Orthopaedic Rehabilitation

Support for recovery after injury, surgery and joint problems

Orthopaedic rehabilitation helps people recover movement, strength and physical function following an injury, operation or condition affecting the bones, joints, muscles, tendons or ligaments.

You may need rehabilitation after a fracture, joint replacement, ligament repair or other orthopaedic procedure. It can also help when pain, stiffness or weakness has made normal movement difficult over a longer period.

Treatment is based on your stage of recovery, medical guidance and the activities you need to return to.

What is orthopaedic rehabilitation?

Orthopaedic rehabilitation is a structured programme designed to help restore physical function after an injury or procedure involving the musculoskeletal system.

Depending on the condition, rehabilitation may focus on:

• Restoring joint movement
• Rebuilding muscle strength
• Improving walking
• Managing stiffness
• Improving balance
• Regaining confidence in an injured area
• Returning to work
• Returning to exercise or sport
• Becoming more independent with everyday activities

The programme changes as healing progresses. Exercises that are appropriate in the early stages may be very different from those used later in recovery.

When orthopaedic rehabilitation may help

Rehabilitation may be appropriate following:

• Hip replacement
• Knee replacement
• Shoulder replacement
• Fractures
• Ligament injuries or surgery
• Tendon repair
• Shoulder surgery
• Knee surgery
• Hip surgery
• Foot or ankle surgery
• Hand or wrist surgery
• Spinal or back surgery where physiotherapy has been recommended
• A period in a cast, brace or sling
• Significant muscle or joint injury
• A long period of reduced mobility

It may also be useful when an injury has technically healed but movement, strength or confidence has not returned to its previous level.

What happens during your first appointment?

Your first appointment begins with a discussion about your injury, operation and current stage of recovery.

The physiotherapist may ask about:

• The original injury or condition
• The type and date of surgery
• Any instructions from your surgeon
• Current pain or swelling
• Areas of stiffness
• Walking and mobility
• Current use of crutches, braces or other supports
• Activities you are currently able to manage
• Work and exercise
• Previous rehabilitation
• Other medical conditions
• What you would like to return to doing

The physical assessment may include:

• Joint movement
• Muscle strength
• Walking
• Balance
• Swelling
• Functional movements
• Getting up from a chair
• Using stairs
• Movements specific to your work or activity

The assessment helps establish what is appropriate at your current stage of healing.

What rehabilitation may include

Treatment will depend on the injury or operation and any restrictions provided by your medical team.

Movement exercises

After surgery, injury or immobilisation, a joint may become stiff and difficult to move.

Exercises may be used to gradually restore movement while respecting any restrictions that remain during healing.

Strengthening

Muscles can lose strength quickly following injury, surgery or reduced activity.

Strengthening may begin with simple exercises before progressing towards greater resistance and more demanding movements.

The goal is to rebuild the strength needed for normal daily activities rather than strengthening a muscle in isolation.

Walking rehabilitation

If an injury or operation affects the hip, knee, ankle or foot, walking may initially change.

Rehabilitation may include:

• Weight-bearing practice
• Walking with crutches or a frame
• Improving step pattern
• Gradually reducing reliance on walking aids
• Increasing walking distance
• Practising uneven surfaces
• Returning towards normal walking

Progress depends on the procedure and any weight-bearing restrictions provided by your surgical team.

Balance and control

After an injury or operation, you may feel less confident putting weight through the affected area.

Balance exercises can help improve control during standing, walking, stepping and other everyday movements.

Home exercise programme

You may receive exercises to complete between appointments.

The programme can be updated as your movement and strength improve so that rehabilitation continues to progress outside the clinic.

Rehabilitation after joint replacement

Hip, knee and shoulder replacements often require a period of rehabilitation to restore useful movement and function.

Early rehabilitation may focus on:

• Getting up and moving safely
• Walking
• Managing stairs
• Restoring joint movement
• Reducing stiffness
• Rebuilding muscle strength
• Using mobility aids correctly

As recovery progresses, treatment can move towards longer walks, stronger exercises and a return to normal daily activities.

