What we’re normally talking about is how to avoid surgery. However today the topic is going to in fact be what to do if surgery is actually your only option. Now this is assuming that you have exhausted all other options. And you’ve worked with a good physical therapist and a good body worker and people who know what they’re doing to help you avoid surgery in any way possible. We’re talking about surgeries that are due to injuries that occur over time, like chronic back pain or chronic degenerative hip pain, not necessarily injuries that are from a catastrophic accident that you in fact should use our wonderful medical system to address because we are brilliant at putting people back together. What we’re going to talk about today is if surgery is imminent, and you’ve tried everything else, what should you do leading up to that surgery? What should you be considering and not just sitting around twiddling your thumbs waiting for surgery. And this is a topic that I love. It is something that is catching on more and more. 

There are tons of articles and Instagram posts and different people that are really trying to make this a popular theme in rehabilitation and that is prehab. So instead of rehab after the surgery, we’re talking about prehab, what you can do leading up to the surgery to make it so that your recovery time after the surgery is minimized. Not only can you reduce pain and reduce recovery time, but you can improve your long term outcomes and your ability to actually reach the goals that you want to reach. A lot of people make the mistake of sitting around and waiting for the surgery to happen because they’re assuming that the surgery is going to fix the actual problem. But the important thing to realize here is that with a lot of these issues that we cover on this podcast, all the chronic back pain, all the chronic knee pain, the chronic hip pain is there because of the way that your body moves and the muscular imbalances that you have and the weaknesses that you have the reason for your pain, that root cause is still going to be there. 

At the end of the day, what the surgery is designed to fix is the thing that’s causing you pain, which is the results or the effect of all the other things that are not working appropriately that have led to you having that pain in the first place. 

So what is prehabilitation? Well, it’s actually a pretty amazing concept. It’s for people who are considering surgery or have already signed up to have surgery. I’m gonna give you a couple of examples. I had a client, she came to me probably about two years ago now. And she was having a lot of back pain and  had started seeing a chiropractor for probably about a year before she came and saw me. Her problem was that she had been going to this chiropractor and her back pain hadn’t been getting better. In fact, it had gotten much worse. And it had gotten to the point where she was feeling a little bit of instability and her hips and legs. She was feeling pins and needles in both legs. The first time that we met, we identified that the issue that she was having was something that yes, she had been trying to address for over a year, but it seemed to just be getting worse and worse. The imaging that she had done suggested that, yes, surgery might be the only thing that she would be able to do to improve this because she just had so much instability and the misalignments that she had had caused so much damage to this point that of spinal fusion was more than likely going to be the result of the outcome. 

She came to DPT to see if there was anything else that we could do, because she knows that we have a reputation for helping people actually avoid spinal surgery. So we put together a plan. She scheduled her surgery, which gave us about two to three months to work on things. The plan was if she had gotten a lot better while she was working with us, that she may look into canceling or prolonging the need for surgery. But by chance, she did not while she had done two to three months of strength training, then she had the tools she would need in order to help herself to recover to the best level that she could after surgery. 

So that was the plan and as a It turns out with this particular individual, she did end up needing to go to surgery. Now, while she was coming to see us, she had a lot less pain. She had a lot more function than she would have had if she had just sat at home waiting for this surgery to actually take place. I was happy to talk to her the other day after about two years that have passed and she let me know that what came as a complete surprise to both her and her surgeon was that she recovered in a matter of months! A third of the time that it would have taken and that surgeon was used to seeing his patients take much longer in recovery. She had returned to golfing, biking, and running in three short months with her surgeon’s blessing after a spinal fusion with no restrictions and no pain whatsoever. She’s telling me this two years later, so you know that these results are long lasting. All the targeted pre surgery PT left her body perfectly primed for that successful surgery, and awesome recovery. 

Other surgeries in your future or not, when it comes to back pain, when you do prehabilitation you can dramatically improve the lifestyle that you’re able to get back to. It’s simply amazing how much you can cut the amount of time required for your body to recover post surgically. 

