Prehabilitation – The Importance of Pre Surgery Strength Training
Prehabilitation or ‘prehab’ is not a new concept but it may be starting to gain some ground in the health industry due to recent findings.
The benefits of prehab has been known and taught in universities for decades however it is still not utilised to its full potential and the public are not well educated on its benefits.
Usually patients require or are encouraged to complete inpatient and/or outpatient rehabilitation post surgery yet they are not encouraged to complete any pre surgical exercise or strength work when we already know it can enhance the rehabilitation phase greatly along with many other benefits. The funny thing is that current research doesn’t just find positive outcomes for the patient but can also save hospitals a lot of money.
So What is Prehabilitation?
According to Mr Graham Mercer (Head of Orthopaedics at Repatriation Hospital, South Australia) ‘Prehabilitation is the process of enhancing functional capacity of the individual to enable them to withstand the stresses of orthopaedic surgery and the associated inactivity.’
From our experience at MD Health we see many people who are potentially in need of surgery in the future or are already booked for surgery. The results we obtain from the Full Body Assessment are a clear indication that they need to increase their strength to enable quicker recovery and better rehabilitation post surgery. It is very rewarding to see the positive effects that our clients achieve to get them ready for surgery and in some cases their surgeries are postponed due to improved function and reduced pain.
This in itself is a major reason why patients should be included into a graded exercise plan prior to surgery.
Based on information from Mr Graham Mercer, orthopaedic surgery places many issues within the hospital system these are:
Length of hospital stay post surgery
Patient expectation of inpatient rehabilitation
Growing waiting list for surgery
This means more money goes into funding all of these much needed services. The longer the patient stays the higher the costs.
After conducting a 6 month trial where prehabilitation programs were included as part of patient’s surgery they found that there was:
A reduction of inpatient rehabilitation.
Up to 94% of patients did not need to complete inpatient rehabilitation.
Reduction of length of stay post hip replacements
91% achieved their pre surgical goals
Prehab has a huge role to play in preparation, management and outcomes of surgery. You could almost say it is a wasted opportunity if not completed and there is more chance of pre/post surgical issues.
Here at MD Health Pilates we highly recommend strength training programs prior to surgery to help activate muscles and stabilise your joints to create the best atmosphere for surgery as well as aid in rehabilitation.
If you have a friend or family member who may be in need of or has been booked in for surgery please contact us to start a prehabilitation program today.
Improving our Pilates program, service and your outcomes has been and will continue to be one of our major goals at MD Health Pilates. At the moment, we have been working on these aspects of our program to be launched in the next version of our software (version 6fii).
1. Real time ultrasound imaging of the shoulder – Nicholas has recently undertaken further training in musculo-skeletal ultrasound imaging and has now taught all the other staff how to image the muscles and tendons. We have now further practiced and refined our skills through several in-services and worked out our standard protocols for testing the shoulder. This will now be used as a standard test when you have a shoulder injury
2. Headache assessment and treatment – Mark Charalambous, former physiotherapist at MD Health Pilates, recently trained all of our staff in better assessment and treatment techniques for neck related headaches. We have now further fine-tuned this process and incorporated it into the new version of our software.
3. Better hip assessment and specific treatment – Since we started incorporating new research and techniques for treating hip injuries over the last two years, we have a much better idea of what works well and what doesn’t. These changes will also be included in our new software and testing procedure.
4. Tendon injuries in general – Both Nicholas and Jacinta had done excellent training and taught the other staff how to specifically assess and treat tendon and tendonopathy injuries. We have re-written the process of how to better progress tendon rehabilitation programs throughout the healing process for the best outcomes
5. Heart and other cardiovascular conditions – If you have had heart related issues, you have probably found that we have been asking to rated your effort during an exercise or session out of 10 (RPE) or 20 (Borg scale) to determine the safest level of exercise for you. We have now worked to make this process easier to record and keep a track of during your sessions
6. Home exercises – We are in the process of updating our range of home exercises and working to mare the process faster and more specific to each individual
Jack came in last week and brought with him the ‘Nordbord’ or hamstring testing apparatus. This was specifically designed to assess athletes’ isometric hamstring strength vs their eccentric strength. The test involves kneeling on a pad with your heels through 2 straps that are connected to pressure senses that collect data to a computer.
You are first asked to do an isometric contraction (contracting your hamstrings without lengthening or shortening the muscle). Then you are asked to complete an eccentric load which involves keeping your knees and ankles grounded by the straps and your body falling buy ambien 10 mg forward as slowly and as far as you can before letting go. The computer then generates a comparison between your isometric control and your eccentric control. Ideally your eccentric strength should be better than your isometric strength and knowing this information is vital for preventing hamstring tears which are all too common in many sports! From the data a specific exercise plan can be prescribed.
Thanks for sharing with us Jack! Good luck with testing all of the athletes!
Check out this article on the QUT researchers that came up with the idea of the NordBord
If you or someone you care for experiences bladder or bowel control problems, you’re certainly not alone. In fact, over 4.8 million Australians experience bladder or bowel control problems. Urinary incontinence affects up to 13% men and 37% of women in Australia alone and 70% of these people do not seek advice or treatment.
The most common risk factors of developing urinary incontinence are: -Pregnancy (pre and post natal) -Menopause -Obesity -Urinary tract infections -Constipation -Surgeries such as prostatectomy and hysterectomy -Reduced mobility due to neurological or musculo-skeletal conditions -Health conditions such as heart disease/diabetes/stroke
Incontinence of any level is nothing to be embarrassed about, this is a real problem and it is very important to seek help and advice.
Your pelvic floor is a secondary control of your bladder. The urethra sphincter (muscle that controls amount of urine expelled from the bladder) is stretched during childbirth and so we rely heavily on the pelvic floor to take the rest of the slack. Strengthening your pelvic floor is a must pre and post pregnancy.
We are lucky enough to have access to Real-time Ultrasound and use this as a tool to assess your ability to activate your pelvic floor. From here we are able to prescribe the right exercises for you and we can teach you how to improve your pelvic floor for prevention or treatment of urinary incontinence.
Next week we will post more information on how to go about improving your pelvic floor and what not to do! So stay tuned!
Don’t forget to ask one of our Physiotherapists or Exercise Physiologists about a Pelvic Floor assessment.
Article by Beth Chiuchiarelli, Exercise Phsiologist at MD Health
Late last year Jacinta attended a course on ‘Greater trochanteric pain syndrome’. This syndrome covers many dysfunctions and injuries around the hip. Greater trochanteric syndrome is caused by irritation of the bursa (fat pad) which is a shock absorber as well as a lubricant for the muscles around the hip that lie adjacent to it. The bursa cannot be irritated on its own, there are many injuries that pre-exist that eventually cause the bursa to become inflamed. Once the bursa is inflamed it can be hard to treat as it can become irritated easily. Exercise can help however it needs to be assessed appropriately and only then can a closely watched exercise program commence.
Completing a hip assessment is not an easy process, if you have had your hip assessed by us you may remember there are many objectives that we need to measure and test before we can derive exactly what is causing your hip pain. This is how we can prescribe the correct type of program. One exercise that Jacinta has introduced to MD Health is a seated hip abduction hold with a belt. This is a great way to strengthen the gluteal muscles without causing irritation to the bursa! Once the pain has relieved we can progress to isometric holds with added resistance. You may have seen some of these exercises around the clinic!