What is Prehabilitation?

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By Dr. Sender Deutsch
Published on February 10, 2015

Prehabilitation is a proactive approach to exercise that helps prevent injuries and functional outcomes following surgical interventions. Most commonly, surgeons will recommend their patients begin physical therapy and prehabilitation exercises to reduce the recovery time and improve the rehabilitation post surgery.  With the aging population and the increase in patient’s having to undergo total hip or knee replacements (THR or TKR), this term will become more familiar with the public.

Arthritis is a condition where there is inflammation and stiffness in one or more joints. It is a degenerative condition and patients find with arthritis that they have a decrease in strength, inability to complete functional tasks and pain. At our clinic, we often consult with many of these patients who are waiting to have a THR or TKR and help them develop a personalized exercise program based on their functional ability. This in turn will help increase their strength, functional movements, and decrease their joint pain.   Medical research has shown that prehabilitation helps to improve proprioreception, (position, sense and balance), strengthens the muscles and joints and will speed up the recovery process following surgery. Success is often related to several factors, however; the one that you can control is how healthy and strong you are prior to surgery.

By doing your exercises prior to surgery, you will not only go in strong, but will have educated your mind and muscles on what are to be done immediately following the surgery. Grooving the motor patterns will allow you to begin the exercises as soon as possible and the benefits include: inhibiting muscle atrophy and muscle inhibition from inflammation, muscle movement which increases blood flow and lymphatic drainage in order to prevent excess swelling and helps restore proper mobility and stability- which is key to ensuring that you expedite the rehabilitation process and ensure a successful surgical outcome.

Recommended Prehabilitation Exercises

The following protocol can be used as prehabilitation exercises for THR or TKR.  Remember: we do not want to have any pain when completing the following. If pain ensues, stop exercises immediately.

Complete the following program 3 days a week, 2 sets of approx. 10 repetitions, with alternating days of 20-30 minutes of cycling, swimming or any easy cardio that doesn’t cause pain.

  1. Warmup: Easy walking or cycling for 5 to 10 minutes
  2. Unloaded Squats: Squatting with a band around the knees. This will help train proper mechanics.  Hold onto a chair, wall or post to decrease the amount of body weight on your hips and knee joints.
  3. Glute Bridges: With the band still around your knees lie on the floor and do glute bridges to hep activate your glutes and hamstrings along with stretching your hips.
  4. Clam Shells: Side lie and do clam shell exercises to target your gluteus medius muscle which is the most important muscle in controlling pelvic stability.
  5. Stability Ball Hamstring Curls: Take the band off and use a stability ball to do hamstring curls by rolling the ball in and out with your legs.
  6. Step Ups: Stand up and find a low step or box to step up onto.  It should be the height of a stair or lower.  Focus on full knee extension- as long as you aren’t feeling pain.
  7. Calf Raises: Find a chair to hold onto and do calf raises. This will strengthen your calf muscles.
  8. Band Rows: Stand holding onto a band that is tied around a post. Focus on keeping the core tight as you pull the band toward you. Palms should be facing inwards. Keep the elbows close to the body. You can use the legs to help extend upwards as you pull.
  9. Standing One Arm Dumbbell Press: Put your arm in a 90 degree position beside you and lift the weight overhead one arm at time.  This is great for core activation and building upper body strength.  Keep the body still with no movement in the lower body.
  10. Finish with light stretching of the hips. Hold each stretch for approx. 30 seconds and repeat a few times.
    • A high lunge position. Hold onto a chair.
    • Toe touches.
    • Reaching overhead to decompress spine.