How do physiotherapy and kinesiology work together to provide prehabilitation?
Kinesiology and physiotherapy are related fields that focus on human movement, function, and performance - they have some key differences that can create complementarity and synergy for a comprehensive prehabilitation experience.
To describe how they can each support prehabilitation independently, as well as contribute to a whole that greater than the sum of its parts, it’s worth defining these roles first.
Kinesiology is the study of human movement and exercise. It involves understanding how the body moves, the mechanics of movement, and the factors that influence movement. Kinesiologists often work in areas such as sports performance, exercise prescription, and ergonomics. They may assess movement patterns, develop exercise programs, and provide guidance on injury prevention and performance enhancement. Kinesiologists work in clinical, health and wellness, and performance settings among many other health professionals. Kinesiologists are regulated health professionals in Ontario; however, a comparable title used across Canada and elsewhere in the world is the Exercise Physiologist.
Physiotherapy, also known as physical therapy, is a healthcare profession that focuses on restoring and maintaining physical function and mobility. Physiotherapists assess, diagnose, and treat a wide range of conditions, injuries, and disabilities. They use various techniques such as manual therapy, therapeutic exercises, electrotherapy, and education to help individuals recover from injuries, manage chronic conditions, and improve overall physical well-being. Physiotherapy is a regulated health profession integrated into a wide variety of settings, such as sports, hospitals, and community clinics.
There is considerable overlap in the role of the kinesiologist and physiotherapist which supports strong interprofessional communication and cohesive health experience for their patients and clients. In general (and for which there are many exceptions): physiotherapists tend to focus on impairment-based care, such as addressing the rehabilitation and recovery needs of a patient following surgery; whereas, kinesiologists tend to be focused on wellness or performance based care, which may also be for people with an injury or chronic disease. Physiotherapists are licensed to do many of the things that the kinesiologist can do, but have a broader scope of practice for impairment-based care. Kinesiologists tend to have more extensive experience or training in wellness and high-performance assessment and training which often make them ideal health professionals to optimize general health and fitness.
Together, physiotherapists and kinesiologists can provide a wide range of physical fitness and function programs for patients that ensure impairment and performance based needs are met.
This is reflected in the image below described for people with cancer undergoing rehabilitation.
Image Source: Santa Mina, D; Cutrono, SE; Rogers, LQ. Integrating Exercise into the Electronic Medical Record: A Case Series in Oncology. Translational Journal of the ACSM 3(23):p 181-189, December 1, 2018. | DOI: 10.1249/TJX.0000000000000074
Across prehabilitation literature, physiotherapists, kinesiologists, and exercise physiologists have been the deliverers of exercise prescriptions prior to surgery. To date, there have been no studies that have compared the effectiveness of one exercise professional vs another – likely because both do a great job and stay within the scope of their profession. Most often, whether you get a kinesiologist or a physiotherapist for your prehabilitation is likely a matter of luck and circumstance, where the team simply had a champion for its development originating from someone in one professional or the other.
When physios and kins are on the same prehab team there may be a number of important benefits achieved through their collaboration:
1. Assessment and Evaluation: Kinesiologists and physiotherapists can work together to assess and evaluate a patient's physical condition, functional abilities, and specific needs related to prehabilitation. In instances where an injury may be present that prevents a patient from exercising, the physiotherapist may be best suited to assess and diagnose that condition to support a treatment plan that the kinesiologist can execute. For some surgeries that may interrupt urinary function, a physiotherapist who specializes in pelvic floor health may be appropriate to assess baseline pelvic floor strength prior to a preoperative pelvic floor training program. The kinesiologist might help understand patients’ capacity for exercise through assessments of physical activity and exercise in their daily life.
2. Exercise Prescription: Based on the assessment, both professionals can collaborate to develop an individualized exercise program for prehabilitation. Kinesiologists, who specialize in exercise science, can design and prescribe exercises that target specific muscle groups, improve range of motion, and enhance overall physical fitness. Physiotherapists, with their expertise in rehabilitation, can guide exercises that address specific functional limitations or injuries. Where a localized impairment undermines a particular exercise, a physiotherapist may focus their treatment on that as the kinesiologist adapts an exercise program to ensure other systems are challenged.
3. Rehabilitation Techniques: Physiotherapists can utilize their knowledge of manual therapy techniques, such as joint mobilizations, soft tissue mobilization, and therapeutic modalities, to address any existing injuries or limitations that may impact prehabilitation. Kinesiologists can work alongside physiotherapists to incorporate these techniques into the overall prehabilitation program.
4. Progress Monitoring: Both professionals can collaborate to monitor the patient's progress throughout the prehabilitation process. They can assess improvements in strength, flexibility, endurance, and functional abilities, and make necessary adjustments to the exercise program as needed. For example, a kinesiologist or exercise physiologist may perform a cardiopulmonary exercise test (CPET) to monitor aerobic fitness that has been shown to correlate with surgical risk.
5. Education and Support: Kinesiologists and physiotherapists can provide education and support to patients, helping them understand the importance of prehabilitation, teaching proper exercise techniques, and providing guidance on injury prevention strategies. They can also offer advice on lifestyle modifications and self-management techniques to optimize the prehabilitation process. A physiotherapist may have keen insight on acute postoperative rehabilitation regimes that can be introduced prior to surgery so the patient is aware of what to expect.
By working together, kinesiology and physiotherapy can provide a comprehensive approach to prehabilitation, addressing both performance and rehabilitation needs, to optimize a patient's physical condition before a medical procedure. It's important to note that the specific roles and responsibilities, as well as training and experiences, for these professionals, can vary widely depending on the country or region of their education, certification, and licensure. Consult with your healthcare team to determine the most appropriate professionals to work with for your specific needs.
Check out these papers which discuss the roles and responsibilities of physiotherapists and kinesiologists in prehabilitation and rehabilitation:
From Theory to Practice: An International Approach to Establishing Prehabilitation Programmes
