Post-surgery physiotherapy

Physiotherapy after hip-fracture surgery in older adults

For older adults and family caregivers planning recovery after hip fracture repair or replacement — including weight-bearing rules, falls and delirium risks, and when home physiotherapy may help.

Last reviewed: 25 July 2026 · Educational guide, not personal medical advice

Quick answer

A hip fracture is a break in the upper thigh bone, usually after a fall in later life. Surgery and guided physiotherapy aim to get the person upright and walking again as soon as it is safe — while protecting against another fall, medical complications, and unsafe weight-bearing.

Physiotherapy is a core part of recovery after hip-fracture surgery — not an optional add-on.
NICE recommends physiotherapy assessment and mobilisation on the day after surgery unless medically or surgically contraindicated.
Surgery is planned so many people can fully weight-bear soon after — but always confirm your written instructions.
Home physiotherapy can continue recovery when the person is medically stable and short-distance mobility is possible.
In older adults, falls, delirium, caregiver support, and home safety matter as much as the exercises themselves.

Understanding hip-fracture surgery

Knowing what was operated on — and what still needs protection — makes physiotherapy goals clearer for both the patient and the caregiver.

A hip fracture is a break in the upper thigh bone (femur), often after a fall when bone is weakened by osteoporosis (AAOS, NHS).
Surgery may fix the bone with screws, a nail or plate, or replace part or all of the hip joint — the exact operation depends on fracture type and health.
Pain, bruising, weakness, and fear of putting weight through the leg are common early on.
Prolonged bed rest raises risks of blood clots, chest infection, pressure sores, muscle loss, and confusion (AAOS).
Protect the healing bone or implant from another fall, ignored weight-bearing limits, and unsafe transfers.

What physiotherapy is intended to achieve

Goals should be functional and stage-specific — especially for older adults whose priorities are often toilet access, short walks, and staying at home safely.

Get out of bed and sit-to-stand safely with the agreed walking aid
Walk short distances using the correct weight-bearing status
Manage toilet, chair, and bed transfers with lower fall risk
Practise stairs only when strength, balance, and home layout allow
Rebuild leg strength, balance, and walking endurance for daily life
Reduce avoidable deconditioning from sitting or lying too long
Help caregivers assist without pulling on the operated side unsafely
Support clearer thinking and routines that lower delirium risk after illness and surgery

Typical rehabilitation phases

Timelines vary with fracture type, surgery, previous walking ability, other illnesses, delirium, wound healing, and home support. Use these stages as a map, not a guarantee.

1
Hospital — day of and day after surgery
NICE recommends a physiotherapy assessment and, unless medically or surgically contraindicated, mobilisation on the day after surgery, then mobilisation at least once a day with regular physiotherapy review. Early goals are sitting, standing, upright posture, and short walks with a frame or crutches as taught.
2
Hospital stay and discharge planning
NHS guidance notes many people stay around 1–4 weeks, depending on medical recovery and mobility. Teams plan bone-health follow-up, falls prevention, and whether home, early supported discharge, or a rehabilitation setting fits best. Caregivers should understand the walking-aid plan before leaving.
3
Early weeks at home
Priority is safe transfers, short frequent walks within the weight-bearing plan, a simple exercise programme, and reducing fall hazards. Fatigue, pain flares, and fear of falling are common. Progress is individual — not a race against a calendar.
4
Strength, balance and longer-term recovery
NHS notes recovery often takes several weeks or months, and some people do not regain the same strength or movement as before. Later work may focus on endurance, outdoor walking, stairs, and confidence. Progress depends on previous fitness, other illnesses, complications, and home support — not a promised week-by-week schedule.

What happens during a physiotherapy session

A useful home session is an assessment and safety check — not only a massage or a printed sheet.

1
Review the discharge summary, surgery type, wound advice, and exact weight-bearing status in writing
2
Ask about priorities — toilet transfers, stairs, night walking, fear of falling, or caregiver strain
3
Screen pain, wound concerns, calf symptoms, breathlessness, dizziness, confusion, and recent falls within physiotherapy scope
4
Assess bed and chair transfers, walking pattern, balance, and how the home layout affects safety
5
Practise mobility and exercises matched to this stage — not a generic sheet for every hip fracture
6
Check walking-aid height and technique; correct common errors such as leaning too far or ignoring weight limits
7
Teach a home programme the older adult can remember, and show caregivers how to assist without forcing the hip
8
Record measurable progress (for example walking distance, transfers, or aid use) and escalate concerns to the treating team

Practical preparation at home

Before the first home visit — or as soon as the person returns from hospital — small changes reduce fall risk and make practice safer for older adults.

