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Prehab: How Physical Therapy Can Prepare You for Surgery—or Help You Avoid It

By 20 Jul, 2026 Clinical Case of the Week , , , , , , , , , , , , , , , ,
Prehab: How Physical Therapy Can Prepare You for Surgery—or Help You Avoid It
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This article was written by Danya Sadler, Student Physical Therapist, during her clinical rotation at Nick Rinard Physical Therapy.

What is Prehab?

Many people assume that physical therapy begins only after surgery, but postoperative rehabilitation is just one part of what physical therapists do. The American College of Surgeons defines prehabilitation, or “prehab,” as “a process of improving the functional capability of a patient prior to a surgical procedure so the patient can withstand postoperative inactivity and the associated decline.” Physical therapists accomplish this through targeted exercise, education, and movement strategies tailored to each individual.

What the Research Shows

Prehab is much more than simply “getting ready” for surgery, it gives patients the opportunity to improve strength, mobility, and confidence while working toward their best possible outcome. A growing body of research has shown that prehab is an effective way to make the most of that opportunity. A research article by Konnyu, et al. finds that prehab prior to total knee or total hip surgeries can lead to reduced length of stay in the hospital, increased strength, and decreased stiffness post-operatively. Another article looking at orthopedic surgeries found that “prehabilitation was associated with moderate improvement in several preoperative outcomes (function, 6-minute walk test, knee flexor and hip abductor strength, etc.) among patients undergoing all orthopedic procedures and was also associated with a reduction in back pain among patients undergoing lumbar surgery.” (Punnoose et al., 2023). The research behind this topic has been vastly growing over the years but all other articles shared similar findings. In some cases, the prehab process reveals something patients weren’t expecting: surgery may not be the right next step after all.

When Physical Therapy May Help Avoid Surgery

For many musculoskeletal conditions, current evidence supports physical therapy as a first-line treatment for many musculoskeletal conditions before considering surgery, as many patients achieve similar improvements in pain and function without an operation. This is not to say that surgeries are bad nor never warranted, because they are actually very well researched and helpful in many cases. By using physical therapy first however can help patients find a potential non-surgical way of improving function and reducing pain, or, if symptoms persist despite appropriate rehabilitation, physical therapy can help patients and their healthcare team determine that surgery is the most appropriate next step. Multiple randomized control trials and systemic reviews comparing supervised exercise therapy with arthroscopic surgery for degenerative meniscal tears have found similar improvements in pain and function, while the physical therapy group demonstrated greater improvements in muscle strength early in rehabilitation.

A Closer Look at Low Back Pain

Evidence supporting conservative care extends beyond meniscal injuries. Similar recommendations exist for conditions such as knee osteoarthritis, rotator cuff injuries, and more but I want to present some evidence about its use with patients with low back pain since we see many individuals with this at the clinic. While surgery for back pain is appropriate in certain conditions like progressive neurological deficits or required fusions, most episodes of low back pain improve with conservative care. Current clinical practice guidelines from JOSPT and the American College of Physicians recommend remaining active, participating in exercise-based rehab, and working with a physical therapist before considering surgical intervention when there are no red flags found by your clinician or your physical therapist. Physical therapy can decrease pain, improve mobility, increase strength, and also help patients return to their daily activities while determining whether surgery is truly necessary.

The Right Treatment at the Right Time

Ultimately, the goal of prehab isn’t to avoid surgery at all costs, it is to ensure that each patient receives the right treatment at the right time whether it be surgery on conservative care. If surgery is found to be the best next step, patients will benefit from becoming stronger, more informed, and more active participants in their own care.

Citations

American College of Surgeons. (n.d.). Prehabilitation. Strong for Surgery. Retrieved July 8, 2026, from https://www.facs.org/for-patients/preparing-for-surgery/strong-for-surgery/prehabilitation/

Konnyu KJ, Thoma LM, Cao W, Aaron RK, Panagiotou OA, Bhuma MR, Adam GP, Pinto D, Balk EM. Prehabilitation for Total Knee or Total Hip Arthroplasty: A Systematic Review. Am J Phys Med Rehabil. 2023 Jan 1;102(1):1-10. doi: 10.1097/PHM.0000000000002006. Epub 2022 Mar 12. PMID: 35302954; PMCID: PMC9464791.

