Prehab Before Surgery

What Is a Prehab Program?

Preparing for orthopaedic surgery can feel uncertain, particularly when pain, stiffness or weakness are already affecting your mobility. You may be wondering whether you should keep exercising, which movements are safe and whether there is anything practical you can do before the operation.

Prehab before surgery, also known as prehabilitation or pre-operative rehabilitation, is a structured approach to preparing your body and understanding the early recovery process before an operation. It may include strength training, mobility work, cardiovascular conditioning, functional practice and education tailored to the procedure you are preparing for.

MTP Health also provides dedicated pre-operative rehabilitation services for patients who need individual assessment and clinical guidance. This may include pre-operative physiotherapy care when closer assessment, symptom monitoring or procedure-specific guidance is required. This educational page explains how a prehab program may be structured, who may benefit and what to consider when preparing for orthopaedic surgery.

Prehab does not guarantee a particular surgical result, a shorter hospital stay or a pain-free recovery. Its purpose is to help you approach surgery with an appropriate level of strength, mobility, fitness and confidence, depending on your condition and general health.

A prehab program is a planned period of physical and practical preparation completed before surgery. It is different from following a generic online exercise routine because the program should consider your diagnosis, planned procedure, current symptoms, medical history and functional needs.

The program may be delivered by a physiotherapist, exercise physiologist or another appropriately qualified health professional. Where relevant, the rehabilitation team may also work from instructions provided by your orthopaedic surgeon or treating medical team.

Prehab may address:

• muscle weakness around the affected joint or body region;
• reduced range of movement;
• difficulty walking, using stairs or rising from a chair;
• poor balance or reduced confidence loading the affected limb;
• loss of cardiovascular fitness after a period of reduced activity;
• uncertainty about exercise before surgery;
• functional tasks that may be important during early recovery; and
• understanding what may happen before and immediately after the operation.

The exercises used in orthopaedic prehab depend on the procedure. Someone preparing for a total knee replacement may require a different program from a person preparing for ACL reconstruction, shoulder surgery or a spinal procedure.

What Conditions and Procedures May Prehab Be Used For?

Pre-operative rehabilitation may be considered before several types of orthopaedic surgery. The program should be matched to the body region involved and the expected demands of the operation.

Joint Replacement Surgery

Joint replacement prehab is commonly considered before total knee replacement or total hip replacement. Patients awaiting surgery may already have pain, stiffness, weakness and reduced walking tolerance because of osteoarthritis or another joint condition.

A pre-surgery exercise program may focus on lower-limb strength, walking, balance, transfers and cardiovascular conditioning. The aim is not to reverse advanced joint damage. It is to help the patient maintain or improve physical capacity while preparing for the operation and early rehabilitation.

Knee and Sports Surgery

Prehab may also be relevant before procedures such as ACL reconstruction, knee arthroscopy or surgery for another sports-related injury. Depending on the diagnosis, the program may address swelling, knee movement, quadriceps strength, balance and confidence using the affected leg.

The surgeon or treating clinician may provide restrictions where the knee is unstable or where certain movements could aggravate the injury. A structured program should follow those restrictions rather than applying the same exercises used for joint replacement.

Hip Surgery

Patients preparing for hip replacement, hip arthroscopy or another hip procedure may benefit from exercises that address hip and lower-limb strength, walking tolerance, balance and functional movement.

Hip pain can significantly reduce activity before surgery. This may lead to general deconditioning as well as weakness around the affected hip. Rehabilitation before surgery may therefore include both local strengthening and broader physical conditioning.

Shoulder Surgery

Before rotator cuff repair, shoulder replacement or another shoulder operation, prehab may focus on maintaining movement and strength within the limits advised by the treating team. It may also include practical preparation for daily activities that could be difficult when one arm has restricted use after surgery.

Spinal and Other Orthopaedic Procedures

Some patients preparing for spinal surgery or another orthopaedic procedure may also be referred for prehab. The program may address general conditioning, walking, trunk control, functional movement and confidence with activity.

