If you’ve been told you need a total knee replacement (TKR) or total hip replacement (THR), the period between that conversation and your surgery date can feel like a waiting game.
It doesn’t have to be.
What you do in the weeks and months before surgery can influence how you go into the operating room — and growing evidence suggests it may also affect how well you recover afterward. This post covers what that preparation looks like, what the research actually shows, and where massage therapy fits into the picture.
What Is Prehabilitation?
Prehabilitation — or prehab — refers to structured exercise, education, or a combination of both, done in the weeks or months before surgery. The idea is straightforward: going into surgery stronger, more informed, and better prepared tends to support a better recovery.
For people awaiting joint replacement, prehab typically involves:
Strengthening the muscles around the hip or knee
Maintaining or improving range of motion before surgery limits it temporarily
Learning what to expect from surgery and recovery
Addressing pain beliefs and fear of movement that could affect outcomes
It’s not about doing anything extreme. It’s about arriving at surgery in the best condition possible, given where you’re starting from.
What the Evidence Shows
The evidence on prehab before joint replacement has grown considerably. It’s encouraging, though it’s worth being clear about what it does and doesn’t show.
A 2024 systematic review and meta-analysis published in Disability and Rehabilitation analyzed 28 randomized controlled trials of prehabilitation before TKA and THA. The review found that prehab was associated with improvements in function, pain, quality of life, strength, and range of motion compared to no prehab. These were measured up to 52 weeks post-surgery.
That said, the authors noted that most of the included studies had a high risk of bias, and that significant differences between studies make it difficult to draw firm conclusions. The evidence supports prehab as a worthwhile approach, but it isn’t strong enough to predict exactly how much benefit any one person will see.
A separate 2023 systematic review published in the American Journal of Physical Medicine & Rehabilitation found low-strength evidence suggesting prehab may increase pre-surgical strength and reduce hospital length of stay, though effects on post-surgical pain and function were less clear.
The most consistent finding across the prehab literature is that going into surgery with greater strength and function is associated with better starting points for recovery. It’s not a guarantee — surgery, individual health, and post-operative rehab all matter too — but it’s a modifiable factor worth addressing.
Why Pain Beliefs Matter Before Surgery
One of the more important and sometimes overlooked factors in joint replacement outcomes is what a person believes about their pain going in.
Multiple studies have found that higher pre-surgical pain catastrophizing — an amplified, fearful response to pain — is an independent predictor of poorer outcomes after knee arthroplasty. A systematic review published in the Journal of Pain Research found moderate-level evidence that pain catastrophizing predicted chronic pain after TKA, independent of surgical factors.
This connects to Tasha Stanton’s broader work on OA and pain beliefs: the nervous system’s threat response, shaped by fear and unhelpful beliefs about pain and movement, doesn’t automatically reset after surgery. Addressing those beliefs before surgery — not just the physical preparation — is a meaningful part of prehab.
This isn’t about positive thinking. It’s about accurate understanding: what surgery will and won’t fix, what recovery involves, and why movement after surgery is necessary even when it’s uncomfortable.
Where Massage Therapy Fits
Massage therapy isn’t a substitute for exercise-based prehab or your surgical team’s guidance. But it can play a useful supporting role in the pre-surgical period for some people.
In the weeks before joint replacement, soft tissue work can help with:
Reducing tension and compensatory patterns in muscles that have been overworking due to altered gait or guarded movement
Supporting range of motion and comfort in the lead-up to surgery
Addressing tightness in the surrounding hip, thigh, and lower back that limits how well you can do your prehab exercises
Providing education and reassurance as part of a calm, unhurried appointment
The goal in the pre-surgical period is to arrive at your surgery date moving as well as possible and with as clear a picture of what’s ahead as you can have. Massage therapy can support both.
A Practical Starting Point
If you’re on a wait list for TKR or THR, here are some steps worth taking now:
Ask your surgeon or GP whether physiotherapy-led prehab is available or recommended
Start or maintain gentle activity — walking, pool exercise at the Tournament Capital Centre, or whatever is tolerable
Pay attention to what you’ve been told about your diagnosis and notice whether it’s made you more fearful of movement or more confident
Consider whether hands-on support alongside your prehab routine would be useful
Wait lists in BC can be long. That time is an opportunity, not just a delay.
What to Expect at Well+Able
If you come to us in the pre-surgical period, we’ll start with an assessment of what’s going on — where the tension is, what’s limiting your movement, and what your goals are before surgery. We work alongside your surgical and rehabilitation team, not in competition with it.
We don’t promise that massage therapy will change your surgical outcome. What we can offer is honest, evidence-informed support during a period where the work you put in genuinely matters.
Related reading: What Is Osteoarthritis, Really? — How Massage Therapy Can Support You With OA — Recovering From a Knee or Hip Replacement
Book today
If you’re preparing for a knee or hip replacement and want to talk through whether massage therapy is a good fit, we’re taking new patients. Book online or give us a call.