Exercises After Hip Replacement: How Rehabilitation Progresses

Exercise is a central part of recovery after hip replacement, but the exercises you need in the first few days after surgery should not look the same as the exercises you are doing several months later. Early rehabilitation is usually about restoring movement, reactivating muscles and walking safely. As healing progresses, the emphasis gradually shifts towards rebuilding strength, balance, endurance and confidence. This is why a good hip replacement programme should progress over time rather than simply repeating the same handful of exercises for months. Your exact programme should always be adapted to your surgery, precautions, weight-bearing instructions and individual progress, but the stages below show how rehabilitation commonly develops.

Why are exercises important after hip replacement?

Hip replacement surgery replaces the damaged joint, but it does not automatically restore the strength that may have been lost before and after the operation. Before surgery, pain and reduced mobility may already have caused weakness in the muscles around the hip and thigh. After surgery, pain, swelling and the normal inflammatory response can temporarily reduce how strongly the gluteal and quadriceps muscles work. The Hip Replacement Recovery guide specifically notes that the leg can initially feel heavy or difficult to control for this reason. Rehabilitation therefore has several jobs: • restore muscle activation • improve mobility • support walking • rebuild hip and leg strength • improve balance and control • increase endurance • help you return to daily activities • prepare you for more demanding exercise later in recovery The important point is that these goals change as you recover. What exercises do you do immediately after hip replacement? In the first few days, exercises are deliberately simple. The goal is not to perform heavy strengthening. At this stage, rehabilitation focuses on circulation, gentle movement and beginning to switch muscles back on. The early-stage exercise programme in the Hip Replacement Recovery guide includes: • ankle pumps • quadriceps sets • gluteal squeezes • heel slides • assisted standing hip abduction These exercises are combined with short periods of standing and walking using the appropriate walking aid. Ankle pumps Ankle pumps involve repeatedly moving the ankle up and down. They are one of the simplest early exercises but can be useful when you are spending much more time sitting or lying down than usual. They help keep the lower leg moving and are commonly included alongside early mobility. The Hip guide encourages gentle ankle movement during this stage as part of managing early swelling and maintaining activity.

Quadriceps sets

The quadriceps are the muscles at the front of your thigh. After surgery, they can feel surprisingly difficult to activate. A quadriceps set involves tightening the thigh muscles while keeping the leg supported. Early on, the contraction may feel weak. That is not unusual. The guide specifically encourages patients to keep attempting quadriceps and gluteal contractions even if they initially feel difficult. Gluteal squeezes Your gluteal muscles play an important role in hip strength and walking. Early gluteal squeezes are a simple way of beginning to reactivate these muscles without requiring a large hip movement. They are only the starting point. As recovery progresses, gluteal strengthening should become progressively more demanding.

Heel slides

Heel slides involve bending and straightening the leg by sliding the heel along the bed or another surface. They allow you to practise controlled movement without placing large loads through the recovering hip. Your range should remain within the precautions and advice you have been given. Standing hip abduction Hip abduction means moving the leg out to the side. In the earliest stage, this may be performed with support. The aim is not to see how far you can move the leg. The emphasis should be on controlled movement and keeping the trunk relatively still. As strength improves, this movement can later be progressed to more challenging versions. What happens to exercises after the first week? Once the earliest stage of healing is underway, rehabilitation begins moving beyond very basic activation exercises. The Hip guide describes weeks one to two as a period of building walking distance and confidence, re-establishing a normal routine at home and progressing exercises as symptoms allow. At this point, the aim is still not heavy strengthening. You are gradually increasing what the hip can tolerate while continuing to work on: • walking • hip and thigh activation • controlled movement • transfers • everyday mobility • confidence Some early exercises may remain in the programme while others are progressed. That is normal.

What happens between weeks 2 and 6?

