What is “PreHab”? And how is it changing the physical therapy industry?
December 16, 2016

“PreHab” - a newer term that is becoming increasingly popular in the physical therapy field is short for pre-rehabilitation.

“PreHab” – a newer term that is becoming increasingly popular in the physical therapy field is short for pre-rehabilitation. PreHab, has been used in the past to keep athletes and active individuals away from preventable injuries and unnecessary surgeries. Recently, PreHab has become even more popular with the increasingly health conscious general population. One small injury can stay with a person throughout their entire lifetime, even with careful rehabilitation.

For these reasons, many people are turning to PreHab to help prevent injuries before they happen. This in turn helps decrease healthcare costs and can improve the quality of life for many individuals.

How does it work?

PreHab utilizes aspects and precautions of pre-existing pathology that plays an important role in an individual’s recovery. Typically, a physical therapy evaluation is used to uncover possible muscular dysfunctions, imbalances, or restrictions. For individuals who have jobs with repetitive negative stress on their tissues/joints posture is also assessed. After evaluation, a PreHab program is typically designed to help reverse some of these negative changes and help prevent roadblocks to long-term health and fitness. A solid PreHab program will incorporate flexibility, stabilization, equilibrium between muscles, and optimization of movement.

Who benefits from PreHab?

To be quite honest, almost everyone benefits from PreHab. I’ve personally been involved in the health and wellness industry for over eight years and am now a physical therapist and I use PreHab techniques on myself daily. Whether I am running, weightlifting, swimming, biking, or sitting all day at a desk there are things that I do to counteract all those negative forces. Lets use some examples:

  • Running – Have you ever seen runners running backwards or sideways? Most runners run forward, that’s typically what “going for a run” means. The point I am trying to make is that I know that if I only run “forward”, I am definitely missing out on many large and small muscles around the hip joint that will eventually become weak. That is why I incorporate PreHab exercises such as lateral band walks, banded monster walks, lateral shuffle, single leg squats, and many other one sided activities.
  • Weight lifting – Lifting weights primarily utilizes an “open chain exercise system”, which has a high potential for injury. Some of the best exercises to teach your joints and muscles proprioception, coordination, and optimized movement involve “close chain” activities. I typically incorporate various close chain exercises for shoulder mobility, strength, and coordination. One such exercise that I like to do is shoulder rolling in a quadruped position. You roll your shoulder blade forward (elevation/protraction) and backward (depression/retraction) attempting to control every aspect of the movement. This helps improve coordination and proprioception of your shoulder joint. Another favorite – pushups! Pushups are a great “close chain” exercise that many people do incorrectly. By many, I would say almost 90% of people I see at the gym. Doing a correct pushup requires excellent strength, coordination, and proprioception of the shoulder girdle.
  • Swimming – I like to swim freestyle, which tends to load the anterior muscular chain (chest, pecs, lats), which might make my shoulders more rounded, increase scapuler winging, and weaken my posterior chain muscles. As a PreHab workout regimen I typically do a ton of work on my posterior chain muscles. Superman’s, deadlifts, lower and middle trapezius strengthening exercises are all some of my favorites. Serratus punches are also great to help improve upward rotation of the scapula and decrease winging of the shoulder blade.
  • Cycling – I love biking, but sitting hunched over for an hour might really cause some back pain later in the day. Make sure you incorporate some extension activities after a biking session – prone press up, superman’s and all the exercises I mentioned above for swimming are great as they activate the posterior chain musculature. You should also spend some time stretching your hip flexors, pecs, and hamstrings as those are typically tight on patients who are regular cyclers.
  • Sitting – I can proudly say that I do PreHab for sitting on a daily basis. Writing patient notes, exercise/workout programming, and business management have me sitting at least 4 hours a day. As I am writing this blog (which took about an hour) I feel my back starting to become stiff, my posture starting to become poor, and my head starting to get closer to the screen. Sound familiar? For most patients, including me, people who sit over 8 hours per day tend to have tight hip flexors, hamstrings, pecs (specifically pec minor), sternocleidomastoid, and sometimes even the quadriceps. Stretching the culprits and strengthening the opposing muscle groups are typically the way to PreHab yourself when it comes to sitting. There are variations for more advanced PreHab such as strengthening your newly lengthened muscles that you just finished stretching to keep them strong throughout their full range of motion.

Tight hip flexors – cause excessive anterior pelvic tilt, which might cause back pain due to more lordosis in the spine.
Tight hamstrings – may cause more tension at the hip along with an abnormal pull, which will cause the lumbar spine to compensate when squatting/bending down to pick something up. Basically, make your lower spine round more to compensate for the lack of hamstring mobility.
Pecs – may cause winging, forward shoulder posture. Doorway stretch is great to address this issue.
Sternocleidomastoid (SCM muscle) – supine chin tucks, focusing on elongating your cervical spine really help strengthen the deep neck flexors and inhibit/lengthen the SCM musculature. A tight SCM may cause headaches, neck pain, and will physically contribute to a forward head posture.

Who can help me create a PreHab program?

A licensed physical therapist can help create a Prehab program for you. Most physical therapists now have doctorate degrees which make them the best movement experts out there. Try to find a physical therapist that understands your goals, needs, and lifestyle. If you are a more active person, I would recommend finding a physical therapist who is also active and lives a similar lifestyle as you. You want someone who practices what they preach! I would even go as far as recommending a physical therapist that is a certified strength and conditioning coach (CSCS) as they tend to understand active individuals a little bit more. Most importantly, choose someone that you would trust with your health!

Author: Dr. Konrad Koczwara DPT, PT CSCS | Counter Force Physical Therapy | 1115 W. Armitage Ave, Chicago IL 60614