Prehab used to describe pre-surgical rehabilitation but nowadays it is also used to describe preventative rehabilitation. It is widely used in human physiotherapy for things like injury prevention or to improve outcomes after surgery for anything from tumour resections, to neurological injury, to total joint replacements, to organ transplants. There is plenty of evidence for its use on humans, however, so far there is very limited evidence on it’s direct use in veterinary medicine. Pets don’t generally have long wait times before surgery, therefore more research needs to be done especially for pre-surgery prehab, in order to see if it really will reduce complications and speed up recovery. However, both forms of prehab are being used with positive anecdotal evidence in many instances within vet medicine.
Photo credit: Sydney West Sports Medicine
Regardless of the reason for it, the principles of prehab include:
Optimal medical management
Education for owners
Providing nutritional support
The main purpose of prehab prior to surgery is to improve outcomes after the operation, for the patient to be able to have a higher level of function and ability, and potentially even heal quicker.
The target areas of this period include:
Medicine – pain control and optimise general health to prepare the body for a decrease in muscle strength and fitness after the surgery.
Education – learning in more detail what is involved with the surgery, the expected recovery times and the expectations for the post-op period.
Nutrition – underweight patients are at a higher risk of complications and overweight patients are more likely to develop infections and have longer surgery times.
Psychological – occupying the animals mind while they are painful and decreasing stress, able to acclimatise to the rehab facility (e.g. underwater treadmill) to make the post-op rehab slightly faster.
Exercise – improve mobility, stability, and strength, as well as reducing compensations throughout the body.
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Some common conditions that could benefit include:
Likely before a total joint replacement to strengthen the area or to acclimatise before something like an arthrodesis/joint fusion. A period of prehab may help the patient become a healthier weight, improve range of motion of the joints, and improve compensatory issues.
Cranial cruciate ligament rupture (CCLR):
Possibly not the best thing for most cruciate cases as weight bearing on the unstable joint will quicken the progression of OA. However, it could benefit patients that are obese and have other conditions like endocrine disorders, cardiac conditions, or those that have cruciate ruptures on both legs at the same time. These types of additional conditions generally delay surgery anyway and so a period of prehab would likely benefit these cases (hydrotherapy would be ideal).
Lumbosacral (LS) disease:
Probably most beneficial used in cases of pain rather than pain on top of significant neurological signs as these cases require surgery more imminently. Prehab will help to improve strength and muscle mass of the back and hind limbs that tend to diminish with this disease.
Type II disc disease or intervertebral disc protrusion (IVDP):
May help with the pain and weakness associated with this disease, especially in older, larger breeds where surgery might be delayed.
Could be done even if not undergoing an elective surgery, as obesity would potentially cause a delay if they needed a surgery in the future. For patients that are undergoing elective surgery, obesity increases the risk of anaesthetic and surgical complications. Therefore, a combination of reducing calorie intake and increasing exercise (where appropriate) can reduce weight and reduce these risks.
Prehab in this sense includes implementing different strategies that are used in physiotherapy, rehabilitation, and strength and conditioning, in more of a proactive manner. The goal being to reduce the risk of injury and improving overall physical capacity. This is as much about educating and empowering yourself as the owner, as it is about any fancy exercise. What prehab is not, is a magic key that will prevent 100% of injuries or a cure-all for sources of pain, unfortunately, neither of these exist.
This type of prehab can be used as conservative management, where surgery is not an option at a particular moment in time due to the disease being more mild, the condition of the animal, or financial restraints. Therefore, this could be for the management of a lot of the conditions mentioned above. The principles mentioned at the start all apply here too in a similar way to the pre-surgical group. For example, mild hip dysplasia, physiotherapy can be used here to maintain good and comfortable range of motion, reducing compensatory changes, whilst providing information on how you can manage the condition at home, manage their exercise and weight, and reduce the severity of the condition as the dog ages.
Another application of this is in the canine athlete. Depending on the job or sport the dog is doing, there are different injuries that can occur due to the demand placed upon the body’s tissues (which we’ll cover in a subsequent blog!). Utilising a period of prehab can provide you with the knowledge of what the common injuries are, helping achieve optimal nutrition for an athlete, and medical management if an injury does occur. Of course, exercise plays a huge role for athletes and as well as providing strength and conditioning advice, a rehab professional will be able to help you with a protocol for “injury prevention”. This requires in depth knowledge of the activity in order to be able to evaluate the likeliness and severity of common injuries associated with it, and establishing how it occurs within the activity. They will then be able to introduce a preventative measure that will help expose your dog’s body to appropriate stresses to develop positive change (including adequate rest!) and allow them to adapt and be ready for the challenges of their sport. This will then need continual assessment to make sure we are achieving what we set out to.
Whilst at this point, prehab is not an exact science and is different for every patient, hopefully this has shed some light on what prehab is and how it can help. Hopefully it will also help you to not despair if your dog does become injured, there is help out there and whilst for many conditions surgery is vital, for others, we might be able to achieve a good quality of life without it.
Until next time,