Waiting for knee surgery? Three things you need to start doing NOW.

With the current long waits for common knee surgeries, such as ACL repair and knee replacement, did you know that physiotherapy treatment before surgery can set you up for a better result and easier rehabilitation process after surgery?

“Prehabilitation”, or physiotherapy rehabilitation before surgery, is thought to:
1. Enhance pre-operative function and strength
2. Improve patient expectations and promote recovery after surgery
3. Increase pre-operative capacity may improve one’s ability to tolerate surgical stress(Ref 1)
4. Reduce risk of complications
5. Contribute to improved function 6 months after surgery(Ref 2)

More specifically, research suggests:

ACL Reconstruction

Pre-operative quadriceps strength is an important predictor of functional outcome after ACL reconstruction(Ref 3). Shaarani et al compared patients who underwent a 6-week progressive prehab program to those that did not and found that knee function (measured using the single-leg hop test as well as a self-report questionnaire) in the prehab group was better pre-operatively and these improvements were maintained 12-weeks after surgery as well(Ref 3).

Total Knee Replacement

Clode et al looked at the effects of prehab on patients waiting for total knee replacement and found that an 8-week prehab program led to statistically significant improvements in pre-operative pain and function(Ref 4). Additionally, they found that elderly patients had even more to gain from prehab, as their ability to regain strength after disuse is lower than that of a younger adult(Ref 4).

Take home message – Three things you need to start doing NOW:

1. Quadriceps strengthening.

In ACL prehab, quadriceps strength is of utmost importance. In the study by Shaarani, the quadriceps strengthening exercises included leg press, leg extension, ½ lunge and 45°squats, but before doing these it is essential that you have the ability to recruit your quadriceps effectively.

2. Hamstring strengthening.

Researchers consistently find persistent hamstring strength deficits after ACL reconstruction.
Current post-operative rehab protocols emphasize early and aggressive hamstring strengthening as a means to prevent strain on the ACL graft5 – building up hamstring strength prior to surgery gives you a better place to start from.

3. Balance and proprioception exercises.

When you have a ligament injury, improved knee stability comes from being able to recruit your muscles efficiently and effectively – the right amount of force at the right time. Balance exercises such as single leg stance on a wobble cushion or BOSU ball can help you improve in this area.

If you are preparing for knee surgery, start your prehabilitation now – our team of physiotherapists in Alaia Physio would be happy to design an individual prehab program to address your needs and set you up for success. Contact us.


1. Ditmyer MM. Prehabilitation in preparation for orthopaedic surgery. Orthopaedic Nursing. 2002;21(5):43-51.

2. Fortin PR. Outcomes of total hip and knee replacement: preoperative functional status predicts outcomes at six months after surgery. Arthritis Rheumatology. 1999;42(8):1722-1728.

3. Shaarani SR. Effect of Prehabilitation on the Outcome of Anterior Cruciate Ligament Reconstruction. The American Journal of Sports Medicine. 2013;41(9):2117-2127.

4. Clode NJ. Does physiotherapy prehabilitation improve pre-surgical outcomes and influence patient expectations prior to knee and hip joint arthroplasty? International Journal of Orthopaedic and Trauma Nursing. 2018;30:14-19.

5. Hardin, JA. Hamstring muscle strength prior to and following ACL reconstruction surgery using a patella tendon autograft. Journal of Sport Rehabilitation. 1998;7:172-181.