Preventative Rehabilitation for Orthopedic Surgeries

Prehab: It's not a typo for rehab.

You may have heard the term being tossed around by orthopedic doctors and rehab professionals. Prehab, an abbreviation for preventative rehabilitation, is the use of rehabilitation principles and strength training prior to any actual injury. Prehab can also be used to improve strength and endurance prior to a surgery with the idea that the stronger you are prior to surgery, the quicker you will recover.

Today, I want to discuss how prehab can help prior to surgery. In upcoming blogs, I will discuss the benefits of prehab for athletes of all types and the active, injury-free population.

Studies have found that prehab prior to abdominal or cardiac surgery results in fewer postoperative complications, shorter hospital stay and improved quality of life. Unfortunately, research has shown prehab and pre surgical education is not necessarily beneficial for orthopedic surgeries including total joint replacements. So those six PT visits your orthopedic surgeon suggests you complete prior to surgery are not always necessary.


So why am I talking about prehab if it is not beneficial with orthopedic surgeries? Often times, when surgery is imminent, a person will feel as though there is nothing they can do but wait. Control is lost over the situation, which can be scary. Having a concrete role in your health by having specific exercises to do, can give you some control back. PT's are also helpful with answering questions, decreasing anxiety and providing a support system during a stressful time. Being proactive about your physical strength and endurance will also give you a daily exercise routine. This will make it easier to be compliant with your exercise routine after surgery.

So is just going to the gym sufficient? Probably not. The most important part of a prehab program is to strengthening the key muscles in recover while minimizing pain. Your best bet is to get in and see your physical therapist.

What will Prehab look like? First, your physical therapists will complete a full evaluation and assessment. This will include gait and posture analysis, strength and flexibility testing, as well as balance and movement screens. After, a PT will be able to customize an exercise routine that is specifically tailored to address the weakness they uncover. Expect to have a 30-45 minute routine that you can complete 3-5 times a week. These can be exercises that you can complete in your home if you do not have access to a gym.

Don't wait until the week before a scheduled surgery to meet with your PT about setting up an exercise routine.The best time to start a prehab program is as early as possible. Two to three months prior to a planned surgery is ideal. This will allow for true strength and endurance gains and develop a strong habit of exercises. If you don't do this before a joint replacement, you will still have to do it after…it's your call.

Agility Physical Therapy and Sports Medicine

(303) 773-0771

Poor Balance, Dizziness, Vertigo all Cause Risks to Your Health

Did you know that dizziness is the number one cause of a fall in persons over the age of 70? Even more staggering the falls in this population are responsible for most Traumatic Brain Injuries (TBI) and Fractures of the wrist, thigh, and hip as well as the shoulder in this group of seniors. These injuries can lead to our seniors being placed in Homes or Long Term Care Facilities. Of those that fall, 20% will die with in the first year afterward if they sustain an injury.

Vertigo Chart

The cost of a fall can be staggering to both the person and the Medical system, but also the family of the person that falls. Imagine that your mother or father fall and fracture a hip. They have surgery, but due to their age they have more difficulty in recovery. Instead of going home immediately, where they can be in familiar surroundings, they are sent to a rehab facility for a stay ranging from 2-8 weeks. Often times going to a rehab Facility can cause depression because the persons want their independence and feel like they are having their freedoms taken away. This can lead to them not participating n the rehab need to go home so the end up going to Long Term Care instead.

What if there was another way?

Physical Therapists trained to do rehabilitation for Dizziness; Vertigo and balance dysfunction, Like those at Agility Physical Therapy and Sports Medicine, can help prevent that fall, that potential TBI or Fracture. I won’t say that it is easy, but the right steps and exercises can make a huge difference in Quality of life for persons over the age of 60.

Steady as You Go Infographic

Vestibular and Balance Rehabilitation exercises focus first on getting your vision clear with head movement. We then gradually progress through standing balance tasks with cognitive tasks and head movement to help move you through at a pace that is right for you. We also add things for simple tasks like sit to stand and core strength.

