surgery patients received post-op physical therapy the lower the risk of long-term opioid use.  

As quoted from the article, “Physical therapy interventions after TKR are effective in reducing pain and improving functional outcomes, and given these effects, they may be effective in reducing opioid use after TKR.”  

This study is just one example of how powerful attending prehab can be in improving your overall function and well-being before and after your operation. 

Prehab Therapy Before Surgery

Now, another question you may be asking is, “Isn’t PT just going to make my pain worse if I come before my surgery?” 

The simple answer to this question is no. Your physical therapist is trained to modify exercises to allow for improved strengthening without aggravating your pain.  

Oftentimes, there are areas of weakness surrounding the surgical location that can be improved through exercise to help offload the painful joint.  

For example, I commonly see hip weakness in patients before a total knee replacement. With prehab, we can show you exercises to strengthen your hips which will help to improve the alignment of your knee and can actually reduce your knee pain prior to surgery, while also helping ease your recovery process.  

Now with that being said, our goal is to get you as strong as possible before surgery, so some muscle soreness is to be expected, but don’t worry, we will never push you past what you can handle!

How Soon Before Surgery Should I Attend Prehab?

Prehab Physical Therapy Before Surgery

There is no exact answer to this question as it is different for each surgeon. For example, we have seen patients six months before surgery and some only one month before surgery.  

Keep in mind, the sooner we are able to see you, the more time you will have to work on improving strength, range of motion, flexibility, and overall mobility which translates to an earlier return to function after surgery.  

What Should I Expect At A Prehab Visit?

Prehab Therapy

At Cardin and Miller, all initial prehab visits are one hour in length, when you will have the opportunity to sit down one-on-one with a licensed physical therapist (PT).  

The first part of the initial session will include a conversation with your PT, in which we will ask you questions about your symptoms, medical history, and home setup which helps us to formulate proper rehab expectations and goals.  

You will also have time to ask any questions you may have regarding the surgical process and recovery.  

Then, your PT will run you through a series of tests including but not limited to your range of motion, strength, joint mobility, flexibility, and gait analysis (looking at how you walk). 

Then, your PT will show you how to perform a series of stretching and strengthening exercises to address areas of weakness found during your exam.   

We will review preoperative and postoperative expectations and processes with you. If the surgery will require you to walk with an assistive device such as a cane or walker, we will review proper techniques to best utilize this equipment. 

We can also discuss pain management techniques that you may find beneficial before and after surgery. Our therapists commonly discuss warning signs of blood clots after surgery and help you to know when you should call your surgeon. 

Don’t worry, we know this is a lot of new information to digest in one hour! At the end of the session, you will leave with a printed copy of personalized exercises with pictures, descriptions, and written instructions on how often and how many to perform. 

We can also give you a printout to summarize expectations based on your specific operation. All Cardin and Miller employees strive to help people to move better, feel better, and live better.  

As part of that promise to you, we will ensure you have an email address or phone number that you can use to reach your PT in the event of any additional questions, concerns, or things we can help you with. 

What If My Doctor Did Not Recommend Prehab? 

What If My Doctor Did Not Recommend Prehab Physical Therapy?

You have two options. The first option is to call your surgeon or primary care physician (PCP) and request a referral for physical therapy.  

Just remember to let your physician know which Cardin and Miller location is most convenient for you. 

Option two would include being seen without a referral or prescription which is commonly known as direct access. 

In the state of Pennsylvania, you can be seen by a direct access licensed PT for 30 days without a referral from your physician. There are some exceptions to this rule regarding Medicare and some private insurances.  

If you have Medicare before we begin official treatment with you, you will need a script/referral from your physician. You are always welcome to call our offices to ask if you will need a referral to be seen for your initial prehab session. 

If you need help securing a referral, our front desk staff will be happy to help!

What Should I Wear To My Prehab Visit? 

What Should I Wear To Prehab Physical Therapy?

We recommend you wear shorts if you are being seen for back, hip, knee, or ankle prehab, and a tank top if you are being seen for neck, shoulder, elbow, or wrist prehab. 

As movement specialists, it is difficult for us to properly assess your movement if we can’t see it happening.

In conclusion, prehab is receiving therapy before a surgical operation to work on improving joint mobility, muscle flexibility, and strength to decrease post-op discomfort, improve mobility, and facilitate faster recovery following surgery.  

At Cardin and Miller, we strive to spend one-on-one time with our patients during the prehab visit to ensure all of your questions are answered and you feel confident before surgery. Just remember, the stronger you go into surgery, the stronger you come out, which ultimately means a faster recovery. 

If you are still unsure if prehab is right for you, we do offer One-On-One FREE SCREENS with one of our expert Physical Therapists. 

This will provide you with an opportunity to sit and meet with your potential therapist so that they can hear the issues you are having and tell you the best step to take to resolve the issue with no obligation. 

If you are interested in scheduling a prehab evaluation or free screen, please give us a call! We look forward to working with you and getting you back to the activities that you love. 

Carlisle (717) 229-9370

Harrisburg (717) 229-0058

Mechanicsburg-Cumberland Parkway (717) 229-0421

Mechanicsburg-Flowers Drive (717) 458-5875

As a final note, never feel embarrassed about asking for help. We are never here to judge, and having problems with your joints, muscles, or ligaments is nothing to feel ashamed of. You are not a freak of nature simply because you are heading in for surgery. We will do this together!

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Citations 

Aoyagi K, Neogi T, Peloquin C, et al. Association of Physical Therapy Interventions With Long-term Opioid Use After Total Knee Replacement. JAMA Netw Open. 2021;4(10):e2131271. doi:10.1001/jamanetworkopen.2021.31271

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