Clear walking paths; remove loose rugs, clutter, and trailing wires
Improve lighting, especially for night toilet trips — night lights reduce fall risk
Keep a stable chair with armrests near where the person sits most of the day
Place frequently used items within easy reach to avoid stretching or twisting
Prepare bathroom support: dry floor, non-slip footwear, and help for the first days if needed
Have the prescribed walker, crutches, or stick ready and correctly fitted — do not improvise with unstable furniture
Keep discharge papers, medication list, and weight-bearing instructions where the physiotherapist can see them
Arrange a caregiver for early sessions if transfers still need close supervision or two-person help

Exercises and treatment techniques

The right dose depends on surgery type, weight-bearing status, pain control, cognition, and balance. These are examples of what a clinician may use — not a do-it-yourself prescription.

Ankle pumps and circulation exercises

Purpose: Encourage blood flow in the legs and reduce stiffness while resting in bed or a chair.
When it may be used: Often taught early in hospital if the team agrees; usually continued at home between walks.
Stop and get advice if: Stop and seek medical advice for new calf pain, one-sided swelling, chest pain, or sudden breathlessness.

Bed and chair transfers with a walking frame

Purpose: Rebuild the safest way to stand, sit, and turn while protecting the operated hip and reducing falls.
When it may be used: Started under supervision after surgery and repeated at home with caregiver support as needed.
Stop and get advice if: Pause if the person becomes dizzy, confused, or unable to follow the taught sequence safely.

Supported walking within weight-bearing rules

Purpose: Restore upright mobility and confidence while respecting how much load the surgeon allows on the operated leg.
When it may be used: NICE and AAOS emphasise early mobilisation when medically safe; distance increases gradually as strength and balance improve.
Stop and get advice if: Stop for chest pain, fainting, new severe hip pain after a stumble, or if the person cannot keep to the prescribed weight-bearing status.

Sit-to-stand and later balance or strength work

Purpose: Rebuild thigh and hip support muscles needed for toilets, chairs, and safer everyday walking.
When it may be used: Progressed only when transfers are stable and the treating physiotherapist clears the next step.
Stop and get advice if: Do not add resistance bands, stairs practice, or outdoor walking because a video suggested it. Confirm first.

Red flags — seek medical help

Stop physiotherapy and get urgent medical help for the following. Older adults after hip fracture are at higher risk of blood clots, infection, another fall, and delirium — these signs need prompt action, not “wait and see.”

Emergency care now

Sudden chest pain or difficulty breathing — seek emergency care immediately (possible blood clot in the lung)
Collapse, severe new breathlessness, or sudden marked confusion with rapid deterioration
Inability to move the leg after a new fall onto the operated side — treat as urgent medical assessment

Contact your surgeon, treating hospital team, or urgent medical care promptly

Throbbing or cramping calf pain, or new one-sided swelling, redness, or tenderness in the calf, ankle, or foot
Fever, feeling hot/cold/shivery, or wound oozing, pus, increasing redness, or increasing hip/thigh pain at rest
Wound opening, unexpected bleeding, or rapidly increasing swelling around the hip or thigh
New or worsening confusion, agitation, or unusual sleepiness — delirium needs prompt medical review in older adults
Repeated near-falls, new dizziness on standing, or inability to follow the weight-bearing plan safely at home
Sudden inability to move the foot or new major neurological change in the operated leg

A physiotherapist can help you notice warning signs, but they do not replace emergency or orthopaedic assessment when these symptoms appear.

When home physiotherapy may be useful

Home physiotherapy can be practical after hip-fracture surgery when the person is medically stable enough for community care — it is not always better than clinic or inpatient rehab.

Home visits can help when

Less exhausting travel while walking and stairs are still difficult
Assessment of the real bed, chair, bathroom, stairs, and night walking route
Practice adapted to the home layout and available caregiver help
Caregivers can watch sessions and learn safer assistance
Easier continuity when regular outpatient travel is not realistic yet

Prefer clinic or hospital when

Close medical monitoring is still needed
Delirium, unstable blood pressure, or other acute illness makes home sessions unsafe
Specialised equipment or multi-disciplinary inpatient rehab is required
More physical assistance is needed than the household can provide safely
Urgent investigation of infection, clot, wound failure, or another fall is needed
The person cannot yet transfer or mobilise short distances safely enough for home-based practice

Why qualifications and verification matter

Rehabilitation after hip fracture is more than massage or a shared exercise PDF. An unqualified or unverified provider may ignore weight-bearing rules, progress too quickly, miss infection or clot warning signs, overlook delirium, or fail to reduce fall risk in the real home.

