Introduction to Pre-habilitation and How it Relates to Golf (Part 1)
“An ounce of prevention is worth a pound of cure.” – Benjamin Franklin
The emerging concept of “prehabilitation” (prehab) essentially blurs the lines between traditional preventative medicine (delaying/avoiding disease with “healthy living”) and acute care (directly treating symptomatic illness) by cramming preventative measures like weight loss and aggressive chronic disease management into the weeks leading up to a major medical procedure. Procedures like major surgery or chemotherapy place stress on the body, and taking the time to intensively prepare provides many potential benefits including fewer complications during treatment, fewer side effects after, and a faster return to regular life. As Mosaic Golf and Admire Medical begin a series of articles that will incorporate prehabilitation into golfing-specific injury discussions, the best place to start is by providing a baseline of understanding.
“Preventative medicine” covers the kinds of conversations that take place in an annual check-up between a patient and his or her primary care physician, the highlights of which are that exercise, weight loss, and cutting back on alcohol and tobacco will lower the risk of developing/worsening chronic diseases. However, without a discrete reason for motivation, change is hard- especially if it involves giving up life’s pleasures that family and friends continue to enjoy. In such a situation, struggling individuals tend to rationalize this behavior by referencing a celebrity who lived to 100 despite drinking and smoking daily or someone who lived a pristine life and died suddenly in their forties to justify the periodic indiscretion.
Alternatively, “prehabilitation” is more of Basic Training before being thrown into battle. Prior to ‘Basic’, recruits may do some daily pushups and jog a few miles; in this analogy, these measures are “preventative medicine.” Taking advantage of this preliminary period makes what follows a bit easier to tolerate. This baseline conditioning smooths out the body’s learning curve for adopting new fundamental movement patterns, developing required self-discipline, and facilitating recovery from exercise. Fundamentally, however, the immersive basic training experience provides the major mileage in terms of physical resilience, and for the average American, the same is true about prehabilitation. As medical teams developed prehab programs for cancer therapy and organ transplant, describing the application in one of these cases may help clarify all the typical tenets and justify the oversight from a prehab-specialized physical medicine & rehabilitation physician.
For this case, consider a 50-year-old male patient who has lived with high blood pressure and diabetes for approximately 20 years. Despite his best efforts, both diseases eventually damaged his kidneys, and he’s now requiring dialysis to compensate for kidney failure. Given his young age and otherwise fair health, he qualifies for a kidney transplant. Of course, “fair health” is relative, and uncontrolled blood pressure and diabetes both dramatically increase the risk of complications during/after surgery.
Unfortunately, he can’t just pick up a new jogging habit as he has two bad knees and chronic low back pain, and his sleep quality is abysmal for multiple reasons. Kidney failure makes it extra difficult to maintain enough protein in his body, which increases the amount he needs from his diet, all while he struggles with poor appetite.
Prehab specialists design elegant treatment programs to fix each of these unique variables in the fewest number of interventions. In this example, a plan may include treatments like:
- Working with a pain psychologist, he begins to address underlying depression symptoms of poor motivation, guilt, and chronic fatigue that have prevented him from exercising and have contributed to maladaptive behaviors like poor diet and inconsistent adherence with his medications.
- His physician injects both knees to treat his chronic pain but avoids steroids that could worsen diabetes.
- As his knee pain improves, his physical therapist transitions him from exclusively aquatic therapy (which is lower impact on painful joints) to including land-based training to better stimulate building muscle. This improves his appetite and hastens improvement in diabetes and blood pressure. These also directly improve joint/back pain and lower inflammation, which indirectly improves pain.
- A nutritionist helps identify high-protein, low carbohydrate meals he can both afford and enjoy.
- On top of the sleep quality improvement he notes from reduced pain/inflammation, his prehab physician also prescribes certain supplements and low doses of medications that improve sleep. The better sleep will also improve pain, lower blood pressure, benefit diabetes, and support building muscle.
Throughout the course, his team also acts as coaches and cheerleaders. Inherently, these programs are highly personalized and capitalize on the one fundamental thing preventative medicine lacks, which is the nature of a countdown. A looming surgery is exceptional motivation, and most individuals are churning with a mix of nervous energy and helplessness. Pre-habilitation provides an extremely productive outlet for this pent-up energy and will likely improve symptoms even before surgery.
Prehabilitation does not require such an extreme health event to have utility. Although historically patients have participated prior to organ transplant or cancer therapy, the benefits likely translate to any major intervention including joint replacement, limb amputation, spine surgery, high risk pregnancies, bariatric surgery, and others. Essentially, if the procedure is not emergent (which would prevent advanced notice), patients can take individualized action to improve their outcomes.
We hope this was an insightful introduction to prehab. In part 2, we’ll dive into examples of how this relates to golf when trying to prevent or prepare once serious injuries occur. Follow Mosaic Golf and Admire Medical for more information.
Meet the Author:
Alexander Watson, MD
Founder, Admire Health
Dr. Watson (Alex), is the founder of Admire Medical and also serves as the Associate Medical Director of Encompass Health in Middletown, Delaware. Alex completed his residency training in Physical Medicine & Rehabilitation at the University of Pittsburgh Medical Center (UPMC) where he published multiple book chapters and articles on prehabilitation, back pain, obesity, and the continuum of care for cancer rehabilitation.
He is trained in both Physical Medicine & Rehabilitation (PM&R) and Obesity Medicine, one of a handful of such physicians in the country.
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