Pre-hab | Building Strength Before Surgery

What is Pre-hab

Pre-habilitation involves preparatory exercises and stretches done before surgery. Pre-hab before knee surgery is now recommended for most knee replacement patients.

Why is it Important?

Pre-hab before knee surgery (in particular knee replacement) is particularly important because the average knee replacement patient has been losing strength for more than seven years resulting in leg muscle atrophy.

Knee Surgery Prehab (Pre-hab prior to surgery)

A lot of research has been completed about strength work before knee surgery, and more is upcoming. To read an in-depth comparison of traditional pre-hab as compared to pre-hab before knee surgery on the X10, written by Professor Carl Freeman, click here: Knee Pre-hab Enhances Outcomes of Knee Surgery

2020 Research Study (Knee Prehabilitation on X10)


Study Abstract

The efficacy of prehabilitation, for knee surgery, is controversial. Meta analyses show that range of motion is improved, but not quadriceps or hamstring strength. Here, we evaluate prehabilitation using the newly patented, computerized, in-home, X10 knee recovery system for both prehabilitation and rehabilitation. We retrospectively examined 201 patients at multiple time points for range of motion (extension, flexion), quadriceps, hamstring, and calf strength between the intervention group (n=125) which used the X10 for both prehabilitation (2-3 weeks) and rehabilitation (3-4 weeks)and the control group (n=76) which used the X10 for only rehabilitation (3-4 weeks). Range of motion was measured by the X10 machine using an ultrasensitive inclinometer and strength was measured as pressure applied to a load cell. We also compared X10 prehabilitation and rehabilitation to standard physical therapy using a literature study (Calatayud et al. 2017).


Prior to surgery, prehabilitation significantly improved extension, 8.0°(5.8°) mean (standard deviation), flexion 12.1°(12.3°), range of motion 16.0° (16.7°); quadriceps strength 5.8 (5.4) kg, hamstring strength 2.5 (2.3) kg, and calf strength 11.2 (9.3) kg. Post-surgically, X10 prehabilitation increased flexion 120.7° (10.7°) vs 113.8° (13.0°), range of motion, 120.4°(11.6°) vs 112.9° (11.7°). X10 prehabilitation improved quadriceps strength 5.5%, while the non-prehabilitation group lost 17.1%. Calf strength improved in the prehabilitation group by 30.5%, but only 0.2% in the control group. Hamstring strength was unchanged. Compared to standard physical therapy, X10 prehabilitation and rehabilitation were superior.

Click Here to Read the Full Study

Pre-Hab before knee surgery with the X10 is not painful:

Traditional Pre-hab before knee surgery programs using standard exercise equipment are painful to use. The beauty of the X10 is that it was specifically designed for damaged knees—it does not hurt to use it, even intensively. In fact, our patients achieve more in three weeks than what standard intensive programs do in eight weeks, and our results show more than 90% compliance vs. 12-42% compliance with standard exercise equipment.

X10 Therapy featuring The X10 Knee Recovery System™

How does Pre-hab before knee surgery work?

The painful swelling in damaged knees results from fluid which inhibits brain/muscle communication and promotes scar tissue. By strengthening your muscles before surgery, you have stronger leg muscles to pump this fluid out of the knee and eliminate it from the body thereby restoring communication between your muscles and your brain. This by itself increases your strength. Being stronger going into surgery leads to you being stronger coming out of surgery and enables you to immediately do more things, which sets you up for a better recovery.

What are the benefits?

Increased Strength and Faster Recovery:

On average X10 patients increase their quadriceps leg strength by 20% in three weeks. Our comprehensive Pre-hab program helps patients strengthen all the major muscles of both legs prior to surgery. The normal knee replacement patient has a 30% strength deficit, on average, at one year. This deficit may persist for 10 years or longer. X10 Pre-patients are often back to their full pre-operative strength or better within 30 days.

Pre-hab is well worth your investment of time and the best thing is, that X10 Pre-hab is done in your own home. What could be more convenient?

The X10 is available through your insurance (in some cases) and as a short-term-rental. Most patients to not need the X10 for more than 17 days. Our clinical team is ready to help you at any time with your knee surgery recovery. You can reach us with a phone call at 1-855-910-5633 or an email at To schedule a 15 minute call with us click on the Want to Learn More? image on this page.