Physical Therapy Before Surgery: What Is Prehab and Does It Help?

Most people think of physical therapy as something that starts after surgery. But for some orthopedic procedures, therapy can begin well before the day of surgery.

This is known as prehab, short for prehabilitation. The idea is simple: help you go into surgery as strong, mobile, and prepared as you can be.

That doesn't mean prehab guarantees an easier or faster recovery. It doesn't. Research does suggest, though, that physical therapy before surgery may improve strength and function for some orthopedic patients. How much it helps after surgery can vary depending on the procedure, your overall health, and the type of prehab program you follow.

Prehab Before Surgery: Key Takeaways

• Prehab is physical therapy or exercise done before surgery.

• It may include strength, flexibility, balance, walking, and everyday movement training.

• Prehab may help improve or maintain your physical function before an operation.

• Your program should be based on your condition, planned surgery, and your surgeon's recommendations.

• Prehab doesn't replace physical therapy after surgery when postoperative rehabilitation is recommended.

What Is Prehab Before Surgery?

Prehab, or prehabilitation, is a program designed to improve your physical condition before surgery. In orthopedic care, that may mean strengthening exercises, mobility work, balance training, walking practice, or learning what to expect once surgery is over.

There's no one-size-fits-all prehab program. What you do will depend on your condition and the type of surgery you're preparing for. Someone getting ready for a knee replacement, for example, may spend time working on leg strength and walking. A patient preparing for shoulder surgery will have very different goals.

Prehab also isn't the same as deciding to "get in shape" on your own before surgery. A physical therapist can determine which movements are safe for you, which muscle groups need the most attention, and which activities may need to be limited or avoided.

Eleni Russow, DPT, Physical Therapy Director at Arthritis & Sports, explains that prehab should be tailored to each patient rather than treated like a general workout program: "Prehab isn't about pushing your body as hard as you can before surgery. It's about finding the right exercises to help you go into surgery as prepared as possible."

What Is the Difference Between Prehab and Rehab?

Prehab and rehabilitation both use physical therapy, but they happen at different stages of treatment.

Prehab takes place before surgery. The focus may be on building or maintaining strength, mobility, balance, and everyday function.

Rehab comes after surgery. At that point, therapy is focused on safely restoring movement, rebuilding strength, and helping you return to everyday activities as your body heals.

There's another benefit to starting early: some of the exercises and movements you learn during prehab may be used again after surgery. That means they won't necessarily feel brand new when recovery begins.

Does Physical Therapy Before Surgery Actually Help?

It can, but the benefits aren't the same for every patient or every type of surgery.

A large systematic review published in JAMA Network Open looked at 48 clinical trials involving 3,570 orthopedic surgery patients. The researchers found evidence that prehab improved several measures of physical function and strength before surgery. The benefits after surgery were less consistent and differed depending on the procedure and the outcome researchers measured.

For patients having total knee replacement, for example, there was moderate-quality evidence of better function before surgery. Before total hip replacement, prehab was associated with improved hip muscle strength. Researchers also found some benefits after surgery, although the quality of evidence for many postoperative outcomes was considered low or very low.

A newer systematic review that included several types of surgery reached a similar conclusion. Prehab may improve physical function, but the findings were mixed for other outcomes, including how long patients remained in the hospital.

So, prehab can be useful. It just shouldn't be viewed as a guarantee that recovery will be faster or easier.

What Are the Potential Benefits of Prehab?

Depending on your condition and your planned surgery, prehab may help you:

• Improve or maintain muscle strength

• Improve mobility and flexibility when appropriate

• Work on balance

• Practice walking safely

• Build endurance

• Learn exercises you may use after surgery

• Practice with crutches, a walker, or another assistive device if you'll need one

• Prepare for stairs and other daily activities

• Get a better sense of what rehabilitation will involve

There can also be value in simply knowing what to expect.

According to Eleni, one benefit of prehab is giving patients a chance to become familiar with movements they may need during recovery: “When patients have practiced the exercises and movements before surgery, they're often more familiar with what we're asking them to do afterward. That can make the first few therapy sessions feel less overwhelming.”

What Can't Prehab Guarantee?

Even a well-designed prehab program can't promise that you'll:

• Have less pain after surgery

• Leave the hospital sooner

• Avoid complications

• Recover within a certain amount of time

• Get back to work or sports sooner

• Avoid physical therapy after surgery

Recovery is influenced by much more than prehab. Your procedure, age, general health, severity of your injury or arthritis, activity level, and the way your body heals can all play a role.

What Happens During Prehab Physical Therapy?

Prehab usually starts with an evaluation so your physical therapist can see where you're starting from. They may look at your:

• Strength

• Range of motion

• Balance

• Walking

• Ability to go up and down stairs

• Ability to sit down and stand up

• Current pain and physical limitations

• Home and work demands

• Activity goals

From there, your therapist can build a program around your planned surgery and any precautions or restrictions from your orthopedic surgeon.

Arthritis & Sports offers orthopedic physical therapy in their Sterling location, allowing therapists to coordinate care with a patient's orthopedic provider.

