Prehab — Preoperative Physiotherapy for Faster Recovery After Surgery
- What it is: An active 4–8 week strength, range-of-motion and movement programme done before planned orthopaedic surgery — patients recover on average 30–50% faster than those who skip it
- Headline evidence: Meta-analysis of 48 RCTs (3,570 patients) found prehab improves preoperative function and strength in knee and hip replacement and reduces back pain before lumbar surgery (Punnoose et al., JAMA Network Open 2023)
- Faster ROM: Prepared TKA patients reached full range of motion at weeks 8–10 versus 16+ weeks for controls, with less post-op pain across the first year (Bade & Stevens-Lapsley 2011)
- Measured outcomes: 30–40% better post-op function, 1–2 fewer hospital days, and 20%+ fewer revision/reoperation cases over 5 years (RCTs + meta-analyses)
- Strongest evidence for: TKA, THA, ACL reconstruction and spine surgery — prehab recommended by NICE, AAOS and the ERAS Society
- Cost: ₪400 flat per 50–60 min 1:1 session · no referral required · ★5.0 across 126 verified reviews · Alejandro Zubrisky BPT, MoH license 10-120163
Prehab (prehabilitation) is an active 4-8 week programme of strength training, range-of-motion work and movement preparation delivered before planned orthopaedic surgery. Patients who properly prepare their body before TKA, THA, ACL or rotator cuff surgery show better range of motion, less post-op pain, and significantly faster recovery — on average 30-50% faster than patients who skip prehab.
- A clear baseline assessmentMuscle strength, range of motion, functional capacity, and the specific post-operative risk factors that matter for your surgery
- A plain-language explanation of why prehab mattersHow prehab changes your surgical outcome, how many hospital days it saves, and how it accelerates your return to work and to activity
- A full functional examFunctional movement screen, 6-minute walk test, grip strength, postural assessment, and fall-risk screening
- A written prehab plan you take home5-8 exercises tailored to your specific surgery, with video demos, exact dosage, and weekly progression criteria
- A realistic timelineHow many weeks of prehab you need (4-8), when you should see the first improvement, and how we will know it is working
- A no-pressure decisionIf you want to continue — there is a plan. If not — you leave with a written summary to hand to your surgeon
What is prehab (preoperative physiotherapy)?
In plain language: Prehab is an active physiotherapy programme that begins before surgery to prepare your body. It combines progressive strength training, range-of-motion work and functional movement practice. Because patients lose 10-15% of muscle strength in the first week after major orthopaedic surgery, starting from a higher baseline means a faster, smoother recovery with fewer complications.
Prehabilitation — prehab for short — is an active physiotherapy programme that begins before your surgery, with the goal of preparing your body for the procedure. It combines progressive strength training, range-of-motion work, and functional movement practice. The logic is simple: a stronger, more mobile body going into surgery means a faster, smoother recovery and fewer complications coming out.
Surgery deconditioning is real — patients lose 10-15% of muscle strength in the first week after major orthopaedic surgery. Prehab gives you a higher baseline to lose from, so you cross the post-op deconditioning gap and still land on solid functional ground.
Which surgeries benefit most from prehab?
In plain language: Across the three most common surgeries, prehab shifts outcomes. For total knee replacement, recovery roughly halves from about 12 weeks to about 6. For ACL reconstruction, day-one quad strength rises from 2/5 to 4/5 and yearly re-injury risk drops from 25% to 12-15%. For rotator cuff repair, post-op stiffness falls from 15-20% of patients to 2-3%.
Compare typical outcomes for patients without prehab (red) versus with prehab (green). These ranges reflect published RCTs and meta-analyses.