Dizziness Home Remedies

Some of the Things can even be as simple as Drinking water, while others require some work on the part of the patient. Decreased Strength, Dehydration and Low Blood Sugar can all attribute to the cause of your dizziness. We can teach you how to manage them all and help prevent a fall in you or your family.

People who are at risk include anyone with a neurological condition such as MS, stroke, TBI; Concussion, even if it was in your earlier years, anyone over the age of 40, people who don’t regularly exercise. Research has shown that as much as 35% of persons over 40 have had at least one episode of Vertigo

If you or someone you know has suffered from episode of poor balance, Contact a Vestibular Therapist today.

Vertigo Shark

Improving Lives of People with Parkinson’s Disease

Imagine living in a world where when you want to step forward a foot, you really step forward a mere 6 inches. Every step you take is half the size of what you expect but your brain can't adjust and take a bigger step. It takes you twice as long to walk anywhere, but you just can't seem to speed up or take bigger steps.

This is a world people with Parkinson's disease live in every day. Parkinson's Disease is a progressive neurological disease that primarily affects movement control. The disease makes it hard for a person's brain to connect what they want to do with what their body actually does. This is called a sensorimotor deficit. Other motor control symptoms of PD are tremors, small movements, decreased balance, shuffled gait and stiffness. Medications and exercise can improve motor control symptoms in many people. But there is only one program that is specifically designed to address the motor control and sensorimotor deficits in this progressive disease.

This program is called the LSVT BIG program. It is based off the LSVT LOUD program which is now the gold standard for treating voice impairments in people with Parkinson's Disease. This program has been researched and developed over the past 25 years with funding from the National Institute of Health. Research has shown that after completing the LSVT BIG program, people demonstrate faster walking with bigger steps, improved balance, increased trunk rotation, and improvements in activities of daily living such as bed mobility.

So what makes the BIG program so unique? It is an intense program that is completed over 4 weeks. Each week consists of 4 one on one hour long sessions with a physical or occupational therapist whom is a certified LSVT BIG practitioner, daily homework and assignments. The program is customized to each person's needs and goals. Goals can be as simple as being able to stand up from the couch without help to getting back to road biking 20 miles a day.

"I got my life back"

"I feel like I have purpose again"

People who complete this program, are truly grateful for what they have learned and how they have improved. With hard work and dedication, amazing things can happen. Lives can be changed. Movement becomes the medicine.

It is not an easy program to complete. It is intense and requires complete dedication. People have said it takes over their lives for a month. Exercises are performed two times a day, seven days a week. Each exercises session takes about 30 minutes to complete. Once the program is finished, people are encouraged to continue with the exercises one to two times a day for the rest of their lives. The BIG program can be completed every year to continually adjust exercises to allow for continued challenge and improvement. Medicare and other insurances will typically cover the program.


Is the LSVT BIG program for you? If you have Parkinson's Disease, yes, it is for you. No matter what your level of ability is, this program can be customized to allow you to achieve your goals. Make an appointment to see your local LSVT BIG certified therapist and learn how movement can be your medicine or call Agility Physical Therapy and Sports Medicine to speak with Jenna for any questions or concerns.

Visit the LSVT Global website for more information.

Dr. Jenna Schauer, PT, DPT, CKTP

LSVTBig Cert

Improving Communication is Absolute Key in the Current Social Media World

Recently, My husband and I have been attending classes with our Twin Boys to help them improve Brain Organization and Function at a higher level. See, as it turns out, Both of my children border on the Autism Spectrum of disorders. They have been labeled high energy, lack of ability to focus and even disruptive. What I have learned about development Neurologically from Physical Therapy School and what I have seen my children do or not do told me something more was going on. I started doing some research and came across Brain Highways. (you can check out there onsite and distance Learning programs here: )

The most important thing I learned in my research is that every brain has the potential to keep developing and Every Person, Not just Children, Can gain from simple 35 minutes/daily patterning that mimics what babies should naturally do as they move from in-utero to 1 year of age.

