Why you should do prehab before joint replacement surgery
There are currently 2.1 million Australians (9.0%) reported living with osteoarthritis (OA).
Commonly affected areas of OA include the hips, knees, lower back, and neck. Signs and
symptoms of OA include joint stiffness, pain, swelling, and weakness. As the disease worsens,
so to do the symptoms. While OA is often correlated to “wear and tear” of the body, the exact
cause is unknown. It affects equally among race, gender, background, and lifestyles. However,
there are many well-known risk factors which contribute to a worsening or rapid progression of
symptoms; these include physical inactivity, obesity, and decreased leg strength.
OA is usually treated with conservative management first: that is exercise, bracing, and medications for pain management. When OA has progressed to a point where conservative management is no longer effective (e.g. increase in functional deficit, too much pain), surgical interventions in the form of a Total Knee Replacement (TKR) and a Total Hip Replacement (THR) may be suggested by your doctor or surgeon. These surgeries have excellent outcomes with regards to patient satisfaction, but they come hand in hand with a lengthy rehabilitation process.
What is prehab?
Prehabilitation (prehab) carries different meanings depending on the target audience. In elite
athletes, prehab comes before the start of the season where specific strength training,
flexibility training, and body control exercise are performed in an attempt to prevent injury. For
individuals waiting for a knee or hip surgery, prehab exercises are performed to enhance
recovery following surgery.
Once the knee has adequately settled, treatment should be focused on addressing the underlying causes specific to the runner. A strength and running assessment can help identify muscular imbalances and altered running mechanics which may be causing the runner knee pain (Mellinger & Neurohr, 2019). A targeted and specific strength program is essential to improve running biomechanics and reduce forces placed on the front of the knee. In conjunction with load management and gait specific re-training individualized to the runner, patella-femoral pain can be well managed.
Following a joint replacement, the body not only has to adapt to the new hardware in place in the body but depending on the surgery, the surrounding muscles that had to be cut in order to place the hardware in. The early stages of recovery in hospital and at home results in a lot of time sitting or lying down which negatively impacts our cardiovascular fitness. It is also common to feel unsteady on a joint while the person gets use to it and the pain medications prescribed post-surgery also may make balance difficult.
Prehab for both hip and knee replacements focuses on the muscles surrounding the hip and knee (often the quadriceps, hamstrings, and glutes). Improving balance and stability, optimizing the cardiovascular system post-surgery, and improving flexibility are other factors also addressed prior to surgery. These exercises will also aid in recovery post-surgery and these same exercises can help decrease pain and stiffness in the affected joint.
Studies have shown that prehab is able to:
- Decrease length of stay in the hospital
- Improve knee range of motion (ROM) after surgery
- Increase strength and ability to perform everyday tasks prior to surgery
- Reduce complications associated with surgery
Prehab exercises should focus on the following:
Range of motion (ROM) - joints need adequate ROM to complete everyday tasks like going up
and down stairs, reaching up the cupboard, and sitting comfortably. Having a good ROM prior
to surgery makes it easier to regain the ROM post surgery. Stretching of the thigh, hamstrings,
and calves can help.
Strength - Strong muscles in the legs, specifically in the quads,
hamstrings, and glutes make walking up and down stairs,
getting out of a chair, and walking easier post surgery. Exercises
that aid in this include wall squats, heel raises, and leg
extensions.
Balance - The better the balance before surgery, the less affected you will be post surgery when
the body becomes adjusted to the hardware. Strategies to improve balance include standing in
a tandem stance (one foot in front of another), closing eyes, and standing with your legs closer
to each other. To really challenge your balance, practice your exercises on one leg!
Cardiovascular fitness - increasing exercise endurance and the cardiovascular health will help
with your post-surgical rehab sessions. Stationary bikes, walking, and pool exercises are low
impact exercises on the affected joints that can improve cardiovascular fitness while
maintaining safe loads on the joints
Written by Avery Wong – Physiotherapist MPhty.B.Sc(Kinesiology)
If you are waiting for an upcoming joint replacement surgery, then the staff at Northside Sports
Physiotherapy can guide you through your prehab journey in the lead up as well as post-
operative rehabilitation.
Call your nearest practice to book in an appointment:
Hornsby – 9476 1666
Wahroonga – 9489 4588
Lindfield – 9489 4588