Melanie Cole, MS (Host): Welcome to Bryan Health Podcast. I'm Melanie Cole. And here today to talk about pre-surgical rehabilitation is Amberly Byington. She's a physical therapist and Administrator at Prairie Orthopedic and Plastic Surgery.

Amberly, thank you so much for joining us today. Can you please start by giving us a little background on the many uses for physical therapy.

Amberly Byington: Sure. Thank you for having me. Whether somebody has been injured, somebody's had chronic pain, or somebody is getting ready to go to surgery or recovering from surgery, we can do all sorts of different services for those clients.

Specifically, when it comes to rehabilitation after surgery, we can help with things like pain control, swelling, helping the patient just get through those initial stages of where things can be kind of overwhelming. And then, we always take into account the goals that patients have as far as what they want to get back to doing. So, that differs if somebody is younger, like a teenage athlete versus somebody who's maybe in their sixties or seventies, those goals that they have for return to their prior level function are going to differ.

Melanie Cole, MS: Well, thank you for that. So then, tell us about pre-surgical rehab or prehab, why it's so important. What are some of the benefits of this?

Amberly Byington: Yeah. So if we just look at the word itself, so prehabilitation means before whereas most people hear the word rehabilitation, which is more after insult or injury. So, the prehab, some specific examples of why that is helpful. Let's take the younger person, maybe a teenage athlete who has torn their ACL. And that injury is going to cause swelling, dysfunction, disuse, some walking or gait abnormalities. And oftentimes, it's helpful if we can get those clients in for a few sessions to actually explain what the injury was, if they're going to have a reconstructive surgery, what to expect from that surgery, and then actually work on specific exercises and interventions to help with optimizing function, muscular function, walking mechanics, balance. And then, giving them an idea of what to expect after surgery, because the rehabilitation after surgery is quite a few months for that type of injury.

Now, if we have somebody perhaps with knee osteoarthritis who is going to have a knee replacement, oftentimes depending on how bad the situation has been for them, their dysfunction can be pretty extreme. So, maybe their pain and the osteoarthritis has limited how much movement they can do, and so we can actually help get them moving a little bit more beforehand just to get them stronger before the surgery. So, in either of those scenarios, we can kind of get their body, mind, ready for surgery. We can check their baseline functioning, so strength, balance, range of motion, also their emotional status as far as like how they're dealing with this upcoming surgery, and how they're doing if they had a previous injury. We can give them expectations for surgery. We can increase just a general activity level if they've been inactive.

As we do all these different things, a lot of times will help with their recovery time, like decreasing their recovery time. We can instruct and educate them on how they will do postop and what to expect postoperatively. We can also give them advice on how to deal with that initial postoperative pain, so we're talking like one to seven days after surgery, different tactics to help minimize pain. We can give them advice on maybe changing some risk factors to make sure that optimal healing takes place. Better on the way in, better on the way out. So if we can give them and arm them with all this information, a lot of times that makes them feel a little more at ease going into the process of surgery.

Melanie Cole, MS: It's such an important part of recovery that people don't often realize. Now, you've been mentioning knees and hips and things, but what about other types of surgery? If somebody is going in for really any kind of surgery, the importance of prehab, are there other surgeries for which this could be beneficial?

Amberly Byington: Sure. So if somebody has had like a chronic ankle sprain situation or they've had multiple instances of some foot ankle instability, that same scenario could apply to them if they're going in for like a ligament reconstruction stability type of surgery for their foot and ankle. The shoulder, same type of thing, if somebody's had rotator cuff problems in their shoulder or if they have any osteoarthritis there, a lot of times if we can get somebody going on the correct exercise program, maybe even just three to five exercises that they could do at home on their own to start, for example, increase the activity and the strength of their scapular or shoulder blade muscles, because those muscles are part of the shoulder complex. So, just teaching them a few exercises to work on at home is very helpful in that situation as well for the shoulder.

Melanie Cole, MS: Tell us what an appointment with you is like. What kinds of things do you do for prehab to prepare for surgery? What does it entail? How long are the appointments? What kinds of exercises do you do? That sort of thing.

Amberly Byington: We have an hour evaluation for each new client. During that evaluation, we examine the systems that we're working with. If it's a shoulder, we'll make sure that we screen the neck, the shoulder and the mid-back regions. We make sure we're looking globally at the patient in that area. So during that examination, we'll look at their impairments. Do they have decreased range of motion, decreased strength? Where is their pain located? Are there certain muscles that are involved, trigger points, myofascial restrictions?

Then, we will also ask the patient what their goals are. We always try to save some time for patient education and some treatment. So, that may include things such as some self-tissue mobilization, tactics for home for some pain control, some exercises related to posture, like once again, if it would be before a shoulder injury. And then, we can talk about the immediate postoperative stages just to help those patients be more comfortable with their pain control. That would be the first visit.

And then, based on how much we need to work on it and the timing between when we visit with the patient and when their surgery is going to be, that's going to dictate it. Could we get a lot of work done in two to three sessions? Do we need just the one session? Oftentimes, not very many sessions are needed.

Melanie Cole, MS: Amberly, how much in advance of surgery do you recommend people start using prehab services?

Amberly Byington: It depends on the diagnosis. But I think for most people, it's best if it's closer to when the surgery is going to be so it all can kind of sink in and make sense for them. If they start too early, they may lose a little bit of their zest to keep doing what we've asked them to do. So if I use the example of the ACL reconstruction, we may see them approximately four to six visits beforehand to get them going on their program. And oftentimes, the surgeon will then decide when surgery needs to be, if there was a lot of swelling in the knee. So, there's a couple of factors that influence the timing of that situation, if somebody's going to have a knee replacement, a hip replacement, or a shoulder surgery. And maybe they're in their later years of their life, they may benefit from a handful of sessions, you know, even just a few weeks before their surgery is scheduled.

Melanie Cole, MS: Thank you so much, Amberly, for joining us today. And to listen to more podcasts from our experts, please visit bryanhealth.org/podcasts. And that concludes this episode of Bryan Health Podcast. Please always remember to subscribe, rate, and review Bryan Health Podcast on Apple Podcasts, Spotify, iHeart, and Pandora. I'm Melanie Cole. Thanks so much for joining us today.