Jennifer Noll NASM Master Trainer Prehab Training

The Importance of Pre-hab and Why You Should Be Doing It with Your Clients

What is “prehabilitation” and why should you be doing it? Pre-hab is a relatively new concept, but is gaining momentum. Prehabilitation prepares the body for upcoming surgery or injury prevention. Just like going to the dentist every six months or getting a physical from your MD, Pre-hab is preventative maintenance for your muscles. The better prepared your body is for an upcoming workout or surgery, the better it will respond afterward.

Whether you client is an injured athlete, a recreational exercise enthusiast, or an older client waiting to have a knee or hip replaced or has been diagnosed with cancer, pre-hab can help speed up recovery after surgery and also with the stress surgery puts on the body during and after. Studies have shown that people respond better to surgery if they have participated in some type of prehabilitation 6 to 8 weeks prior to the procedure. Pre-hab is designed to increase strength, stamina, functional movements, range of motion and decrease recovery time and pain. The stronger a person is before surgery, the stronger they will be after. This applies to clients in general as well, even if they do not have surgery on the horizon.

Program Design

Designing an individualized training protocol for clients is key when it comes to pre-hab. Not all injuries are the same and each person’s body will respond differently to an injury. Taking this into account will ensure you, as the trainer, will not injure the client. I trained a client a few months ago, who was a swimmer, and she came to me because she had a small tear in her supraspinatus. The orthopedic doctor informed her she would need surgery and they scheduled it 3 months out. Her main objective was to possibly avoid surgery, but ultimately get back to swimming and competing in triathlons. Her training protocol I created consisted of using her body weight for resistance, and then progressed to using TRX and gradually she began to increase her range of motion in her shoulder without causing pain.

We worked together for 2 months, and when she went back to the doctor for a follow-up, and not only did she have full range of motion back, but she also had built up enough strength so the doctor cancelled her surgery. She was back in the pool the next day and able to swim all strokes. Not only did pre-hab make this client stronger, but also it allowed her body the time it needed to heal.

Pre-hab for clients with cancer

Everyone is pretty familiar with rehabilitation after surgeries, but pre-hab before chemotherapy, radiation, or surgery can prepare the body for those treatments. While more studies need to be done when it comes to pre-hab, especially so insurance will cover it, there are positive benefits to recommending it to clients. Benefits for clients with cancer overall include less fatigue, and for specific types of cancer: greater range of motion for neck cancer patients, less swelling and greater range of motion in breast cancer patients prepping for mastectomy surgery, as well as fewer complications after colon cancer.

Pre-hab before knee and hip replacement

Total knee and hip replacements are two of the top elective surgeries orthopedic doctors deal with today. The number of projected surgeries for both of these areas will also continue to climb over the next decade, so the fitness industry needs to be aware of how to help clients before and after these surgeries. Helping clients lose weight before surgery can reduce the adverse affects after, such as joint infection, muscle atrophy, and loss of range of motion. Building and strengthening the hip and leg musculature will help with mobility before and after surgery too.

If too much atrophy occurs after surgery, recovery can be painful and longer than expected. This could also lead to longer physical therapy visits, and more of them. Pre-hab can decrease recovery time in the PT office, which is good news for the wallet and your business, because clients will be paying less in the long run. People tend to have better functionality of his or her joint and are more satisfied if they participated in a pre-hab program.

Exercises I have found that positively effect clients getting ready for knee replacement surgery have been: step ups, step downs, raising from a chair, seated VMO leg raises, and tube walking. Clients also did well doing squats with TRX, but be careful with this one as some clients will want to squat lower than they should or can, which can cause them more pain while in the pre-hab phase.

Looking at the bigger picture, successful participation in pre-, peri-, and post-operative protocols after a surgery or injury will collectively have better outcomes then just using one alone. Modifying or reducing risk factors will also help your clients achieve better results as well, such as weight, glycemic control, and smoking.

Want to incorporate pre-hab routines into client training? Try one of these sample workouts:

Sample Workout: Upper Body Circuit/2 sets/12 reps

TRX Windmills

TRX Alligators

TRX Bicep Curls

TRX Tricep Extensions

TRX Push ups

TRX Standing row



Sample workout: Lower Body Circuit/2 sets/12 reps

Cat-Cow Yoga exercise


Tube walking/side steps

BOSU standing with med ball toss

Step ups, 3-4 risers high

Step downs, 2-3 risers high (within client comfort)

TRX squats (no lower than 90 degree bend at knee) or regress to rising from a chair

TRX Alligator

TRX Curtsy or regress to seated VMO leg raises

The author’s opinions are their his own and neither ELIVATE nor NASM takes responsibility for content, statements and opinions. You should seek expert counsel in evaluating opinions, treatments, products and services. For more info see our Editorial Policies.  

Recommended Products from ELIVATE