Not every operation requires the same preparation, and not every patient needs formal prehab. Suitability should be considered individually.

When Might Prehab Before Surgery Be Considered?

A structured prehab program may be considered when surgery has been recommended, provisionally planned or booked and the patient wants guidance on preparing safely.

It may be particularly useful when:

• pain or stiffness has reduced normal activity;
• muscle weakness is affecting walking or everyday tasks;
• the patient has lost fitness while waiting for surgery;
• stairs, transfers or other functional tasks are difficult;
• the patient is unsure which exercises are safe;
• there are several weeks available before the operation;
• the patient wants to understand early rehabilitation expectations;
• the planned procedure has specific physical preparation needs; or
• medical conditions require exercise to be prescribed or monitored carefully.

Starting earlier may provide more time to build strength and confidence, but patients who are close to their surgical date may still benefit from an assessment, practical advice and a focused exercise plan. The available time should influence the program rather than determine whether preparation is worthwhile.

Who May Be Suitable for a Prehab Program?

Suitability depends on more than age or diagnosis. An older patient with several health conditions may still be able to participate in a modified program, while a younger and active patient may require restrictions because of the nature of the injury.

Factors considered may include:

• the planned operation and surgical date;
• the diagnosis and affected body region;
• pain severity and symptom behaviour;
• joint movement and muscle strength;
• walking ability and balance;
• current level of physical activity;
• previous treatment or surgery;
• heart, respiratory or neurological conditions;
• falls risk;
• the use of a walking aid;
• the surgeon's instructions or restrictions; and
• the patient's goals and home circumstances.

Existing imaging, medical reports or surgeon correspondence may help provide context, but they do not replace functional assessment. New imaging is not usually ordered simply because a patient is beginning prehab unless the treating medical team considers it necessary.

When Surgery May Not Be the First Option

Prehab is generally designed for patients preparing for a planned or likely operation. It should not be confused with a broader non-surgical rehabilitation program used when surgery has not been recommended or remains uncertain.

Some knee, hip, shoulder and spinal conditions may initially be managed with physiotherapy, strengthening, medication prescribed by a doctor, injections, activity modification, bracing or monitoring. In these situations, the purpose of rehabilitation may be to manage symptoms or improve function rather than prepare for surgery.

If the need for surgery has not been established, a broader assessment may be more appropriate. MTP Health's rehabilitation programs include pathways for patients at different stages of treatment.

Participating in prehab does not mean that surgery is inevitable. Surgical suitability and timing remain decisions for the patient and their surgeon, taking into account symptoms, diagnosis, health, previous treatment and personal preferences.

When Should You Start Prehab Before Surgery?

There is no single timeframe that applies to every patient. The best starting point depends on the operation, how far away it is, your current capacity and whether there are any medical restrictions.

If Surgery Is Several Weeks Away

Several weeks may allow time to establish an exercise routine and progress strength, mobility and conditioning gradually. The program can be reviewed as the surgical date approaches and modified according to symptoms and progress.

If Surgery Is Only a Few Weeks Away

A shorter period does not necessarily prevent useful preparation. The focus may be on learning safe exercises, maintaining current function, practising essential tasks and understanding what to expect during early recovery.

It would be inappropriate to introduce a highly demanding program immediately before surgery if there is not enough time to adapt. The emphasis should remain on safe and practical preparation.

If the Surgical Date Changes

If surgery is postponed, the prehab plan can be reviewed and extended. This may create an opportunity to build further strength or general fitness, but the program should still account for pain, fatigue and the underlying condition.

If surgery is brought forward, the treating clinician may simplify the program and prioritise the most relevant education and functional tasks.

Review of Your Planned Procedure and Health

Your clinician may ask about the diagnosis, planned operation, surgical date, current symptoms, medication, previous surgery and any instructions from your surgeon.