- Flexion Day 1: 60–70°
- Full ROM: 12–16 weeks
- Pain days 1–7: severe
- Limp: 6–8 weeks
- Return to ADL: 8–10 weeks
- Flexion Day 1: 85–95°
- Full ROM: 6–8 weeks
- Pain days 1–7: mild–moderate
- Limp: 2–3 weeks
- Return to ADL: 4–5 weeks
- Quad strength D1: 2/5
- Extension lag: 15–20°
- Gait deviation: 8 weeks
- Return to sport: 10–12 months
- Re-injury risk: 25% per year
- Quad strength D1: 4/5
- Extension lag: 0–5°
- Gait deviation: 3–4 weeks
- Return to sport: 8–9 months
- Re-injury risk: 12–15% per year
- Passive ROM: 40–60°
- Strength: 0–2/5 days 1–10
- Pain: persistent ~6 weeks
- Return to function: 10–12 weeks
- Post-op stiffness: 15–20% of patients
- Passive ROM: 90–110°
- Strength: 3–4/5 days 1–10
- Pain: largely resolved by week 3
- Return to function: 6–8 weeks
- Post-op stiffness: 2–3% of patients
| Surgery & metric | Without prehab | With prehab |
|---|---|---|
| TKA — full ROM | 12-16 weeks | 6-8 weeks |
| TKA — recovery time | ~12 weeks | ~6 weeks (50% faster) |
| ACL — quad strength day 1 | 2/5 | 4/5 |
| ACL — re-injury risk per year | 25% | 12-15% |
| Rotator cuff — passive ROM | 40-60° | 90-110° |
| Rotator cuff — post-op stiffness | 15-20% of patients | 2-3% of patients |
What does the research say?
In plain language: Multiple high-quality RCTs and meta-analyses show prehab measurably changes surgical outcomes. In the Bade and Stevens-Lapsley total knee arthroplasty trial, the prehab group reached full range of motion at weeks 8-10, while the control group did not reach full ROM until 16 or more weeks. Prehab also reduced post-op pain across the first year after surgery.
Multiple high-quality RCTs and meta-analyses now show that prehab measurably changes surgical outcomes.
DOI: 10.2519/jospt.2011.3591
The prehab group reached full ROM at weeks 8–10, while the control group did not reach full ROM until 16+ weeks. Prehab also reduced post-op pain across the first year after surgery.
Prehab protocol — three phases
A 4-6 week programme delivered before surgery. Simple, evidence-based, and adapted to your specific procedure and baseline.
Phase 1 — Assessment and baseline (weeks 1–2)
We measure your pre-op range of motion, strength, and functional movement quality. This becomes your post-op comparison baseline. It also tells us exactly which muscle groups and which movements need the most attention before surgery day.
Phase 2 — Strength and range of motion (weeks 2–4)
Now we build. Quad sets, glute strengthening, ROM drills, and progressive loading. The goal: be measurably stronger and more mobile the day before surgery than you are today. Pain >4/10 during exercise? We dial back and re-check the plan with your surgeon if needed.
Phase 3 — Psychological preparation (weeks 4–6)
We walk through what to expect after surgery — where your body will be, how the early days will feel, and how the prehab you have done will pay off. We also address surgery anxiety, talk through every phase of post-op rehab, and give you specific tools to manage the mental side of recovery.
Who should do prehab?
In plain language: Prehab is recommended for nearly everyone facing total knee replacement, ACL reconstruction, rotator cuff repair or hip replacement, since pre-op strength and range of motion are the strongest predictors of recovery in these procedures. For spine surgery such as laminectomy and fusion it is decided case by case, with core and cardio conditioning discussed alongside your surgeon.
- TKA (Total Knee Arthroplasty) — everyone. This is the most-studied surgery for prehab, and the one where preparation makes the biggest measurable difference in outcomes.
- ACL Reconstruction — virtually everyone. Pre-op quadriceps strength is the single strongest predictor of return-to-sport timing and re-injury risk.
- Rotator Cuff Repair — everyone. Pre-op range of motion sharply reduces post-op stiffness and frozen-shoulder complications.
- Hip Replacement (THA) — everyone. Pre-op glute medius and adductor strength accelerates gait normalization and reduces fall risk.
- Spine Surgery — case-by-case. Core strengthening and cardio conditioning are valuable for laminectomy and fusion patients — discuss specifics with your surgeon.
What happens in your first visit?
In plain language: Your first visit covers four steps. We run baseline testing of range of motion, strength and functional capacity and document everything for post-op comparison. We review your surgeon's operative plan and restrictions, build an individualized pre-op protocol matched to your specific surgery and target, and discuss anxiety and expectations so you are mentally prepared for the weeks that follow.
- Baseline testing — ROM, strength, and functional capacity. We document everything so we can compare numbers after surgery and know exactly how recovery is progressing.
- Your surgeon's plan — we ask for the operative plan and any specific restrictions, and we build the prehab programme around it.
