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Pre & Post Rehabilitation

Physiotherapy can help with both pre & post rehabilitation of injuries. But what is the difference between the two? How can physiotherapists help with each?

Prehabilitation of injuries

How many of us book appointments for the physiotherapist after we have an injury or spot of pain? What if we could prevent the injury before it starts? This is the idea behind prehabilitation. Instead of reacting to an injury, we are proactive and take steps to help avoid injury.

General tip to follow!

Prehabilitation is vital in preparing your body for sport, exercise and surgery. However, if approached the wrong way, the desired benefits will not be achieved. It is important to remember that muscular loading is not the same as tendon loading, isolated exercise and functional exercise can both be beneficial, and it’s easier to prehabilitate than to rehabilitate. Therefore, it is imperative that you see a physiotherapist, who will design a prehabilitation program specifically aimed at loading and working the desired structures!

Starting activity after a break

Prehabilitation is especially important if you are looking to start a new exercise program or return to exercise after an injury or a period of inactivity. It is important to make sure you are exercising in a safe and effective way, and our Pivotal Motion Physiotherapists can help with that. Furthermore, returning to exercise increases the load on your joints and muscles, and as such, appropriate prehabilitation of these areas helps minimise the risk of injury in the presence of increased load. Check out Pivotal Motion’s tips on starting back exercising!

For the older population

As we age, there is a natural decline in physical function and independence with daily living. Participating in prehabilitation has been shown to decrease the functional decline in the ageing population. Furthermore, studies have shown that improved strength and balance promotes increased physical performance, allowing for greater independence and satisfaction and improved quality of life. Check out Pivotal Motion’s blog regarding prehabilitation in the elderly! Also, at Pivotal Motion Physiotherapy, we run specialised exercise classes aimed at improving the health and wellbeing in older populations. Click here for information on Pivotal Motion Physiotherapy strength and balance classes.

Before surgery

As expected, there is always a decline in strength and function after surgery. People awaiting orthopaedic or other surgical interventions can benefit greatly from prehabilitation to improve post-operative outcomes. Research has shown that patients who participate in a prehabilitation program prior to surgery have significantly better outcomes than those who do not. There is high quality evidence that suggest that ACL reconstruction and total knee and hip replacement patients whom engaged in a specialised prehabilitation program have improved post-surgical outcomes. Initially, patients will have a reduced length of hospital stay following surgery, and functional capacity is improved at the 6 month and 2-year mark.

As a part of the prehabilitation, patient’s will begin an exercise program to ensure they maintain strength and mobility prior to surgery. As familiarity with the exercises can increase your confidence and outcomes after surgery, many of the exercises you perform will be similar both pre- and post-surgery. Prehabilitation will also include information regarding your surgery. Your physiotherapist will give you an idea of what to expect before, during, and after surgery. They will design a specific and tailored exercise program which targets the region of the body being operated on.

Post injury rehabilitation

Post rehabilitation of injuries is the process of restoring full function after injury or accident.

What happens after an injury?

Following an injury, there are 3 stages the injured tissue passes through before returning to a functional healthy status. Healing times can vary based on your age and nutrition, the type of injured tissue, and the amount of blood supply or infection in the area.

1. Acute inflammatory phase

When: from the time of the injury, up until 72 hours following the injury.

The body’s first reaction to injury is inflammation, which is a protective response. Inflammation helps contain the injury, limit further harm, destroy damaged tissue, and provide ideal conditions for healing. Inflammation is characterised by:

  • Swelling
  • Bruising
  • Redness
  • Heat
  • Pain, especially with movement
  • Loss of strength and/or movement

Swelling is very common during this phase. Increased amounts of blood and protein-rich fluid rush to the injured area, causing the area to swell.  Blood flow brings nutrients, oxygen, and cells to break down dead or damaged tissues. Protein-rich fluid brings white blood cells into the area to begin healing.

White blood cells clean the wound by killing bacteria, breaking down dead or damaged tissue, and engulfing harmful agents. They also promote the creation of collagen fibres. Collagen is a protein that forms the structure for skin, bone, muscle, and blood vessels.

As a general rule of thumb, RICER and avoiding HARM are recommended in the first 24-72 hours following an injury. However, this will not apply to all injuries, so it is always a good idea to check with your physiotherapist.

2. Repair phase

When: 72 hours to 4-6 weeks following the injury.

Dead or damaged tissue is being broken down, and new blood vessels are forming in the injured area. Collagen producing cells are also migrating to the area to form a scar matrix which helps close the wound and protect the new blood vessels. Collagen fibres are laid down very quickly and randomly, making the injured area weak and prone to re-injury.

At his time pain usually decreases substantially, so many people believe the injury is healed. It is not! This is when the injury is most vulnerable to injury, so heavy loads should still be avoided.

3. Remodelling phase

When: 6 weeks to 12 months following the injury.

During this stage scar tissue is being strengthened and reorganised. Stronger collagen fibres replace the random arrangement of original collagen fibres, strengthening the injured area. To promote a more organised and strong pattern of fibres we start to put more load through the injured area

Physiotherapists will tailor this loading to the activities and positions you require for sport, work, or everyday life. But, it can take 12 month to achieve full tissue strength and maturity.

Can physiotherapy help with prehabilitation and post-rehabilitation?

Yes!

Physiotherapists can work with patients to correct faulty movement patterns and functional issues which may predispose them to injury. Often, there is an underlying cause for why the injury has occurred in the first place and returning back to baseline is only half the job. The aim of these interventions is to correct deficiencies in your movement to restore appropriate function and ensure that there is no recurrence of the injury in the future.

Also, because of the injury, the body will compensate by trying to take load off the injured area. This can mean changes in the way you walk, go up/down stairs, sit, or stand. These compensations are to protect the injured area and avoid pain. Unfortunately, compensation can increase the load for other parts of the body. These other areas may not used to higher levels of load and can result in other injuries down the track. Physiotherapists can help manage these compensations to avoid other injuries popping up.

Whether you’re going for surgery, looking to get back into activity, or have just injured yourself, Pivotal Motion Physiotherapy can help your meet your rehabilitation goals. Ring us on 07 3352 5116 or click here to book an appointment today!

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