Other medical conditions are important because they may affect exercise tolerance or require further clearance. These can include cardiovascular disease, respiratory conditions, diabetes, neurological conditions or a history of falls.

Strength, Movement and Functional Assessment

Depending on the procedure, the assessment may consider:

• joint range of movement;
• muscle strength;
• balance and lower-limb control;
• walking pattern and tolerance;
• ability to sit and stand;
• stair use;
• upper-limb function;
• general exercise tolerance; and
• tasks likely to be important after the operation.

These assessments form part of pre-operative physiotherapy when closer clinical evaluation or symptom monitoring is required.

Goals and Program Planning

The program should reflect the patient's goals and available time. Goals may include maintaining independence, improving walking tolerance, becoming more confident with stairs or preparing to use a walking aid after surgery.

The clinician can then select an appropriate starting level and decide which exercises should be supervised and which can be completed at home.

How Is a Prehab Program Performed?

Prehab is not a surgical procedure. It is a structured preparation pathway that may combine assessment, supervised exercise, education and home practice.

Before Starting

Relevant information about the procedure and health history is reviewed. The clinician identifies any restrictions and determines whether the patient requires medical or surgical clearance before beginning exercise.

A baseline assessment is then used to develop the initial plan.

During the Program

Sessions may include resistance exercises, mobility work, walking, balance activities and cardiovascular conditioning. The intensity should be appropriate for the patient rather than based on a fixed program for everyone.

Exercises may be progressed by changing:

• resistance;
• repetitions;
• movement range;
• exercise duration;
• balance demands;
• walking distance; or
• the complexity of a functional task.

A home program may be provided to support regular practice between appointments.

Immediately Before Surgery

As the operation approaches, the program may shift towards maintaining capacity, reviewing exercise technique and reinforcing practical preparation. Patients should follow any specific instructions provided by the surgeon, anaesthetist or hospital.

Exercises should not be continued against medical advice or through a substantial change in symptoms.

What May Be Included in a Pre-Surgery Exercise Program?

Strength Training

Strength exercises may target the muscles that support the affected joint or body region. Before lower-limb surgery, this may include the quadriceps, hamstrings, gluteal muscles and calf muscles.

Upper-limb strength may also be relevant if the patient is likely to use crutches, a frame or handrails after surgery. Exercise selection depends on the planned procedure and any restrictions.

Mobility and Range-of-Motion Exercises

Mobility work may be used where stiffness is limiting function. The aim is not always to restore full movement before surgery. It may be to maintain the available range or improve movement needed for walking, transfers or self-care.

Balance and Walking Practice

Balance may be affected by pain, weakness or reduced activity. Prehab may include supported standing, stepping or walking exercises.

Patients preparing for lower-limb surgery may also practise safe use of stairs or walking aids when this is recommended by the treating team.

Functional Surgery Preparation Exercises

Functional exercises reproduce movements that are relevant to daily life. These may include:

• sit-to-stand practice;
• getting in and out of bed;
• getting in and out of a chair;
• using stairs;
• walking with an aid;
• reaching or dressing strategies; and
• tasks required within the home.

Cardiovascular Conditioning

Reduced activity can lead to general deconditioning before surgery. Depending on the patient's health and symptoms, the program may include walking, stationary cycling or another form of aerobic exercise.

Exercise physiology before surgery may be appropriate when a patient needs broader conditioning, support with chronic health conditions or a more progressive exercise plan.

Home Exercise

Home exercise allows the patient to practise regularly without attending a supervised session every day. The program should be realistic and suitable for the available space and equipment.

A smaller number of well-selected exercises is often more manageable than a long and complicated routine.

Preparing for Surgery Beyond Exercise

Prehab may include practical education as well as physical training. The exact advice should be consistent with instructions from the surgeon and hospital.

Understanding the Early Recovery Period

Patients may be introduced to the types of movements or exercises commonly required after surgery. This can make the early rehabilitation process feel more familiar.

The prehab clinician should not replace procedure-specific advice from the surgeon or hospital team.

