If you have been told you need a total knee replacement or a total hip replacement, the wait between that news and your surgery date can feel like dead time.
It does not have to be.
What you do before surgery can affect how you go in. And there is growing evidence it may also affect how well you recover. This post covers what that preparation looks like, what the research actually shows, and where massage therapy fits in.
What Is Prehabilitation?
Prehabilitation — or prehab — means doing structured exercise, learning about your surgery, or both, in the weeks or months before your operation. The idea is simple: going in stronger and better prepared tends to support a better recovery.
For people waiting for joint replacement, prehab usually involves:
Building strength in the muscles around the hip or knee
Keeping or improving range of motion before surgery temporarily limits it
Learning what to expect from surgery and the recovery process
Addressing fear of movement and pain beliefs that could affect how you recover
It is not about doing anything extreme. It is about arriving at surgery in the best condition you can, given where you are starting from.
What the Evidence Shows
The evidence on prehab before joint replacement has grown a lot in recent years. It is encouraging, though it is worth being clear about what it does and does not show.
A 2024 review published in Disability and Rehabilitation looked at 28 randomized controlled trials of prehab before knee and hip replacement. It found that prehab was linked to better function, less pain, improved quality of life, more strength, and better range of motion compared to no prehab. These were measured up to 52 weeks after surgery.
The authors noted that most of the included studies had a high risk of bias. That means the findings are encouraging but not definitive. Prehab is a worthwhile approach — but it is not possible to predict exactly how much benefit any one person will see.
A 2023 review in the American Journal of Physical Medicine and Rehabilitation found low-strength evidence that prehab may increase pre-surgical strength and reduce hospital stay length, though effects on post-surgical pain and function were less clear.
The most consistent finding is that going into surgery with better strength and function gives you a stronger starting point for recovery. That is a modifiable factor and one worth addressing.
Why Pain Beliefs Matter Before Surgery
One of the most important and often overlooked factors in joint replacement outcomes is what a person believes about their pain going into surgery.
Multiple studies have found that high pre-surgical fear and catastrophizing about pain is linked to worse outcomes after knee replacement, separate from the surgery itself. A review in the Journal of Pain Research found moderate evidence that pain catastrophizing predicted chronic pain after knee replacement.
This connects to Tasha Stanton’s work on OA and pain beliefs. The nervous system’s response to threat, shaped by fear and unhelpful beliefs about pain and movement, does not automatically reset after surgery. Addressing those beliefs before surgery — not just the physical preparation — is a meaningful part of prehab.
This is not about staying positive. It is about having an accurate picture. What surgery will and will not fix. What recovery involves. Why moving after surgery matters even when it is uncomfortable. Getting that picture before surgery is part of the preparation.
Where Massage Therapy Fits
Massage therapy is not a substitute for exercise-based prehab or your surgical team’s guidance. But it can play a useful supporting role in the weeks before surgery for some people.
In the pre-surgical period, soft tissue work can help with:
Reducing tension and compensatory patterns in muscles that have been overworking due to changes in how you move
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 is ahead as you can have. Massage therapy can support both.
A Practical Starting Point
If you are on a wait list for knee or hip replacement, here are some steps worth taking now:
Ask your surgeon or GP whether physiotherapy-led prehab is available or recommended for you
Start or maintain gentle activity — walking, pool exercise at the Tournament Capital Centre, or whatever is tolerable
Pay attention to what you have been told about your diagnosis and notice whether it has 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 start with an assessment. We look at where the tension is, what is limiting your movement, and what your goals are before surgery. We work alongside your surgical and rehabilitation team, not in place of it.
We do not 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 are preparing for a knee or hip replacement and want to talk through whether massage therapy is a good fit, we are taking new patients. Book online or give us a call.