This is often where rehabilitation begins to feel more like a strengthening programme. Walking is usually improving and many people begin progressing away from their walking aids. The focus increasingly moves towards rebuilding meaningful strength in the: • gluteal muscles • quadriceps • core • wider lower limb This is also the stage where exercises may begin to become more functional. Instead of only tightening muscles while lying down, rehabilitation can increasingly involve movements that resemble everyday tasks. Examples might include: • sit-to-stand exercises • bridges • mini squats • step-based exercises • clam shells • standing hip strengthening The exact exercises and timing will depend on your programme and individual progress. Why does hip replacement rehabilitation need to progress? Your muscles adapt to the challenge placed on them. An exercise that feels difficult during week one may feel extremely easy several weeks later. If the exercise never becomes more difficult, it may no longer provide enough challenge to continue building strength. That does not mean every exercise should constantly become heavier. Progression can happen in several ways: • increasing repetitions • increasing resistance • increasing movement range • reducing hand support • changing the exercise position • progressing from two legs to more single-leg work • moving from home exercises into gym-based strengthening The aim is gradual progression rather than sudden jumps. When do squats become useful? Squat variations can be useful because they involve several major lower-limb muscle groups and resemble everyday movements such as sitting down and standing up. Early versions may involve a relatively shallow range and support. As strength improves, the movement can gradually become deeper or more heavily loaded if appropriate. You should not force a full-depth squat simply because it appears in a later-stage programme. Quality matters more than depth.

Why are bridges and hip thrusts useful?

Bridges and later hip thrusts are used to progressively challenge the muscles around the hips and pelvis. A simple bridge can be introduced before a more demanding weighted hip thrust. This is a good example of how rehabilitation evolves. The movement pattern is related, but the load placed on the muscles can change significantly. What happens between 6 and 12 weeks? By around six weeks, rehabilitation increasingly shifts towards genuine strength, endurance and confidence. The Hip Replacement Recovery guide describes goals during this period including: • building single-leg strength, balance and control • increasing walking endurance • reintroducing gym equipment • returning towards normal daily and social activities The guide's later-stage exercises include movements such as: • leg press • hamstring curls • terminal knee extension with resistance • monster walks • light Romanian deadlifts • hip thrusts • shallow lateral lunges This looks very different from ankle pumps and gluteal squeezes. That is exactly the point. Your programme should change as your capacity changes. Is leg press safe after hip replacement? Leg press can form part of later-stage hip replacement rehabilitation when it is appropriate for the individual. It provides a way to progressively strengthen the lower limb using external resistance. However, the amount of weight, depth of the movement and timing of introduction all matter. You should begin with a manageable resistance and controlled range rather than treating the first gym session as a test of maximum strength.

What about Romanian deadlifts?

Romanian deadlifts are another later-stage strengthening option. They target the posterior chain, including the gluteals and hamstrings, while introducing a more demanding hip-hinge pattern. They should be introduced with appropriate technique and initially light resistance. A later-stage exercise being useful does not mean it should be performed during the early post-operative period. Why is balance work important? Walking involves spending part of every step supported on one leg. If strength and control around the operated hip remain poor, this can contribute to limping and reduced confidence. Balance work can therefore become increasingly important as rehabilitation progresses. Later-stage goals in the Hip guide specifically include improving single-leg strength, balance and control. Balance training might begin with simple supported exercises and gradually become more challenging as confidence improves.

Can walking replace my exercises?

No. Walking is important, but walking and strengthening do different jobs. You can gradually increase your walking endurance while still having weakness around the hip. This becomes particularly obvious when you try more demanding activities such as: • stairs • hills • prolonged standing • getting up from a low chair • returning to the gym • carrying heavier items • single-leg tasks A complete rehabilitation programme therefore needs more than walking alone. How often should I exercise? This depends on the exercise and stage of rehabilitation. Early activation and mobility exercises may be performed more frequently. Later strength exercises generally need more recovery between sessions, particularly when resistance becomes more challenging. This is another reason one generic instruction such as “do all of your exercises three times every day” is unlikely to remain appropriate throughout the whole recovery. A structured programme should tell you: • what exercise to do • how many sets • how many repetitions • how often • when to progress • how to make the exercise easier or harder Should exercises hurt after hip replacement? Some discomfort or muscle effort during rehabilitation can be expected, particularly as exercises become more challenging. However, exercise should not simply be a case of pushing through significant pain. Pay attention to how the hip responds both during and after the session. If a new exercise produces a large increase in pain, swelling or limping that persists, the exercise may need to be modified or temporarily reduced. More difficult is not automatically better. The goal is progressive loading that your body can tolerate.

