Preparing for a Knee or Hip Replacement with Prehab Exercises

Prehabilitation, or "prehab," means working on strength, mobility and movement patterns in the weeks before a scheduled knee or hip replacement. Building this foundation ahead of surgery is something virtual physiotherapy can guide from home, with no travel needed while you're still getting around on your own.

If you're on a wait list for a joint replacement in Ontario, the time between your surgical consult and your operating date is not just waiting time. It's an opportunity to prepare your body so recovery afterward has a stronger starting point.

What is prehab, and why does it matter?

Prehab is a short, targeted program of exercises designed to:

• Build strength in the muscles around the joint being replaced
• Maintain or improve the range of motion you have before surgery
• Practice the movement patterns you'll need immediately after surgery, like getting in and out of a chair or bed safely
• Address any compensations on the opposite side that have built up from favouring the painful joint

Entering surgery with better baseline strength and mobility gives your body more to work with during the early recovery period, when swelling and surgical precautions limit what you can do.

Who is a good candidate for prehab?

Most people waiting for a knee or hip replacement can benefit from a prehab program, including those who:

• Have a confirmed surgical date or are on a wait list
• Experience pain that limits certain exercises but not all movement
• Want a structured plan rather than guessing which exercises are safe
• Are also managing the opposite hip or knee, which often takes on extra load before surgery

Physiotherapy is a direct-access service in Ontario, so you do not need a referral from your surgeon or family doctor to start a prehab program.

Can prehab be done through virtual physiotherapy?

Yes. A virtual physiotherapist can guide a full prehab program through virtual physiotherapy by video, including:

• An initial assessment of your current strength, range of motion and movement patterns
• A customized home exercise program using body weight, resistance bands, or household items
• Coaching on technique and pacing, adjusted as your symptoms respond
• Guidance on using mobility aids, pacing activity, and protecting the joint day to day

Because prehab relies on exercise instruction and movement coaching rather than hands-on manual therapy, it fits a video-based format particularly well. Your physiotherapist can watch you move in real time and correct form just as they would in person.

What does a typical prehab program include?

Programs vary by joint and by what your assessment finds, but common elements include:

• Strengthening for the muscles supporting the hip or knee, such as the quadriceps, glutes and calf muscles
• Range-of-motion work to maintain flexibility without aggravating pain
• Balance and single-leg stability exercises, which support safer movement after surgery
• Functional practice, like sit-to-stand transfers, stair technique, and safe use of a walker or cane if one will be needed post-surgery
• General conditioning, since overall fitness supports a smoother recovery

Your physiotherapy plan is adjusted over your sessions as your surgical date approaches and as your tolerance for exercise changes.

How early should I start, and how often do I need sessions?

Starting as soon as your surgery is scheduled gives you the most benefit, though even a few weeks of consistent work can help. Session frequency depends on your needs and how comfortable you are progressing the program independently between visits — some people need weekly check-ins, while others do well with less frequent guidance once they understand the exercises.

Consistency with your home program between sessions matters more than the number of visits. Your physiotherapist will help you find a routine that fits realistically into your schedule.

Does insurance or OHIP cover prehab?

OHIP does not cover physiotherapy sessions for most adults outside of specific exempt groups. Coverage usually comes through an extended health benefits plan. If your joint replacement is related to a workplace injury, WSIB may be the applicable coverage instead, with the claim billed directly. Review your extended health benefits or WSIB and auto coverage, or see our insurance page, to understand what applies to your situation before booking.

Is virtual prehab as private and secure as an in-person visit?

Virtual sessions are held over secure, encrypted video and follow the same privacy standards an in-person clinic would, in line with Ontario's Personal Health Information Protection Act (PHIPA). Your physiotherapist is a registered member of the College of Physiotherapists of Ontario, and virtual care is held to the same professional and regulatory standards as care delivered in person.

Getting started

If you have a knee or hip replacement on the calendar, starting a prehab program while you wait is one of the most useful things you can do with that time. Get started with a virtual physiotherapy assessment to build a plan suited to your surgery and your current mobility.