21 Sep What is Prehab?
What is Prehab? At some point, there’s a solid chance you’ve asked yourself this question while experiencing our content on social media. It’s important that we define what prehab is for you and more importantly, what prehab isn’t as the term is loosely being applied to anything nowadays in the health and fitness space. In this article, you will learn what prehab actually is, the origins and expansion of prehab, and why we believe prehab is the ultimate long-term solution to your health and well being!
What is Prehab?
Prehab, also known as prehabilitation or preventative rehab, is taking the reactive strategies used in physical therapy, neuromusculoskeletal rehab, as well as strength & conditioning, and implementing these in a proactive manner with the goal of reducing the risk for injury and improving overall physical capacity. Prehab is all about learning knowledge that applies to your body and your mind and using it to optimize your life and how you experience it by practicing exposure. Prehab can help you with your daily activities, your favorite hobbies, your beloved sport, how to deal with that annoying issue that has been persisting, or an old injury that was never resolved or handled appropriately in the first place. Prehab is a legitimate preventative medicine solution for common neuromusculoskeletal problems that burden our healthcare system.
It’s our turn to define [P]Rehab! Tune in to hear our story!
How Can Prehab Help Me?
Prehab is designed to help you by empowering you with knowledge. When you educate yourself on what it is that you should incorporate in your daily routine to manage aches and pains, what is it that you are at risk for and you should be aware of when it comes to your favorite activities, and exercises you should perform to help protect your body, you’re optimizing your life with prehab. Below you will find a few examples of how prehab can help you!
What is Prehab For Someone With Back Pain?
What is Prehab For ‘Knock Knees’?
What is Prehab For The Rotator Cuff?
What is Prehab For The Entire Body?
Prehab for one person can look different than prehab for someone else, it’s something that should be individualized. In order to apply prehab, you have to understand what is it that you need to practice being exposed to! This is where our education and expertise come into play! Click here to explore [P]Rehab content for the entire body and learn how you can optimize the way you experience life!
The Origins of Prehab
“Preparation is key to success, the failure to prepare is preparing for failure.”
Throughout this article, we will discuss the expansion of prehab and how this is practiced on a variety of levels, but first, we need to recognize the history and application of prehab to better appreciate how it’s grown. Like we mentioned earlier, prehab is an attempt at preventative medicine, which has become a primary focus in efforts to decrease the burden on our healthcare system. Prehabilitation was first acknowledged in research as rehabilitation in preparation for an anticipated orthopedic surgery (aka prehab) with the goal of enhancing functional capacity. The thought was this preparation would better enable patients to appropriately handle mental and physical stresses associated with surgical procedures and post-surgery recovery. Some of the early prehab research was for joint replacements such as total knee replacements or total hip replacements. The real drive behind this research was improving outcomes and decreasing the burden on the healthcare system. If we can improve the patient’s baseline prior to surgery, theoretically the patient would rebound faster after surgery and we could save costs for the patient and the hospital by decreasing the length of the hospital stay after surgery (1).
As humans, we can appreciate the benefits you can experience by preparing. If it’s really sunny outside, you prepare by applying sunscreen to your skin but if it’s raining outside, you should prepare by putting on a raincoat. If you want to pass a test, you should prepare by studying. If you want to get stronger so that it is easier when you carry your groceries, you should prepare by lifting weights. If you want to get faster so that you can win a race, you should prepare by practicing your race distance. Prehab is preparation for your body and your mind. Prehab is practicing graded exposure with your neuromusculoskeletal system so that it is prepared for what you’ll ask of it!
Just by moving often and getting into a rhythm of exercise, our body innately becomes stronger in so many ways. Just look below at this infographic to see for yourself!
Prehab for Surgery Has Expanded
The results from early prehab research on orthopedic surgery support the idea that prehab can actually improve recovery, physical function, reduce postoperative pain, and decrease the length of the hospital stay after orthopedic surgery. However, we will also acknowledge that there is evidence that does not support prehab and notes that it is not any more effective than standard procedures for care, but it totally depended on what outcomes the research was investigating – for instance in some articles prehab did not change hospital readmissions or nursing home placement. But if we look at the balance of the prehab data out there according to one systematic review, it appears to favor total-body prehabilitation over standard care for patients undergoing surgery in ways that may result in significant cost savings through reduced length of stay and peri-operative complications (2, 3, 4).