Another example is a woman who came to us who was considering getting a hip replacement. She was starting her search and consulted with us and said ”Look, I’m gonna get a hip replacement and I want to do some stuff prior to the surgery because my personal trainer has told me I need to do some things beforehand in order to improve my ability to recover afterwards.” She was just starting out her search for an orthopedic surgeon who could help her with her hip replacement. She went to two individuals who practice two different approaches. She got their advice on what she would do and we started working together, she still wanted a third consult with another hip surgeon. About three weeks into us working together, we had established the plan – you’re going to get a hip replacement, but we’re going to do the exercises and the programs that we would do to help someone avoid it. We really didn’t push her on the fact that she might be able to avoid it. We try to respect everybody’s desires and wishes. When somebody has a firm belief that they’re already getting surgery, sometimes we just explore PT and see what happens as we go. As it turned out, about three weeks into her PT treatment with us this patient was no longer having any hip pain when she woke up in the morning when she walked her dog. 

She was starting to see that she might even be able to hike. She went for her third hip surgical consult and the surgeon looked at her image and said, “Yes, you have a lot of degeneration in your hip, but what I like to see is that you don’t have any pain in your function and it seems to be improving. I absolutely would not recommend surgery, regardless of what your imaging says.” He said he wanted to follow up with her in a month to see how she’s doing. As far as he was concerned, she did not need a hip replacement right now and wouldn’t recommend it. She was pretty pleased with that. I just remember the look on her face as she told us that she was starting to reconsider the entire need for hip surgery in the first place. Fast forward to about two to three weeks later, she was already doing beginning level hikes going on moderate level hikes as well, taking her dog for walks a couple times a day and really hadn’t had any hip pain whatsoever. We were able to actually start getting her squatting with weights and doing some deadlifts and hip hinging and RDLs. Things that are pretty complicated for anyone not to mention, this individual was 64 and had arthritic changes in her hip. The stronger that we get her hip the further and further away from that need for surgery she’s going to be when it comes to replacements, the longer you can prolong getting any sort of replacement, the better technology improves. Hip replacements have a lifespan so if you get them early on, you may not have to get another replacement before the end of things. The older you get those surgeries they tend to have more risk involved. 

So there you have it, there’s two cases, one in which working with us shortened recovery time and enabled someone to get back to their extremely active lifestyle after a spinal fusion. Golfing, biking and running in just three months. Now granted, you have to have a great surgeon for this type of outcome as well. Another example where we were able to completely avoid surgery 100% overall and get this person back to enjoying an active lifestyle with minimal to zero discomfort for a prolonged period. The jury’s still out on how long it will be before she ever needs to consider having a hip replacement. Again, I will always maintain that it is all about maximizing the quality of life that you have left in the years. No matter how many years you do have left. This is what we stress to our patients, making sure that whatever situation you’re going into, you have a good team of health care providers around you who you feel have your best interest at heart and who will help you develop plans like the ones we discussed in this story. 

Whether you need surgery or not, prehabilitation is going to be something that can help almost anyone. The key here is knowing that your provider is not going to push you one way or the other, but that your provider is going to help you increase the number of options that you have. That’s what it’s really about. You don’t want to be pigeonholed into having only one option – surgery or bust, or completely avoid surgery even though you’re still having a severe amount of pain. That’s also not a good approach. 

In the end, you end up developing all sorts of compensation movement patterns. You avoid doing things in life that you love because you’ve had so much pain. What you need is a balanced approach. You need providers on your side, that are giving you options and trying to give you the ability to get a moment of clarity so that you can make the decisions of what you want to do with your health. The more decisions that you have, and the more clarity you get about whatever direction it is that you’re going, the more you’re going to be able to make the right decision. You’re going to feel certain that the decision that you’re making is the one that will help you to have the ultimate outcome, which is to live a long high quality life.