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Improving Surgery Outcomes with Prehab

You have been dealing with your knee pain for several years… listening to the grinding while you walk, hearing the crunching with stairs, and you cringe when you think of having to squat or kneel. You finally make an appointment to see your doctor and find surgery to be your best option.

Physical therapy, injections, and medications have all failed. You think, “Okay, that will fix the problem and I’ll be back to my usual activities fairly quick.” But Doc instructs you to schedule with a physical therapist for a “pre-habilitation” or “pre-hab” program. You’ll likely ask, “Why on earth do I need to exercise BEFORE surgery?

Particularly on a knee that already hurts and will eventually be repaired. After all, I’ll be going to physical therapy AFTER surgery.” You’re not alone. The last thing most patients can think about is exercising an already painful limb. However, an effective pre-hab program can maximize your recovery and improve outcomes. Performing a pre-hab program designed by a physical therapist can help control existing pain, while maintaining or even restoring strength and motion.

What is Pre-Hab?

Pre-hab is defined as enhancing the functional capacity of an individual to enable him or her to withstand the stressor of inactivity.1 It seems logical that the more fit and active you are prior to a surgery, the better outcome and recovery. Physical activity allows our muscles, bones, and joints to become stronger, while allowing for tissue repair and rebuilding. Without physical activity, our muscles become tight and weak. It’s not just a single body part, either. A shoulder injury will result in inactivity at the elbow and wrist. The entire chain becomes weak or compensates.

For example, a patient waiting for knee surgery, whether it be for their ACL or simply waiting for a joint replacement, will walk differently. They will negotiate and squat differently. The load, strength, and motion will need to come from elsewhere. It’s not uncommon for a patient to develop low back, hip, and or ankle pain resulting from a deficiency at the knee. Sharma et. al reported that functional ability one month prior to a total knee replacement predicted the functional ability at three months after surgery.3 In addition subjects who participated in a pre-hab program decreased their pain and improved their knee strength in both legs between 30 and 90 days post-surgery.2 Control subjects were also found to be weaker when compared to the pre-hab group between 30 and 90 days.

The Effect of Age

As always, age complicates the situation. For most, physical inactivity and increased risk for falling increases with age. Less fit and frail patients have a higher incidence of pre surgical morbidity and mortality.3 This is all the more reason to keep our bodies moving, strong, and active as we age. Remember, the better you go into surgery, the better you come out.

If health does suede your decision to enlist in a prehab program maybe money will. A 2008 study by Nielson et al have shown that your overall health care costs are diminished with improved post-surgical outcomes.4 The savings rides on the back of less doctor’s visits and imaging (x-rays, MRI, etc.). Savings can measure into the thousands, particularly those with high co-pays and deductibles.

If you or a loved one has concerns over developing an exercise program with your current ailments or wondering if a prehab program is appropriate prior to surgery, consult with your physician or a physical therapist. It can make a world of difference on your quality of life and long term success of your surgery. Again, the more strength, flexibility, and overall health you take into a surgery, the quicker you recover.

To begin your “pre-hab” with a physical therapist, click the link below to schedule a free discovery visit with a physical therapist.


1. Ditmyer, M, Topp, R, Pifer, M. Prehabilitation in Preparation for Orthopedic Surgery. Orthopedic Nursing. 2002; 21 (5): 43-54.
2. Topp, R, Swank, A, Quesada, P, Nyland, J, Milkani, A. The Effect of Prehabilitation Exercise on Strength and Functioning after Total Knee Arthroplasty. American Academy of Physical Medicine and Rehabilitation. 2009; 1: 729-735.
3. Jack, S et al. Perioperative Exercises Training in Elderly Subjects. Best Practice and Research Clinical Anaesthesiology. 2011; 25: 461-472.
4. Nielsen, R, Andreasen, J, Asmussen, M, Tonnesen, H. Costs and Quality of Life for Prehabilitation and Early Rehabilitation After Surgery of the Lumbar Spine. BMC Health Services Research. 2008; 8: 209



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