LISTEN: The [P]Rehab Audio Experience
The fact is there have been positive benefits and legitimate value for patients that participated in prehab prior to surgery – this is huge for the medical world that is shifting their focus on preventative measures. With that being said, the scope of prehab prior to surgery has expanded and is no longer limited to orthopedics. Prehab is being utilized for cardiac, oncology, and even neurology surgeries! Also, prehab is no longer limited to joint replacement orthopedic surgery, we have seen this in our practice with arthroscopic shoulder and knee surgery like rotator cuff repairs and ACL reconstruction! The opportunities for prehab improving surgical outcomes are endless, thus we look forward to more research emerging on this topic!
Prehab for ‘Injury Prevention’
Let’s be honest, prehab is much more than something you only do before surgery! In the past few years especially, prehab has blown up in the fitness and health & wellness space. There are many reasons for this expansion of prehab, but let’s acknowledge the driving factor for this – the rising popularity of ‘injury prevention’. Injury prevention is nothing new to the sports world, but it sure is in the spotlight with terms like load management being thrown around on ESPN and athletes showing off their recovery tactics on social media! ‘Injury prevention’ is probably the most popular and debated term in the sports medicine world. It sounds sexy, it’s appealing, and damn it sounds promising for athletes, coaches, parents, and fans! There is no doubt prehab and injury prevention tactics work for decreasing the number of injuries that occur, which saves time missed from sports, work, and decreases the burden on our healthcare system (stay tuned as we dive into this shortly). But first, time for a reality check people!
The reality is we cannot prevent 100% of injuries and you should run away from anyone that promises you this…
A Framework For Understanding Injuries – It’s Complicated
Understanding how and why injuries occur, especially sports injuries, are still an enigma to the world! We cannot 100% predict when an injury is going to occur, but as time goes on we are gaining a better understanding of what contributes to injuries. As you can appreciate from the image above, understanding the contributing factors to injuries is complicated. Unfortunately in any circumstance when you want to understand why an injury occurs, you cannot narrow it down to one single factor. There are so many factors you have to consider when you analyze an injury, more importantly, you have to understand how these factors affect and influence other factors!
ACL Injury Risk Factors Are Significantly Different Across Various Sports
Injuries are tricky and messy, and that is why you’ll see some healthcare professionals get very upset and frustrated when the term ‘injury prevention’ is loosely thrown around. So we want to be extremely clear how the term ‘injury prevention’ and its connection with prehab should be interpreted. With prehab, we are reducing the risk of potential injuries by addressing modifiable risk factors and building capacity based on an individual’s needs analysis. Some will refer to ‘injury prevention’ as risk-reduction or risk-mitigation strategies, but for the average consumer, this is confusing and seems like a mouthful! So we get why people like to use the term ‘injury prevention’ and yes, theoretically we are preventing injuries with prehab! The takeaway here is injuries are not simple, but our goal with prehab is to simplify what you need to know in order to protect your body by decreasing your risk for an injury.
How To Get Started With Prehab
“An ounce of prevention is worth a pound of cure.”
The good news, prehab does not have to be as complicated as sports injuries are! Our goal is to take the guesswork out of what it is that you should be doing to prehab your body with education and exercise! According to an article by Meir et al. 2007, “Prehabilitation describes a systematic approach to identifying common injuries within a specific sport and then designing an appropriate series of exercises that work toward minimizing their incidence.” Below we will outline our systematic approach while referring to the image above as this is an excellent and simplified step-by-step process to help you get started with prehab in efforts to prevent injuries and limitations in your life!
#1 Establish The Problem
Let’s face it, the definition of an athlete has expanded and now even Google recognizes weekend warriors! The intangible price tag on health and longevity is now in the limelight more than ever, which is a great thing for humankind! With that being said, more and more people are taking their physical & mental fitness seriously and the limits are being tested on a daily basis.
The issue with testing your limit all the time is that when the demand exceeds the capacity, an injury/limitation can occur. So let’s take a step back and reflect on the problem – in this case, the injury/limitation. Is this a common injury or a common issue associated with the activity that was being performed when the problem occurred? How serious is this problem? Was there something that could have been done differently to prevent this problem or was it just an accident? What is the likelihood that this problem will happen again if there is no intervention? These are all fair questions to ask and consider! This is where education comes into play, especially with topics like minimizing injuries in youth sports and ACL injuries. In order to better understand the problem, you have to establish the causes! Remember, sometimes it may be best for a professional to determine the problem, not Dr. Google. Don’t be afraid to seek a consultation with a skilled healthcare professional!
Sample Patellofemoral Pain [P]Rehab Program Education Video
#2 Establish The Causes – Needs Analysis
In order to better understand the problem and the causes of the problem, you have to perform a needs analysis. Ask yourself the following questions:
- What is it that you’re doing? What does it require from your body physically and your mind mentally?