The other thing I learned is that my husband and I also could benefit from further development and that our communication during the process is far more important. Warning:PERSONAL INFORMATION OF SENSITIVE NATURE ABOUT TO DROP
after almost 16 years of marriage we had our very FIRST FIGHT. it was like we as a team forgot to actually look at the other with respect and one of us became accusatory instead of knowledge seeking. The following steps are the way we tried to come back to our normal even Keeled selves and COMMUNICATE

The Intentional Dialogue Process
I'm not an expert on this process, but here's how we've been practicing it:

Have one person be the "sender" and the other be the "receiver." If one of you has a frustration, you ask the other person to have an Intentional Dialogue. By agreement, the other person can ask to do it later when they're not busy, but they have to pick a time within the next 24 hours. Commit to doing this process when the other person needs you. It's good to separate the roles like this, because usually when we have relationship talks, it is both people trying to be heard and understood, and neither is trying to do the hearing and understanding.
Prepare for your role. The sender should give some thought to how they might concisely state their frustration in the beginning. The receiver should do their best to show up ready to listen and empathize, and to put aside their own story about whatever the issue is so they can hear the other person's side. This can be difficult.
The sender shares and the receiver listens. When the dialogue starts, the sender shares what they're frustrated or hurt about, by saying something like, "When you did this, I felt this way." And then continues to try to share their experience and perspective. The receiver just listens, trying to really understand their partner with an open heart, without trying to explain themselves. The receiver should try to notice when their own story is getting in the way of listening (for example, "Hey, I was only trying to __!") and put their story aside for now. Just try to understand.
The receiver mirrors and confirms. When the sender is done talking, the receiver should try to mirror back what the sender said, in the sender's words. Yes, that can mean just repeating what they said, without putting it into your own words or interpreting it. Try to be true to what they said. It helps them feel heard, and can help them show you where you mis-heard them. If the sender has a lot to say, they might do it in chunks, allowing the receiver to mirror the first part of what they have to say before going on to the next part. When the receiver mirrors the sender's message back to them, they should end by saying, "Did I get that?" (sender: "yes") and then "Is there more?" Then the sender can say, "Yes, there's more..." or "No, that's all."
The magic words are: "That makes sense." When the sender is done talking, and the receiver has mirrored their words and gotten confirmation that they got it right... that's when the magic happens. That's when the receiver simply says, "That makes sense." Those three words are what the sender really wants to hear. Now, the receiverdoesn't have to agree with the receiver, he or she just has to see that it's understandable that they feel this way, given their perspective. That's all. If you're really trying to understand the other person's perspective, you can see that they're not crazy, that how they feel makes sense.
The receiver then does empathy. Next, the receiver will try to give empathy to the sender, after saying, "That makes sense." For example, "It does makes sense that you'd feel that way... I imagine you felt hurt when I did that, maybe you were hoping I'd be more supportive, and you felt abandoned, rejected by me, frustrated that I wasn't listening to you. And when I didn't want to hear your side and just accused you of complaining again, that probably felt like I didn't want to understand you, and felt like I was judging and criticizing you for feeling the way you do." This is just a quick example, but the main idea is that the receiver is trying to get into the sender's shoes, and really show the sender he or she can understand what they're going through. At the end of this step, the receiver says, "Did I get that right? Is there anything else you wish I had said?" And the sender can then fill in any holes or correct the receiver's perceptions. That's it!
You can switch roles if needed. At this point, if the sender feels heard and understood, the receiver might want to share their side of the story. And so he or she can ask to switch roles, and then start the process from the beginning.

This is all better explained by John Wineland and his co-teacher Guru Jagat in this great video (

Watch it and you'll understand the process, I think.