Pre-hab: What Exercises Should I Do Before ACL Surgery to Improve Recovery?

Medicine Made Simple Summary

Before ACL reconstruction, doctors often recommend a phase of “pre-habilitation” or “pre-hab.” This is a structured set of exercises designed to prepare your knee for surgery. By reducing swelling, regaining motion, and strengthening muscles, pre-hab makes the operation easier and speeds up recovery afterward. In this article, we explain why pre-hab matters, what goals it achieves, and which exercises are most commonly recommended by specialists and physiotherapists. The exercises are simple, safe, and can be done at home with little to no equipment.

Why Pre-hab Matters Before ACL Surgery

Many patients think surgery alone fixes the problem. In reality, the condition of the knee at the time of surgery plays a big role in how well recovery goes. A stiff, swollen, or weak knee before surgery often leads to slower progress afterward. That is why most surgeons encourage at least four to six weeks of pre-hab.

The main goals of pre-hab are to reduce swelling, restore full range of motion, strengthen the quadriceps and hamstrings, and improve balance. Achieving these goals allows the surgeon to operate on a healthier knee and gives patients a head start on rehabilitation.

Goals of Pre-hab

The first goal is to reduce swelling and inflammation. A swollen knee is harder to operate on and more likely to stiffen afterward. The second goal is to restore range of motion. Being able to straighten and bend the knee fully before surgery makes it easier to do so afterward. The third goal is to strengthen muscles, especially the quadriceps and hamstrings. Finally, pre-hab helps improve balance and control, teaching the body to stabilize the knee even when the ligament is torn.

The Role of Physiotherapy in Pre-hab

Pre-hab is not just a list of exercises—it is usually guided by a physiotherapist who personalizes the plan. The physiotherapist monitors progress, ensures correct form, and adjusts exercises based on pain and swelling. While many exercises can be done at home, supervised sessions provide reassurance and motivation.

Core Pre-hab Exercises Before ACL Surgery

Quadriceps activation is essential. After an ACL injury, swelling often shuts down these muscles. Quad sets—tightening the thigh muscle while the leg is straight—help reactivate them. Straight leg raises build strength without stressing the knee.

Hamstring strengthening provides additional support. Hamstring curls, done lying or standing with or without resistance bands, prepare the muscle for its role after surgery.

Range of motion must be restored. Heel slides gently increase flexion, while resting the heel on a towel roll allows full extension.

Hip and core training exercises such as bridges, clamshells, and planks add stability to the leg. Balance and control work, like standing on one leg or on an unstable cushion, teaches the body to compensate for instability.

How Long Should Pre-hab Last?

The duration of pre-hab depends on the patient’s condition. Some need only two to three weeks to reduce swelling and restore motion. Others may require six to eight weeks, especially if the injury was severe. The most important marker is not time but progress. Surgeons generally prefer to operate once the knee is quiet—meaning it is no longer swollen, can bend and straighten fully, and the muscles are functioning again.

Evidence Supporting Pre-hab

Studies have shown that patients who complete pre-hab recover faster after ACL reconstruction. They achieve milestones such as walking without crutches, regaining motion, and returning to sports earlier. Pre-hab has also been linked to lower rates of stiffness and stronger quadriceps strength months after surgery.

Patient Stories: The Difference Pre-hab Makes

Consider two patients with similar injuries. The first enters surgery with a stiff, swollen knee and weak quadriceps. Recovery is slow, with difficulty straightening the knee afterward. The second spends six weeks on pre-hab, regains motion, and builds strength. After surgery, this patient walks with confidence within weeks and returns to activities months earlier.

Common Misconceptions About Pre-hab

Some patients believe pre-hab delays necessary surgery. In truth, surgeons rarely recommend operating on a swollen, stiff knee because outcomes are poorer. Another misconception is that rest alone prepares the knee. While rest reduces pain, it does not restore motion or build strength. Structured pre-hab is essential.

What to Avoid Before Surgery

Not all exercises are safe before ACL reconstruction. High-impact movements like running, jumping, or cutting can worsen instability and risk further injury. Deep squats or heavy leg presses may also strain the knee unnecessarily. Patients should stick to low-impact, controlled movements recommended by their physiotherapist.

Preparing the Mind Alongside the Body

Pre-hab is not just physical—it is also mental preparation. Surgery and rehabilitation can feel overwhelming. Patients who actively participate in pre-hab gain confidence, learn how their body responds to exercise, and enter surgery with a positive mindset. This mental readiness often makes rehabilitation smoother.

Life Beyond Pre-hab: Transitioning Into Post-Surgery Rehab

The exercises learned during pre-hab are often continued after surgery, with gradual progression. Patients already familiar with quad sets, straight leg raises, and heel slides find it easier to resume them in the early weeks of rehabilitation. In many ways, pre-hab is the first stage of recovery, simply started before surgery.

Conclusion

Pre-hab before ACL surgery is one of the smartest steps you can take to improve recovery. By reducing swelling, restoring motion, strengthening muscles, and improving balance, pre-hab prepares your knee and your mind for the journey ahead.

If you are scheduled for ACL reconstruction, ask your doctor or physiotherapist about starting pre-hab. Even a few weeks of targeted exercises can make a big difference in your long-term outcome.

_{References and Sources:  
American Academy of Orthopaedic Surgeons. ACL Injury 
Mayo Clinic. ACL Injury Treatment 
Cleveland Clinic. ACL Reconstruction and Pre-hab}  

_{*Information contained in this article is not intended or designed to be a substitute for professional medical advice, diagnosis, or treatment. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other professional health care provider with any questions you may have regarding a medical condition or advice in relation thereto.}