- What do you need in order to perform well? What type of preparation will set you up for success?
- What are the common injuries and issues associated with what you’re doing? What do you need to expose your body to in order for it to adapt and be ready?
It may be challenging for the average person to answer all of these questions, especially for those that are exploring a new sport or a new activity. It’s not your fault you don’t know this stuff, that’s our job and ultimately the goal of the [P]Rehab platform – to educate the masses!
Again, our goal is to simplify prehab for you and in some cases it is simple! It should be common sense to everyone (at least we hope) that you should practice running if you’re going to sign up for a marathon race. If you do not expose your body to the demands of a marathon race and build your body’s capacity to tolerate the stresses associated with a marathon race, you’re setting yourself up for failure because there is no preparation involved! In order to prepare yourself for success, you have to practice graded & repeated exposure. Now there may be nuisances to this and you may need to learn how to balance the stresses across your entire body to avoid overuse injuries (this is where our expertise come into play). But again, you cannot practice and prepare without having the correct information from a needs analysis! Our runner’s prehab checklist will educate you on the runner’s need analysis!
A needs analysis will help you prepare via prehab by identifying what you need to expose your body & mind to, which will better protect you against common injury causes
So what about the causes? This is where we benefit from having researchers in our field! In the case of common soccer injuries, there seems to be a correlation with poor eccentric strength and soft tissue injuries such as hamstring strains whereas with runners’s knee there are numerous risk factors that can be the problem! There are a couple of assessments you can perform to help you identify what may be causing your back pain with deadlifting or your poor performance with jumping & landing. Or perhaps you want to learn about why the serratus anterior matters with shoulder pain and what contributes to Achilles tendinopathy. Whatever the cause may be, the problem is typically due to a lack of exposure. The lack of exposure is typically due to poor identification and/or execution of the needs analysis! In efforts to avoid the problem, we have to implement a preventative measure against the causes we can affect and influence – prehab.
#3 Introduce A Preventative Measure – [P]Rehab
Prehab is a proper dosage of exposure for your life’s needs! As we discussed earlier, the definition of an athlete has expanded, and so has the way athletes train. Prehab is the revolution of periodized programming for athletes packaged and delivered to the average fitness enthusiast. It is the 21st century training style for people that desire the DIY (do it yourself) method. Prehab will teach you what it is that you should consider to minimize your risk for injury and optimize your performance, whether you just want manage aches and pains in the gym or you want to be prepared for recreational activities! Prehab is designed to increase the longevity of the things you love to do so that you can live your life limitless!
Prehab for athletes whose sports involve repeated sprints should include eccentric hamstring strengthening as hamstring strains are common with sprinting. The Nordic Hamstring Curl is the gold standard prehab exercise against hamstring strains!
Prehab for the shoulder girdle and any overhead activity should include serratus anterior exercise. Here is an excellent serratus anterior exercise to prehab your shoulders
Prehab for soccer players should include groin-focused eccentric strengthening exercises as groin injuries are common in this demographic. The Copenhagen Adductor is the gold standard prehab exercise against groin strains.
Ankle sprains are the most common lower-body injury with the highest reinjury rates. One of the biggest risk factors for reinjury is poor dynamic ankle stability secondary to impaired proprioception and balance. The Y balance exercise is a must-perform in any ankle sprain prehab program.
#4 Assess For Effectiveness
“Assess, don’t guess…”
There should always be a reason why you’re doing prehab. It may be as simple as staying active and pain-free, but the fact is you can still measure this! How many days were you not able to work out because of a problem – an injury or limitation? After sticking to a prehab program, did this change? Perhaps you’re focused on improving your ankle mobility so that you can squat deeper, did you measure your ankle dorsiflexion mobility before and after?
A sample assessment from our ankle dorsiflexion mobility program. Limited ankle dorsiflexion mobility can reak havoc through the entire kinetic chain and cause compensatory movements and strategies, which may put unnecessary stress and strain on other structures!
Assessment is the foundation to prehab, you want to make sure your time is well spent working on your goal by having a before and after measurement. That is why it is so important to assess and get baseline measurements, think back to #1 – what was the problem in the first place? When you revisited this activity, was there any change to the outcome? Was there still a problem? We know this can be overwhelming for some and you just want to be told what to do and measure, that is where our [P]Rehab Programs come into play! We have at least one if not multiple assessments for almost all of our programs!
Check Out Our [P]Rehab Programs For Your Prehab Needs!
Whether you want to prehab your shoulder or your hip, recover from a meniscus or low back injury, improve your running capacity or your ankle dorsiflexion mobility, or prepare for soccer, we got you covered with our [P]Rehab Programs! Click here to learn more about what we have to offer!
