If you’ve got a hip or knee replacement booked, there’s a good chance someone has told you to “get stronger before surgery”. It’s good advice. But it’s worth being straight about what it can and can’t do, because there’s a lot of hype around prehab.
What the research actually says
Studies on exercise before joint replacement are mixed, and that’s the honest picture. A review of 18 trials found that exercise before hip replacement gave a moderate improvement in pain and function before surgery, but no clear benefit for people waiting on a knee. More recent reviews of knee trials found less pain in the months after surgery, and some found better knee movement and faster walking tests. Others found little effect on function or time in hospital. Most of these trials were small, and the programs varied a lot, so it’s hard to say which type of exercise matters most.
So prehab isn’t a guarantee. It won’t change your surgeon’s results or replace your physio. What it can do is get you into surgery as strong, mobile and confident as your joint allows.
How I train people before surgery
When a client tells me they’ve got surgery coming, I start as soon as I know what’s happening with the date. The earlier the better, because the work is slow and it builds up over months.
The focus is on the muscles around the joint, and the muscles that keep your pelvis and spine steady. That means a lot of core and hip work: glute bridges, side planks, hip extension work, bird dogs and cat-cow. Alongside that, I do plenty of balance and stability work, the kind that trains your body to know where your joint is in space and to control it.
I also keep the rest of the session as normal as I can. People still do their standard resistance training, I just work around the injured area and avoid loading it. There’s no reason to stop training the rest of your body just because one joint is a problem.
Don’t rush it
The one thing I tell everyone is not to rush. Follow the process. Prehab is slow, steady work, and the temptation is to push harder as the date gets closer. Don’t. Stick to the plan, build things up gradually, and respect what your surgeon and physio have told you.
Working with your physio and surgeon
Before anything else, I check with your surgeon or physio about what’s okay for you. I stay in close contact with the physios my clients see. I follow their guidelines from the start, then again after surgery, and I get messages and calls from my clients along the way too. Your surgeon and physio know your joint and your surgical plan. I know how to keep you strong and moving around it. It works best when we’re all on the same page.
Why it’s worth the effort
One of my clients spent months training before a hip replacement, and was back training about ten weeks after surgery. I can’t say that was down to prehab alone, because every body and every surgery is different. But what I’ve noticed over the years is that people who’ve spent months stabilising, balancing and strengthening the muscles in and around the problem area come back to training a lot quicker. They also come back with more confidence, and that matters. They trust their body, and they’ve done the work.
If you’re waiting on surgery
Talk to your surgeon or physio first, and ask what they’re happy for you to do. Then get moving with something sensible, and keep going until the day. If you’d like help with that, I train people in small groups of up to six here in Maroubra, and I’ll work with whatever your surgeon and physio advise.
You might also find my post on exercising with arthritis useful.
Related reading: getting back to training after a hip or knee replacement.
Sources
- Gill SD, McBurney H. Does exercise reduce pain and improve physical function before hip or knee replacement surgery? Arch Phys Med Rehabil, 2012.
- Su W et al. Effect of preoperative rehabilitation on total knee arthroplasty outcomes. J Orthop Surg Res, 2022;17:175.
- Zhang W et al. Prehabilitation and knee arthroplasty outcomes. Front Med, 2025;12:1457407.
- Wang D et al. Preoperative exercise intervention and rehabilitation after total knee arthroplasty. Ann Palliat Med, 2021;10(10).