By: Frederick Frost, MD
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Patients often ask me questions about “prehab,”or exercise programs they can do before an elective surgery. These questions show how exercise has taken on such major importance in people’s lives.
Often these patients are scheduled to have an elective orthopedic surgery, which can include surgery of the knee or hip. It is ironic, but for many, the decision to go forward with surgery is hinged on their inability to exercise because of musculoskeletal pain.
Regardless of what type of surgery you are having, here are a few general tips that can help before a procedure:
1. Don’t wait too long to have surgery
This is particularly true for elective orthopedic surgery. Sometimes a surgeon will tell patients, “You will know when it’s time to have the surgery.” This advice guarantees that the surgeon will have a patient who has absolutely no second thoughts about undergoing a procedure. Furthermore, any rational human being is going to hold out as long as possible.
The problem comes when patients delay surgery until they are physically immobilized by their pain. This usually happens over weeks and months, during which time the patient gets weaker and weaker.
Waiting until you are desperate with pain often means that you have become so deconditioned that your post-operative rehabilitation will be many times more difficult. Waiting too long can add weeks or months to the recovery period, and it can delay return to work and play.
2. Don’t attempt to make drastic changes in your lifestyle during the days, weeks and months before surgery
Often, we see patients trying to force themselves into better condition by an aggressive exercise program, which only results in a musculoskeletal injury. You want to avoid drastic changes in diet, activity and medications in the run-up to your surgery.
I learned this lesson well. The night before checking in for a general surgery procedure, I spent an hour shoveling our driveway during a snowstorm so that my wife would not have to worry about it. Early the next morning, I went into the operating room with the worst back strain of my life. At least that distracted me from my post-operative pain!
The days before surgery are not the best time to clean out the garage, start training for a marathon or carry the barbells to the attic.
3. Don’t think that all exercise options are out
Many patients waiting for orthopedic surgery are having too much pain to exercise on land, but they can get into a pool and walk with the added buoyancy of the water.
If you start a pool program, make sure that you know that water exercise can be deceptively strenuous on the skeleton, and on the heart. Most patients do not appreciate how hard they are working until they climb out of the pool.
If you are not a water lover, consider a stretching and gentle core strengthening program. Your trunk, belly and back muscles are the prime compensatory body parts when we try to move after surgery, protecting and guarding the surgical site.
Most of our patients are not able to do sit-ups and planks, but they can participate in a beginner-level yoga or Tai Chi class. For 25 years, I’ve been recommending the book Stretching, by Bob Anderson. Stretching can work wonders; a little added flexibility can make a world of difference when you are in the recovery phase of your surgery.
4. Don’t minimize the fact that you will need help after surgery
Even after major operations, hospital stays are very short, usually just three or four days. Recovery and rehabilitation does not occur in the acute care hospital.
In some instances, the type of medical, nursing and rehabilitation care that a patient needs cannot reasonably be provided in the home setting. Patients are moved very quickly to another site of care if their care needs can’t be met in the home. This may include a rehabilitation hospital or skilled nursing facility.
The first or second day after a major surgery is not the best time to start thinking about choosing a post-acute care facility. As surgery is in the planning stage, patients should ask their surgeon to project the types of assistance that they will need after their operation. If you will need therapy in a rehabilitation facility, it is much better to scout out your choices and verify your insurance coverage before your surgery.