What Is Prehab?

Many people have done rehabilitation (rehab) after an orthopedic surgery or trauma. But few people know about prehabilitation (prehab). Rehab helps to get your physical abilities and quality of life back after an injury or surgery. Prehab helps you prepare your body before surgery. And it may allow for a better and more comfortable recovery.  

If you or a loved one has an upcoming surgery, you may be wondering how to improve the rate of recovery after surgery. Preparing in advance through prehab might be a tool to reach those goals.

How does prehab work? 

Prehab is preparation work you can do to get your body ready for surgery. This may be physical to improve your fitness, or it can be psychological to prepare your mind. About 1 month of exercise can help improve physical fitness. So you can plan an exercise program ahead of surgery. Training before joint surgery can involve:

• Muscle strengthening 

• Stretching 

• Range of motion exercises

• Aerobic exercise (like cycling)

• Balance and gait training  

Prehab also addresses any issues that may prevent or slow down your healing. Poor nutrition, loss of muscle mass, and too much body fat can lead to poor recovery after spine, hip, or knee surgery. You may have more complications from surgery if you have a history of:

• Low iron (iron deficiency)

• Low vitamin D

• Overweight

• Smoking

• Heavy alcohol use

Your healthcare team can help you make a plan to cover all your bases in preparation for surgery.   

What are the benefits of prehab before major surgery?

Major surgery is a big challenge for your body. And it can put your body through significant stress. Your body will manage that stress better if you lead it to a state of well-being beforehand. Some benefits of prehab are:

• Increased physical fitness: As people age, they can get less fit, less active, and lose muscle mass. The less fit you are, the higher the risks of complications after surgery. 

• Increased mobility: Once you have surgery, your activity and mobility will decrease. The less you move after surgery, the higher your risk of complications. Getting moving in advance may help improve your recovery. 

Cardiac and cancer surgery are examples of major surgeries that benefit from prehab.

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Cardiac surgery 

Prehab may be helpful for those who undergo cardiac bypass. Studies show that walking on a treadmill daily for at least 1 week before surgery has benefits. People who trained before surgery had fewer complications than those who didn’t do prehab. Aerobic exercise may be useful by preparing the heart cells for the stress of surgery.

Cancer surgery 

Prehab may also be safe and suitable for people having cancer surgery. Aerobic exercise and resistance training can help to improve physical fitness in people with cancer. Being physically fit before your surgery may improve your recovery after surgery. Prehab may be useful for those who have:

• Colorectal cancer

• Lung cancer

• Prostate cancer

• Esophageal cancer

• Stomach cancer

What are the effects of exercise before major joint surgery?

Some people think that exercise may hurt a joint with arthritis. But it may help calm your fear, help you cope with pain, and motivate you to keep moving after surgery. It’s also a good idea to strengthen both joints before surgery. This will help to prevent any imbalances during the recovery process.

Prehab for knee replacement surgery

There’s strong data about the benefit of prehab before knee replacement surgery. Some studies have shown shortened hospital stays and improved pain immediately after surgery. 

Other studies have shown that prehab may even offer an added benefit. Almost 20% of people with prehab improved so much that they canceled their knee replacement surgery. The research is ongoing to understand how prehab helps those who need knee replacement. 

Prehab for hip replacement surgery 

There’s a small amount of research available about prehab before hip replacement. And it seems promising, with some reporting slightly improved pain after surgery. 

Prehab also seems to have an impact on functioning after hip replacement. After 6 weeks of prehab, it’s more likely that you’d be able to go home after surgery rather than to a rehab facility.

Prehab for shoulder replacement surgery 

People who need shoulder replacement surgery may also benefit from prehab. In some cases, there’s improvement in as little as seven treatments. One case-report study showed that prehab improved pain and movement so much that surgery was no longer needed. 

Prehab for knee anterior cruciate ligament (ACL) surgery

An anterior cruciate ligament (ACL) tear of the knee is a common sports-related injury. You don’t always need surgery after this injury. But if you do need a surgical repair, outcomes are better when you get prehab. Some of the benefits of following a 4 to 6 week prehab program before ACL repair include:

• Improved quadriceps strength

• Better range of motion

• Decreased rate of reinjury

• Decreased rate of injury to the other (unharmed) knee

Studies have shown that the benefits can last from several weeks to years in some people. 

What about prehab before spine surgery?

The evidence isn’t as strong for the benefits of prehab before spine surgery. Researchers found no differences in pain or disability between people who did prehab before lower back surgery and those who didn’t. But they found that prehab was safe. They also found that with education, people felt prepared and positive toward surgery. 

Should you talk to your provider about trying prehab?

Although prehab helps some people recover faster after surgery, it may not be an option for everyone. That’s because every surgery is different. The condition of your body before surgery may be different from that of other people having the same surgery. Your pain tolerance may not be the same and your goals after surgery may also vary. 

So the best recommendation is to talk with your healthcare team before surgery. They can help you learn how to be in your best shape in preparation for surgery in order to get the best possible results. 

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Written by:

Itza Rivera, MD

Dr. Rivera is a board-certified physical medicine and rehabilitation specialist. She completed her medical degree and residency training at the University of Puerto Rico School of Medicine, and her neuromuscular disorders subspecialty training at Northwestern University.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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