Your surgery is scheduled, and you are eager to get it over with. You have been instructed on the post-operative process, including the need for rehabilitation. Your surgeon explains that following the surgery, you will need physical therapy to restore strength and mobility. This is absolutely true, but what if you can make that rehab process smoother and quicker?
I’m not here to sell a magic copper-filled garment or ab belts claiming to rapidly build muscle, I am talking about prehabilitation.
Prehabilitation, or prehab for short, is participating in exercises to build muscle, endurance, strength, and power prior to surgery. You are building your foundation prior to the rigors of surgery. Loss of muscle, endurance, strength, and power are unavoidable following surgery. The severity depends on the surgery. A knee meniscectomy may be minimal as you are able to resume some level of activity almost immediately following surgery. You will decondition some, but the activity will minimize loss of muscle, known as atrophy.
If you elect to receive prehab, what should you expect?
Improving strength and muscle size are typically the primary goals, as they expedite early post-op progression. Another area - one that needs more attention but is growing - is building self-efficacy and addressing pain.
Addressing Fear of Movement
Pain catastrophizing, poor pain-coping strategies, and kinesiophobia are common in patients receiving a total joint replacement.
Research suggests psychosocial health plays a large role in determining the success of post-operative care. Patients with high levels of kinesiophobia - fear of movement - and pain catastrophizing - exaggerating fear and feeling helpless - are less active. Low levels of self-efficacy diminish a patient's confidence in completing rehabilitation tasks, particularly those that involvements pain-inducing movements.
Self-efficacy can be defined as "how well one can execute courses of action required to deal with prospective situations." As you can imagine, this is vital for anyone rehabilitating from surgery.
This study compared the pre-operative presentation of patients with and without elevated hip pain three-months following hip arthroscopy in terms of self-reported function and psychosocial health. More than one-third of the participants reported anxiety or depression. Indicators of poor psychosocial health were present in nearly half of the participants.
Participants with elevated postoperative pain at rest had worse pre-operative psychosocial health and function compared to those without. Participants with elevated postoperative pain during activity had worse pre-operative psychosocial health, however, they did not have worse pre-operative function.
Pre-operative self-efficacy explained more than one-third of the variance in both elevated postoperative pain at rest and during activity.
Addressing a patient's beliefs about pain and movement prior to surgery can positively influence activity level and participation in rehabilitation after surgery.
If you are planning to pursue surgery for pain, speak with your doctor about your activity level. Pain is complex and movement is almost always beneficial. Learning how to improve your activity and address pain can improve your surgery and rehabilitation experience. I highly recommend seeking a physical therapist prior to surgery. The can help you understand pain better and build a personalized approach to activity.