If you have an operation coming up, most of your attention may be on the surgery itself. However, the weeks before your operation can also make a real difference to how you recover afterwards.
Pre-op physiotherapy, sometimes called “prehab”, is about preparing your body before surgery. It usually focuses on strength, movement, fitness and knowing what to expect. The aim is to help you go into surgery in the best possible condition and feel more confident about your recovery.
In this guide, we explain why pre-op physiotherapy can help, what it usually involves and what you can do before your operation.
Quick answer: is pre-op physiotherapy worth it?
For many people, yes. Pre-op physiotherapy can help you:
- build strength in the muscles around the affected joint
- maintain or improve your movement
- improve general fitness before surgery
- practise exercises you will use after the operation
- learn how to use crutches or walking aids safely
- prepare your home and daily routine
- feel more confident about the recovery process
Research into prehab is still developing. The benefits also vary between operations and individuals. Even so, better strength and fitness before surgery often make the early stages of rehabilitation feel more manageable.
Always follow the advice of your surgeon and hospital team. A physiotherapy assessment can then help you build a plan that fits your operation, your symptoms and your goals.
What is pre-op physiotherapy?
Pre-op physiotherapy is rehabilitation that starts before surgery rather than after it.
It is commonly used before:
- hip replacement
- knee replacement
- ACL reconstruction
- shoulder surgery
- spinal surgery
- ankle and foot surgery
- some abdominal or general surgery
The content depends on the operation. For example, someone preparing for a knee replacement may focus on quadriceps strength and knee straightening. In contrast, someone preparing for shoulder surgery may focus on maintaining movement and learning how to manage with one arm.
Why does pre-op physiotherapy help?
Surgery places a significant demand on your body. After an operation, you may have pain, swelling, reduced movement and lower activity levels for a period of time. As a result, muscles can lose strength quickly.
If you start from a stronger position, you may have more “in reserve” during this early phase.
1. It builds strength before surgery
Pain and reduced activity often cause the muscles around a painful joint to weaken. For example, many people waiting for hip or knee surgery have already lost strength in the thigh and hip muscles.
Strengthening these muscles before surgery may make it easier to stand up, walk and complete your exercises afterwards.
2. It helps maintain movement
Stiffness before surgery can sometimes make it harder to regain movement afterwards. Gentle, regular movement can therefore help you keep as much range as possible.
3. It improves general fitness
Your heart, lungs and overall fitness also play a part in recovery. Walking, cycling, swimming or other suitable exercise can help you prepare for the demands of getting up and moving soon after surgery.
4. You learn your exercises in advance
Learning exercises for the first time after surgery can be difficult. You may be sore, tired or on pain medication. Practising beforehand means the movements will already feel familiar.
5. It reduces uncertainty
Many people feel anxious before surgery. Understanding what the first few days and weeks may look like can help you feel more prepared and in control.
What to do before surgery: a practical checklist
The right plan depends on your operation and your surgeon’s advice. However, the following steps are useful for many people.
Start your exercises early
If possible, begin pre-op physiotherapy several weeks before your operation. Even a short period of preparation can help, though, so it is rarely too late to start.
Focus on strength and control
Your programme may include:
- sit-to-stand exercises
- step-ups
- bridges
- straight leg raises
- heel raises
- supported squats
- balance exercises
- upper-body strength work, especially if you will use crutches
The exercises should feel challenging but manageable. They should not cause a lasting increase in pain.
Keep moving
Stay as active as your symptoms allow. For example, you might:
- walk little and often
- use an exercise bike
- swim or exercise in the pool
- break activity into shorter sessions
- avoid long periods of sitting still
Practise with walking aids
If you are likely to use crutches or a frame after surgery, practise beforehand. This includes walking on flat ground, managing stairs and getting in and out of a chair.
Prepare your home
Small changes can make the first few weeks much easier. Consider:
- clearing trip hazards such as loose rugs and cables
- placing everyday items at waist height
- checking the height of your bed, chair and toilet
- arranging a firm chair with arms
- planning meals and shopping in advance
- arranging help with lifts, pets or childcare
Look after your general health
Your hospital team may give specific advice. Generally, it can help to:
- stay as active as possible
- eat a balanced diet with enough protein
- reduce or stop smoking
- limit alcohol
- prioritise sleep
- manage long-term conditions such as diabetes
How long before surgery should pre-op physiotherapy start?
Ideally, pre-op physiotherapy starts four to eight weeks before surgery. That gives your muscles time to respond to strength training.
However, many people only receive a surgery date a few weeks in advance. In that case, a shorter programme can still help. It can focus on learning your post-op exercises, practising with walking aids and preparing your home.
If you are on a longer waiting list, pre-op physiotherapy can also help you manage pain and stay active while you wait.
Is it safe to exercise before surgery?
For most people, yes, provided the exercise is appropriate for your condition.
Pain from a worn or injured joint does not always mean that exercise is harmful. In fact, avoiding all activity can lead to further stiffness and weakness. The key is finding the right level.
Speak to your surgeon or GP before starting if you have:
- a heart or lung condition
- recent chest pain or breathlessness
- an unstable fracture or injury
- specific restrictions from your surgeon
- severe or rapidly worsening pain
A physiotherapist can help you exercise safely and adjust your programme if your symptoms flare up.
Can pre-op physiotherapy help if I am waiting for a hip or knee replacement?
Yes. People waiting for joint replacement often find that strength and movement gradually decline while they wait.
A pre-op physiotherapy programme can help you stay stronger and more active in the meantime. It can also prepare you for the rehabilitation that follows surgery.
If you are preparing for a hip operation, read our guide to hip replacement rehabilitation to understand what recovery may involve.
How Freedom Physio & Wellness can help before surgery
At Freedom Physio & Wellness, a pre-op physiotherapy plan may include:
- a physiotherapy assessment
- a progressive strength programme
- advice on managing pain while you wait
- practice with crutches and stairs
- guidance on preparing your home
- strength and conditioning rehabilitation
- physio-led Pilates or 1:1 reformer Pilates for control and confidence
- AlterG Anti-Gravity Treadmill sessions where suitable
- a clear plan for your rehabilitation after surgery
Seeing the same team before and after your operation can also make your recovery feel more joined up.
Book an appointment
If you have an operation coming up, pre-op physiotherapy can help you prepare with confidence.
Book an appointment with Freedom Physio & Wellness today.
FAQ section
What is pre-op physiotherapy?
Pre-op physiotherapy is rehabilitation that takes place before surgery. It usually focuses on strength, movement, fitness and preparing you for recovery.
Does pre-op physiotherapy improve recovery?
It can help many people feel stronger and more prepared, which may make early rehabilitation easier. However, the evidence varies between operations, and results differ from person to person.
When should I start physio before surgery?
Ideally, four to eight weeks before your operation. A shorter programme can still be useful if your surgery date is sooner.
What exercises should I do before a knee or hip replacement?
Common exercises include sit-to-stands, bridges, straight leg raises, heel raises and step-ups. The right programme depends on your symptoms and your surgeon’s advice.
Should I exercise if my joint is painful?
Often, yes. Gentle, appropriate exercise can help maintain strength and movement. Exercise should not cause sharp pain or a flare-up that lasts into the next day.
Can I have pre-op physiotherapy while on a waiting list?
Yes. Pre-op physiotherapy can help you manage symptoms, stay active and prepare for surgery while you wait.
