Everybody has heard of rehabilitation, most likely from your physio or chiro nagging you to
do it. But put a ‘p’ in front of the word and you have a completely new one, prehabilitation.
You may, or may not have heard of prehabilitation, but what exactly is it? Prehabilitation
describes the concept of providing ‘rehabilitation’ before an event occurring, usually a
surgical procedure. Prehab can consist of a combination of strength & conditioning exercises
and education. Whilst the evidence in scientific journal articles for rehabilitation programs
(post-op and post injury) are extensive, evidence for prehabilitation exercise programs is still
emerging but is quickly becoming popular. Usually the studies are performed on
pre-operative patients, but prehabilitation exercises can be performed for sporting injuries
too. This is to help stop injuries occurring before they happen by analysing the athlete and
movement patterns. This is when it starts to blend with strength and conditioning, which will
be covered in another blog post. Now prehabilitation can be performed before any surgery,
but the evidence I will be discussing observed prehab programs prior to a total knee
replacement (TKR), total hip replacement (THR) and ACL reconstruction.

Two studies conducted in 2017 and 2018 observed prehab programs performed prior to
TKR. For both studies the prehab program consisted of leg strengthening exercises, such as
leg extensions and hamstring curls and some proprioceptive (balance) exercises. The study
group performed the program over a 6 week period before surgery, while another group
performed no exercises at all. In the 2018 study, both groups’ progress was followed up at 3
and 6 months post-op. They found that doing the prehab program led to earlier return to
normal range of motion (ROM) in the knee, decreased overall loss of strength of the
operated leg and decreased time returning to functional tasks such as self care or mobilising
in the community. They also found that individuals who underwent the prehab program had
decreased postoperative pain and spent less time in hospital, so they were able to return
home quicker.

A systematic review performed in 2020 observed studies that looked at prehab programs
performed prior to an ACL reconstruction. The systematic review found that individuals who
completed prehab programs, 6 weeks prior to surgery, had an overall decreased loss of
quad strength when compared to individuals who performed no prehab. This is a super
important finding as a decrease in quad strength can be argued to be an indicator of whether
an individual will injure or reinjure their ACL ligament. The study also observed that prehab
groups had better functional outcome scores, such as a single leg hop and bound, when
compared to the control group and were able to return to sport faster.

Similar findings were found in a systematic review conducted in 2022, but this time they
included studies regarding individuals who underwent a THR. What the systematic review
found was that the groups who performed prehab program before surgery (6 weeks prior),
returned to functional tasks quicker and had improved functional outcome scores post-op.
Similarly to the TKR individuals, they had decreased postoperative pain, decreased stay in
hospital post-op and decreased time spent in outpatient physiotherapy rehabilitation post-op.
Studies also claimed that individuals who underwent the prehab programs had increased
quality of life post-op.

So what does all this mean? In all the studies mentioned, completing prehabilitation
programs was associated with increased benefits post-op, such as decreased pain. A
consequence of undergoing surgery is loss of strength to the limb post-op. But these studies
showed that building the surrounding musculature prior to surgery will help combat this
problem and make it easier to perform your post-op rehab and regain muscle strength and
mass. Another big takeaway message from the studies, is that completing prehab programs
decreased the stay in hospital and in outpatient physio rehab. This means that you can
return home quicker and begin your rehab journey earlier. This is a huge benefit, and not to

mention, less money would be spent on hospital and physiotherapy fees. One thing worth
mentioning is that all studies had the prehab group perform exercises 6 weeks prior to
surgery. A study commented on this fact and suggested that prehab programs should be
performed a minimum of 8 weeks prior to surgery. This is because it has been shown in the
literature that it usually takes 8 weeks for there to be a noticeable change in the muscle
when performing strengthening exercises.

Here is a final piece of anecdotal evidence as to why prehab programs should become the
norm prior to surgery. When I was on placement for my physiotherapy degree, I spent some
time in an orthopaedic ward. A lot of the surgeries performed were TKR’s and THR’s. I recall
two individuals who underwent a TKR by the same surgeon and were admitted to the ward
at roughly the same time. They were both 73 year old males with their birthday a few days
apart. One of them, we’ll call patient A, had performed prehab exercises 3 months prior to
surgery, while patient B did no exercise. Patient A also had a respiratory condition, which
could have affected his progress. Fortunately for him, it didn’t and he was able to leave the
hospital within 2 days of surgery, walking with crutches. Unfortunately patient B had multiple
complications such as increased pain and swelling, and was discharged 7 days after
surgery. Whilst it is anecdotal evidence and I am unsure of the severity of the condition prior
to surgery, it is something that I have always reflected upon. By performing prehab exercises
early it could have led to patient A having a more positive postoperative experience when
compared to patient B.

Proactive Health & Sports offer a wide range of prehabilitation exercise programs. Each
program is individually tailored to suit your current capacity, taking into consideration your
condition and pain tolerance. If you are undergoing a surgery and would like to perform a
prehab program so you can see the benefits for yourself, enquire with us today on 0401 115
583 or email us at info@proactivehealthandsports.com.au. Alternatively you can book a
consultation online from the link below. We would love to be a part of your pre and
postoperative journey and get you back to doing the things you love!

References:

Giesche, F., Niederer, D., Banzer, W. and Vogt, L., 2020. Evidence for the effects of
prehabilitation before ACL-reconstruction on return to sport-related and self-reported knee
function: A systematic review. PLoS One, 15(10), p.1-21

Jahic, D., Omerovic, D., Tanovic, A.T., Dzankovic, F. and Campara, M.T., 2018. The effect of
prehabilitation on postoperative outcome in patients following primary total knee arthroplasty.
Medical Archives, 72(6), p.439-443.

Peer, M., Rush, R., Gallacher, P. and Gleeson, N., 2017. Pre-surgery exercise and
post-operative physical function of people undergoing knee replacement surgery: a
systematic review and meta-analysis of randomized controlled trials. Journal of rehabilitation
medicine, 49, p.304–315

Widmer, P., Oesch, P. and Bachmann, S., 2022. Effect of prehabilitation in form of exercise
and/or education in patients undergoing total hip arthroplasty on postoperative outcomes—a
systematic review. Medicina, 58(6), p.1-13