Punnoose A, Claydon-Mueller LS, Weiss O, Zhang J, Rushton A, Khanduja V. Prehabilitation for Patients Undergoing Orthopedic Surgery: A Systematic Review and Meta-analysis. JAMA Netw Open. 2023;6(4). doi:10.1001/jamanetworkopen.2023.8050

Kise N J, Risberg M A, Stensrud S, Ranstam J, Engebretsen L, Roos E M et al. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up BMJ 2016; 354 doi:10.1136/bmj.i3740

Qaseem A, et al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline from the American College of Physicians. Annals of Internal Medicine. 2017;166(7):514–530.

George, S. Z., Fritz, J. M., Silfies, S. P., Schneider, M. J., Beneciuk, J. M., Lentz, T. A., Gilliam, J. R., Hendren, S., Norman, K. S., et al. (2021). Interventions for the management of acute and chronic low back pain: Revision 2021. Journal of Orthopaedic & Sports Physical Therapy, 51(11), CPG1–CPG60. https://doi.org/10.2519/jospt.2021.0304

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Tough Chronic Hip Pain – Problem Found and Fixed

By 11 Dec, 2013 Clinical Case of the Week , , , , , ,

Image of Back and Hip Nick Rinard PTThe case study I would like to share with you today is only the second hip derangement of this type that I have seen in 18 years of practice.  “Jim” was a 55 year old male who presented with right hip pain that started for no apparent reason 5-6 months prior to coming to physical therapy.  He said the pain was provoked only when he was walking, but it occurred consistently at a distance of about 50 to 100 yards.  Often it was so painful he could not continue walking.  Jim figured out that changing his right foot position enabled him to walk a little further, albeit slowly, and then he could resume normal walking for another 50 yards or so.  He would change the foot position by stepping partway onto a curb or raised ground such that the outer edge of his foot was tilted up (eversion, as we therapists call it), and then he would angle his right knee inwardly.  That was the only way he had found to improve walking, but the hip just would not stay better.

In desperation, Jim said he had looked online and tried numerous “hip exercises” without any relief.  He consulted his doctor, who recommended MDT, which we do here at Nick Rinard Physical Therapy.

Assessment

The mechanical assessment was positive for only two findings:  limited and painful hip motion into flexion (folding the knee to chest), and weak and painful testing of hamstring resistance.  The protocol for ruling out a joint derangement is to repeat motions to determine if the baselines change.  The question is which motion to repeat.  One can move either into the most painful direction, go the opposite direction, or check rotations.  I chose to go into the most painful direction, in this case, flexion.  But before testing I wanted to establish how far Jim could walk in the clinic before his pain started.  By the time he walked one length of the hallway and back, he reported pain.  I then instructed Jim to bend his knee to chest (compressing the groin) repeatedly and after 20 to 30 times.  It produced his familiar pain initially, then the pain abolished and his motion increased.  I tested walking after that and Jim said there was no pain even after walking 3 lengths up and back through the hallway!  I gave Jim his exercises and scheduled him for 2 days later.

Progress

When Jim returned he reported that he could walk longer distances without the pain starting, however, he still got to the point where he had to modify his foot position in order to continue.  I knew we were on the right track, and the next step in treating a joint derangement is to progress forces.  I did this manually by applying over-pressure, and instructed Jim to do it in standing by folding his chest down to his knee with it supported on a bench or chair.  By the next visit, Jim reported that this had worked very well and he had not experienced any pain at all!  So, the derangement was reduced and I needed to wean him off the home exercises to see if it would return or not.  I gave him the weaning program and asked to see him back in 2 weeks.

Pain Free

After 2 weeks, Jim came back reporting that he had been able to walk unlimited distances!  He resumed walking his dog, going on walks for exercise, and walking wherever, and whenever he wanted.  He reported his longest walk lasted 4.5 hours.  He said there was no return of the original hip pain from which he had suffered for months.  However, on his last two walks, he had started noticing a new hip pain, this time in the front, not on the sides.  I re-checked his baselines and neither flexion motion nor resisted hamstrings were painful.  That meant it could not be a re-derangement.  Resisted hip flexion was painful, and that was new.  I concluded that his sudden ability to walk pain-free resulted in his over-doing it.  Jim had increased walking too fast and gotten a minor tendonitis.  That was easy to treat, and by his next visit, Jim was pain-free again and able to progress walking, though this time more gradually, which was safer.

Successful Treatment

Jim’s hip treatment was obviously a success.  It took only 4 visits.  This hip derangement was unique because the direction that reduced it (flexion); I have only seen one other hip derangement require flexion to reduce it.  The fact that Jim resumed normal activity too fast is typical of reduced derangements – the patient feels so good that they over do it.  Luckily in Jim’s case, we found the new problem and fixed it just as fast as we found and fixed his chronic hip pain.

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