Benefits Of Pre-habilitation

By Matt Weissbach
Interviewed by Rasa Fournier
Wednesday - June 15, 2011
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Matt Weissbach
Physical therapist at Orthosport hawaii

Where did you receive your schooling and training?

I’m originally from Canada, so all my undergraduate work including my physical therapy degree was at Queen’s University in Kingston, Ontario. I am also currently enrolled in the doctorate program at the University of St. Augustine, which is in Florida. It’s a combination of an online learning component with a focus on orthopedic manual therapy. So I go to the Mainland for twoto five-day hands-on courses. With the online learning aspect, there are video clips, online discussions, assignments and exams. Upon completion of the course work, there is a capstone project. It’s directed toward those who already have their physical therapy degree, who want to increase their level of knowledge, improve their critical thinking skills and their level of competency.

My initial aquatic rehabilitation training was through working at Prins Aquatherapy, named for Dr. Jan Prins - a name that is familiar to most people within the acquatics field. Prins is a professor at the University of Hawaii and his name is synonymous with aquatic rehab. He is the former head coach for the UH swimming team. I worked for him at his clinic for more than five years.

How long have you been practicing?

A little over nine years. For the past three years I have been working at Orthosport Hawaii in Niu Valley.

Can you give an overview of your pre-habilitation program?

Pre-hab looks at improving an individual’s functional capacity through exercise before a scheduled procedure whether for a joint replacement, shoulder surgery, back surgery or any orthopedic procedure. It has been proven that by doing the programs beforehand, the person will have a better functional outcome following the procedure.

From an insurance perspective, as insurance makes cutbacks we have looked at pre-hab procedures for the total joint in the knee or hip and found that there’s a significant cost reduction in post rehab, and patients are even less likely to be discharged to a rehab hospital if they follow through with the recommended eight- to 12-week pre-habilitation program. Physical therapists teach patients the individual exercises they can do prior to surgery, be it on land or in water.

Matthew Weissbach demonstrates to patient Virginia Hench how to perform single leg squats during an aquatic rehabilitation session. Nathalie Walker photo .(JavaScript must be enabled to view this email address)

Would they still need to continue doing exercises after the surgery?

Correct, there would be a different set of exercises. The direction for exercises these days is looking at functional movements and activities to address functional limitations. So for total joint replacement for the lower extremity - the hip and knee - you look at walking and squatting, which would be in and out of a chair, in and out of a car, on and off the toilet, as well as negotiating stairs. You gear the exercises before and even after toward those movements by addressing functional exercises and working on building up an individual’s cardiovascular and muscular endurance as well.

Is there a best candidate?

Anybody is a candidate. We get people in their mid- to late 20s who are having to undergo an orthopedic procedure even for a joint replacement, and people in their 80s. We screen people before and after a procedure, and depending on the age of the individual and their activity level coming into the pre-hab program, we have to gauge what their strengths and abilities are, as well as address elements like gait and balance.

Can you talk more about aquatic-based therapy?

The advantage of doing part of the prehab and then the rehab in the water is it’s going to decrease pain. Anything associated with weight-bearing or compression of the joint - which is anytime we’re standing, walking, sitting - that will be significantly reduced if not alleviated by being in the water, which allows us to do functional exercises such as walking, squats and practicing stairs. And it’s adaptive. As the individual progresses and gets stronger, their pain goes down and we move to more shallow water. That allows for more strengthening, and it’s a nice transition as they get ready for land exercises.

Initially, after a total joint surgery, we won’t be getting the individual in the pool. We have to wait until the incision has safely healed. The water helps to decrease pain during exercise, but also the hydrostatic pressure will reduce some of the joint swelling. When you can reduce the swelling inside the joint, you get a significant increase in quadricep strength, which is a big determinant in an individual’s walking speed, and also with negotiating stairs.

Is there anything else you want to mention about pre-hab or aqua-therapy?

Often, when the concept of aquatic-based rehabilitation comes into the discussion, people automatically say, “I don’t swim. I’m not a water person and I don’t see how swimming is going to help me with this program.” But it’s far from swimming. Some people love to swim and say, “I can swim, will that help me?” It will to a degree, but even with the individual who’s not accustomed to being in the water, pre-hab can take place with them always having one or two feet on a flat surface. We’re not going to cart the individual right off and throw them into the deep end. We work at an individual’s comfort level, but also their functional level.

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