If you are waiting for hip replacement surgery or knee replacement surgery, it is natural to focus on the operation itself and on the rehabilitation that follows. But the weeks and months before surgery are also a valuable window to prepare your body, and this is exactly what pre-operative physiotherapy, or ‘prehab’, is designed to do.
At Physio-logical, we provide individualised prehab for people preparing for hip replacement or knee replacement surgery. Our approach combines hands-on physiotherapy with progressive strengthening, balance work and functional exercise, helping you build confidence and physical capacity before your operation and setting you up for a smoother rehab afterwards.
We also work closely with orthopaedic consultants, who regularly refer their patients to us for pre-operative rehabilitation ahead of hip and knee replacement surgery.
What Is Prehab Before Hip or Knee Replacement Surgery?
Prehab is physiotherapy undertaken before surgery, with the aim of helping you prepare physically and practically for your hip replacement or knee replacement, and for the rehab that follows it.
If you have severe hip or knee osteoarthritis, you may have gradually become less active because movement has become painful or difficult. Over time, this can lead to reduced muscle strength, poorer balance, lower fitness and less confidence with everyday activities all of which prehab can help address before your operation.
The National Institute for Health and Care Excellence (NICE) recommends pre-operative rehabilitation for people listed for hip or knee replacement. The guidance recognises that preparation before surgery can include exercise, education and interventions designed to maintain or maximise physical function and independence.
Prehab is not about trying to avoid your hip or knee replacement, or about ‘fixing’ an arthritic joint. It is about helping you go into surgery, and into your subsequent rehab, as prepared as possible.
Why Is Strengthening Important Before Hip or Knee Replacement?
Strengthening is a key part of our prehab approach for both hip replacement and knee replacement patients.
When a hip or knee has become painful over a long period, it is common to reduce the amount you do. You may walk less, avoid stairs, stop going to the gym or find activities such as getting up from a chair increasingly difficult. This reduction in activity can affect muscle strength and general fitness, which in turn can affect your recovery and rehab after surgery.
NICE recommends tailored therapeutic exercise for people with osteoarthritis, including local muscle strengthening and general aerobic fitness. Supervised exercise can also be considered as part of prehab.
At Physio-logical, we do not believe in simply handing you a generic exercise sheet. We assess where you are now and develop a prehab programme that is appropriate for your symptoms, strength, mobility and goals ahead of hip or knee replacement.
Progressive Strengthening, Not Just ‘Doing Exercises’
An important part of prehab before hip or knee replacement is progression.
As you become stronger, your exercises should be adapted to continue challenging you appropriately. Depending on your ability, this might involve exercises such as:
- Sit-to-stands
- Squats and supported squats
- Step-ups
- Bridges
- Hip strengthening exercises
- Knee strengthening exercises
- Resistance-band exercises
- Free-weight exercises
- Balance exercises
- Functional exercises based on your everyday activities
Our clinic has a range of equipment available, including resistance bands, weights, steps and wobble cushions, allowing us to tailor and progress your prehab exercises according to your individual needs.
The aim is to build strength that is useful in real life, helping you move, walk, climb stairs and manage everyday activities with greater confidence before your hip or knee replacement and throughout your rehab afterwards.
What About Hands-On Physiotherapy Before Hip or Knee Replacement?
Hands-on treatment can be particularly useful when pain and stiffness are making movement or exercise difficult in the run up to hip or knee replacement.
At Physio-logical, we use hands-on techniques such as joint mobilisation or soft tissue treatment as part of your individual prehab treatment plan.
Hands on treatment can help you move more comfortably, while progressive exercise helps you build the strength and physical capacity you need for surgery and rehab.
Preparing for Rehabilitation After Hip or Knee Replacement Surgery
One of the benefits of prehab is that you become familiar with the types of movements and exercises that are likely to form part of your rehab after hip or knee replacement surgery.
After a hip or knee replacement, rehabilitation will involve getting moving again, completing exercises and gradually increasing your activity.
Doing appropriate prehab exercises before surgery means you have already started developing the habits, confidence and understanding needed to engage fully with your rehab afterwards.
It also gives us an opportunity to work on things that may be challenging for you now, such as:
- Walking
- Stairs
- Getting up from a chair
- Getting in and out of bed
- Balance
- Lower-limb strength
- General fitness
- Confidence with movement
Our Lower Limb Strength & Balance Class
For some people, individual physiotherapy is not the only prehab option.
At Physio-logical, we also offer small group exercise classes, including our Lower Limb Strength & Balance class.
This can be particularly useful for people preparing for a hip or knee replacement who would benefit from supervised exercise in a supportive group environment as part of their prehab.
The class gives you the opportunity to work on lower-limb strength, balance and functional movement while exercising alongside other people with similar goals.
Our physiotherapists can adapt exercises to different abilities, helping you work at an appropriate level while gradually building strength and confidence ahead of hip or knee replacement surgery.