What if an exercise feels too easy?

That can be a sign that it is time to progress. For example, you might: • increase resistance • increase repetitions • move to a harder variation • reduce external support • progress to a more functional exercise However, do not progress several things at once unnecessarily. Small changes make it easier to judge how your hip responds. What if an exercise feels too difficult? Regression is also part of good rehabilitation. You might reduce: • range of movement • resistance • repetitions • number of sets • complexity • balance demands An exercise should challenge you without completely breaking down your technique. There is no benefit in performing an advanced exercise badly simply because it appears in a later phase. When can I start gym exercises? There is no single date that applies to everyone. The Hip guide begins reintroducing structured gym-based work during the later rehabilitation stages, with week 6 to week 12 shifting towards more substantial strength and endurance work. However, the timing should depend on: • your surgical guidance • wound and tissue healing • strength • pain • walking ability • exercise technique • individual goals A gym programme after surgery should begin as rehabilitation, not as a return to your previous maximum loads.

What happens after three months?

For many people, three months is not the end of rehabilitation. It may actually be the point where strengthening can become much more meaningful. Your focus may shift towards: • heavier resistance training • more advanced single-leg control • gym-based strengthening • longer walks • cycling • swimming • sport-specific preparation • returning to hobbies The aim is increasingly to bridge the gap between being able to manage everyday life and returning to the level of activity that matters to you. Do I have to do exercises forever? You are unlikely to need to perform your early post-operative exercises forever. Ankle pumps and basic muscle squeezes serve an important purpose during the early stages, but later in recovery they should normally be replaced by more meaningful strength and activity. Long term, maintaining strength and regular physical activity remains important. That may eventually look more like a normal exercise routine than a “rehab programme”. What are common mistakes with exercises after hip replacement? Some common problems include: • doing too much too soon • performing the same basic exercises for months without progression • stopping strengthening as soon as walking feels better • progressing resistance faster than technique allows • copying another person's programme • ignoring individual precautions • treating pain as something that must always be pushed through • relying only on walking • returning to heavy gym training before rebuilding basic strength Your rehabilitation should be progressive, but progression does not mean rushing.

How do I know when I am ready for the next phase?

Time since surgery is one consideration, but it should not be the only one. Progression may also depend on whether you can: • walk safely • perform your current exercises with good control • manage symptoms appropriately • complete everyday activities • demonstrate improving strength • progress without a significant worsening of pain or swelling The early Hip guide, for example, uses functional criteria such as walking a short distance safely, managing pain and showing some quadriceps and gluteal activation before moving forward. This is more useful than assuming everybody must change phase on exactly the same day. What if my surgeon has given me different restrictions? Follow them. Hip precautions, weight-bearing restrictions and rehabilitation recommendations can vary depending on your operation and surgical approach. Specific advice from your surgical team takes priority over a general online exercise article. If you are uncertain whether a particular exercise is appropriate, ask your physiotherapist or surgeon.

A good hip replacement programme should change with you

The main principle is simple: Your rehabilitation should progress as you progress. In the first days after surgery, ankle pumps and muscle activation may be exactly what you need. Several weeks later, those exercises should not necessarily remain the centre of the programme. Over time, rehabilitation should move towards progressively more meaningful strengthening, balance, endurance and activities that prepare you for everyday life, the gym and the things you want to return to. Looking for a complete hip replacement exercise programme? The Complete Hip Replacement Recovery eGuide provides a structured programme from preparation for surgery through five progressive post-operative exercise phases. It includes detailed exercise instructions, sets and repetitions, common mistakes, easier and harder options and QR-linked video demonstrations, alongside guidance on walking, recovery milestones and returning to everyday activities.

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*This article provides general educational information and does not replace individual advice from your surgeon, physiotherapist or healthcare team. Always follow any specific precautions, weight-bearing restrictions or exercise instructions you have been given.*