If you’ve ever gotten injured and had to either get surgery or go to physical therapy, you’re familiar with the concept of rehab. Sometimes there’s just no other choice after you hurt yourself.
But what if you could get out ahead of exercise injuries and work proactively to help keep them from even happening? Enter prehab—that’s pre-rehab, get it?
Traditionally, prehab has been done to prepare a joint or certain area of the body for surgery, says Cameron Yuen, D.P.T., C.S.C.S., of Bespoke Treatments Physical Therapy in New York City. “With surgeries like a hip or knee replacement or ACL surgery, you’re going to have to do certain strength exercises and range-of-motion exercises to get you strong enough before surgery so you have a better outcome,” Yuen explains. In fact, a 2014 review and meta-analysis of 21 previously published studies concluded the prehab was effective at improving post-surgical pain, reducing length of hospital stay, and improving physical function.
But prehab has evolved from a pre-surgical staple to something regular exercisers are adding to their fitness routine too. Here’s everything you need to know about this preventive technique.
What the heck is prehab—and how can it work for you?
In the fitness realm, prehab means simply working on any small issues to prevent them from becoming bigger, Arash Maghsoodi, D.P.T., C.S.C.S., co-owner of the Prehab Guys, tells SELF.
It’s more nuanced than simply warming up before a workout: “[It’s] prepping the body for the activities and stresses of daily life and making sure it is prepared for any sport or activity you want to do,” he says. This includes things like stretches that help improve range of motion, mini-band exercises that prep muscles for more challenging work, and exercises that help you build strength and stability in specific areas.
“Most people deal with little aches and pains—that’s just normal—but another aspect of prehab is making sure those get taken care of before becoming real issues,” says Maghsoodi.
In fact, everyone should be doing prehab, says Maghsoodi. Even if you don’t exercise a ton, if you just want to move about daily life without pain, it’s worth preparing your body in the right ways to make sure it can handle any external demand you put on it, he says.
Prehab, if done properly, can help enforce good movement patterns and reduce your chances of ending up with an injury due to things like poor form. But there’s no blanket prescription on how to do it: What prehab looks like will depend on each person, what you do when you work out, and what kind of injuries are more common in those movement patterns, Yuen says.
For example, if you run, you’ll likely be at greater risk of running-related ailments like patellofemoral pain (runner’s knee) and IT band pain, says Yuen. If your sport involves lots of shoulder movement—like tennis—you’ll want to do what you can to bolster and protect your rotator cuff. If you do a lot of HIIT workouts or circuit training, you’ll want to think about the muscle groups you use often and note any particularly challenging spots where your body could use some bolstering.
Of course, you can never fully prevent injury, Yuen says, but you can prepare your body to better handle your moves and any weight you add, so that it is less likely to happen.
The three components of prehab help protect your body.
Depending on your body’s particular needs, your prehab routine may address one or more of the following components: mobility and stability, muscle activation, and strength and conditioning.
Take mobility: We need a balance of mobility and stability for our joints to move safely and efficiently, says Maghsoodi. Having too much of one or the other can lead to potentially harmful movement patterns that can increase your chances of injury. For example, the shoulder is one of the most mobile joints in the body, but many people lack shoulder stability, which can cause the joint to turn and rotate too much. As a result, it can tear or pull out of the socket during certain activities like heavy overhead lifting or any swinging or throwing movement. Exercises that work on both mobility and stability upfront can help fend off that type of injury.
Muscle activation, or priming, just means getting a specific muscle or muscle group warmed up—by using your body weight or light resistance tools like bands—before adding a more challenging load. Activation helps by warming up the tissues, getting the joint used to moving through its full range of motion, and activating the mind-muscle connection so that you feel and understand the right joint positioning, says Yuen. This work can be done in your warm-up or as an active rest between heavier exercises, he adds.
And finally, strength-based exercises can help reduce your risk of injury by building strength in specific areas, which allows you to complete activities that are more demanding to those muscles. They’re often isolation exercises, as opposed to compound movements, which work multiple muscle groups, says Maghsoodi. Say, for instance, you sprint, or incorporate short bursts of high-speed running into your cardio workouts: Your strength-based prehab may include weighted hamstring curls, which will keep those muscles in the back of your leg strong and ready for the explosive force of a sprint.
How to incorporate prehab into your routine
How often you prehab is going to depend on what sort of exercises you’re doing, says Maghsoodi. “You can’t give one-size-fits-all [recommendation],” he says. Generally, some kind of prehab every day is best, but it depends on what your problem is and what component of prehab you’re using.
For example, he says, if someone has an issue with mobility, he may recommend they do related exercises three to five times a day (which seems like a lot, but these moves—hip circles, glute bridges, cat/cow, bodyweight lunges—are quick, and you can do them in the middle of other everyday activities). If you’re working on strength, he’d suggest doing the work every other day or so to give your muscles time to recover.
Muscle activation work can typically be done before every workout as part of your dynamic warm-up, Yuen says.
While the exact prehab exercises you do will depend on what workouts and sports you’re preparing your body for, there are a few general areas people can benefit from prehabbing. (And like all things related to your body and injury prevention, working with a professional is the best way to learn what you need and how to do it right.)
“The outer hips—the gluteus medius and minimus, and hip rotators—tend to get overlooked unless you do a ton of single-leg training,” says Yuen. That can cause hip strength and mobility limitations and lead to overuse injuries when you do put a lot of stress on those areas.
Strength or mobility issues in your hips can also affect your knees and feet (remember, it’s all connected!), so Yuen stresses that if you have any kind of issues there, prehab work on your hips may help.
That’s why Yuen encourages lateral hip strength exercises, activation work with bands, or strength moves on one leg, which help you focus on one hip at a time and improve stability and balance too.
“Another big one to focus on is core stability, which is being able to prevent your back from rounding, extending, and rotating,” says Yuen. If you lack core stability, you may find your back going into these improper positions during everything from squats and deadlifts to core-specific moves like planks.
As your core prehab, you’d do activation and strength exercises where you’re going against a force that’s trying to flex or rotate the spine. This will help your core muscles fire to stabilize you.
Most people in modern society spend the majority of the day sitting, whether that’s at a desk or in a car. Because of this, your spine tends to round and your chest tightens, Yuen says. This can make it difficult to do upper-body exercises properly and limits your range of motion.
Mobility exercises and stretches that open up your upper back and loosen up your pecs are great to combat this.
Your shoulders include your rotator cuff, a group of four small muscles that keep your joint in place, and your scapula (shoulder blades), which is part of your upper back.
“If you don’t have a mobile upper back, the shoulders can’t move as well,” says Yuen. As a result, you may have a tough time doing certain exercises with a full ROM [range of motion], and may end up straining your shoulders.
It’s important to do exercises that allow you to pull your shoulder blades back (called retraction), push them forward, and get them rotating up (like you would for an overhead press). Exercises that build and maintain stability in your rotator cuff are important too, since they help keep the very mobile joint healthy.
It’s important to note that while prehab is an important way to help ward off injuries, nothing can fully prevent them from occurring. So if you still feel mobility issues, tightness, or pain or discomfort even after incorporating prehab, it may be time to loop in a doc or physical therapist to see if you do have an injury.