What Prehab is not
Remember, prehab is different for everyone and there should be a specific reason you’re labeling something as prehab.
Prehab is not…
- Silly exercises with misinformed intentions
- Only corrective exercises
- ‘A cool looking exercise and movement on the gram’ with that hastag #prehab
- An entertaining, yet questionable exercise on the internet
- A golden ticket to an injury & pain-free life
Prehab is a verb, its an action, its something you apply to your life, your body, and your mind in order to optimize it. There is a systematic approach to prehab and it starts with awareness, you have to educate yourself and get informed on what is relevant to you, from your job to your hobbies. Its the understanding of what are the daily demands on your body and how do you maintain the functional capacity needed in order to tolerate these demands. By doing so, you are able to physically perform anything your life asks of you, but more importantly the things you want to choose and enjoy doing.
There is one caveat to this individualized aspect of prehab, we believe there are a few core values to [P]Rehab that everyone should practice. Everyone could benefit from moving more on a daily basis to help with general aches and pains. Everyone should value practicing the fundamentals of health & wellness including sleep, hydration, eating well, and managing stress. Everyone needs to take ownership of their health and understand the difference between knowing vs. doing. You may have learned a lot exploring our content, but if you don’t practice any of it, you won’t reap the benefits. These foundations need to be in place before you even consider optimizing anything because, without the proper structure in place, it is hard to build upon.
Why [P]Rehab? Why The [P]?
The three of us wanted to see change in a healthcare system and a profession whose approach was stagnant. The average person getting injured or dealing with a setback was stuck in a reactive system. But things changed and the power of technology made knowledge more easily accessible. Its no secret to a physical therapist that a lot of what we do is educate and guide people. With the opportunity now available to educate the masses, we committed to the purpose of educating people on the benefits of prehab. Our goal is to teach you how to take control of your own health!You can learn more about us as well as what we believe in here!
Why [P]Rehab with an [P] in brackets? The P stands for prevention. The brackets symbolize prevention by trying to protect the P. However, we understand that we cannot prevent 100% of all injuries, hence it is not a full circle. However, that does not go without saying prehab is still extremely valuable, again its preparation and we do this all of the time. If a really bad storm was coming to threaten your home, would you still not prepare your home to withstand the forces from the storm? Of course you would! Protecting is human nature and you see this happen all the time. Think about the last time something can at your face full speed when you weren’t ready, what did you do? You tried protecting yourself with your hands and dodging the object by moving your head. You still may have gotten hit, but that doesn’t mean you didn’t try to protect yourself! You can listen to more of our brand story during our roundtable discussion with our team!
As we like to say, prehab is a lifestyle. Its an opportunity to improve yourself, to educate yourself, and to stay healthy. We want to provide people all over the world with the RIGHT information at the RIGHT time, regardless of their location or access to traditional health care. Health and education are two basic things everyone should have access to, and our goal is to deliver prehab to everyone around the world!
- Prehabilitation in preparation for orthopaedic surgery. Ditmyer MM, Topp R, Pifer M. Orthop Nurs. 2002;21:43–51
- Gometz A, Maislen D, Youtz C, et al. : The effectiveness of Prehabilitation (Prehab) in both functional and economic outcomes following spinal surgery: a systematic review. Cureus, 2018, 10: e2675.
- Santa Mina D, Clarke H, Ritvo P, et al. Effect of total-body prehabilitation on postoperative outcomes: a systematic review and meta-analysis. Physiotherapy. 2014;100:196–207.
- Cabilan CJ, Hines S, Munday J. The effectiveness of prehabilitation or preoperative exercise for surgical patients: a systematic review. JBI Database System Rev Implement Rep. 2015;13(1): 146-187.
- Kalkhoven JT, Watsford ML, Impellizzeri FM. A conceptual model and detailed framework for stress-related, strain-related, and overuse athletic injury. J Sci Med Sport [Internet]. 2020; Available from: https://doi.org/10.1016/j.jsams.2020.02.002
- Bittencourt NF, Meeuwisse WH, Mendonca LD, et al. Complex systems approach for sports injuries: moving from risk factor identification to injury pattern recognition-narrative review and new concept. Br J Sports Med 2016;50:1309–14
- Bahr R, Krosshaug T. Understanding injury mechanisms: a key component of preventing injuries in sport. Br J Sports Med 2005; 39(6):324–329.
- Meir R, Diesel W, Archer E. Developing a Prehabilitation Program in a Collision Sport: A Model Developed Within English Premiership Rugby Union Football. Strength & Conditioning Journal. 2007 Jun 1;29(3):50-62.