Prehabilitation

Usually someone who has just been given a surgery date and doesn't want to spend the wait doing nothing.

Sometimes it's a joint replacement that's been coming for years, and the last twelve months of avoiding stairs have quietly cost a lot of leg strength. Sometimes it's a knee or shoulder repair after a specific injury, where the limb has been guarded and unloaded since the day it happened. Sometimes there's no injury at all: an abdominal or general procedure where the concern is conditioning, confidence and getting moving again safely afterwards.

And sometimes people are sent by their surgeon, who has said in as many words that it's worth arriving in the best shape you can manage.

You don't need a referral to book. If you have one, bring it, along with anything the surgeon has given you about the procedure and what's planned afterwards.

We start with the surgery itself. What's being done, when, and what you've been told about the recovery: the sling, the brace, the crutches, the weight-bearing restrictions, the things you won't be allowed to do for the first few weeks. That's the target we're working back from, so the more of it you can bring, the better.

Then we assess where you are now. Strength, range, how you're walking or lifting or reaching today, what the other side looks like by comparison, and what you've stopped doing since this started. We're looking for the things that will make the first fortnight afterwards harder than it needs to be: the arm that can't yet manage a crutch, the leg that can't take your weight standing up from a low chair.

We tell you plainly what we found, including the parts that are already fine. If your preparation mostly needs one or two things rather than a full program, we'll say so rather than booking you in weekly until the date.

You leave with something specific and short. A handful of exercises, how many, how often, and what they should and shouldn't feel like. If something is sore, that's information we want, not a sign you've done it wrong.

We also cover the practical side, because it matters more than people expect. How you'll get off a bed or a couch, how to manage stairs at home, what you'll need set up before you go in, and what to do in the first days back. Working that out now is far easier than improvising it on painkillers with a fresh wound.

There's no standard prehab program, because there's no standard surgery. Preparing for a knee procedure and preparing for a shoulder procedure have almost nothing in common beyond the principle.

So the plan works backwards from three things: what the operation is, what your recovery is expected to involve, and what you personally need to get back to. Someone returning to a physical job has a different finish line from someone whose main goal is being independent at home, and the preparation should look different too.

Time matters as well. Some people come to us with months before the date, some with a fortnight. We'd rather give you three things you'll actually do in the time you've got than a program that assumes a runway you don't have.

The whole-person part is real here too. Sleep, stress and how much you're moving in an ordinary week all shape how you'll cope with an operation and what comes after it. Having surgery scheduled is stressful, and feeling like you're doing something useful in the lead-up is part of the point.

Your surgeon owns the surgical plan. We work inside it.

That means the procedure, the timing, the restrictions afterwards, and anything to do with medication, pain relief or injections are their decisions and your GP's, not something a physiotherapist prescribes or administers. If something we find during an assessment needs a doctor rather than a physio, we'll tell you and point you back in that direction.

What we do is the movement side: preparing the body for what's coming, working within whatever restrictions you've already been given, and making sure nothing we ask you to do cuts across the surgical plan. If you've been given a protocol or a set of instructions, bring it. We'd rather build around the real document than assume.

If you're sending a patient to us before an operation, here's what you can expect.

Any restriction or instruction you've already given is treated as fixed, and where your instructions are silent we'll ask rather than assume. We don't run a house prehab program that every patient gets put through; the plan is built from the procedure, your stated restrictions and the patient's own assessment findings. Patients can book directly without a referral, so a formal one isn't required to start, but written pre-operative instructions, a procedure name or an expected post-operative protocol makes the first session far more useful. Clinical questions about a shared patient are welcome, and we'd rather ask than guess.

Preparation and recovery are the same pathway, not two separate services. The same team picks up your post-surgical rehabilitation once you're cleared to start, already knowing your history, your baseline and what you were able to do beforehand.

That continuity saves you repeating yourself at the worst possible time, and it means the goals you set before surgery are still the ones being worked towards afterwards.

If you're not having surgery and just want to stay ahead of problems generally, that's a different service. See wellness and preventive care instead.

We can't promise that preparing well changes your surgical result. That's your surgeon's domain, and any service page that guarantees you an outcome is selling you something.

What prehabilitation can offer is this: you go in knowing what to expect, with a clear picture of where you currently stand, with the practical problems of the first week already thought through, and with a physiotherapist who knows your case before you need them. That's worth having, and it's a very different claim from a guarantee.