For some patients, the class can complement individual prehab physiotherapy appointments particularly well.
What Happens at Your First Prehab Appointment?
Your initial Physio-logical prehab appointment is 45 minutes.
We will take the time to understand how your hip or knee is affecting you, what you currently find difficult and what you would like to achieve before and after your hip or knee replacement.
We will assess relevant areas such as:
- Strength
- Mobility
- Balance
- Walking and functional movement
- Current activity levels
- Pain and stiffness
- Your confidence with movement
- The activities that are important to you
We will then develop a treatment and exercise programme based on your individual needs.
Follow-up appointments are 30 minutes, allowing us to review your progress, provide hands-on treatment where appropriate and progressively adapt your prehab strengthening programme.
Working Alongside Your Orthopaedic Consultant
At Physio-logical, we are fortunate to work closely with orthopaedic consultants and their teams.
Consultants regularly refer their patients to us for pre-operative rehabilitation, giving patients the opportunity to begin preparing for hip or knee replacement with a physiotherapy team experienced in managing musculoskeletal conditions and lower-limb rehab.
Where appropriate, we can work as part of your wider healthcare team, helping to provide continuity between the decision to have surgery, your prehab preparation beforehand and your rehab afterwards.
When Should You Start Prehab Before Hip or Knee Replacement?
There is not one ideal time for everyone.
If your hip or knee replacement surgery is several months away, starting prehab early can give you more time to build strength and fitness progressively.
If your operation is already booked for the near future, there can still be value in using the time available to prepare.
The important thing is to work within your current abilities and progress gradually.
You do not need to be ‘fit enough’ before starting prehab physiotherapy. That is what prehab is for.
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A Common Concern: What If Exercise Causes Some Pain? This is a common concern, particularly if your hip or knee is already painful. NICE advises that joint pain can increase when someone starts therapeutic exercise. It recommends explaining that regular, consistent exercise can still be beneficial and that long-term adherence can help reduce pain and improve function and quality of life. That does not mean you should ignore significant or worsening symptoms. Your physiotherapist can help you find an appropriate starting point, understand how to manage your symptoms and gradually progress your prehab exercises as your strength and confidence improve. |
Prehab at Physio-logical: Preparing You for Hip or Knee Replacement and Rehab
Having a hip or knee replacement can feel like a major step. Prehab gives you an opportunity to take an active role in your preparation.
At Physio-logical, our prehab approach combines:
- Individual assessment — understanding your current strength, mobility, balance, pain and functional ability
- Hands-on physiotherapy — using appropriate manual techniques where they can help alongside exercise
- Progressive strengthening — building the strength and physical capacity needed for everyday movement and rehab
- Functional exercise — working on movements that have relevance to your daily life, such as walking, stairs and getting out of a chair
- Small group exercise — our Lower Limb Strength & Balance class provides an additional supervised exercise option for suitable patients
- Close links with consultants — we regularly receive referrals from orthopaedic consultants for patients preparing for hip and knee replacement
Frequently Asked Questions About Prehab for Hip and Knee Replacement
What is prehab for hip replacement or knee replacement?
Prehab is physiotherapy carried out before hip replacement or knee replacement surgery. It focuses on strengthening, balance, hands-on treatment and functional exercise to help prepare you for the operation and for rehab afterwards.
How soon before hip or knee replacement surgery should I start prehab?
There is no single ideal time. Starting prehab several months before surgery allows more time to build strength progressively, but there can still be benefit in starting prehab closer to your operation date.
Does prehab replace the need for a hip or knee replacement?
No. Prehab does not aim to avoid surgery or fix an arthritic joint. It is about preparing you as well as possible for your hip or knee replacement and the rehab that follows.
Will prehab exercises hurt if my hip or knee is already painful?
Exercise can sometimes increase joint pain when you first start. Your physiotherapist will help you find an appropriate starting point and progress your prehab programme gradually, while monitoring your symptoms.
How does prehab help with rehab after hip or knee replacement?
Prehab familiarises you with the types of exercises and movements used in rehab, such as walking, stairs and sit-to-stands, so you begin surgery with strength, confidence and habits that support your recovery.
Ready to Prepare for Your Hip or Knee Replacement?
If you are waiting for a hip or knee replacement and would like to find out whether pre-operative physiotherapy could help you, contact Physio-logical to arrange your initial 45-minute prehab assessment.
Starting your rehab before surgery can give you the opportunity to build strength, improve confidence and prepare for the next stage of your recovery. Don’t just wait for your operation use the time beforehand to prepare with prehab.
Our prehab approach is informed by current NICE guidance, including:
- NICE NG157 – Joint replacement (primary): hip, knee and shoulder
- NICE NG226 – Osteoarthritis in over 16s: diagnosis and management
NICE recommends pre-operative rehabilitation for people listed for hip or knee replacement and recommends tailored therapeutic exercise for people with osteoarthritis. For hip and knee osteoarthritis, manual therapy should only be considered alongside therapeutic exercise