When facing orthopedic surgery—whether it’s a joint replacement, ligament repair, or spinal procedure—it’s natural to focus on what happens after the operation. However, what you do before surgery can be just as important. Enter prehabilitation, or “prehab” for short: a customized physical therapy program designed to prepare your body for the challenges of surgery and improve your recovery afterward.
Surgery, particularly on joints or bones, can lead to temporary muscle weakness or atrophy. Prehab helps strengthen the muscles surrounding the surgical site, giving you a head start on post-op recovery. The stronger your muscles are going in, the better they will perform coming out. Many orthopedic conditions cause stiffness and limited mobility. A physical therapist can help you improve your joint flexibility before surgery, which may help preserve or even enhance your post-surgical range of motion.
Chronic joint or muscle pain is often one of the main reasons people seek orthopedic surgery in the first place. But managing pain before surgery doesn’t have to rely solely on medication. In fact, physical therapy offers several non-pharmacological tools that can significantly reduce discomfort—and help you build long-term strategies for pain control. It includes techniques like manual therapy, stretching, and modalities such as ultrasound or electrical stimulation. These approaches can reduce pain and inflammation naturally, potentially minimizing the need for pre-op pain meds.
Here’s how physical therapy supports pain relief without relying on medications:
- Many people avoid movement when they’re in pain, fearing it will make things worse. But inactivity often leads to stiffness, weakness, and even more discomfort. A physical therapist designs a safe and progressive exercise program that increases joint lubrication and blood flow, which can reduce inflammation; activates natural endorphins, the body’s built-in painkillers; and enhances muscle strength and flexibility, which reduces strain on injured or arthritic areas. Gentle movement can do more than just prevent pain—it can actively relieve it.
- Physical therapists are trained in hands-on techniques that can relieve pain and tension without any medication. These may include soft tissue mobilization which loosens tight muscles and fascia; joint mobilization which Improves joint mobility and alignment; and myofascial release which can ease chronic muscle tightness and reduce nerve irritation. These techniques can target the root cause of discomfort and promote healing at a deeper level.
- Depending on your condition and therapy plan, your PT may use adjunct treatments such as electrical stimulation (TENS) to block pain signals or ultrasound therapy to promote tissue healing or heat and cold therapy for inflammation and muscle relaxation or kinesiology taping to support joints and reduce swelling. These non-invasive tools can enhance pain relief while avoiding the side effects or dependency risks associated with long-term medication use.
- Sometimes pain is worsened by posture, poor mechanics, or overuse. A physical therapist helps you understand pain triggers, modify daily movements, practice ergonomic adjustments, and/or strengthen supporting muscles to offload pressure on painful joints. This education empowers you to manage and reduce pain in real time—without needing to reach for a pill bottle.
By integrating these techniques into a prehab program, patients can go into surgery with less pain, reduced inflammation, and fewer medications in their system—a win-win for both short-term comfort and long-term health outcomes.
However, undergoing surgery isn’t just a physical challenge—it’s an emotional and psychological one too. Many patients report feeling anxious, uncertain, or even fearful leading up to their operation. This is where prehabilitation plays a powerful dual role in preparing both the mind and body. One of the biggest sources of stress before surgery is the unknown. What will recovery feel like? How much pain will there be? Will I be able to walk or move right away? Prehab gives you a plan, a team, and a sense of control. Knowing what to expect and being actively involved in your preparation can reduce anxiety and improve overall mental well-being going into surgery. Physical therapy prior to surgery addresses these concerns by:
- Educating you about the surgical process and recovery: Knowing what to expect can dramatically lower anxiety.
- Introducing you to post-op exercises and equipment: Practicing movements with crutches or walkers before surgery boosts confidence and ensures you’re not learning new skills while also managing post-surgical discomfort.
- Creating a sense of control: When patients actively engage in preparing for surgery, they shift from feeling passive or helpless to feeling empowered. This mental shift can lead to improved motivation and a more optimistic outlook during recovery.
Patients who feel mentally prepared often experience better pain tolerance, improved sleep, and are more likely to adhere to rehab routines post-surgery—all critical components of a successful outcome.
Surgery temporarily disrupts the body’s natural balance. Muscles weaken, mobility decreases, and energy levels dip. Prehab helps to:
- Improve circulation and tissue health, which can support healing post-op.
- Enhance core strength and balance, reducing the risk of falls or complications during early mobility after surgery.
- Develop stamina: Basic cardiovascular and strength training in prehab can help you bounce back quicker and tolerate more activity during early rehabilitation stages.
The combination of mental and physical preparation means you’re not just enduring surgery—you’re actively setting the stage for a faster, smoother, and more successful recovery. This preparation ensures you’re not learning everything while recovering from surgery—you will already be ahead of the curve. Additionally, establishing a relationship with a physical therapist before surgery creates continuity of care. They’ll know your baseline, your goals, and your limitations—making post-op rehabilitation smoother and more personalized. In fact, some research suggests prehab can reduce recovery time by up to 30%.
While it’s especially beneficial for procedures like knee or hip replacements, rotator cuff surgeries, and spinal operations, almost anyone undergoing orthopedic surgery can benefit from a prehabilitation program. Talk to your surgeon or a physical therapist about creating a pre-surgical program tailored to your needs. Think of prehab as training for a big event. Just like an athlete wouldn’t run a marathon without preparing, your body shouldn’t go into surgery without conditioning. Physical therapy before orthopedic surgery isn’t just helpful—it’s often essential for the best possible recovery.
Written by Kelly Reising who is passionate about nutrition, fitness and health.
Dr. Mc Millan is a Board-Certified orthopedic sports medicine surgeon practicing in the Virtua Health System of south Jersey. For more information please visit www.drseanmcmillan.com or follow us on twitter @sportsdrsean.
