They tried to make me go the rehab but I said, “No, no, no”.
Amy Winehouse
Prehab can keep us in the Goldilocks zone.
A Goldilocks planet is one which falls within its star’s habitable zone.
The earth is in the sun’s Goldilocks zone, not too hot, not too cold, but just right, and containing the conditions for life to flourish.
Rehabilitation provides the setting for recovery from illness, injury or addiction.
Rehabilitation involves restoration.
The Latin word habilis means ‘easily managed’ or ‘fit’.
The words ‘ability’ and ‘able’ are derived from it.
The abbreviation ‘rehab’ came into to use after the Second World War to describe the rehabilitation of soldiers. It embraces the ideas of ‘ability’, ‘fitness’, and ‘fitness for purpose’.
The idea of prehabilitation, or prehab for short, is a neologism.
The word describes a programme of training leading to the development of healthy practices to enhance wellbeing and reduce the risk of injury.
It puts us in the Goldilocks zone.
Prehab contexts
‘Prehabilitation’ is practised to avoid physical rehabilitation for sports injuries.
The practice of an effective programme can help elite athletes to avoid injury in training and competition. The more advanced the athlete, the greater the need for a prehabilitation programme.
Often repetitive movements or the daily stresses of training lead to physical vulnerability. A limited training technique may cause tightness of muscle groups, imbalances of strength, coordination or muscle stabilisation. This can lead to injury.
‘Prehab’ is a practised prior to surgery for a number of conditions.
Orthopaedic patients anticipating joint replacement surgery benefit from a programme of physical exercise for six weeks or so before surgery. Recovery rates are better for those who practice prehab.
A trial is currently underway in Canada to assess the benefits of a programme of prehab for older patients undergoing cardiac surgery [1]. The trial is designed to assess the benefits of a pre-operative eight-week exercise and education intervention on surgical outcomes and post-operative recovery.
The concept of prehab is becoming more widespread.
With limited exceptions, the term has yet to be applied to the area of mental health [2].
It is analogous to the World Health Organisation’s suggested model for public mental health which identifies three areas of intervention: mental illness prevention, mental health promotion and treatment, recovery and rehabilitation [3].
A study into the mental health of the UK Armed Forces in the 21st century found that there appeared to be evidence that a number of factors promoted resilience to mental illness amongst service personnel [4].
The report acknowledges that the long-term psychological effects of recent military appointments remain to be seen and further research would be warranted to explore the nature of resilience in service personnel exposed to extreme or prolonged stress in the longer term.
It concluded that, in general, resilience was associated with deployed military personnel who were well trained, well led, cohesive and had access to high quality mental health services and a number of evidence-based mitigation measures.
Balance and integration
Athletic prehabilitation is designed to prevent injuries caused by body imbalances.
For example, if someone works the abs but neglects the lower back, this can cause imbalance leading to injury.
A hamstring injury usually occurs when sprinting or jumping. Quite often the upper side of the hamstring receives the injury so a stretching plan that incorporates the top and the bottom of the hamstring connections is critical.
From a bio-mechanical perspective we require balanced prehab to reduce the risk of injury.
A recent article uses the picture of a see-saw to illustrate a working definition of ‘wellbeing’ [5].
The authors acknowledge that the concept of wellbeing is complex.
They propose the idea of a ‘set point’ for wellbeing, a position of rest between the fluctuating pressures of challenges and resources. The see-saw represents the drive of an individual to return to a set-point and balance for wellbeing.
On one side of the see-saw sit the resources for wellbeing (psychological, social, and physical); the other is weighted by challenges to wellbeing (psychological, social, and physical.) Wellbeing is positioned like a ball at the fulcrum, at the point of balance.
The authors state, “in essence, stable wellbeing is when individuals have the psychological, social and physical resources they need to meet a particular psychological, social and/or physical challenge. When individuals have more challenges than resources, the see-saw dips, along with their well-being, and vice versa” [5].
To my mind this illustration is helpful, but also two dimensional.
Maybe we should not just be looking for balance in our lives, but integration of different aspects of life?
Synthesis and equilibrium …
(Next)
[1] Stammers, A. N., Kehler, D. S., Afilao, J., et al (2015). Protocol for the PREHAB study – Pre-Operative Rehabilitation for reduction of Hospitalization After coronary Bypass and valvular surgery: a randomised controlled trial. BMJ Open 2015; 5; e007250.
[2] Swift, C. (2009). PREHAB: Essentials For Successful Change.
[3] Davies, S. C. (2014) Annual Report of the Chief Medical Officer 2013. London: Department of Health.
[4] MacManus, D., Jones, N., Wessely, S, et al (2014). The mental health of the UK Armed Forces in the 21st Century: resilience in the face of adversity. J R Army Med Corps 0, 1-6
[5] Dodge, R., Daly, A. P., Huyton, J. & Sanders, L. D. (2012). The challenge of defining wellbeing, International Journal of Wellbeing, 2 (3), 222-235
(This is an edited excerpt from my book A Lawyer’s Guide to Wellbeing and Managing Stress published by ARK Group in 2015.)