Preparing the Home

Depending on the operation, patients may need to consider access to frequently used items, seating height, stairs, bathroom setup and support from family or friends.

Detailed discharge planning belongs with the hospital and surgical team, but prehab can help identify practical questions before admission.

Preparing Mentally

Confidence often improves when patients understand the purpose of their exercises and have practised key tasks in advance. Prehab may provide a clearer sense of what they can do before surgery and what support may be required afterwards.

Mental preparation does not mean promising a straightforward recovery. It means helping the patient approach surgery with realistic expectations and a plan.

Benefits and Goals of Prehab Before Surgery

The intended goals of a prehab program may include:

• maintaining or improving strength before surgery;
• supporting joint movement where possible;
• improving walking or functional capacity;
• reducing deconditioning while waiting for surgery;
• building confidence with relevant movements;
• becoming familiar with exercises used during rehabilitation;
• identifying practical barriers before the operation; and
• helping the patient understand the early recovery pathway.

Individual results vary. Prehab may support physical readiness, but it cannot guarantee fewer complications, a shorter hospital admission, faster recovery or a specific level of pain relief.

Risks and Considerations

Pre-operative rehabilitation should be adapted to the patient, but exercise can still cause temporary soreness, fatigue or an increase in familiar symptoms.

Potential considerations include:

• joint or muscle soreness;
• temporary symptom flare-ups;
• fatigue;
• falls risk during balance or walking exercises;
• aggravation of an unstable injury;
• medical conditions that reduce exercise tolerance;
• difficulty completing the home program; and
• changes in the condition or surgical plan.

The program should be reviewed if symptoms become substantially worse, swelling increases unexpectedly or a patient develops new weakness, neurological symptoms, shortness of breath, chest pain or another significant medical concern.

Exercise should not delay appropriate medical care or override instructions from the treating surgeon.

How Prehab Compares With General Exercise

A general exercise program may improve fitness, but it may not account for the planned procedure, painful movements, medical conditions or restrictions provided by the surgeon.

A structured orthopaedic prehab program is intended to connect exercise with the patient's surgical pathway. It may include functional testing, symptom monitoring and preparation for movements that are likely to matter after surgery.

Patients who already exercise may not need to stop their usual program. However, it may still be useful to review whether their training addresses the specific strength, mobility or functional demands associated with the operation.

What Happens After Surgery?

Prehab finishes when the focus of care changes from preparation to recovery. After surgery, exercise and rehabilitation should follow the operation performed, tissue healing, medical status and instructions from the treating team.

Postoperative care may include mobility practice, swelling management, restoration of movement and gradual strengthening. These topics belong within a dedicated post-operative rehabilitation program rather than being reproduced in detail on this page.

Questions to Ask Your Surgeon or Rehabilitation Clinician

• Is prehab appropriate for my planned operation?
• Are there movements or exercises I should avoid?
• When should I begin preparing for surgery?
• Do I need medical clearance before exercising?
• What should I bring to my prehab assessment?
• How will my strength and mobility be assessed?
• Which exercises are most relevant to my procedure?
• What should I do if my symptoms worsen?
• Should I continue exercising until the day of surgery?
• What happens to my program if the surgical date changes?
• What support or equipment might I need after surgery?
• How will postoperative rehabilitation be organised?

Take the Next Step

Prehab before surgery may be appropriate when an orthopaedic procedure has been recommended or planned and you would benefit from guidance on strength, mobility, fitness and practical preparation.

An individual assessment can help determine which surgery preparation exercises are relevant, whether any medical or surgical restrictions apply and how the program should be adjusted to the time available before your operation.

To review MTP Health's full range of care pathways, visit the rehabilitation programs page or speak with a qualified health professional about the most appropriate next step for your situation.

This information is general and does not replace personalised advice from your orthopaedic surgeon, physiotherapist, exercise physiologist, GP or other treating health professional.

Frequently Asked Questions