Can Patients Be “Trained” for Spine Surgery? The Rise of Prehabilitation

Athletes train before competition. Should patients train before spine surgery?

Much of the spine surgery pathway focuses on what happens after the procedure mobilization, rehabilitation, pain management, and return to activity. But growing interest in prehabilitation is shifting part of that focus to the weeks before surgery.

The question is no longer only how patients recover after an operation, but whether they can be better prepared for it.

What Is Prehabilitation?

Prehabilitation, or “prehab,” refers to interventions undertaken before surgery to improve a patient’s readiness for the physical and psychological demands of surgery and recovery (1) 

While rehabilitation focuses on postoperative recovery, prehabilitation extends the recovery pathway upstream, using the preoperative period to address potentially modifiable factors that may influence surgical readiness.

Prehabilitation → Surgery → Rehabilitation

Prepare → Operate → Recover

In spine surgery, this extends well beyond exercise. Spine-specific prehabilitation interventions described in the literature have included education, exercise, cognitive behavioral therapy, pain neuroscience education, health-behavior counseling, and mindfulness (2) .

What Does Spine Prehabilitation Involve?

A 2026 international consensus published in The Spine Journal identified five major areas for spine surgery prehabilitation (3) : education, psychological preparation, physical preparation, multidisciplinary preparation, and lifestyle factors.

1. Education and expectation setting

Preparing patients for the surgical and postoperative pathway, including recovery expectations and their role in the recovery process (4). 

2. Physical preparation

Encouraging patients to remain active and incorporating appropriate physical conditioning based on individual needs and capabilities (5). 

3. Psychological preparation

Addressing factors such as goal setting, coping, anxiety, fear of movement, and psychological readiness for surgery and recovery.

4. Lifestyle optimization

Addressing modifiable lifestyle factors, including nutrition and other health behaviors that may affect surgical readiness.

5. Multidisciplinary preparation

Identifying patient-specific concerns, including frailty, and coordinating additional support when appropriate.

Notably, education was ranked as the most important overall theme, with postoperative expectations receiving the highest priority within that domain. This reinforces that surgical readiness extends beyond physical conditioning to include informed expectations, psychological preparedness, and active engagement in postoperative recovery.

The Preoperative Window: An Opportunity to Optimize Readiness

The interval between the decision for surgery and the procedure itself may provide an opportunity to identify and address factors relevant to the individual patient.

For one patient, the priority may be maintaining physical activity. For another, it may be nutrition, psychological readiness, expectation setting, or management of frailty and other individual risk factors.

This expands the preoperative conversation from asking only:

“Is this patient medically ready for surgery?”

to also asking:

“How can this patient be better prepared for surgery and recovery?”

Importantly, prehabilitation is not a single standardized program. Current spine-specific consensus supports a stratified, multimodal approach, with interventions tailored to the factors most relevant to the individual patient.

Recovery May Begin Before Surgery

Traditionally, much of the recovery pathway has focused on:

• Surgery → Rehabilitation
  

Prehabilitation introduces a broader continuum:

• Preparation → Surgery → Rehabilitation
  

The goal is not to prescribe the same preoperative program for every patient. Rather, it is to recognize the preoperative period as another opportunity to address the physical, educational, psychological, lifestyle, and patient-specific factors that may shape readiness for surgery and recovery.

If recovery matters after spine surgery, perhaps preparing for that recovery should begin before the first incision.

Reference: 

1. de Oliveira LA, Anthony Vitale J, Singh Sachdeva J, Rudrapatna S, Ivosevic S, Nuradin Ismail N, et al. Effects of prehabilitation on outcomes following elective lumbar spine surgery: A systematic review and meta-analysis. Br J Pain. 2025;19(4):257–73. 

2. Eubanks JE, Carlesso C, Sundaram M, Bejarano G, Smeets R, Skolasky R, et al. Prehabilitation for spine surgery: A scoping review. PM R. 2023;15(10):1335–50. 

3. Janssen ERC, Eubanks JE, Schneider MJ, Smeets R, Skolasky RL, Participants NGT. International consensus on the content of prehabilitation in spine surgery: results of a nominal group technique. Spine J. 2026;26(1):9–17. 

4. Burgess LC, Arundel J, Wainwright TW. The Effect of Preoperative Education on Psychological, Clinical and Economic Outcomes in Elective Spinal Surgery: A Systematic Review. Healthcare (Basel). 2019;7(1). 

5. Marchand AA, Houle M, O'Shaughnessy J, Chatillon CE, Cantin V, Descarreaux M. Effectiveness of an exercise-based prehabilitation program for patients awaiting surgery for lumbar spinal stenosis: a randomized clinical trial. Sci Rep. 2021;11(1):11080.