Strengthening Exercises

Pain and injury often change the way people move. Over time, being less active can also lead to muscle weakness.

One goal of prehab may be to strengthen the muscles you'll rely on during recovery. Before knee surgery, for example, therapy may focus on the muscles around the knee and hip. Before hip surgery, the emphasis may be on hip and leg strength.

The right exercises will depend on your situation. An exercise that makes sense before one procedure may be inappropriate before another, which is why your program should be individualized.

Mobility and Range-of-Motion Exercises

Your therapist may also work on maintaining or improving joint movement when it's safe to do so.

That doesn't mean forcing a painful or injured joint to move farther than it comfortably can. Instead, your therapist can adjust the movement based on your symptoms, your condition, and any restrictions your surgeon has provided.

Balance and Walking

Balance and walking may be another part of prehab, particularly for people preparing for hip or knee surgery. If you'll need crutches, a walker, or another assistive device after surgery, you may also get a chance to practice using it beforehand. Learning how it works before the procedure can make it feel more familiar when you actually need it.

Preparing for Everyday Activities

Recovery isn't just a series of exercises. Everyday tasks can become challenging for a while, too.

Before surgery, your physical therapist may help you practice things such as:

• Getting in and out of a chair

• Getting in and out of bed

• Going up and down stairs

• Getting into a car

• Walking with crutches or a walker

• Moving safely around your home

Those practical skills can become especially useful during the first days or weeks after surgery.

What Types of Orthopedic Surgery May Use Prehab?

Prehab may be considered before a number of orthopedic procedures. That doesn't mean everyone having one of these surgeries needs physical therapy beforehand.

Your surgeon and physical therapist can help you decide whether it makes sense in your case.

Prehab Before Knee Replacement

Knee arthritis can cause more than pain. It can also lead to stiffness, muscle weakness, and trouble walking, climbing stairs, or getting up from a chair.

Before a total knee replacement, physical therapy may focus on maintaining or improving:

• Leg strength

• Knee movement

• Balance

• Walking

• Stair climbing

• Getting in and out of a chair

Research suggests that prehab can improve certain measures of strength and function before total knee replacement. Some studies have also found early improvements in function after surgery, although the benefits aren't clear across every outcome.

Patients considering surgery for knee arthritis can also learn more about knee pain and orthopedic knee care and total joint replacement at Arthritis & Sports.

Prehab Before Hip Replacement

Hip arthritis can make it harder to walk, keep your balance, or perform everyday movements. It may also lead to weakness in the hip and surrounding muscles.

Prehab before hip replacement may include:

• Hip and leg strengthening

• Balance exercises

• Walking practice

• Safe movement and transfer training

• Practice with an assistive device, when needed

Research has found improvements in some measures of hip strength and quality of life before total hip replacement in patients who participated in prehab. The benefits after surgery have been less consistent.

You can also learn more about hip conditions and treatment options and total joint replacement at Arthritis & Sports.

Prehab Before ACL or Other Knee Surgery

For some knee injuries, physical therapy may begin well before surgery takes place.

Depending on the injury, treatment might focus on improving knee movement, reducing functional limitations, strengthening the muscles around the joint, and getting ready for postoperative rehabilitation.

There isn't one standard prehab program for every ACL, meniscus, or cartilage injury. Different injuries place different demands on the knee.

Your orthopedic surgeon and physical therapist should decide what is safe based on which structures are injured and what type of surgery is being considered.

You can also learn more about ACL vs Meniscus Tears and sports medicine treatments at Arthritis & Sports.

Prehab Before Shoulder Surgery

Physical therapy may also be appropriate before certain shoulder procedures.

Depending on the problem, prehab might focus on shoulder movement, strength, posture, shoulder-blade control, or preparing for the limitations you'll have while the shoulder heals.

Physical therapy is commonly used for many shoulder conditions and may be part of treatment both before and after certain shoulder surgeries.

How Long Before Surgery Should You Start Prehab?

There's no single timeline that works for everyone.

Some research suggests that, when enough time is available, an orthopedic prehab program lasting about four to six weeks may be reasonable. That isn't a rule, though, and it won't apply to every person or every procedure.

Your timeline may depend on:

• When your surgery is scheduled

• Your diagnosis

• Your current strength and mobility

• Your pain level

• The type of surgery you're having

• Your overall health

• Your surgeon's recommendations

Prehab needs to fit into the larger surgical plan. In general, surgery shouldn't be delayed simply so you can complete a certain number of therapy sessions unless your medical team specifically recommends doing so.

Is It Ever Too Late to Start Prehab?

Not necessarily.

Even when surgery is only a short time away, meeting with a physical therapist may still be useful. A shorter program might give you time to learn safe exercises, practice with a walker or crutches, review movements you'll need after surgery, and ask questions about the rehabilitation process.

Whether that's worthwhile will depend on your individual situation.

What If Exercise Hurts Before Surgery?

Prehab isn't supposed to mean pushing through severe pain. Exercise may take effort, and some soreness can occur. But new, significant, or worsening pain can be a sign that an exercise needs to be adjusted.