The exact programme will depend on the joint replaced, your medical guidance and how your recovery progresses.

Rehabilitation after knee surgery

Knee surgery can temporarily affect movement, strength, walking and confidence in the leg.

Depending on the procedure, rehabilitation may include:

• Restoring knee bending and straightening
• Reducing stiffness
• Rebuilding thigh and leg strength
• Walking practice
• Balance exercises
• Step and stair exercises
• Returning to squatting and bending
• Returning gradually to exercise

Later rehabilitation may include more demanding movements if your goal is to return to running, gym training or sport.

The pace of progression depends on the procedure and healing requirements.

Rehabilitation after hip surgery

Following hip surgery, normal activities such as walking, getting out of a chair and using stairs may initially require more effort.

Physiotherapy may focus on:

• Restoring movement where appropriate
• Hip and leg strengthening
• Walking
• Balance
• Sit-to-stand practice
• Stair use
• Gradually increasing walking distance
• Returning to everyday activity

Some operations have specific precautions during the early recovery period, so exercises and activities need to follow the guidance provided by the surgical team.

Rehabilitation after shoulder surgery

Shoulder surgery may temporarily limit the amount of movement and load that can be placed through the arm.

Early rehabilitation may involve protecting the operated area while gradually restoring movement within the permitted range.

Treatment can then progress towards:

• Increasing shoulder movement
• Rebuilding strength
• Improving shoulder control
• Reaching overhead
• Lifting and carrying
• Returning to work
• Returning to gym or sport

Different shoulder procedures have very different recovery requirements, so rehabilitation needs to follow the specific operation rather than a general shoulder exercise programme.

Rehabilitation after fractures

A fracture may require a cast, brace or surgery while the bone heals.

Even after healing has progressed, the affected area may remain:

• Stiff
• Weak
• Swollen
• Sensitive
• Difficult to use normally

A period of immobilisation can also affect the surrounding muscles and joints.

Once movement and loading are considered appropriate, rehabilitation may focus on:

• Restoring joint movement
• Rebuilding strength
• Improving balance
• Returning to normal walking
• Improving grip or upper-limb function where relevant
• Gradually increasing weight-bearing
• Returning to work and exercise

The programme depends on the location and severity of the fracture and how it has been treated.

Rehabilitation after ligament injuries

Ligaments help support and stabilise joints.

Following a significant ligament injury or repair, rehabilitation may need to rebuild both strength and control around the joint.

Treatment may involve:

• Restoring movement
• Strengthening
• Balance exercises
• Joint-control exercises
• Walking or running progression
• Jumping and landing where appropriate
• Changes of direction
• Sport-specific movements

Later-stage rehabilitation is particularly important when returning to activities that involve running, turning or rapid changes of direction.

Rehabilitation after tendon repair

Tendons connect muscles to bones and need time to heal following a significant injury or surgical repair.

During the early stages, certain movements or loads may need to be restricted.

Physiotherapy then gradually introduces movement and strengthening according to the healing stage.

Rehabilitation may include:

• Protected movement
• Gradual restoration of range
• Progressive strengthening
• Scar management where relevant
• Building tolerance to load
• Returning to everyday activity
• Returning to sport or work

Progressing too quickly can place unnecessary stress on healing tissue, so the rehabilitation plan should follow the guidance for the specific tendon repair.

Recovery after being in a cast, brace or sling

A period of immobilisation protects an injured area but can also lead to stiffness and muscle weakness.

When the cast, brace or sling is reduced or removed, the affected area may initially feel unfamiliar or difficult to use.

You may notice:

• Stiffness
• Weakness
• Swelling
• Reduced confidence
• Changes in walking
• Difficulty lifting or gripping

Rehabilitation can gradually restore normal movement and strength rather than expecting the area to immediately function as it did before the injury.

Managing stiffness

Stiffness is common following injury and surgery.

The amount of stiffness depends on factors such as:

• The type of procedure
• How long movement was restricted
• Swelling
• Pain
• The joint involved
• Individual healing

Treatment may include movement exercises, active use of the joint and, where appropriate, hands-on techniques.

