PREHAB – Who, What, Where and Why?

This Blog explores what exactly PREHAB is, who it is for, where you should do it and why you should be doing it. 

PREHAB vs REHAB

It is likely you know what REHAB, or Rehabilitation is. It refers to performing exercises as part of a program designed to help restore the body back to normal function following injury or surgery. That is, back to the way it was, prior to the injury or surgery.

PREHAB, on the other hand, is still a fairly recently used (and quite fashionable) word.

PREHAB in full is Preventative Rehabilitation. This concept was established to prepare individuals as best as possible for surgery, in order to promote the smoothest recovery and rehabilitation phase following surgery, for the quickest return to normal function. For example, if someone has ruptured their ACL, it is highly recommended they undertake a thorough PREHAB program under the guidance of a Physiotherapist (and/or exercise physiologist/strength and conditioning coach). This program may focus on achieving full knee range of movement, good quadriceps and hamstrings activation and strength, and good biomechanics and function. Many orthopaedic surgeons will not undertake the reconstruction until the individual can achieve these things, with the main reason being to minimise the effects of surgery (as well as rest and immobilisation), such as joint stiffness, and muscle atrophy (wasting) and weakness.

Again, the aim of REHAB is to return the individual back to normal function, or back to the way they were prior to injury or surgery. However, it was the previous level of function (with potential predispositions to the certain injury) that lead to the injury in the first place. So, to return the individual back to where they were before may simply be setting the person up for injury again in the future. Thus, REHAB should aim to return the individual back to where they were before, as well as, fine tune things (body mechanics, strength, balance, movement quality) to bring the individual to a new level, which would allow the greatest likelihood of avoiding injury again. If you are unlucky enough to sustain injury, well then you might as well come back bigger and better than ever! Good PREHAB is paramount for this.

For a deeper understanding of this whole process, please read on…

Movement is the result of muscles acting on joints. The action of muscles is the result of conduction of impulses through neural pathways from the brain – when performed consciously, the mind-muscle connection. The nerves, in a way, are like the electrical circuitry of a house. One major difference however, is the nervous system is plastic – that is, it’s adaptable and ever-changing. These neural pathways become stronger with training. The muscles involved also become stronger, and over time, a movement being trained becomes smoother and more efficient. This can be seen when someone is learning a new skill or movement pattern.

You may have heard the term ‘muscle memory’? This suggests muscles will activate or ‘fire’ quicker and easier if they have been trained before. The process of surgery has the effect of ‘turning down the dimmer switch’ on the particular neural pathway to the muscles acting on the joint. That means it will be more difficult to activate specific muscles because those neural pathways and the mind-muscle connection has been affected.

Now, the better the joint function is prior to surgery, that is, the stronger the surrounding muscles, the better the biomechanics and the smoother the movement, the greater the likelihood for a successful outcome post-surgery.

PREHAB should be specific to the individual based on a thorough assessment carried out by a professional. The best approach is always a team approach. This will involve the Orthopaedic Surgeon, the Physiotherapist, and may include a Sports Physician and a Strength Coach as mentioned above. 

Now, this idea of PREHAB has been taken from the surgical setting to the training environment. Which is brilliant!

In this instance, PREHAB refers to an athlete partaking in specifically prescribed exercises (taking somewhere from 5-15 minutes to complete) in order to PREpare the athlete for their given sport or activity, and thus, PREvent them from getting injured.

In the elite or semi-elite sporting environment, this PREHAB is non-negotiable. The PREHAB program is designed, based on particular findings in a musculoskeletal screening carried out by the Physio. The exercises will be aimed at addressing impairments such as joint stiffness (for example, the ankle, or thoracic spine), muscle tightness (e.g. the calves or hamstrings), or poorly activating muscles (such as the glutes). Thus, exercises may include mobility exercises and dynamic stretches, as well as exercises to activate the specific muscles required for the sport or task (endless mini-band exercises and functional movements can be used).

We want to prepare the body as best as we can for the specific task.

The idea would be to perform PREHAB prior to team warm up or before jumping into your gym program. We want to switch on, both mentally and physically. We want to turn the dimmer switch UP (fire up the nervous system and mind-muscle connection), prepare the joints/muscles/tendons for what they are about to go through, and to optimise body mechanics and movement quality. The ultimate aim – to prevent injury. But it’s very easy to see how this would also contribute to improved performance.

Now yes, at the elite level, PREHAB is performed. But you do not have to be a professional athlete to do PREHAB. PREHAB would be encouraged to any individual, whatever your age, whatever your sporting level, and whatever your given sport or activity. Whether you’re playing netball for the West Coast Fever, or your local club on a Saturday. Whether you’re a Cross Fit athlete or a weekend warrior. It would be highly encouraged that you spend a minimum of 5-15 minutes performing specific movements/exercises that are preparing your body for the particular task. Now yes, everyone is time-poor, and we know you want to get to the fun stuff, but take the time to adequately prepare yourself. To get more out of your workout and prevent injury. It’s worth it. Every time.

Now, let’s take a step back and look at this holistically. In order to prevent injury and optimise performance/function, PREHAB can, and should, include all aspects of your life. For example, nutrition and hydration (what fuel are you putting in?), sleep (adequate rest and recovery) and mindset (mindfulness, focus). If any of these things are out or inadequate, it is very difficult to perform at your best, plus your risk of injury is significantly higher. Control the controllables. If you need more help specifically in any of these areas, we can point you in the direction of the right people (i.e. Dietitian, Sports Psychologist). 

In terms of what exercises…well there are endless options, but it depends on the individual and the activity/sport. The exercises should be meaningful to you, and specific to the activity. Of course, keep in mind, anything is better than nothing. But if you’re at all serious about your training (that’s not saying you’re an elite athlete, simply that you love it), it would be recommended you get the advice of a professional – be it, a Physio, or Strength coach. It’s what we do.

Your particular issues (the quiet little impairments like the stiff ankle or weak glute) will be identified, and a specific program will be prescribed to you. PREHAB exercises not only prepare you for the task at hand, but if performed consistently (consistency is key) then these things will no longer be impairments. They will become your strengths!

As always, move often and move mindfully. Put the extra work in to prevent injury and enjoy performing to your potential and feeling great! You can’t go wrong getting strong!

At Darch Physio, we do musculoskeletal screenings for athletes from specific sports including netball, football and cricket. These are the same screenings that the professionals are doing. From there, a program would be prescribed to address any areas to improve. If you want to get serious about your training, please give us a call and enquire. We would love to help you perform at your best and avoid getting injured.