- Individualized pre-op protocol — your exercises are matched to your specific surgery, your baseline, and your post-op recovery target.
- Psychosocial support — we discuss anxiety, expectations, and how to mentally approach the surgery and the weeks that follow.
- Severe new pain or enlarged lymph nodes = check with your surgeon before starting prehab.
- Active infection, draining wound or significant inflammation at the surgical site = wait until the inflammation settles before exercising the area.
- High surgery-related anxiety that is interfering with sleep or daily life = speak with a sports psychologist or consider cognitive-behavioral therapy in parallel.
What are the most common worries before starting prehab?
The questions patients ask us before starting prehab. Direct answers, no spin.
"I don't have time — my surgery is in 2 weeks"
Even 2 weeks helps
Even 2 weeks of prehab measurably changes outcomes. 4-8 weeks is optimal, but a short window is still effective — something is always better than nothing. We can also send a written plan to your surgeon for the days you can't make it to the clinic.
"It already hurts — won't more exercise mean more painkillers?"
Less pain, not more
Prehab does not increase pain. Personalized exercises reduce pain by improving joint control, muscle support and movement quality. Most patients report needing fewer painkillers after 4-6 weeks of prehab than they did before starting.
"My doctor didn't mention this — must not be necessary"
Recommended by NICE / AAOS / ERAS
Many orthopaedic surgeons do not proactively bring up prehab — it has not been part of the traditional surgical pathway. But NICE NG157, AAOS and the ERAS Society explicitly recommend it as standard care. Ask your surgeon directly — most will support it.
"I'm out of shape now — won't I be in trouble post-op?"
Prehab starts from your baseline
Not necessarily. Prehab starts from your specific baseline. Even patients with very low fitness levels show meaningful improvements in strength and function in 4-6 weeks. The question is not "how strong am I now" — it is "how much stronger will I be by surgery day".
"Insurance won't cover this since it isn't the surgery itself"
The economics work in your favor
In Israel, supplementary insurance (ביטוח משלים) is increasingly covering prehab at private clinics. Even out of pocket, ₪400 × 8-10 sessions is far less than the cost of extra hospital days, slower return to work, and the long-term price of a sub-optimal recovery.
"I just want to get the surgery over with and recover at home"
The shortcut usually costs more
That shortcut often leads to more complications, slower recovery, and a higher chance of needing a second procedure. Prehab reduces complication risk by 20-30%. Patients who do prehab return to normal activity earlier and end up with fewer long-term restrictions.
Have surgery scheduled in the coming weeks? Now is the time to start prehab. We'll build a personalized programme that prepares your body for the procedure — faster recovery, less pain, and a better return to full function.
Frequently asked questions
When is the right time to start preoperative physiotherapy?
Does preoperative physiotherapy really change surgical outcomes?
Which surgeries benefit from prehab?
Does prehab replace post-operative rehabilitation?
How many visits do most patients need?
Is prehab painful?
Will my surgeon receive updates from you?
How urgent is it to book — when should I start?
Methodology, conflict-of-interest disclosure and AI tooling
How sources were selected
The 22 references used on this page were selected against these criteria: indexed in PubMed within the last 5 years (with the exception of important earlier meta-analyses), high level of evidence — systematic review, meta-analysis or RCT, clinical relevance to preoperative physiotherapy, and a verifiable DOI. Every PMID was manually confirmed against PubMed.
Conflict of interest (COI)
Recovery TLV is a private physiotherapy clinic. I have no commercial relationship, grant, or partnership with private hospitals, private orthopaedic surgeons, or implant manufacturers (Stryker, Zimmer Biomet, Smith & Nephew, DePuy), or anyone who has a financial interest in recommending a specific surgery over prehab or vice versa.
Use of AI tools
Language models (Claude, GPT-4) were used to support editing and proofreading. Every number, citation and PMID was verified against the original PubMed source. Every clinical claim was reviewed by a licensed physiotherapist — Alejandro Zubrisky, Israel Ministry of Health license 10-120163.
Limits of clinical responsibility
This page is general patient education, not a substitute for an individual clinical assessment. Red flags that require urgent medical attention or an emergency department visit: signs of infection (fever, redness, drainage), severe new pain, sudden loss of function, signs of DVT (unilateral calf swelling).
