Why should you try physical therapy before your surgery?

THE BENEFITS OF PRE-OPERATIVE STRENGTH TRAINING 

Numerous studies have shown the positive effects of pre-operative strength training on patients awaiting TKA. A study conducted by Birgit Skoffer et al evaluated 59 patients awaiting the knee surgery. The participants were split into control and intervention groups. The control group did not receive any instructions to exercise while the intervention group performed lower body exercises for an hour each session, with 3 sessions a week for 4 weeks. The training sessions comprised of primarily lower body strength exercises like the leg press, knee extension, squats, and cycling. Then, all 59 patients underwent their knee surgeries, and their knee strength, range of motion, and overall function was measured post-operation. The researchers found that while there was no significant difference in range of motion between the control and intervention group, there were significant improvements in strength and function of the knee for the intervention group. The intervention group performed 31% better than the control group during the 30 second sit-to-stand test, as they were able to perform more repetitions, indicating improved strength and endurance in their knees post-op. The patients in the intervention group also reported lower pain scores than the control group post-op, indicating better results of pain management through pre-operative strength training. Conclusively, this study found that pre-operative strength training results in significant improvements regarding knee strength and pain levels for post-op TKA patients. This has important implications for the realm of not only physical therapy, but medicine as well, as it demonstrates how measures can be taken before operations to help improve quality of life for patients after their surgeries. 

Source: Skoffer, Birgit, et al. “Efficacy of Preoperative Progressive Resistance Training on Postoperative Outcomes in Patients Undergoing Total Knee Arthroplasty.” Arthritis Care & Research, vol. 68, no. 9, 2016, pp. 1239–1251., doi:10.1002/acr.22825. 

THE DRAWBACKS OF PRE-OPERATIVE STRENGTH TRAINING 

While there is a significant amount of literature in support of pre-operative strength training for patients awaiting TKA, this kind of intervention is not suitable for all patients. There are several limitations to strength training prior to an operation. Strength training can aggravate signs and symptoms of osteoarthritis. A study conducted by Keegan Hovis et al found that high levels of physical activity lead to greater generation of articular cartilage. The researchers studied 128 subjects with and without symptoms of osteoarthritis and used a physical activity scale to determine the amount of exercise each individual performed per week. Self-reported activities were also taken into account when determining physical activity level. The researchers used MRI scans to observe the level of cartilage degeneration and found that participants who had greater physical activity levels also had greater amounts of degeneration. Thus, this study shows how too much training can actually hinder knee function as a result of increased cartilage degeneration. Furthermore, strength training can be dangerous for patients who are not supervised during exercise. Improper form during weight-bearing exercises like barbell squats, leg press, and running can put further stress on the knee, increasing signs and symptoms of osteoarthritis. These implications are crucial because it is important to educate patients on the correct form of prescribed exercises if they are undergoing surgery to prevent further deterioration of the knee. 
 
Source: Hovis, Keegan K., et al. “Physical Activity Is Associated with Magnetic Resonance Imaging-Based Knee Cartilage T2 Measurements in Asymptomatic Subjects with and Those without Osteoarthritis Risk Factors.” Arthritis & Rheumatism, vol. 63, no. 8, Aug. 2011, pp. 2248–2256., doi:10.1002/art.30419. 

FINAL THOUGHTS AND CONLUSIONS 

Overall, scientific literature supports the notion that pre-operative strength training is effective in retaining strength and endurance in osteoarthritis patients awaiting TKA. While it can be argued that too much physical activity can actually accelerate cartilage degeneration, moderate intensity strength training through low impact exercises like the leg press and squats has been shown to not only retain more strength in the knee post-op, but also help reduce pain levels when compared to patients who were not part of any kind of pre-operative strength training program. A study conducted by Ahmad Alghadir et al compared the effects of pre-operative physical therapy versus post-operative physical therapy on patients’ pain following TKA. The physical therapy sessions were each an hour long, and both the pre-op and the post-op groups underwent two sessions a week for 6 weeks. The study concluded that the patients who had physical therapy prior to their procedures reported lower pain scores overall and relied on less pain medications than the patients who had physical therapy after surgery. Therefore, it can be concluded that pre-operative strength training is effective in retaining strength and reducing overall pain levels in patients awaiting TKA. 
 
Source: Alghadir, Ahmad, et al. “Comparison of the Effect of Pre- and Post-Operative Physical Therapy versus Post-Operative Physical Therapy Alone on Pain and Recovery of Function after Total Knee Arthroplasty.” Journal of Physical Therapy Science, vol. 28, no. 10, 28 Oct. 2016, pp. 2754–2758., doi:10.1589/jpts.28.2754.