What is Prehabilitation?

Prehabilitation also known as preoperative rehabilitation is the practice of enhancing a patient’s functional capacity before surgery.

What is the purpose of prehabilitation?

The aim of prehabilitation is to improve postoperative outcomes. There have been multiple published studies which have shown patients who undertake a prehabilitation plan experience less postoperative pain and complications and experience earlier recovery and discharge from rehabilitation facilities compared to patients who don’t undertake a prehabilitation plan.

How long does the prehabilitation plan take?

It may take a surgeon between 4-6 weeks to make a decision to proceed with surgery which leaves the patient with a great opportunity to participate in a prehabilitation plan. However, we have seen patients who have had the luxury of scheduling in a date for surgery 3-4 months in the future, giving them more time to participate in prehabilitation. There isn’t a blueprint, rather it is created based on the specific case.

What is our approach to prehabilitation?

A good prehabilitation plan should include not only physical exercises to optimise strength, endurance, flexibility, mobility and proprioception at the affected and surrounding joints but also include medical advice, nutrition and psychological support with a multimodal approach being the most beneficial for the patient.

What is Post Operative Rehabilitation?

Post Operative Rehabilitation is the plan of management for a patient following a surgical intervention for a musculoskeletal condition.

What is the aim of Post Operative Rehabilitation?

There are several aims of Post Operative Rehabilitation including the optimisation of patient recovery following a surgical procedure, successful return the work and leisure and a return to patient’s prior level of physical function.

How long does the Post Operative Rehabilitation plan take?

This can vary from case to case based on a number of factors including but not limited to the surgical procedure itself e.g. a hip replacement, patient’s healing ability e.g. chronic conditions like diabetes can hinder and delay healing capacity, smoking history, participation in a prehabilitation program and integrity of operated structures prior to surgery.

What is our approach to Post Operative Rehabilitation?

We understand that surgery and the need for post operative rehabilitation isn’t someone’s first choice when it comes to injury management, however sometimes surgery is the best option. Then if only you were able to recover 100% after leaving the operating theatre. Studies have shown that it may take between 6 weeks to 12 months to obtain optimal function post operation.
A graded program of specific exercises and goals are individualised to your case as you progress through different stages of healing. We have seen in the past that we can have two different patients presenting after receiving the same surgical intervention and their plans were quite different due to a number of factors. Another important fact which must be considered is that after surgery, you may not be able to obtain 100% function at the post operative joint, ligament or tendon, which in some cases may be normal, but we will try to get you as close to 100% as possible.

What is rehabilitation?

Rehabilitation is the restoration of proper joint function and form. It comes from the Latin prefix re = again and habitare = make fit.

What is the aim of rehabilitation?

The aim of rehabilitation is to limit the extent of the injury, reduce or reverse the impairment and functional loss, and prevent or eliminate the disability.

What are sports injuries?

Sports injuries are injuries that tend to occur during sports participation, training or competition. Sports injuries can occur through all levels of sport from novice competitors to professional athletes.
These injuries are generally in the from of soft tissue injuries affecting ligaments, muscles, tendons, connective tissue, joints and nerves.

What are some contributing factors to sports injuries?

Athlete factors

• Strength, endurance and conditioning
• Previous Injuries
• Technique
• Nutrition and hydration
• Psychology

Sports factors

• Contact vs non-contact sport
• Repetitive loads e.g. Tennis or running
• Awkward movements e.g. side stepping or cutting
• Load management e.g. over training

Environmental factors

• Surface e.g. AstroTurf
• Weather
• Distractions
• Other athletes

What is our approach to sports injury rehabilitation?

When managing the injured athlete we need to consider not only the presenting injury, we must consider the patient profile be it physical and mental, patient goals and expectations as well as patient understanding and compliance.
Our primary goals when rehabilitating the athlete is to reduce pain and swelling, improve mechanics and return the athlete to pre-injury status in as little time as possible. As practitioners, if we are unable to beat the natural healing cycle of an injury, then we have failed the task at hand.