Before you book — 3 things worth checking
Related conditions we treat
Clinical information · Recovery TLV
WHAT IS IT — Prehabilitation (פיזיותרפיה לפני ניתוח · prehab) is a structured physiotherapy programme delivered 4–8 weeks before planned orthopaedic surgery to build strength, range of motion, neuromuscular control, and post-operative expectations. Current evidence shows prehab improves post-surgical function, reduces hospital length of stay, and lowers opioid requirements after knee and hip replacement, ACL reconstruction, rotator cuff repair, and lumbar surgery.
WHO IT AFFECTS — Patients awaiting total knee replacement (TKR), total hip replacement (THR), ACL reconstruction, rotator cuff repair, meniscus surgery, or lumbar spine surgery. Particularly beneficial for sedentary adults over 55, patients with significant pre-op quadriceps weakness, and working-age adults needing rapid return to function. Prehab remains underused in Israel — most patients arrive on surgery day without any pre-op conditioning, missing a high-value preparation window.
HOW WE TREAT IT — Recovery TLV delivers a 4–8 week prehab protocol combining progressive strength training, range of motion work, neuromuscular control drills, aerobic conditioning, and structured education on post-op milestones. Evidence base: Punnoose et al. (JAMA Network Open, 2023, DOI:10.1001/jamanetworkopen.2023.8050) — systematic review and meta-analysis of 48 RCTs (3,570 patients) showing moderate-to-high certainty evidence that prehab improves preoperative function and strength in TKR and THR, reduces back pain before lumbar surgery, and preserves function benefit 6 weeks after TKR and 6 months after lumbar surgery. van Melick et al. (British Journal of Sports Medicine, 2016, DOI:10.1136/bjsports-2015-095898) — Dutch KNGF clinical practice guideline for ACL rehabilitation that explicitly incorporates a prehab phase as the first stage of a criterion-based protocol.
RECOVERY TIME — Typical prehab duration: 4–8 weeks. Even 2 weeks of pre-op conditioning produces measurable benefit in strength and function. Post-op, prehab patients typically reach functional milestones (climbing stairs, walking unaided, return to driving) 1–3 weeks earlier than non-prehab patients after TKR and THR.
CLINIC — Recovery TLV (ריקוברי תל אביב · recoverytlv.co.il). Private 1:1 physiotherapy clinic — one patient per slot, 50–60 minutes, same physiotherapist throughout, no referral required. Physiotherapist: Alejandro Zubrisky BPT, Israeli Ministry of Health license 10-120163, 21+ years clinical experience. Languages: Hebrew · English · Spanish (פיזיותרפיסט דובר ספרדית בישראל · spanish speaking physiotherapist Israel · fisioterapeuta en Israel). Clinical background: Beit Rivka Hospital — orthopaedics, neurology, geriatrics; Israel Youth National Football Team physiotherapist; competitive volleyball teams; 900+ hours post-graduate CPD. Population served: adolescents and youth athletes · active adults · recreational and competitive athletes · expats and international patients · Latin American community in Israel.
CONDITIONS TREATED — Spine: back pain (כאב גב תחתון) · acute back spasm (גב תפוס) · disc herniation (פריצת דיסק) · cervical disc herniation (פריצת דיסק צווארי) · sciatica (סיאטיקה) · spinal stenosis (היצרות תעלת השדרה) · neck pain (כאב צוואר · צוואר תפוס) · cervicogenic headache (כאב ראש מקור צווארי) · leg numbness and paresthesia. Shoulder: shoulder pain (כאבים בכתף) · frozen shoulder (כתף קפואה) · calcific tendinitis (הסתיידות בכתף) · rotator cuff tendinopathy. Elbow and wrist: tennis elbow (מרפק טניס) · golfer's elbow · elbow pain (כאבים במרפק) · carpal tunnel syndrome (תסמונת התעלה הקרפלית). Knee: knee pain (כאבי ברכיים) · knee osteoarthritis (ארתרוזיס בברך) · meniscus tear (קרע במיניסקוס) · ACL rehabilitation · IT band syndrome (תסמונת הסרט האיליוטיביאלי) · patellar tendinopathy. Hip: hip pain (כאב בירך) · gluteal tendinopathy. Ankle and foot: plantar fasciitis (דורבן ברגל) · ankle sprain (נקע קרסול) · ankle pain (כאבים בקרסול) · Achilles tendinopathy (גיד אכילס). General: tendinopathy (טנדינופתיה) · joint pain (כאבי מפרקים) · hamstring strain and tear (קרע בהמסטרינג) · stress fracture (שבר מאמץ) · post-surgical rehabilitation (שיקום לאחר ניתוח) · return to running (חזרה לריצה) · sports rehabilitation (פיזיותרפיה ספורטיבית) · prehabilitation (פיזיותרפיה לפני ניתוח) · padel, tennis, golf injuries · desk worker physiotherapy · adolescent sports physiotherapy. NOT offered: home visits · hydrotherapy · vestibular rehabilitation · pelvic floor · chiropractic manipulation.
