The importance of Prehab: how to prepare for knee surgery

If you’ve suffered a serious knee injury and are awaiting surgery, the temptation may be to wrap yourself up in cotton wool and rest the knee as much as possible until the big op. New thinking, though, is that ‘prehab’ can be key to ensuring a rapid recovery and return to play.

In a 2013 study published in the American Journal of Sports Medicine, researchers looked at the effect a six-week exercise programme had on patients about to undergo ACL reconstructive surgery compared to a group that underwent no preparation. Twelve weeks after the operation both groups were tested for strength, function and patient outcome and the group that had undergone prehab were found to have better function and patient outcome and, significantly, returned to sport earlier than the other group.

Thankfully, the benefits of prehabilitation – a programme of therapy that not only physically prepares the client for surgery but also puts them in the optimum frame of mind to deal with whatever the procedure throws at them, with the goal of getting them back to their peak in the earliest time possible – are becoming better known.

While an extended period of RICE (rest, isolation, compression and elevation) is a given during the pre-op period, it’s also essential to introduce an element of low-level exercise. Not only does it strengthen the knee, increase flexibility and help the patient recover faster, it also gives them the feeling that they’re actually doing something to get back on track.

Mental preparation is key

There are numerous exercises that are suitable for an injured athlete to prepare themselves for surgery, and an orthopaedic surgeon such as Mr Jonathan Webb will work closely with the physio team to design a programme that will work best for the specific injury. But it’s equally important to consider the mental state of the client, because they’ve suffered far more damage than an injured knee.

Whether the client is a professional player or a hobbyist, they’re someone whose life revolves around physical activity. In a lot of cases, their sporting activity is more or less who they are. If they’re a pro, their career can be on the line, and they could be forced into thinking about giving up what they’ve spent a considerable part of their life on sooner rather than later. Even if they’re a weekend player, they have to consider giving up the activity they love, or at least being forced to spend a long time away it. In both cases, there’ll be a sense of disconnection: a feeling that they’re letting their teammates – and themselves – down.

Allay fears, set realistic goals

Obviously, this isn’t the optimal state of mind to be in when preparing for surgery, and prehab is the best way to counter that. The patient can become realistic about the timescale of recovery, with the goal of eliminating any frustration and demotivation that can occur both before and after surgery. It can also allay any fears the patient has. Most importantly, it can make them feel part of the team at a time when they feel they’re holding the rest of the squad back.