In the past, we’ve discussed the pros and cons of physical therapy as opposed to surgery, but what about when you know you’ve got an upcoming surgery? Are there certain times where we can benefit from physical therapy before surgery?
You should try physical therapy before surgery if you need to improve strength, flexibility, or mobility to enhance recovery and reduce post-surgical complications. Starting physical therapy early can lead to better surgical outcomes and a faster recovery.
Pre-surgical physical therapy, also known as prehabilitation, can help manage pain, build endurance, and prepare your body for the physical demands of surgery.
Specific situations where pre-surgery physical therapy makes sense
Determining if you need physical therapy before surgery depends on your specific condition, the type of surgery, and your overall health goals. Here are some specific situations where pre-surgery physical therapy may be necessary or beneficial:
1. Your surgeon or physician recommends it
Many surgeons prescribe physical therapy before procedures like total joint replacement surgeries, spinal surgeries, or ACL repairs to improve surgical outcomes.
2. Weight loss is recommended
If achieving a healthy weight is necessary to reduce surgical risks, a physical therapist can help design a safe exercise program tailored to your needs.
5. Your surgery is on a joint or musculoskeletal structure
Procedures like hip or knee replacements, rotator cuff repairs, or spinal surgeries often benefit from pre-surgery muscle strengthening. Additionally, improving your range of motion in advance often jump-starts the recovery process after the surgery.
6. You have underlying health conditions
If you have other conditions like diabetes, cardiovascular issues, or obesity, physical therapy can improve your overall health, reducing surgical risks.
7. You’ve experienced recurrent injuries
If the surgery addresses a recurring issue, prehabilitation can help correct biomechanical imbalances or weaknesses contributing to the problem.
8. You want to improve mental readiness
If you’re feeling anxious about surgery or unsure about the recovery process, working with a physical therapist can build confidence and help you feel more prepared.
Three main reasons for physical therapy before surgery
Based on the guidance of your physician or surgeon, it can be a very good idea to seek prehabilitation from a licensed physical therapist. Though we generally advocate for physical therapy before and after surgery, there are three main reasons to get your physical therapy started early:
1. To address pain and mobility issues
Physical therapy can reduce pain and improve joint or muscle function, potentially delaying or even avoiding surgery in some cases (a topic for another article!).
We do understand that in some cases, a joint is so immobile or fragile that attempting to mobilize or strengthen it in advance of a surgery would not be a good idea. However, there are many more cases where some gentle strength and mobility work will jump-start your recovery process on the back end.
2. To prepare for weight-bearing and functional demands
For surgeries like joint replacements, the benefits of physical therapy beforehand are two-fold:
- First, it can strengthen supporting muscles and improve movement patterns, making post-surgery rehab easier.
- Second, it can provide you with a structured physical therapy program to help you achieve a healthier weight that is more conducive to surgical success.
There is no question that being stronger, more mobile, and at a healthier bodyweight both improves the likelihood of success in these surgeries, and it also allows the joint replacement to last longer.
3. To minimize post-surgery complications
Though this could dovetail into the first two points above, we feel it warrants its own section here:
With any surgery or rehabilitation process, we’re working to heal you while simultaneously working to decrease your risk of re-injury. Patients who have done some work to stabilize their joints, improve their balance, and mobilize the area in advance often have an easier time re-acclimating to life after their surgery, and their risk of reinjury through things like falls is reduced.
Do you need physical therapy before surgery?
Though physical therapy can often be an alternative to try before a more invasive intervention (see our full article on physical therapy versus surgery here), we’re going to assume in this scenario that you’ve got a musculoskeletal condition that we know will require surgery.
In this case, patients looking for the best surgical outcomes can benefit from asking their physician if they should try doing some physical therapy before their procedure.
Your physician or specialist should know, based on your presenting condition and medical history, whether or not it makes sense for you to seek physical therapy first. For certain conditions, strengthening, mobilizing, and stabilizing the area before orthopedic surgery may make a lot of sense:
- Joint replacements (hip, knee, shoulder)
- ACL or ligament repairs
- Rotator cuff surgery
- Spinal surgeries (discectomy, laminectomy, fusion)
- Tendon or muscle repairsWeight-loss (bariatric) surgery
- Fracture fixation or orthopedic hardware placement
- Amputations or prosthetic preparation
- Cardiovascular surgeries (bypass, valve replacement)
- Abdominal surgeries (hernia repair)
In these scenarios, we see post-surgical outcomes improve and recovery times shorten when the patient has put in a concerted effort to develop strength and resilience in the affected joints or areas of the body beforehand. We call this practice prehabilitation.
When to start pre-surgery physical therapy
Ideally, you should begin physical therapy 4-8 weeks before surgery or as soon as your surgery is scheduled. The earlier you start, the more time you have to build strength and address functional limitations.
By starting physical therapy before surgery, you set a strong foundation for recovery, reduce surgical risks, and improve your overall health.
Benefits of physical therapy before surgery
Prehabilitation offers several benefits that can significantly improve both surgical outcomes and recovery. Prehabilitation focuses on strengthening muscles, improving joint flexibility, and boosting cardiovascular endurance to prepare your body for the physical demands of surgery and post-operative rehabilitation.
Patients who undergo prehabilitation often experience faster recovery times, reduced pain, and improved function due to better baseline strength and conditioning. Additionally, physical therapy can help manage inflammation, lower the risk of complications like infections or blood clots, and promote healthier weight management if needed before surgery.
Pre-surgical physical therapy also provides mental and emotional benefits by building confidence, reducing anxiety, and helping patients feel more in control of their recovery process. Physical therapists develop individualized treatment plans to address specific weaknesses, imbalances, or mobility issues, ensuring the body is as prepared as possible for surgery.
In some cases, prehabilitation can even delay or eliminate the need for surgery by improving function and reducing symptoms.
What to do next
As we’ve alluded to through this article, consultation with a medical professional is really the way to know. If you’ve got a condition that will require surgery, ask your doctor whether you’d benefit from pre-surgery physical therapy.
Another option is to consult with a physical therapist. If you’ve got a therapist that you’ve used in the past, give their office a call and ask – many PTs offer pre-surgical evaluations to assess your specific needs.