Before you book, check that the physiotherapist has:

Recognised physiotherapy qualifications
Identity and professional details you can verify
Experience with hip-fracture or older-adult post-surgical rehabilitation
Willingness to review discharge papers and weight-bearing instructions before starting
A clear plan for falls prevention, delirium warning signs, and progress measures
Willingness to communicate concerns back to the surgeon or treating team when needed

Questions to ask a physiotherapist

Use these in your first call or visit — caregivers can screenshot this list.

Have you treated older adults after hip-fracture surgery before?
Will you review the discharge summary and exact weight-bearing status before the first session?
What should therapy aim to achieve at this stage — transfers, walking distance, stairs, or something else?
How will you measure improvement in a way that matters for daily life?
Which symptoms would make you stop a session and contact the surgeon or emergency care?
What should the caregiver help with, and what should they avoid?
How will you reduce fall risk in this specific home?
When would you recommend clinic, hospital, or inpatient rehabilitation instead of home visits?

Frequently asked questions

+When should physiotherapy begin after hip-fracture surgery?

NICE recommends a physiotherapy assessment and, unless medically or surgically contraindicated, mobilisation on the day after surgery, then mobilisation at least once a day with regular physiotherapy review. After discharge, continue the home programme and arrange supervised physiotherapy if transfers, walking, falls risk, or caregiver strain remain difficult.

+Can the person put full weight on the operated leg?

NICE advises operating with the aim that people can fully weight-bear without restriction in the immediate postoperative period. In practice, always follow the written instructions for your specific surgery. AAOS notes that after internal fixation the surgeon may set limitations; after many hip replacements, full weight-bearing is often allowed unless complications intervene. Never guess — check the discharge plan.

+How long might recovery take in older adults?

NHS guidance says a broken hip usually takes several weeks or months to heal and can take longer. Some people do not regain the same strength and movement as before and may need a walking aid longer term. Age, previous fitness, other illnesses, delirium, complications, and home support all affect the timeline.

+Why is delirium important after a hip fracture?

Older adults after hip fracture are at higher risk of delirium — a sudden change in attention, alertness, or thinking. NICE recommends looking for cognitive impairment early and reassessing for delirium during admission, with care that minimises delirium risk. At home, new confusion, agitation, or unusual sleepiness needs prompt medical review; do not assume it is “just age” or push exercise through unsafe confusion.

+Can rehabilitation continue entirely at home?

Many people continue exercises and supervised physiotherapy at home after discharge. NICE also describes early supported discharge when the person is medically stable, can participate in rehab, can transfer and mobilise short distances, and has not yet reached their full rehabilitation potential — with the multidisciplinary team still involved. Some people need a rehabilitation facility first, especially if there is little caregiver support (AAOS).

+How often might home physiotherapy sessions be needed?

There is no single correct frequency. Some households manage with a clear home programme and periodic review; others need more frequent supervised sessions because of falls risk, weakness, stairs, cognitive changes, or limited caregiver support. The plan should match goals and safety — not a fixed commercial package.

+Will physiotherapy be painful?

Some discomfort with standing and walking after hip-fracture surgery is common. That is different from sharp new pain after a stumble, wound-related pain, chest pain, or calf pain. A careful physiotherapist grades effort, respects weight-bearing rules, and does not ask anyone to push through warning-level symptoms.

+When might home physiotherapy not be appropriate?

Home care is a poor fit if the person is medically unstable, newly confused and unsafe, needs urgent investigation, requires more hands-on help than the household can provide, or cannot yet transfer and mobilise short distances safely. In those situations, hospital, clinic, or inpatient rehabilitation is more appropriate.

References

Disclaimer

This page is for general education for patients and caregivers in India. It is not a personal diagnosis, treatment plan, or substitute for advice from your orthopaedic surgeon, hospital team, or treating physiotherapist. Always follow your own discharge instructions and weight-bearing rules. If symptoms suggest infection, blood clot, wound failure, delirium, another fall, or sudden deterioration, seek medical care urgently. Super Physio helps you find physiotherapists who offer home visits; it does not provide medical treatment through this article.

Last reviewed: 25 July 2026. Not labelled “medically reviewed” because no named clinician has signed off this page yet.