There will always be a form of passive care applied in the earlier stages of recovery which may include but isn’t limited to soft tissue therapy, dry needling, cupping, mobilisations and manipulation.
Active care is also encouraged from the initial presentation with key focuses on flexibility, strength, stability, balance and proprioception.
General injury management advice is provided e.g. application of ice or heat and bracing to allow for the injury to further heal and to minimise breakdown of surrounding structures.

When managing an athlete, it is important to identify when co-management with another practitioner is required e.g. a general practitioner, orthopaedic surgeon or psychologist. If this is the case then a referral will be organised to optimise the athlete’s recovery.

What is Dynamic Neuromuscular Stabilisation (DNS)

Dynamic Neuromuscular Stabilisation or DNS as it is often referred to as is a newer manual rehabilitative approach used to assess and treat certain conditions affecting the musculoskeletal system including nerves, joints and muscles.

What is the basis behind DNS?

During the early development of an infant, there are certain movement patterns that are formed as the central nervous system matures which allows the infant to control posture, lift their head up, grasp a toy, roll, crawl, sit etc. These movement patterns will normally automatically occur in a particular sequence as the central nervous system matures. The brain influences development of these movement patterns, which in turn, influences development of bodily structure.
Certain factors may influence the disruption of some of these movement patterns e.g. sport or work injuries, prolonged overloaded postures, osteoarthritis and joint replacements to name a few. DNS is then utilised to help ‘re-acquaint’ the brain to the body and the body to the brain through these movement patterns we inherited as an infant.
We think about how functional an infant or toddler is with the depth and control of their squat position, this can once again be achieved later in life.

How is it applied in the clinic?

It all starts with the ‘core’ or sagittal stabilisation, which is dependent on the diaphragm’s ability to create sufficient Intra-Abdominal Pressure, while still performing its breathing function. Basically, it isn’t just about tightening the core, rather working to normalise one’s breathing pattern which in turn will help with stabilising the core from inside out through the creation of this intra-abdominal pressure. The core is defined as the centre of a mass, hence if the core is stabilised then movement around it can be easily normalised.

Who is a good candidate for DNS?

Anyone and everyone can benefit from DNS. There is strong research and clinical evidence that lower back, neck, shoulder, hip and knee pain is more prevalent in those individuals with a reduced ability to activate and maintain control of their core. We have seen great results in pre-natal and post-partum patients, post operative patients, osteoarthritic patients and patients who suffer from chronic niggling injuries.

DNS is heavily utilised in our practice and can be applied at almost any stage of the rehabilitation process. We can utilise passive therapies such as soft tissue therapy, trigger point dry-needling and mobilisations prior to the use of DNS but the ultimate goal would be to shift from the passive care model being ‘hands on’ to the active care model where you as the patient are empowered to manage the injury or ailment through some of the DNS exercises. After all, motion is lotion.

What is Dry Needling?

Dry needling is a technique that is fast gaining appreciation in the manual therapy realm. It involves multiple advances of an acupuncture-type needle into the ‘trigger point’ of a muscle. The aim is to achieve a twitch in the muscle, which is associated with reduced muscle tension and pain.

How does dry needling help?

Dry needling helps to reduce pressure on the nerve by releasing muscle shortening. It is now well researched that the twitch response in the muscle during dry needling is associated with the release of the body’s own anti-inflammatory mediators which may help relax and stop the tension on adjacent areas.

What are the benefits of dry needling?

The benefits include but are not limited to;
1. Acceleration and promotion of your body’s natural healing processes
2. Pain reduction
3. Increases blood flow and oxygenation
4. Decreases muscle tension
5. Improvements in range of motion
6. Improvements in recovery period

Which conditions can dry needling help manage?

The current literature states that there are a number of conditions which can be managed with the use of dry needling as a sole form of therapy or as an adjunctive form of therapy. These include but are not limited to;

• Neck and lower back injuries
• Nerve entrapments or dysfunctions
• Myofascial pain and discomfort
• Cervicogenic and tension headaches
• Tendinopathic injuries
• Ribcage related injuries
• Temporomandibular (jaw) joint disorder
• Frozen shoulder
• Rotator cuff injuries
• Tennis and golfer’s elbow
• Runner’s and jumper’s knee
• Plantar Fasciitis
• Degenerative arthritic conditions
• Fibromyalgia

What will I experience?

