Everything You Need to Know About Pre-Operative Physiotherapy and Its Benefits Before Orthopedic Surgery

What is Pre-Operative Physiotherapy and How Can It Be Beneficial Before Orthopedic Surgery?

Pre-operative (pre-op) physiotherapy, also known as pre-habilitation or pre-hab, refers to a specialized form of physical therapy that is conducted before a surgical procedure. It aims to optimize a patient’s physical condition and functional abilities, through pre-op exercise to enhance the overall outcome and improve the recovery process. The goals of pre-operative physiotherapy can vary depending on the type of surgery and the individual patient’s needs.

Orthopedic surgery is a specialized field of medicine that focuses on injuries and diseases of the body’s musculoskeletal system. This includes your bones, joints, muscles, tendons, ligaments, and nerves. Pre-op physiotherapy will also aim to address these structures and their function in preparation for surgery. It will also provide you with insight and education on how to best manage your condition prior to surgery and what you may expect in post-op rehabilitation.

An Overview of the Benefits of Pre-op Physiotherapy and How It Can Help Optimize Your Recovery

Pre-op physiotherapy is particularly important prior to orthopedic surgery for several reasons:

1. Improving strength: Orthopedic surgeries often involve joints, bones, or soft tissues. Pre-hab exercises focus on strengthening muscles around the affected area, which provides better support and stability during and after the surgery. Strong muscles can also contribute to a faster recovery and reduce the risk of complications.
2. Improving range of motion: Orthopedic surgery is often followed by a period of decreased activity and can sometimes result in decreased motion in the affected joint or limb. Pre-op physiotherapy aims to improve flexibility and range of motion before the surgery, which can help restore movement and functionality more quickly post-surgery. It can also prevent muscle wasting and joint stiffness that may occur due to prolonged immobilization.
3. Pain management: Pre-hab may involve pain management techniques such as manual therapy, therapeutic modalities (e.g., heat or cold therapy), and education about pain management strategies and coping mechanisms. By addressing pain before surgery, it can help reduce post-op pain and the need for pain medication.
4. Enhancing post-op outcomes: Studies have shown that patients who undergo pre-op physiotherapy may experience improved post-op outcomes, including reduced pain, shorter hospital stays, and faster return to normal activities1,2,3. As pre-hab helps improve a patient’s cardiovascular endurance, strength, flexibility, and overall physical fitness through various exercises and activities, the recovery process can be smoother and more successful.
5. Minimizing post-op complications: Pre-hab may help minimize the risk of post-op complications, such as blood clots, infections, and respiratory issues(1). By improving cardiovascular fitness, respiratory function, and overall health, pre-op physiotherapy prepares the body to better withstand the stress of surgery.
6. Psychological preparation: Orthopedic surgeries can have a significant impact on a person’s quality of life and may cause anxiety and/or stress. Pre-op physiotherapy provides an opportunity for patients to discuss their concerns, receive education about the surgery and recovery process, and receive emotional support. This can help alleviate anxiety and improve overall psychological well-being, leading to a more positive surgical experience.

Overall, pre-op physiotherapy plays a crucial role in optimizing a patient’s physical condition and functional abilities before orthopedic surgery. It can lead to:

• improved surgical outcomes
• enhanced recovery

and better long-term results by:  

• focusing on strengthening muscles,
• improving range of motion,
• reducing complications,
• and providing psychological support(1)(2)(3)

However, the decision to undergo pre-op physiotherapy is made on an individual basis and should be discussed with a healthcare professional.

What to Expect from a Pre-Op Physiotherapy Program Before an Orthopaedic Procedure?

A pre-op physiotherapy program before an orthopedic procedure is designed to optimize the patient’s physical condition prior to surgery. The specific goals and components of the program may vary depending on the type of surgery and the individual patient’s needs. However, here are some general ideas of what to expect during a pre-op physiotherapy program and assessment.

1. Evaluation and assessment: The physiotherapist will conduct an initial evaluation to assess your current physical condition, functional abilities, and any limitations you may have. They will also identify specific areas of concern and potential risks that may influence your recovery. This evaluation may include assessing your strength, range of motion, balance, flexibility, and overall functional abilities.
2. Education: You can expect to receive education and information about your upcoming surgery, the expected post-op course, and the rehabilitation process. The physiotherapist will explain the goals of pre-op therapy and how it can help optimize your recovery specific to your case.
3. Individualized home exercise program: The physical therapist will provide you with a customized home exercise program to continue your therapy outside of the clinic. Your program will be tailored to your specific needs and will help you maintain and further improve your progress, which may include any of the following:

Common Pre-op Physiotherapy Interventions

A. Range of motion exercises

B. Strengthening exercises

C. Balance and proprioception training

D. Pain management techniques

E. Preparation for assistive devices if applicable

F. Breathing exercises

It’s important to note that every individual’s pre-op physical therapy program may differ based on their unique circumstances and the recommendations of their healthcare team. Working closely with your physiotherapist and surgeon will ensure a personalized program that addresses your specific needs and optimizes your readiness for the orthopedic procedure.

Here at Collegiate Sports Medicine, we are committed to helping our clients achieve their goals. We want to ensure that when you come into the clinic that you are educated about your injury, if surgery is a possibility for your specific injury, what to expect in the recovery process and how to optimize your recovery in the short and long-term, whether with or without surgery. By collaborating with you, our client, we act as your advocate to navigate the health care system.

References

1. Punnoose, A., Claydon-Mueller, L. S., Weiss, O., Zhang, J., Rushton, A., & Khanduja, V.   (2023, April 3). Prehabilitation for patients undergoing orthopedic surgery: A systematic review and meta-analysis. JAMA network open. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10102876/  
2. de Almeida, L. L., Mendes Júnior, A. F., Neto, J. da M., Simoni, L. F. D., Lopes, K. H. S., Guimarães, P. C., Valério, B. I. de O., & Sciascia, A. (2021, February 1). Pre-operative scapular rehabilitation for arthroscopic repair of traumatic rotator cuff tear: Results of a randomized clinical trial. International journal of sports physical therapy. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9135471/  
3. Garrison, S. R., Schneider, K. E., Singh, M., & Pogodzinski, J. (2019, May 23). Preoperative physical therapy results in shorter length of stay and discharge disposition following total Knee Arthroplasty: A retrospective study. Journal of rehabilitation medicine. Clinical communications. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008722/