Most people know that physiotherapy is important after surgery. But very few know that physiotherapy before surgery — called prehabilitation, or “prehab” — can be just as important, if not more so.
The concept is simple: the stronger and more functional you are going into surgery, the faster and more completely you will recover coming out. Research has consistently demonstrated that patients who complete a structured prehabilitation program before elective surgery have shorter hospital stays, fewer complications, faster return to function, and better long-term outcomes.
At Rishaan Physio & Wellness Clinic in Mississauga, prehabilitation is a structured, evidence-based program we offer for patients awaiting orthopaedic, cardiac, abdominal, or other major surgical procedures.
WHAT IS PREHABILITATION?
Prehabilitation is a proactive rehabilitation program undertaken in the weeks or months before surgery with the goal of optimising your physical condition before your procedure. Think of it as building your body’s “reserve capacity” so that the inevitable physical stress of surgery and recovery has less impact.
Prehabilitation typically includes:
- Targeted strength training for the muscles surrounding the surgical site
- Cardiovascular conditioning to improve surgical risk profile
- Range of motion and flexibility exercises
- Pain management and postural correction
- Breathing exercises (particularly for abdominal and thoracic surgeries)
- Education about what to expect post-operatively and how to use aids (crutches, walkers, etc.)
- Nutritional and lifestyle counselling (in collaboration with your care team)
THE EVIDENCE FOR PREHABILITATION
The research supporting prehabilitation has grown substantially over the past decade:
KNEE REPLACEMENT SURGERY
A landmark study published in the Journal of Bone and Joint Surgery (JBJS) found that patients who completed 4–8 weeks of prehabilitation before total knee replacement had significantly better knee function scores at 12 months post-surgery compared to those who did not. They also required less physiotherapy post-operatively.
HIP REPLACEMENT SURGERY
A systematic review published in Disability and Rehabilitation found that prehabilitation before total hip replacement improved post-operative function, reduced length of hospital stay, and decreased discharge to rehabilitation facilities — saving patients and the healthcare system significant resources.
ACL RECONSTRUCTION
Neuromuscular prehabilitation before ACL reconstruction has been shown to reduce post-operative quadriceps weakness and accelerate return to sport timelines.
ABDOMINAL AND CARDIAC SURGERY
Inspiratory muscle training and aerobic conditioning prehabilitation has been shown to reduce post-operative pulmonary complications — one of the leading causes of surgical morbidity — by up to 50% in high-risk patients.
CANCER SURGERY
Prehabilitation for patients undergoing cancer-related surgery (colorectal, breast, lung) has demonstrated improvements in functional capacity, quality of life, and tolerance of chemotherapy.
WHO SHOULD CONSIDER PREHABILITATION?
Prehabilitation is beneficial for virtually anyone facing elective surgery, but it is particularly recommended for:
JOINT REPLACEMENT PATIENTS
Total knee replacement, total hip replacement, and shoulder arthroplasty patients benefit enormously. Post-surgical outcomes correlate strongly with pre-surgical quadriceps strength (for knee replacement), hip abductor strength (for hip replacement), and rotator cuff function (for shoulder replacement).
ACL AND KNEE LIGAMENT RECONSTRUCTION
Athletes and active individuals awaiting ACL reconstruction should begin prehab immediately after injury to reduce the muscle wasting (atrophy) that begins within days.
SPINAL SURGERY (DISC REPLACEMENT, FUSION, DECOMPRESSION)
Core stability, hip flexibility, and postural training before spinal surgery reduce post-operative pain and improve functional recovery.
ROTATOR CUFF REPAIR
Strengthening the non-torn components of the rotator cuff and the scapular stabilisers before surgery significantly improves post-surgical shoulder function.
OLDER ADULTS (65+) FACING ANY MAJOR SURGERY
Frailty is one of the strongest predictors of poor surgical outcomes. Even a 4–6 week resistance training program before surgery can meaningfully improve strength, reduce frailty risk, and improve post-operative resilience.