The aim is to gradually regain useful movement rather than aggressively forcing a healing joint.

Managing swelling

Swelling may continue for some time following an operation or significant injury.

It can make movement feel tighter and may temporarily affect strength and comfort.

Depending on the condition, management may involve:

• Appropriate movement
• Elevation
• Gradual activity
• Compression where recommended
• Regular exercises

A sudden or unexpected increase in swelling, particularly when combined with other symptoms, should be assessed appropriately rather than assumed to be part of normal rehabilitation.

Rebuilding strength

Regaining movement is only one part of orthopaedic rehabilitation.

The affected muscles may need to regain enough strength to support normal activity.

Strengthening can progress from basic movements towards exercises involving:

• Body weight
• Resistance bands
• Weights
• Gym equipment
• Single-leg or single-arm exercises
• Lifting
• Carrying
• Functional movements

The level of resistance is increased gradually according to healing and physical ability.

Walking after surgery or injury

Walking may initially feel different following lower-limb surgery or injury.

You may:

• Take shorter steps
• Walk more slowly
• Avoid putting weight through one side
• Need crutches
• Tire more quickly
• Feel uncertain on stairs

Rehabilitation can address both the movement pattern and the strength needed for walking.

As recovery progresses, you may work towards:

• Walking independently
• Increasing distance
• Walking outdoors
• Managing slopes
• Walking on uneven ground
• Returning to your normal pace

Using crutches or other walking aids

Crutches, walking sticks and frames may be used temporarily or for longer periods depending on the condition.

The appropriate aid can help you move safely while an injured or operated area heals.

Physiotherapy can provide guidance on:

• Correct height
• Walking technique
• Stairs
• Weight-bearing
• When it may be appropriate to reduce support

Walking aids should be reduced according to your physical ability and medical guidance rather than simply because a certain amount of time has passed.

Using stairs

Stairs can be one of the more challenging everyday activities following lower-limb surgery or injury.

Rehabilitation may include:

• Leg strengthening
• Step exercises
• Balance
• Controlled lowering
• Practising stair technique
• Using a handrail or walking aid where required

As strength improves, the aim may be to gradually return towards your usual way of using stairs.

Getting up from a chair

Hip, knee and lower-limb problems can make standing from a chair difficult.

Physiotherapy may work on:

• Foot position
• Forward body movement
• Leg strength
• Balance
• Repeated sit-to-stand practice

This simple movement can also be used as a practical measure of progress during rehabilitation.

Returning to everyday activities

Orthopaedic rehabilitation should prepare you for more than exercises completed inside the clinic.

Your goals may include:

• Walking around the home
• Dressing
• Cooking
• Shopping
• Driving
• Using stairs
• Caring for children
• Gardening
• Household tasks
• Walking outdoors
• Returning to hobbies

The programme can become more specific to these activities as recovery progresses.

Returning to work

The demands of work differ considerably.

A desk-based role may require you to tolerate sitting and travelling, while a manual job may involve lifting, carrying, kneeling, climbing or working overhead.

Rehabilitation may gradually prepare you for these demands.

This can involve:

• Strengthening
• Lifting practice
• Carrying
• Squatting
• Reaching
• Walking
• Using stairs
• Increasing physical endurance

In some situations, a gradual return or temporary adjustment to duties may be appropriate.

Returning to driving

The ability to return to driving depends on the injury or surgery, which part of the body is affected, your ability to control the vehicle and any medical or surgical restrictions.

You should be able to perform the movements required to drive safely and respond appropriately in an emergency.

If you have had surgery, follow the specific advice provided by your medical team and any relevant driving requirements.

Returning to exercise

Returning to exercise usually happens gradually.

Early rehabilitation may involve simple movement and strengthening before progressing towards:

• Longer walks
• Cycling
• Gym training
• Swimming where appropriate
• Running
• Exercise classes
• Recreational sport

The right progression depends on the operation or injury and the physical demands of the activity.

You do not necessarily need to return to exactly the same type of exercise you performed before. Rehabilitation can also help identify suitable alternatives while recovery continues.

