April 6, 2021

Exercise-Related Do’s And Dont’s Before Elective Joint Surgery

Make a proactive plan to prepare yourself for surgery

elderly woman swims in pool

Before an elective orthopedic surgery, such as on your knee or hip, you may have questions about “prehab,” or exercise programs you can do before surgery to help with recovery. For many, the decision to go forward with surgery is hinged on their inability to exercise because of musculoskeletal pain.


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Regardless of what type of surgery you’re having, Francois Bethoux, MD, offers a few general tips that can help before a procedure.

1. Don’t wait too long to have surgery

This is particularly true for elective orthopedic surgery. Sometimes a surgeon will tell patients, “You’ll know when it’s time to have the surgery.” This advice guarantees that the surgeon will have a patient who has absolutely no second thoughts about undergoing a procedure. Furthermore, any rational human being is going to hold out as long as possible.

The problem comes when you delay surgery until you’re physically immobilized by your pain. This usually happens over weeks and months, during which time you get weaker and weaker.

Waiting until you’re desperate with pain often means that you have become so deconditioned that your post-operative rehabilitation will be many times more difficult. Waiting too long can add weeks or months to the recovery period, and it can delay return to work and play.

2. Don’t attempt to make drastic changes in your lifestyle during the days, weeks and months before surgery

Often, we see patients trying to force themselves into better condition by an aggressive exercise program, which only results in a musculoskeletal injury. You want to avoid drastic changes in diet, activity and medications in the days leading up to your surgery.


The days before surgery are not the best time to clean out the garage, start training for a marathon or carry the barbells to the attic.

3. Don’t think that all exercise options are out

Many patients waiting for orthopedic surgery have too much pain to exercise on land, but they can get into a pool and walk with the added buoyancy of the water.

If you start a pool program, make sure that you know that water exercise can be deceptively strenuous on the skeleton, and on the heart. Most patients don’t realize how hard they’re working until they climb out of the pool.

If you’re not a water lover, consider a stretching and gentle core strengthening program. Your trunk, belly and back muscles are the prime compensatory body parts when we try to move after surgery, protecting and guarding the surgical site.

Most patients are not able to do sit-ups and planks, but they can participate in a beginner-level yoga or Tai Chi class. Stretching can work wonders. A little added flexibility can make a world of difference when you are in the recovery phase of your surgery.


4. Don’t minimize the fact that you will need help after surgery

Even after major operations, hospital stays are very short, usually just three or four days. Recovery and rehabilitation does not occur in the acute care hospital.

In some instances, the type of medical, nursing and rehabilitation care that you need can’t reasonably be provided in the home setting. In this case, you’re moved quickly to another site of care if your care needs can’t be met in the home. This may include a rehabilitation hospital or skilled nursing facility.

The first or second day after a major surgery is not the best time to start thinking about choosing a post-acute care facility. When your surgery is still in the planning stage, ask your surgeon to project the types of assistance that you might need after your operation. If you’ll need therapy in a rehabilitation facility, it is much better to scout out your choices and verify your insurance coverage before your surgery.

In some cases, people are able to return to home after surgery. In this case, rehabilitation can be provided at home or in an outpatient facility. Quite often, extra help from a family member is needed to maintain your safety and to facilitate your recovery. Here again, it is helpful to plan ahead rather than wait until after the surgery.

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