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The Myth of Waiting:
Why Rehab Should Start Before Surgery for ACL & Achilles Injuries
If you’ve suffered a major sports injury like an ACL tear or Achilles rupture, chances are surgery is on the horizon. And while most athletes and active individuals assume they should wait until after surgery to begin physical therapy, the truth is that early rehabilitation- often called “prehab”- can set you up for a much smoother recovery and better long-term outcomes.
Why Wait? The Harmful Myth of Delaying Rehab
Many people believe that physical therapy should only begin after the surgeon has done their work. Some worry that working on an injury site before it is repaired will make it worse, or that they are incapable of performing exercises due to pan and instability.
The idea is that rehab will be more effective once the surgical repair is complete. However, waiting too long to start rehabilitation can actually slow down recovery, increase stiffness, and lead to muscle atrophy- making it harder to regain strength and function post-surgery.
The Benefits of Pre-Surgery Rehab
Starting physical therapy before surgery isn’t just an option-it’s often a game-changer. Here’s why:
1. Reduces Swelling and Pain
Post-injury inflammation can limit mobility and delay the healing process. Structured movement, manual therapy, and controlled exercises can help reduce swelling and pain, making surgery and recovery more manageable.
2. Maintains Strength and Mobility
When you stop using an injured limb, muscles quickly weaken. By engaging in targeted strength and mobility work before surgery, you’ll prevent excessive muscle loss and keep your body in a better state for post-op rehab.
Blood Flow Restriction Therapy is a great way to maintain strength without adding excessive load to the site of injury. Research shows that building up strength prior to surgery leads to improved healing time and decreases post-surgical muscle atrophy (loss of muscle mass).
3. Improves Post-Surgical Outcomes
Studies have shown that patients who engage in prehab recover faster and regain function more effectively than those who don’t. A stronger, more mobile joint going into surgery means an easier return to sport and daily activities after.
4. Enhances Mental Preparedness
Going into surgery with a plan- and knowing you’re already making progress- can significantly boost confidence and mental resilience. Rehab is just as much a mental battle as it is physical and early wins help keep motivation high.
What Pre-Surgery Rehab Looks Like
While every injury and athlete is different, prehab often includes:
– Range of motion exercises to prevent stiffness
– Strength training to maintain muscle around the injury
– Neuromuscular training to improve movement patterns
– Swelling and pain management through manual therapy and modalities
– Maintaining cardiovascular endurance with appropriate circuit training or stead state cardio (depending on sport specific demands for every athlete)
Bottom Line: Don’t Wait to Start Rehab
If you are dealing with a major injury like an ACL or Achilles tear, the best time to start physical therapy is now. The stronger, more mobile, and more prepared you are going into surgery, the faster and more effective your recovery will be.
At UNITE.rehab.perform, we specialize in guiding athletes through every phase of recovery from prehab to return-to-sport training. If you’ve recently suffered an injury and want to optimize your recovery, reach out today and take control of your comeback.
Dr. Victoria Riester PT, DPT