Why Physical Therapy Before Surgery

Why Physical Therapy Before SurgeryTraditionally, before surgery, people are asked to make basic lifestyle enhancements like stopping alcohol or smoking, reducing saturated fat/salt and/or increasing physical activity above sedentary levels.

This is not enough if you want to get the most out of surgery.

More and more in the last ten years, people are going through physical therapy before surgery as well as after.  In the medical research, this is called “prehabilitation” and can help improve surgical outcomes related to:

  • Joint replacement (BMJ Open 2016)
  • Lung cancer (British Journal Surgery 2010)
  • Heart bypass (International Journal Cardiology 2009)
  • Aortic aneurysm (BMJ Open 2014)
  • Rectal cancer (British Journal Anesthesiology 2014)
  • Spine, especially stenosis (Clinical Rehabilitation 2010)
  • Bowel resection (International Journal Surgery 2013)

Overall, patients who completed 4-8 weeks of exercise-based physical therapy before the aforementioned surgeries experiences quicker recovery time, shorter hospital stay, fewer surgical complications, less pain, less depression, greater fitness after surgery and improved quality of life compared to those who didn’t. 

To achieve such benefits, however, the physical therapy program implemented before surgery must be effective enough to yield benefits in a short time and avoid aggravating your condition.  After all, you are preparing for surgery!

The prehabilitation physical therapy program must consider how often, how hard, how long, what type of exercise and how quickly you can be progressed safely.  The physical therapist must develop on a program that you can perform on your own, whether at a health club and/or home.  A patient who does not have access to exercise equipment can still engage in prehabilitation physical therapy, but this requires a more skilled physical therapist to develop a program that does not require equipment.

A common problem: some surgeons still erroneously believe that advanced chronological age has a “cause and effect” relationship to increased risk of having surgery (European Journal Sports Medicine 2012).  In other words, if you’re 80 years old, assumptions about your health are made regardless of lifestyle, which can lead to unnecessary surgeries, over medication and overuse of medical resources.

This perception is slowly being replaced by a focus on specific measures taken on the patient before surgery, such as how frail the patient is, their mental capacity and degree of muscle wasting as a result of their condition (Anaesthesia 2014).

Another common problem: surgical/medical personnel fail to educate and motivate patients on the importance of completing a physical therapy prehabilitation program before surgery.  This may be due in large part to not being familiar with what research shows in this regard, as physical therapy/prehabilitation is relative a relatively new concept in optimum surgical management of patients.  Regardless, sometimes is it necessary for a patient to educate his/her medical staff to protect his self-interests.  If the medical staff takes offense to this, get a second opinion as this is a red flag that ego may be trumping sound medical care.

If you’re preparing to undergo surgery, talk with your surgical team and request that they set you up with a physical therapist who can customize a prehabilitation program for you.  If they are not willing to do so, go online and fine a physical therapy group near you, as a referral is not necessary in most states.

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