ACL injury is very common in individuals between 16 – 30 years mainly due to contact injury while playing sports. Depending on the grade of ACL tear, activity level before the injury and future goals; a surgery may be recommended.
BUT, a Surgery would only be sanctioned when a PREHAB is completed.
What is this PREHAB?
As defined by the authors, pre-rehabilitation (prehab) is the process of “preparing an individual to withstand a stressful event through enhancement of functional capacity” meaning preparing yourself mentally and your knee/body physically to undergo a surgery and recover faster after surgery. A surgeon won’t initiate a surgery before his/her patients achieve the following 3 criteria:
- Minimizing Pain and swelling
- Restoring Knee range of motion especially extension and
- Restore quadriceps muscle strength and balance.
Why is PREHAB so Important?
Loss of 3-5 degrees of knee extension motion compared to the uninjured side (including hyper-extension) has been shown to be associated with decreased functional outcomes.(Sehlbourne & Grey, 2009). Similarly, a 20% deficit in strength before ACL reconstruction has also been associated with decreased functional outcomes.(Eitzen et al, 2009). The risk of developing osteoarthritis is also higher in those with asymmetrical knee extension motion and strength.(Shelbourne & Grey, 2009; Roe et al, 2005)
Who helps during PREHAB?
Physiotherapists are the qualified professionals who assist with prehab. They have a significant impact on the patient and their outcome. These can be categorized in three:
1. Maximizing pre-op range of motion, inflammation control, and strength. Those who have a better range of motion, less swelling and improved quad control pre-operatively tend to regain it quicker postoperatively.
2. Patient education. This not only helps to help expedite their recovery but can also help to elevate a lot of anxiety. This is a critical part and can include lots of things including:
a. Education on the process – educate the patient and caregiver on what to expect after surgery. Educating on proper positioning in bed, use of CPM (if being prescribed) & post-operative instructions (icing, the range of motion, quad sets) that can be performed the day after surgery prior to seeing the Physio for the 1st post op session.
b. Education on use of the assistive device – if they are going to be using crutches, setting them up with proper fitting crutches and how to ambulate with PWB (partial weight bearing) or WBAT (weight bearing as tolerated) and how to navigate stairs or curbs safely.
c. Educate on what to expect in their first Physio visit when they come in.
3. Reassure the patient. It is vital for the physiotherapist to instill confidence in the patient in whoever is performing the surgery. Encouraging them and reassuring them will not eliminate fear and anxiety but it will decrease it.
All that said, there is the unspoken psychological aspect and positive influence this also has on the patient. If there is one thing that is often undervalued in ACLR, it is the impact that psychology has on the patient and outcome. Considering, there is a positive psychological impact on the visit. The Physiotherapists should never undervalue the impact they will have on this pre or post-surgery.
YES, Prehab accelerates the recovery process after surgery in order to gain the strength back and get back to sports.
Dr. Mansi Parikh,
Co-Founder, EndoRush App