When facing surgery, many patients focus primarily on the procedure itself—the skill of the surgeon, the complexity of the operation, and the logistics of hospital stays. Yet one of the most powerful tools in a successful surgical outcome happens before the scalpel ever touches the skin. Known as “prehabilitation” or “prehab,” this proactive approach prepares the body and mind for surgery through targeted physical conditioning, education, and planning. Though traditionally associated with post-operative recovery, rehabilitation is increasingly being recognized as something that should begin before surgery, not after. Among those pioneering the push toward prehab in orthopedic care is Dr. Bret Sokoloff, a Memphis-based orthopedic surgeon who emphasizes its impact on long-term outcomes.
Understanding Prehab: More Than Just Physical Therapy
Prehab is a comprehensive, evidence-based strategy that aims to improve strength, mobility, endurance, and mental readiness prior to a surgical procedure. It is not simply a warm-up or basic physical therapy, but a structured program designed to fortify the body against surgical stress and reduce recovery time afterward.
The rationale behind prehab is grounded in physiology. Surgery—particularly orthopedic procedures like ACL reconstructions, joint replacements, or rotator cuff repairs—places considerable stress on muscles, tendons, and ligaments. A deconditioned or weak joint will have more difficulty healing and regaining full function post-operatively. Prehab strengthens these vulnerable areas in advance, thereby creating a more resilient foundation.
Moreover, prehab programs often include education about the surgical process, post-op expectations, and even mental strategies for pain and anxiety management. By arming patients with knowledge and control, prehab not only enhances physical outcomes but also reduces psychological stress and improves compliance during the recovery period.
Evidence That Supports the Benefits of Prehab
Clinical research continues to reinforce the efficacy of prehab. Multiple studies have shown that patients who engage in prehab before orthopedic procedures tend to have faster recoveries, shorter hospital stays, and improved functional outcomes. This is particularly evident in knee and hip surgeries, where patients benefit significantly from entering the operating room with stronger muscles and greater joint flexibility.
For instance, in anterior cruciate ligament (ACL) surgeries, prehab has been associated with improved post-operative knee extension, faster return to sport, and reduced complications. Similarly, patients undergoing total knee replacements have shown better mobility and reduced reliance on assistive devices when they’ve undergone prehab in the weeks leading up to surgery.
In addition to physical benefits, patients who participate in prehab report higher levels of satisfaction and confidence. Knowing what to expect and feeling empowered to contribute to their own outcomes fosters a proactive mindset—a critical element for long-term recovery success.
What Does a Prehab Program Typically Include?
A standard prehab protocol varies depending on the surgery being planned, the patient’s baseline fitness, and the severity of the condition being treated. However, most programs include several core components: strength training, flexibility work, cardiovascular conditioning, and patient education.
For orthopedic procedures involving the shoulder or knee, prehab might include resistance exercises to build muscle around the joint, mobility drills to improve range of motion, and neuromuscular training to enhance coordination and balance. The program is designed by physical therapists in consultation with the surgical team to ensure exercises are safe and effective.
Another key element of prehab is respiratory conditioning. Patients undergoing general anesthesia can benefit from improved lung function, which can decrease the risk of post-operative respiratory issues and improve oxygenation during recovery.
Educational sessions are also crucial. Patients are walked through the surgical process, shown how to use crutches or braces if needed, and educated on pain management strategies. This information reduces fear, aligns expectations, and builds a mental framework for active participation in recovery.
Timing and Commitment: When to Start Prehab
Timing is essential when it comes to prehab. Ideally, a prehabilitation program begins at least four to six weeks before the scheduled surgery, although shorter timelines can still yield benefits. The earlier the program starts, the more time the patient has to improve muscular support and mobility.
Patients should approach prehab with the same seriousness they apply to post-surgery rehabilitation. While some may view it as an optional step, prehab is now considered a standard recommendation by many orthopedic surgeons and physical therapists, especially for patients who want to optimize their recovery trajectory.
Compliance plays a major role in the effectiveness of prehab. Regular attendance, active participation, and following guidelines at home are all critical. Surgeons who advocate for prehab often see better long-term outcomes not only because of the program itself, but because it filters out patients who are more likely to be passive or non-compliant—traits that can hinder post-op success.
Who Benefits the Most From Prehab?
While prehab is beneficial for nearly anyone undergoing orthopedic surgery, some patients stand to gain even more than others. Older adults, for instance, often have less baseline muscle mass and slower natural recovery rates. For them, prehab can provide a crucial buffer against complications like stiffness, infection, or prolonged immobility.
Athletes facing surgery can also reap significant advantages. By tailoring prehab to sport-specific movements and injury risks, their rehab can begin with a head start, making the return to competition smoother and safer.
Patients with chronic health conditions—such as diabetes, obesity, or cardiovascular disease—may also benefit from prehab by improving general health markers that influence surgical outcomes. These individuals may not only heal faster but also reduce the risk of systemic complications during the surgical and recovery phases.
Psychological and Emotional Dimensions of Prehab
While physical conditioning is the primary focus of prehab, the psychological dimension is equally important. Facing surgery can trigger anxiety, fear, and even depression. Prehab programs that incorporate cognitive-behavioral elements, such as mindfulness, goal-setting, or pain education, have been shown to reduce emotional distress and improve patient engagement.
Mental readiness plays a direct role in physical recovery. Patients who are calm, confident, and educated about the process are more likely to adhere to post-op instructions, push through discomfort during rehab, and communicate effectively with their care team. This emotional preparedness can be just as vital as physical strength.
Furthermore, prehab fosters a sense of autonomy. Rather than feeling like a passive recipient of medical care, patients become active contributors to their own healing. This mindset has a measurable impact on pain tolerance, motivation, and long-term functional outcomes.
The Future of Prehab in Orthopedic Care
As healthcare continues to embrace patient-centered models, prehab is poised to become a default component of surgical care, particularly in orthopedics. Advances in digital health platforms now allow patients to engage in virtual prehab programs from home, expanding access and convenience. Wearable fitness trackers and telemedicine tools can monitor progress and adjust plans remotely.
Insurance providers are beginning to recognize the cost-saving benefits of prehab, including shorter hospital stays and fewer post-operative complications. This financial incentive may lead to broader support and standardization across healthcare systems.
Ultimately, the success of prehab hinges on a cultural shift—moving from a reactive approach to surgery toward one that values preparation, education, and proactive health. As more patients and providers embrace this mindset, surgical recovery will no longer start in the hospital bed, but weeks earlier, with intention and strength.
Conclusion: Preparing for Success Starts Before the Operation
Surgery may be a singular event, but the road to recovery is long and often difficult. Prehabilitation offers patients a chance to shape their outcomes before the procedure begins. By improving strength, building resilience, and preparing mentally and physically, prehab lays the groundwork for a smoother, faster, and more complete recovery.
Through the guidance of healthcare professionals committed to this proactive model—like those advocating for its importance every day in their practice—patients can walk into surgery not with fear, but with confidence, strength, and a plan.