Prehabilitation--add a Physical Therapist to your multidisciplinary team for cancer treatment!

“Prehabilitation is the process of enhancing functional capacity of the individual to enable him or her to withstand the stressor of inactivity associated with a surgical procedure” — Wikipedia

What a concept! Not new, but just in recent years getting more attention. I have been advocating prehabilitation since the beginning of my career.

"I use the analogy that people wouldn't run a marathon without training for it," says Tony Brosky, PT, DHS, SCS, a professor of physical therapy and assistant dean of the Lansing School of Nursing and Health Sciences at Bellarmine University in Louisville, Kentucky. “…knowing the patient's range of motion, strength, and function preoperatively, through clinical examination and direct observation, allows the patient and PT to more accurately set realistic postoperative goals."

This makes total sense to me. Many patients are seeking pre-surgical Physical Therapy intervention from us, many are cancer patients, concerned about a side-effects like lymphedema and/or quality of life issues on long term, and returning to the current function and activities as soon as possible after treatment.

How smart to get pre-measurements, to understand status quo of function, range of motion, strength and volume of limb pre-surgery. Base line measurements are key to early detection of problems, reduce anxiety and will improve outcomes. Physical Therapy should be part of the multidisciplinary team to improve quality of life before, during and after cancer treatment.

But we are still far from being included automatically in a multidisciplinary team of treating cancer. San Francisco General Hospital however has been progressive and adding Physical Therapists into the multidisciplinary team in the breast cancer clinic. See article.

Tell your doctor that you want to have a Physical Therapist included to your team of experts in your cancer treatment as early as prior to your surgery, if time allows. Share the article with your doctors.

I am also teaching a informational class hot to reduce risks for lymphedema at CPMC every third Wednesday of the month at 6PM. Please share this information with anybody who has or had cancer treatment or going to have cancer treatment. We are here to help, This class is at no cost, and will give you lots of information.

Read on the newsletter of SFGH in 2011:

If you want to read more about some research of prehabilitation, please check out this link:

Why Physical Therapists Use Pilates as a Tool

If you ever go to the gym or fitness studio, you may be familiar with Pilates. It is a fitness system that is used to strengthen the core through a controlled workout. Pilates has become a popular choice in exercise and a vital tool in physical therapy. I use Pilates in my clinic because it helps strengthen weak muscles and improves movement practices, which help lower the risk of recurring injuries.

What is Pilates: In Pilates we focus on mind-body techniques in order to stabilize and engage the central core. Developing a strong core aids in controlled movement and teaches us to utilize our breathing patterns in order to power our energy systems. The two types of Pilates (mat-work and machine-based work) target core muscles and stabilization through strengthening, mobilizing, and stretching.

Why I use Pilates in Physical Therapy: Before I go into the reasons why I use Pilates as a physical therapist, it is important to understand the causes for recurring injuries: 9 times out of 10, a recurring injury is caused by poor movement practices. These are the seemingly minuscule habits that frequently take a toll on our physical function.

Our poor movement practices are often comprised of stronger muscles overcompensating for weak ones. Why do we do this? It is completely normal for us to use our strongest muscles because our bodies are programmed to do what feels the easiest. However, the easy way out does not always mean the right way. When we primary use our strongest muscles and neglect to strength weak muscles, our body will begin to suffer from imbalance. Imbalance results in injuries.

The reason why I decided to become a certified mat Pilates instructor, and use the technique in my physical therapy, is because I realized the benefit of rehab Pilates to help my patients realign, correct, and re-educate their muscles in order to prevent injuries from recurring. We find that the Pilates method works because it addresses the smaller muscles that are often overlooked during recovery. It helps us focus on balancing the body’s muscular system, and through that balance, many other body systems as well.

All in all, I use Pilates in treatment and as a rehabilitation tool because it helps my patients be mindful of the muscles they are targeting. Pilates helps adjust the body in alignment and eliminates bad habits so that injuries do not recur.