Returning to the gym

Gym-based exercise can be useful during later stages of rehabilitation.

Your programme may progress towards:

• Squats
• Lunges
• Pressing
• Pulling
• Step exercises
• Resistance machines
• Free weights
• Cardiovascular exercise

The aim is to gradually rebuild load tolerance.

The amount of weight used should reflect the healing stage and the level of control you can maintain.

Returning to sport

Returning to sport usually requires more than being comfortable during normal walking.

Depending on the activity, later rehabilitation may need to include:

• Running
• Faster acceleration
• Slowing down
• Jumping
• Landing
• Changes of direction
• Repeated movements
• Sport-specific drills

The physical requirements of the sport should guide the final stages of rehabilitation.

Return to sport may depend on movement, strength, confidence and performance during relevant tasks rather than simply the number of weeks since the injury.

Preparing for surgery

In some cases, physiotherapy may begin before a planned orthopaedic operation.

This is sometimes referred to as pre-operative rehabilitation or prehabilitation.

The aim may be to:

• Maintain strength
• Maintain movement
• Improve general fitness
• Practise exercises that will be used after surgery
• Learn how to use walking aids
• Prepare for the early stages of recovery

The programme will depend on the planned procedure and your current physical ability.

Confidence after injury or surgery

It is common to feel cautious with an area that has been painful, injured or operated on.

Even once healing has progressed, you may worry about:

• Putting weight through the joint
• Bending
• Lifting
• Running
• Falling
• Reinjuring yourself
• Returning to sport

Rehabilitation gradually reintroduces these activities in a controlled environment.

Confidence often improves alongside strength and movement as you become more familiar with what the body is able to manage.

Rehabilitation is progressed in stages

Orthopaedic rehabilitation is rarely one continuous set of exercises.

The programme may broadly move through stages such as:

• Protecting the healing area
• Restoring basic movement
• Regaining normal daily mobility
• Rebuilding strength
• Improving balance and control
• Increasing physical endurance
• Returning to work or exercise
• Returning to higher-level activity or sport

Not everyone needs every stage, and the speed of progression varies.

The programme should reflect your actual recovery rather than trying to meet a fixed timeline.

Working with your surgical or medical team

Following surgery or a significant injury, the orthopaedic team may provide specific restrictions.

These may relate to:

• Weight-bearing
• Joint movement
• Lifting
• Use of a brace or sling
• Wound healing
• Returning to driving
• Returning to work
• Returning to sport

Physiotherapy should work within these restrictions.

If guidance changes following a surgical review, the rehabilitation programme can be adjusted accordingly.

When further medical assessment may be needed

Some symptoms during recovery require medical review rather than simply progressing or changing the exercise programme.

Seek appropriate medical advice if you experience:

• A sudden significant increase in pain
• A new inability to put weight through the limb
• A new deformity following an injury
• Rapidly increasing swelling
• Significant redness or heat around a surgical wound
• Wound discharge
• Fever or feeling significantly unwell
• New persistent numbness or weakness
• Sudden calf pain or unusual swelling
• New chest pain or unexplained shortness of breath

Follow any specific warning signs or instructions provided by your surgical team.

Treatment based on your goals

The goal of orthopaedic rehabilitation differs from person to person.

You may want to:

• Walk independently
• Stop using crutches
• Manage stairs
• Return to work
• Drive again
• Lift comfortably
• Return to the gym
• Run again
• Return to sport
• Recover after joint replacement
• Regain movement after a fracture
• Feel confident using the affected area

Your rehabilitation can be developed around these goals and adjusted as your recovery progresses.

How long will orthopaedic rehabilitation take?

Recovery time varies considerably.

A relatively straightforward injury may require a short period of rehabilitation, while recovery following major surgery, fracture or ligament reconstruction may take considerably longer.

The timeline can be influenced by:

• The type of injury or operation
• Healing requirements
• Age and general health
• Previous physical ability
• Complications
• How much strength or movement has been lost
• The activities you want to return to

Your progress can be reviewed throughout rehabilitation so that exercises continue to match your stage of recovery.