The needles used during the procedure are very thin and you may not feel the needle enter your skin. If the muscle being needled is tight or sensitive then you may feel a cramping or a twitch sensation. This is very short-lasting and patients soon learn to recognise this sensation as therapeutic as it is followed by a feeling of pain relief and muscle relaxation. Post treatment response may differ from patient to patient.

Are there any side effects?

The most common side effect is temporary muscle soreness after the treatment. Muscle soreness in the area of needling may be felt for up to 24-48 hours following the procedure and your treating practitioner will instruct you on how to minimise the soreness. There are other less common side effects such as bruising. Please consult with your treating practitioner if you have any further questions about side effects of dry needling.

Taping is commonly used as an adjunct to manual therapy. Tapping is used to treat acute and chronic musculoskeletal conditions e.g. joint instability, as a means of rehabilitation or prophylaxis in instances where support or stability are needed and to protect an injured structure while healing is taking place.

There are various taping techniques which serve their specific purpose. The most common form of taping is rigid taping which is primarily utilised to prevent or reduced likelihood of injury. The application typically begins with some under-wrap to reduced skin irritation followed by rigid tape over the under wrap on the area of concern. Each joint has its own taping protocol. The intention is to keep the area of concern in a stable and specific position while allowing the individual to participate in their activity of choice.

Another form of taping that has gained popularity is Kinesio taping. We commonly see this taping technique utilised in basketball, tennis, athletics and rugby. Kinesio tape is designed to mimic the elasticity of the skin and is intended lift the skin in an attempt to promote lymphatic drainage which may help with a reduction in pain.

Mulligan taping which is another form of rigid taping and McConnell taping more specific to the knee are also commonly utilised taping techniques in the clinical and sporting setting to help stabilise and improve joint positioning in an attempt to normalise movement and decrease pain.

What is Soft Tissue Therapy?

Soft tissue therapy encompasses a large variety of hands-on treatment, one of which is massage. Massage is simply part of the larger spectrum of soft tissue therapy.

Does soft tissue therapy refer to the pressure being applied during the therapy?

Soft tissue therapy does not refer to the pressure being applied, but refers to the structures that are being targeted which include muscle, tendons, ligaments, fascia, nerves, blood vessels and skin.

What are the benefits of soft tissue work?

There are a number of benefits of soft tissue work which include but are not limited to:

• Reduction of inflammation of muscles, tendons, ligaments, fascia and connective tissue
• Reduction of muscle spasm and tension
• Improved blood circulation and oxygenation to soft tissues
• Improved range of motion and joint flexibility

What are some conditions that may benefit from soft tissue therapy?

• Acute and chronic muscular injuries
• Lower back and neck pain
• Headache stemming from the neck
• Shoulder stiffness
• Forearm pain from repetitive injuries e.g. tennis elbow or mouse over use
• Calf and hamstring strains
• Certain osteoarthritic conditions

Postural Analysis

Postural analysis is the visual assessment of the musculoskeletal system with the aim of assessing structural bony landmarks. The assessment should always be performed as a component of the physical examination.
When observing the musculoskeletal system, the comparison of the symmetry of bony landmarks in context with evidence of muscle tightness or weakness will aid a practitioner in the conclusion of a potential diagnosis.
The postural analysis is almost always performed during the initial consultations and recorded using a diagrammatic representation of findings. This can then be repeated at subsequent consultations as a quick re-assessment tool.

Gait Analysis

Gait analysis is another powerful investigative tool which is clustered with postural analysis, patient examination and history to help assess and diagnose musculoskeletal disorders.
Gait refers to the manner in which a person walks. Normally, walking is a very efficient biomechanical process which requires little use of energy. Injury and pathology often result in a significant decrease in the ease and efficiency of walking. This may then result in the development of compensatory walking strategies which can cause tightness of some muscles and weakness of others.

When dealing with athletes, understanding their structure and movement can help optimise performance through a detailed customised rehabilitation plan to further improve athletic performance.

Identifying asymmetries during a postural or gait analysis in an un-symptomatic patient might prevent an injury from occurring if identified earlier in the piece and addressed accordingly.

If you have any questions about postural or gait analysis please get in touch or ask us during your next consultation.