What is Prehabilitation?
Whether you are a seasoned professional or a relative newbie to resistance training. the importance of ensuring your body has a solid foundation to build on can not be understated. Prehabilitation exercises or prehab is a proactive approach to training that aims to avoid pain and injury before the actual occurrence.
Prehab is essentially injury prevention risk assessment and training to prevent a problem before it arises.
By analysing our posture, joint alignment, flexibility, muscle control, biomechanics, core stability and movement patterns, it is possible to identify which strengthening and stretching exercises would be beneficial to add into a training routine in order improve our movement patterns and minimise injury.
Prehabilitation benefits include,
achieving normal static and dynamic posture
correcting muscle length imbalance, joint alignment and flexibility
normailise core stability
enhance muscle endurance, strength and power
boost movement pattern efficiency
enhance proprioception - which is the ability for the mind to know where the body is in space and time.
An example of how you may prescriptively add prehab excercises to a workout maybe; if you were sitting at a computer all day for work and you were about to add deadlifts into your exercise program, you may include foam rolling the TFL, ITB, hamstrings and glutes. Stretching the hip flexors, adductors and quads. Using a lacrosse ball for soft tissue work on the mid/upper back and lats. Doing a Face pull to strengthen the mid back and open the chest. Then doing some glute bridges and body weight squats to fire the muscles used in a deadlift to ensure those muscles are active throughout the movement.
It wouldn't be necessary to add every component on the same day, however stretching this prescriptive approach across the entire weeks program would help optimise movement patterns and reduce the risk of injury.
Rope Face Pull for mid back strengthening
A Face Pull is an excellent prehab exercise that is commonly indicated for clients that I see at Strong Therapy, and not just for the addition deadlifts. It targets the mid/lower traps and external rotators, helping to correct upper crossed syndrome, a condition typically seen in people who sit at computers, look down at their phone, have poor posture habits or work with their arms in front of them... so pretty much every one!
What exercises are best?
When considering prehab and analysising the bodies bio-mechanics it is worthwhile to bring awareness to our own behaviour patterns, especially things we are doing consistently on a day to day basis. These behaviour and movement patterns have a commutative effect on our bodies and, if not addressed, lead to injury and soft tissue pain.
The most common causes of imbalance that I see in my clinic are the result of our sleeping position, the way we sit at work and home, our computers ergonomics, our constant phone use, the way we drive, and our behaviour patterns at the gym or in the sports arena. This is because these are the things we do consistently, and as mentioned earlier, have a cumulative effect that builds up over time causing bio-mechanical imbalance within the bodies fascial network that results in soft tissue pain and injury.
We then carry these imbalances back into our daily lives with very little conscious awareness that they even exist, until of course, we move in a way that maybe sudden or slightly out of the norm, and then bang, we end up causing trauma to the tissue that results in days if not weeks and months of soft tissue pain and discomfort.
One of the easiest ways to mitigate risk and a general rule of thumb in prehab is to warm up properly and thoroughly.
Warm up for injury prevention
While a warm up itself wont address a persons own individual muscle imbalances, it will warm the core temperature and change the histological properties within the tissue making it more pliable, (as the glycosaminoglycans within the skin extracellular matrix turn from a consistency similar to hard silicone when cold to something more akin to jelly when warm), increasing its shock absorption ability and decreasing the risk of injury.
Build a Strong Foundation
A major consideration when thinking of prehab should be the core. No matter where motion starts, it either moves through or originates from the core, rippling upward or downward to adjoining links in the myofascial network. A strong, flexible core underpins almost everything the body does with imbalances in the area impairing how effectively the musculoskeletal system is able to operate. This has the potential to create dysfunction within the body, sapping energy both locally and globally, and increases the risk of soft tissue pain and injury.
For this reason, I recommend Pilates to all my clients for the strength, awareness and flexibility it brings to the practitioners body and core. The principles and awareness learnt in Pilates are then easily transferred through to the rest of ones training regime increasing proprioception and reducing the risk of injury.
An excellent example of this can be demonstrated in the Pilates exercise known as Dead Bug. The primary goal of this exercise is to bring stability to the core by pacing demands on the anterior muscles of the hips and abdomen, moving the limbs through space and time, all while holding the position of the pelvis. It is these types of prehab exercises that increase the awareness of how we are holding and moving our body, creating better alignment and functional movement patterns and reducing the risk of injury or soft tissue damage through this insight into our own biomechanics.
Improve core Stability and Awareness with Dead Bug
Common Clinical Prersentations
Prehab exercises and techniques are generally sports specific, however due to our similar lifestyle patterns, there are some common dysfunctions that run through the majority of clients I see in my clinic. As mentioned before, building a strong core is pivotal in having healthy functional movement patterns, and as such, the majority of soft tissue dysfunction I see is a direct result of the imbalances caused within the core muscles from our daily habits.
Arguably, the largest contributor to an imbalance in the core comes from the fact that we sit, and that's because it tends to happen for extended periods of time. Whether it is driving, at a computer, or after a long day of work, sitting shortens the muscles of the anterior core while disengaging those of the posterior. This has an accumulative effect, which, pathologically, results in a shortness in the Psoas, Iliacus, Sartorius, TFL and Rectus Femoris muscles (the hip flexors) in the front of the hips, causing an anterior tilt to the pelvis, and putting an increased load on the Sacroiliac Joint and muscles of the lower back. Because of the mechanics of the pelvis, where the legs are in relation to the pelvis determines whether the adductors or abductors are an internal rotator or external rotator, this is important because an anterior pelvic tilt means parts of the gluteal muscles are no longer required and as such results in atrophy of parts of the muscle group that further compounds the problem.
For this reason here are two prehab exercises I recommend everyone should be doing to help stabilise their hips and optimise function of the core, helping to minimise the risk injury.
Glute Activation for core stability
Core stability involves strength and flexibility
The last prehab excercise I recommend everyone should be doing is the YTWL for mid back strengthening and scapula stability. Once again this is because the majority of my clients present with different degrees of a condition know as upper crossed syndrome. Pathologically this is define by a weakness in the mid back, namely the fibres of the mid and lower trapezius, and a tightness in the deep neck flexors and pectoral muscles of the chest. This can be caused by a number of things however it is especially present in people that are slouched in front of a computer, looking down at a phone or working with their hands in front of them. The accumulative effect of which results in imbalances within the shoulder and if left untreated tendinopathy.
This is especially true because, the shoulder joint is the only joint within the body that relies on the surrounding muscles for its stability and that is because of the enormous range of motion this joint allows. With this increased flexibility can come instability and that is why it is important we are constantly working to protect and balance the shoulder girdle. The YTWL is the perfect exercise to reduce upper crossed syndrome and help bring balance back to the shoulder.