Ask the Experts: The Benefits of Prehabilitation to Prepare for Spine Surgery

If you asked someone the question ‘why do you do rehabilitation after spine surgery?’, you would probably get an answer within 30 seconds. It’s pretty common knowledge that after any type of orthopedic surgery, it is essential to undergo rehabilitation to restrengthen the areas of your body that were affected by surgery. But what most patients overlook is prehabilitation to properly prepare for spine surgery.  

Prehabilitation is a valuable resource that many patients are unfamiliar with, and as a result don’t utilize before surgery. It is a proactive approach for advancing the recovery process, and can significantly shorten healing time. At VSI, we believe that physical therapy through our spine-specialized physical therapists, is vital to the overall success of your treatment to get you back to a pain free life. 

With our unique total wellness model, our spine surgeons and physical therapists work hand-in-hand with our patients throughout the whole treatment plan, ensuring the most effective results for each patient. To give you a multi-dimensional look at prehabilitation for spine surgery, we asked a Spine Surgeon and a Physical Therapist about the benefits of prehabilitation. 

Insight from a Spine Surgeon – Dr. Colin Haines:

Which Cases Do You Recommend Your Patients Undergo Physical Therapy Before Spine Surgery?

With 90% of our patients successfully treated non-surgically, it is our philosophy that physical therapy comes before any surgical discussion. We use physical therapy as an initial treatment option with the goal being to eliminate the patient’s pain and regain functionality before getting to the surgical treatment route. There are times where we don’t use physical therapy before going straight to surgery, but that is few and far between. That path is generally reserved for those patients who show significant symptoms of a spinal condition where, if not treated quickly, they could have permanent physical impairment.

Why is Physical Therapy so Important as Your Patients Prepare for Spine Surgery? Or in General, as a Treatment Option Before Proceeding with Spine Surgery?

Physical therapy is so critical to the success rates of surgery because, while surgery may fix the bones, the joints, and the nerves, we still have the muscles to be so critically concerned about.  Physical therapy is what loosens the muscles up. It simultaneously makes them stronger and allows the structural building blocks of your spine (the discs and the bones) to work more effectively.

What are Your Goals for Patients Who Undergo Physical Therapy? 

With physical therapy being an initial treatment option, the goals are: complete symptom resolution and complete functionality. If that is not the outcome from physical therapy, then the best take away leading into surgery is that the patient has loosened up their muscle and gained strength through physical therapy. This is crucial for post surgical recovery while your spine is healing.

What is Unique About Your Partnership with Spine-Specialized Physical Therapists?

We make each other better. I learn from them, and they learn from me. We’re able to co-manage patients to give them the best care possible, both pre-surgically and post-surgically. For the patient getting to the point of needing surgery, I am able to gain insight from their physical therapist so we can determine if physical therapy should continue or if surgery is the next step. And for the patients who had surgery and are now doing rehab at VSI Physical Therapy, the physical therapists and I can work together to more effectively rehab them – thus getting them back to their life faster. 

How Have You Seen the Outcomes Differ From Patients Who Have Done Physical Therapy Beforehand, Versus the Patients Going Straight Into Surgery?

If someone’s muscles, joints, and ligaments are not optimized before surgery — it’s a tougher recovery, there’s no doubt about it. Ideally we want people’s soft tissue to be optimized through physical therapy before we undergo surgery itself. For those who have completed physical therapy, they show more control over themselves during surgical recovery. This is because of the strength gained through prehab, which allows the spine to work more effectively while healing.

Insight from VSI Physical Therapy:

Explain What Prehab is, and the Mental Benefits.

Prehabilitation or “prehab” is a guided exercise and educational program for patients scheduled to undergo orthopedic surgery. There are multiple benefits to prehab. Research shows prehab produces better surgical outcomes and a decreased hospital length of stay.¹ Patients also report prehab eases concerns leading up to surgery and helps them feel more prepared for the postoperative rehabilitation process.

How Soon Before my Surgery Should I Start Doing Physical Therapy?

Research supports starting prehabilitation two months or more before a scheduled surgery.¹ It is recommended that patients begin a prehabilitation program early enough to gain strength, increase functional abilities, and learn about the recovery process after surgery. 

What are the Differences in Recovery Outcome if I do vs. Don’t do Prehab?

While surgical outcomes vary depending on a variety of factors, research shows prehabilitation produces better outcomes and higher patient satisfaction.  One study of patients undergoing spinal surgery showed prehabilitation patients had improved function on the day of surgery, reached recovery milestones in half the time, and left the hospital earlier when compared to patients who did no prehab.¹ These findings suggest that doing prehab before surgery will result in a faster recovery and increased functional abilities. 

I’m Already in Pain — How Will I be able to Exercise Before Surgery, and What if it Makes it Worse?

Most patients scheduled for surgery are dealing with a considerable amount of pain and may feel prehab isn’t appropriate for them.  Fortunately for these patients, our physical therapists are experts in exercise prescription and have a plethora of exercises available to find the most appropriate prehab routine for you.  With our state of the art aquatic treadmill we also have the ability to incorporate aquatic therapy into your prehab process if land-based therapy is intolerable.  Our therapists are able to strike a balance between keeping you comfortable and getting you ready for surgery.  

What Makes VSI’s Treatment Unique?

Our patients at VSI Physical Therapy routinely speak about how comforting it is to know that their therapist is in direct communication with their spinal surgeon. The physical therapists are experts in postoperative spinal rehabilitation. Our team approach to your recovery ensures that everyone stays on the same page throughout your entire rehabilitation. Should a concern arise, the ability to communicate with your surgical team quickly and openly means less time waiting for a response and fewer office visits overall.

(1) Nielsen, P. R., Jørgensen, L. D., Dahl, B., Pedersen, T., & Tønnesen, H. (2010). Prehabilitation and early rehabilitation after spinal surgery: randomized clinical trial. Clinical Rehabilitation, 24(2), 137–148. https://doi.org/10.1177/0269215509347432