• Rory Finch

Prehab vs Rehab in Musculoskeletal Injuries, what's the deal?

Author: Rory Finch


With the ever-growing demand of rehabilitation methods in and out of sport, the importance of preventative rehabilitation (PREHAB) is at the forefront of attention to diminish the likelihood of injury occurrence.

Poor attention to niggles and acute pain can often lead to long term injuries that can interfere with daily tasks and exercise. The need for exercise specialists before injury/illness takes place is overseen leading to poor mobility, awareness and decreased physical activity due to avoidance, that may in turn have decremental effects on confidence and self esteem and quality of life. Therefore, this article aims to highlights the importance of introducing preventative routines of exercise and mobility to ensure injury occurrence in repetitive strains and exercise is kept to a minimum.

Keywords: Prehab, rehab, injury, pain, overuse, re-education


When we see the top athletes in many sports, we rarely stop and think about how they become so robust to training and match load. This may be due to correct training protocol and the access to top level coaches, therapist and practitioners that create a multidisciplinary team (MDT) to ensure health and performance levels are high and injuries levels are kept to a minimum. However, in between training and recovery sessions, it is expected that these athletes are self administering prehab methods to ensure that they maximise training and competition efforts whilst minimising the potential risks of injury and illness.

However, when it comes to individualised programming of specific activities/injuries, there is limited resources available without mind boggling terminology that will no doubt cause the individual seeking help to not continue. Therefore, it is important to ensure that there is little jargon and confusion in accessible documents to those without scientific knowledge to ensure that they understand how, why and what they are doing to ensure adherence is kept throughout. On the flip side, individuals that become injured overtime within manual labouring jobs and desk jobs often present pain as a result of dysfunction of muscles and tendons due to irregular movement patterns. Of which, only then a massage, physio/sports therapist is brought in to aid recovery and educate those in pain.

But why should therapist only be used after an injury? Is this because the idea of time away from training/the desk too much of a cost? How much money and time could be saved by bringing in movement and exercise specialist in before the injury has occurred to improve productivity, lifestyle and behaviour change. The infrastructure that is currently in a place is slowly being brought to the surface and that this does not benefit anyone.

So, what is Prehab?

Prehab is an individualised programme that is prescribed to the user to improve markers that suggest weakness, muscular imbalance and/or poor proprioception. By carrying out regular bouts of these tasks throughout the day/week, the aim is to improve biomechanical, psychological and physiological capabilities that lead to improved awareness, mobility, strength, coordination and much more.

Prehab programmes are generally designed to prevent the likelihood of injury occurring at work, gym or on the pitch. Typically, a slight “niggle” may be noticed by the individual perhaps due to spikes in work/training load or a strain from irregular movement. These symptoms tend to be ignored and overlooked that can develop to an injury if left untreated. Typically, clients may quote “I thought I could just stretch it out”, I thought I could run it off, I just waited for it to settle down”. These are signs of micro trauma to ligaments, tendons, muscles and irritation to joints that are caused be irregular movement on joints, excessive strain on muscles, and sprains on tendons and ligaments.

So, when are prehab programmes required?

Within the sports environment, typical uses of prehab are used dependant on the activity or sport such as runners should focus on loading the Achilles tendon appropriately to avoid tendinopathy from occurring. Movements such as squatting, lunging, deadlifting will require glute-based prehab exercise to avoid lower back, hip and knee injuries throughout the lift.

In the work environment such as a a desk job, poor posterior muscle strength combined with shortening of the anterior upper body muscle groups causes pain on the upper back and neck muscles as they strain to support the body under external load. Often, individuals will work through the pain and deal with it rather than prevent this by "training the muscles" to cope with the stresses of repetitive strain.

Muscle strains and tendinopathy injuries tend to arise due to poor biomechanics. As the pain symptoms increase (as a sign of protection), the damage to the surrounding tendons, ligaments increase if ignored. Thus, the requirement of immediate rehabilitation is paramount to prevent further injury. However, those that stop following the program (of which will be used as a preventative plan once that is injury has recovered) have a surprise lurking… Because when they go back to old habits, the irregular movement leads to stability and strength reductions that then lead to overcompensation and overuse pain.

Who should be doing Prehab?

Anybody can do prehab! Whether you are into sport or work at a desk. If you have previously suffered from tight neck and shoulders, prehab is for you. Do you suffer from tight hamstrings and/or previous injury? Prehab is for you. Have you had previous injury/pain when you run, jump, squat? Prehab is for you!

At Next Step Therapy we take an individual approach to cater for your sport/occupation that allows you to move better and feel stronger. The typical process includes;

- Health and history screening

This is to ensure appropriate identification of risk and health markers to keep your safe.

- Functional and static assessment

This part of the process assesses all markers of fitness that may contribute to the present condition. By starting at functional movement assessment our therapist can hone in on the problematic area and provide you with a specific program that targets flexibility, strength and movement deficiencies.

- Programme planning

Here is where our therapist will plan the programme with you. Whether it is movements that may hurt, or you find difficult, they will work around this to create a program that works for you.

- Programme review

Our therapist will keep in touch on a weekly basis to ensure you’re happy with the program and whether the exercises need progressing or regressing to ensure adherence is kept throughout the programme.

Take home message

Through this article we have briefly highlighted the importance of preventing injury/illness by being proactive and "training" the soft tissues to deal with the stresses o day to day activities and/or exercise to enable you to be pain free.

Key Points

- If you have previously injured yourself, it's important to strengthen the surrounding structures to ensure that it does not occur again.

- Be more aware with posture and over long periods of time

- The muscles that are under strain need to be strengthened

Despite our recommendation, you should always consult with your doctor or local physiotherapist to gain expert advice before starting any (P)rehabilitation programme to determine the level of care needed.

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