PATIENTS WITH SIGNIFICANT WEIGHT OR COMORBIDITIES
Physiotherapy-supervised exercise before surgery helps manage weight, improve cardiovascular health, and reduce the risk of surgical complications in patients with diabetes, hypertension, or obesity.
PREHABILITATION AT RISHAAN PHYSIO IN MISSISSAUGA
STEP 1: INITIAL ASSESSMENT
Your physiotherapist at Rishaan Physio conducts a comprehensive pre-surgical assessment covering:
– Current strength, range of motion, and functional capacity
- Pain levels and pain behaviour patterns
- Cardiovascular fitness (where relevant)
- Surgical date and procedure details
- Goals and expectations for post-surgical recovery
STEP 2: PERSONALISED PREHAB PROGRAM
Based on the assessment, we design a program specific to your surgery, timeframe, and baseline fitness. Most prehab programs run for 4–8 weeks at 2–3 sessions per week, with a robust home exercise component.
STEP 3: PROGRESS MONITORING
Your physiotherapist reassesses you every 2–4 weeks, progresses your exercises as appropriate, and communicates with your surgical team if needed.
STEP 4: PRE-SURGERY DEBRIEF
In the final week before surgery, your physiotherapist prepares you for what to expect: how to safely get up from a chair, how to use crutches or a walker, what movements to avoid post-operatively, and how quickly to expect your recovery to progress.
STEP 5: SEAMLESS TRANSITION TO POST-SURGICAL REHAB
At Rishaan Physio, your prehab physiotherapist becomes your post-surgical physiotherapist — providing continuity of care throughout your recovery. You will not need to re-explain your history or goals.
HOW LONG BEFORE SURGERY SHOULD I START?
The ideal prehab window depends on your timeframe:
6–12 weeks before surgery: Optimal. Enough time to make meaningful strength and fitness gains.
4–6 weeks: Still very beneficial — focus on quality movement, pain management, and surgical preparation.
2–4 weeks: Short window but worthwhile — focus on education, movement training, and reducing pre-operative anxiety.
If you don’t know your surgery date yet, start prehab as soon as the procedure is scheduled. The waitlist for elective joint replacement in Ontario can extend to several months — this is actually an opportunity to arrive at surgery in the best possible condition.
FREQUENTLY ASKED QUESTIONS
Q: Is prehabilitation covered by insurance?
A: Yes — prehabilitation is physiotherapy and is covered by most extended health insurance plans under physiotherapy benefits.
Q: Will exercising before surgery make my pain worse?
A: This is a common concern but is rarely the case. Your physiotherapist will design exercises that strengthen the muscles around the affected joint without aggravating it. The program begins at an appropriate level for your current condition and progresses gradually.
Q: My surgeon hasn’t mentioned prehab — should I still do it?
A: Yes. Prehabilitation is still underprescribed in the Canadian healthcare system despite strong evidence. You do not need a specific referral from your surgeon — you can book at Rishaan Physio directly. If your surgeon wants to be informed, we are happy to send a progress report.
Q: I have been told to rest before surgery. Doesn’t prehab contradict this?
A: Rest is typically recommended to avoid aggravating the surgical site — not to avoid therapeutic exercise. There is a significant difference between protecting an injured joint and allowing full body deconditioning. Your physiotherapist will work within the parameters recommended by your surgeon.
Q: Can I do prehab if I’m in significant pain?
A: Yes. Pain management is incorporated into every prehabilitation program. Exercises are selected and modified to remain within a tolerable pain range while still providing therapeutic benefit.
BOOK YOUR PREHABILITATION ASSESSMENT IN MISSISSAUGA
Don’t let surgery happen to a deconditioned body. Arrive stronger and recover faster with prehabilitation at Rishaan Physio.
Rishaan Physio & Wellness Clinic
5105 Hurontario St, Unit 7, Mississauga, ON
Phone: (905) 800-1661
Website: rishaanphysio.com
Open 7 days a week | Free pickup & drop-off available