A physical therapist can change:

• The exercise itself

• How much resistance you use

• How far you move the joint

• The number of repetitions

• How much weight you put through the injured area

• Your position during the exercise

If an exercise causes new pain or clearly makes your symptoms worse, tell your therapist.

Eleni also emphasizes that effective prehab isn't about doing as much exercise as possible—it's about finding the right amount for each patient: “More exercise isn't always better. Our job is to find the amount and type of movement your body can handle safely while still helping you prepare for surgery.”

Should Everyone Have Physical Therapy Before Surgery?

No. Prehab isn't necessary or appropriate for every patient.

Whether it may help you depends on several factors, including:

• The surgery you're having

• Your current strength and mobility

• Your pain

• Your injury or condition

• Your medical history

• How soon your surgery is scheduled

• Whether you've already had physical therapy

• Your surgeon's recommendations

Some people remain active and function well right up until surgery. Others arrive with significant stiffness, weakness, or difficulty managing everyday activities.

That's why the decision should be personalized rather than automatic.

Can Prehab Help You Avoid Surgery?

Sometimes, physical therapy improves a person's symptoms enough that the treatment plan changes. But that's not quite the same thing as prehab.

Conservative physical therapy is used as a treatment with the goal of improving pain and function without surgery.

Prehab generally takes place when surgery is already planned or considered likely. Its purpose is to help prepare you for the operation and the recovery that follows.

If your symptoms improve significantly while you're preparing for surgery, talk with your orthopedic provider. Don't cancel or delay a planned procedure without first discussing the change with your medical team.

What Should You Ask Your Surgeon About Prehab?

If you're preparing for an orthopedic procedure, these questions can help you understand whether prehab belongs in your treatment plan:

• Would physical therapy before surgery be helpful for me?

• Are there exercises or movements I should avoid?

• What should I focus on before surgery?

• When should I start prehab?

• Will I need crutches, a walker, or another assistive device after surgery?

• When should physical therapy begin again after my procedure?

• Are there any restrictions my physical therapist needs to know about?

Your surgeon and physical therapist can work together so that your rehabilitation plan matches both your procedure and your individual needs.

Physical Therapy Before and After Surgery at Arthritis & Sports

Physical therapy can be useful at several points during orthopedic care, not just after an operation.

Arthritis & Sports offers pre-surgical rehabilitation, post-surgical rehabilitation, and joint replacement rehabilitation at our physical therapy clinic in Sterling, Virginia. Our rehabilitation team works with patients to improve strength, mobility, function, and confidence while coordinating care with their orthopedic providers.

If you have an orthopedic procedure coming up, ask your surgeon whether physical therapy before surgery should be part of your preparation.

There's no need to be "perfect" before surgery. That's not what prehab is about. The goal is to help you arrive at surgery as safely and confidently prepared as possible.

Frequently Asked Questions About Prehab Before Surgery

What is prehab before surgery?

Prehab is physical therapy or exercise done before surgery to help prepare your body for the procedure and the recovery that follows. It may include strengthening, mobility exercises, balance work, walking practice, and education about what to expect after surgery.

Does physical therapy before surgery help recovery?

It may. Physical therapy before surgery has been shown to improve certain measures of strength and function, and some research has found benefits after orthopedic surgery as well. Results vary based on the procedure, the patient, and the outcomes being measured, so prehab doesn't guarantee a faster recovery.

How long should I do physical therapy before surgery?

There's no standard length of time that's right for everyone. Some research has looked at programs lasting four to six weeks, but your timeline should be based on your procedure, health, current level of function, and surgery date.

What exercises should I do before surgery?

That depends on your diagnosis and the surgery you're having. Prehab may involve strengthening, mobility, balance, and functional exercises. Rather than starting a general exercise program on your own, ask your surgeon or physical therapist which movements are safe and appropriate for you.

Is prehab worth doing before knee replacement?

It may be helpful for some knee replacement patients. Research suggests prehab can improve certain measures of function and strength before surgery, with some evidence of improved function early in recovery. The benefits aren't the same for every patient, though.

Do I still need physical therapy after surgery if I did prehab?

In many cases, yes. Prehab and postoperative rehabilitation have different purposes. Prehab helps prepare your body before surgery. Physical therapy afterward helps restore movement, rebuild strength, and improve function as you heal. Prehab doesn't replace postoperative therapy when your surgeon recommends it.

Can I do prehab at home?

Some prehab programs include exercises that can be done at home. Others combine a home program with supervised physical therapy visits. Working with a physical therapist can help make sure the exercises you're doing are safe and appropriate for your condition and upcoming surgery.

Is it too late to do prehab if my surgery is only a few weeks away?

Not always. Even if you don't have time for a longer prehab program, a physical therapy visit may still be useful for learning exercises, practicing with an assistive device, reviewing important movements, and preparing for rehabilitation after surgery. Ask your surgeon whether prehab makes sense with the time you have available.

Does insurance cover physical therapy before surgery?

Coverage varies from one insurance plan to another. It may depend on your diagnosis, referral requirements, therapy visit limits, and whether prior authorization is required. Check with your insurance carrier or physical therapy office to confirm your benefits before beginning treatment.