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prehab & rehab

Prehabilitation and cardiac rehabilitation is where the health club industry should be heading. London-based osteopath Nick Potter explains why


he NHS is buckling under the pressure of acute illnesses: the combination of an ageing population with increasing

orthopaedic problems, and private health insurance companies abandoning the cover of chronic conditions, will soon make people realise they will have to pay for their care. At this point, they will be motivated to seek a different

approach and the focus of healthcare will start to shift – from reactive to proactive, from cure to prevention.

preventative prehab Prehabilitation is part of this model, which is what we offer at the London Spine Clinic and at my two busy private practices in London. The clinics are multi-disciplinary: neurosurgeons, osteopaths, physiotherapists, podiatrists and pain specialists work together to provide a ‘recipe’ of care to fit individual needs, focused around treatments, exercise programmes and pain relief. Broadly defi ned, prehab is pre-op

preparation to improve the post-op recovery, allowing people to exercise within the parameters of what they can do. In some cases it can remove the need for operations altogether; indeed, the surgeons at the London Spine Clinic are known as the surgeons who don’t operate, because we’ve reduced the need for operations among our clients by 85 per cent. We’ve also shown that, with prehab, stays in hospital are drastically reduced: from 10 days down to three for a lumbar spinal fusion (fusing two vertebrae together so there’s no motion). Surgeons have also commented on the improvement in muscle tone among these patients. As an example, 80 per cent of slipped

discs will get better on their own – if you do nothing at all – but with treatment the results can be much quicker. However, the NHS generally operates too early, as its physio programmes are often ineffective and compliance is low. Compliance in my

There’s an opportunity for GPs specialising in sports injuries to spend time in gyms, referring members to PTs

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patients is 100 per cent better than among NHS patients, since they have made a fi nancial commitment to their treatment – a real motivating factor. One also gets longer with patients to explain, educate and involve them in their care. Pain management also plays a key role

in ensuring compliance: just because something hurts, doesn’t mean you should avoid it. That is, however, very different from ‘no pain, no gain’. Pain is heavily tied up with mood, and people can avoid doing their exercises because they feel low and bad about themselves. We can help them with pain blocks and injections and do clever things with medication, including the use of anti-depressants.

opportunities for operators If one takes a macro view of the current health and fitness market, there’s a major opportunity for gym operators to become involved, not just in general health and fitness, nutrition and weight loss, but also in playing a key role in the provision of more medically-based programmes of prehab and rehab. As a starting point, clubs can approach us, as we’re in the process of launching an in-house training programme for instructors. I regularly liaise with personal trainers

in patients’ gyms, either to set up programmes or to establish avoidance strategies: getting around the fact that people sometimes avoid doing something because it hurts, or simply because they think it will hurt. Good communication is key, as patients need to be reassured and encouraged to understand the benefi ts. Nevertheless, compliance is often still a problem: sometimes it does require some straight-talking to motivate people. Health clubs with pools are

particularly well placed to offer prehab; exercising in water is ideal, as it offers

july 2010 © cybertrek 2010


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