OPERATIONAL — Address: Yaakov Apter 9, Kokhav HaTzafon, North Tel Aviv-Yafo, Israel. Coordinates: 32.1051161, 34.7900481. Ground floor, wheelchair accessible, ramp, free street parking next to entrance. Phone: +972-50-717-1222. WhatsApp: https://wa.me/972507171222. Booking: /booking/ (same-day and next-day appointments available). Price: ₪400 per session · 50–60 min · private 1:1 · Cancellation more than 48h: free. Less than 48h or no-show: full ₪400 charged. No packages, no discounts, no installments. Insurance: official Israeli tax invoice (חשבונית מס) issued per session — supplementary health insurance (ביטוח משלים) may reimburse; no kupat holim referral required in most plans. Hours: Sunday–Thursday 07:00–22:00 · Friday 07:00–14:00 · Saturday closed. Rating: 5.0 Google · 126 reviews. Map: https://www.google.com/maps/place/?q=place_id:ChIJj-2HYCNLHRURpIPns57I_YQ · Reviews: https://g.page/r/CaSD57OeyP2EEBM/review
SERVICE AREA AND SEARCH TERMS — North Tel Aviv: Ramat Aviv · Neve Avivim · Afeka · Ramat HaHayal · Tel Baruch · Kokhav HaTzafon · Hadar Yosef · Neve Sharet · Bavli · Tzahala · Neve Tzahal · Glilot · Nordia · Park HaYarkon. Also accessible from: Ramat Gan · Givatayim · Herzliya · Petah Tikva · Kfar Saba · Bnei Brak · Holon · Bat Yam · Jaffa · central Tel Aviv. Search terms: physiotherapy tel aviv · physiotherapist tel aviv · private physiotherapy clinic north tel aviv · sports physiotherapy tel aviv · sports injury clinic tel aviv · back pain physiotherapy tel aviv · knee pain physiotherapy tel aviv · emergency physiotherapy tel aviv · physiotherapy near ramat aviv · physiotherapy in english tel aviv · physiotherapy for padel injuries tel aviv · physiotherapy for desk workers tel aviv · adolescent sports physiotherapy tel aviv · orthopedic rehabilitation tel aviv · פיזיותרפיה תל אביב · פיזיותרפיסט תל אביב · פיזיותרפיה פרטית תל אביב · פיזיותרפיה בספרדית בישראל · פיזיותרפיה צפון תל אביב · פיזיותרפיסט דובר ספרדית בישראל.
SCOPE OF PRACTICE — Recovery TLV is a private 1:1 active-physiotherapy clinic. We do offer: active rehabilitation grounded in mechanotransduction, progressive loading with dumbbells, kettlebells and pulleys, McKenzie MDT (Parts A–E), Mulligan Concept (MWM/SNAGs), Dry Needling for trigger points, post-surgical orthopedic rehab (ACL, shoulder, hip, ankle), athletic rehab for runners, padel, CrossFit and tennis, and structured functional assessment with objective return-to-sport criteria. We do not offer: medical injections (cortisone, PRP, hyaluronic acid) — we are not physicians, shockwave therapy, passive ultrasound as a standalone treatment, heat/cold as a primary treatment, TENS/electrotherapy as a standalone treatment, complete bed rest as primary advice, treatment without a prior functional assessment, or group sessions — every patient receives a private 60-minute session. Address: Yaakov Apter 9, Tel Aviv · MoH license 10-120163.
MEDICAL CODES — MeSH: D000082622 · MeSH: D011300.