Pre-Surgical Preparation: Why Rehabilitation Should Begin Before Surgery
Most people think of rehabilitation as something that begins after surgery. The operation happens, the incision starts to heal, and then the work of getting moving again begins. But what if some of that work could be done beforehand? This is the principle behind pre-surgical preparation, or prehabilitation: improving the condition of the body before it undergoes the controlled trauma of surgery. Whether you are awaiting a hip or knee replacement, arthroscopic procedure, shoulder surgery, breast augmentation or reduction, mastectomy and reconstruction, abdominal surgery, or another elective procedure, the weeks before surgery provide an often-underused opportunity to prepare.
We cannot change the fact that surgery places significant demands on the body. We can, however, influence the condition in which the body arrives at the operating room.
Surgery May Fix the Problem — But It Doesn’t Erase What Came Before It
By the time someone reaches joint replacement or another significant orthopaedic surgery, they have often been compensating for months or even years.
A painful hip changes the way we walk. An arthritic knee alters weight-bearing and stair mechanics. A dysfunctional shoulder can change the position and movement of the scapula, thoracic spine and neck. Muscles may shorten while others become neurologically inhibited or weak. Fascia adapts. Joint movement becomes restricted. The nervous system becomes accustomed to protective movement patterns.
Replacing the joint addresses the damaged joint — but it doesn’t automatically reverse all of those adaptations.
That distinction matters.
If we enter surgery already restricted, weak and compensating, we begin our recovery from that starting point. Conversely, improving as much mobility, strength, tissue extensibility and functional capacity as reasonably possible beforehand may give the body a better foundation from which to recover.
This concept isn’t merely theoretical. Research into orthopaedic prehabilitation has found improvements in measures including preoperative function and muscle strength, with evidence of improved early postoperative function. The literature isn’t uniform — and prehabilitation certainly doesn’t guarantee an easier recovery — but there is enough evidence to support an important idea:
Waiting for surgery does not necessarily have to mean simply waiting.
What Does Pre-Surgical Preparation Actually Involve?
At Body Kneads, surgical preparation isn’t a generic massage performed a few days before surgery — it’s usually at least two months prior. It begins with understanding the person, the procedure and the way the body is functioning well before surgery.
Assessment helps establish a baseline. How much range of motion is currently available? Where are the significant restrictions? Which muscles are shortened or overworking? Which areas are weak or inhibited? What compensatory patterns have developed because of pain? And, importantly, which parts of the body are about to be asked to do considerably more work during the early recovery period?
Treatment can then be directed toward the findings rather than simply toward the location of the upcoming operation.
Myofascial techniques, manual therapy and Dolphin MPS microcurrent are used to address appropriate soft-tissue restrictions, improve available movement and reduce compensatory pain. As surgery approaches, the goal isn’t to aggressively “fix” a severely arthritic joint or diseased tissue that requires surgical correction. The main goal is to optimize what can reasonably be improved around the surgical site in order to optimize the flow of body fluids specifically. Releasing myofascial restrictions increase the flow of blood and interstitial fluids which not only contribute to decreased swelling and pain but also more efficient healing.
Another reason why I like to start several months prior to surgery if possible is so that individualized exercises can reinforce mobility, strength and movement patterns between appointments prior to surgery. While there are many lifestyle limitations pre-surgical patients experience, there are safe ways to adapt exercises for better surgical outcomes that benefit the patient’s body and mind.
Think of it as preparing the terrain before construction begins.
We Prepare More Than the Surgical Area
One of the most overlooked parts of surgical preparation is anticipating what recovery itself will demand.
Consider someone preparing for a hip or knee replacement. For a period after surgery, that person may rely much more heavily on their arms, shoulders, opposite leg and trunk to get out of bed, rise from a chair, use stairs or manage a walker, crutches or cane.
If their shoulders are already restricted, their opposite hip is problematic or their upper body is poorly conditioned, those issues may suddenly become much more important after surgery.
The same principle applies elsewhere. Following breast surgery, normal movement through the chest, shoulders, rib cage and upper back can be temporarily affected by the surgical procedure, discomfort and protective posturing. Preparing those regions beforehand establishes the best available mobility and gives the patient familiarity with appropriate movement before surgery changes the equation.
Good prehabilitation therefore asks not only, “What is being operated on?” but also, “What will this person need their body to do while that area recovers?”
The Body Kneads Approach: Prepare, Operate, Rehabilitate
I prefer to look at surgical rehabilitation as a continuum rather than something that suddenly begins after an operation.
Before surgery, we assess, establish baselines, improve what can safely be improved, address compensatory restrictions and provide individualized home care. We also discuss what the first stages of recovery are likely to look like so the patient isn’t trying to absorb everything while simultaneously dealing with pain, fatigue, medication and the disruption that accompanies surgery.
Then surgery occurs.
A crucial component within a few days of returning home from hospital is a home visit from me. We review post-operative exercises as directed by the surgeon to ensure they are being done correctly. We discuss how things are going and any problems the patient might be experiencing and if needed I can help with any necessary interventions. I also bring my portable massage table so that I can do some gentle and appropriate post-surgical flushing to help mitigate swelling. This visit truly supports the patient to alleviate worries around “is my experience normal?” while giving confidence to move forward in their recovery.
Rehabilitation proceeds according to the procedure performed, the surgeon’s instructions, tissue-healing timelines and the individual’s presentation. Early care is appropriately conservative. As healing progresses, treatment can evolve toward restoring movement, managing compensatory tension, addressing scar restrictions when appropriate using Dolphin MPS scar release protocols, rebuilding strength and ultimately returning the person to meaningful activity.
The advantage is continuity. We’re not starting over after surgery — we’re continuing a process that began beforehand.
You Don’t Have to Be “Fit” to Benefit From Prehabilitation
Sometimes people hear the word prehabilitation and imagine an intensive fitness program. That can discourage exactly the people who may have the most to gain from preparation.
Someone awaiting a joint replacement may be in considerable pain. Walking may already be difficult. Traditional exercise may be limited. A person awaiting breast or abdominal surgery may have completely different limitations and priorities.
Prehabilitation should therefore meet the person where they are.
For one patient, meaningful progress might involve strengthening and cardiovascular conditioning. For another, it may mean gaining several degrees of useful movement, improving transfers from a chair, reducing unnecessary muscular guarding, learning a handful of appropriate exercises or improving the mobility of tissues that will need to compensate after surgery.
The objective isn’t perfection before surgery.
It is better preparation for what comes next.
Don’t Wait Until After Surgery to Think About Recovery
Surgery is sometimes viewed as the starting line: first we have the operation, then we worry about rehabilitation.
I prefer a different model.
Once the decision for elective surgery has been made, the waiting period becomes part of rehabilitation. Those weeks can be used to assess, educate, improve available function, establish appropriate exercises, identify compensations and prepare both the surgical region and the rest of the body for the demands ahead.
We cannot eliminate postoperative pain, swelling, healing time or the restrictions imposed by a surgical procedure. Nor should prehabilitation ever be presented as a guarantee of a particular surgical outcome.
What we can do is arrive at surgery better prepared.
And when your body is about to undergo something significant, the best time to start thinking about recovery is before the surgery ever takes place.