When Should You Start Strength Training After Hip Replacement?
- Tom Morgan, Chartered Physiotherapist
- Aug 9
- 3 min read
Strength training after hip replacement begins much earlier than many people realise. The first exercises may feel simple, but gluteal and quadriceps activation starts from the earliest stage because surgery and post-operative swelling temporarily reduce how well these muscles work.
The programme should then become progressively more demanding as healing, balance and movement improve.
Why strength is so important
Hip strength supports walking, stairs, balance, transfers and pelvic control. The gluteus medius is particularly important for preventing the trunk from dropping or leaning excessively during walking.
Days 0-3: reactivate the muscles
Very early exercises can include gluteal squeezes, quadriceps sets and assisted hip abduction. These are not intended to create heavy fatigue. They begin restoring muscle activation while you also focus on safe walking.
Weeks 1-2: add functional strength
Sit-to-stands, heel raises, controlled marching and other supported standing exercises can build basic capacity. Where appropriate for the surgical approach, clam shells and further hip strengthening may also be introduced.
Weeks 2-6: make exercise more challenging
The guide progresses towards bridges, step-ups, bodyweight squats, wall sits, band walks, resisted clam shells, balance work and cycling.
This is the stage where the programme starts to look more like training rather than simply post-operative movement.
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Weeks 6-12: progressive resistance
Once healing and control allow, more meaningful resistance can be added. The handbook includes leg press from around six to eight weeks and progresses to exercises such as Romanian deadlifts and hip thrusts around the later part of this window.
Months 3-6: close the remaining gap
By three months, most healing restrictions have resolved for many patients and strength becomes the main target. Split squats, cable hip work, single-leg sit-to-stands and progressively loaded compound exercises can help restore higher-level capacity.
How often should you strength train?
As exercises become more demanding, two to three structured strength sessions each week is a useful pattern for many patients. Recovery between harder sessions is part of the programme.
How do you know when to progress?
Progress when you can complete the prescribed sets with good control and symptoms remain manageable. Increase only one variable at a time, such as resistance, range or exercise difficulty.
Why you should not stop when pain improves
Pain often settles before strength fully returns. Stopping rehabilitation as soon as the hip feels comfortable can leave a residual weakness that affects gait, stairs and long-term activity.
When should you seek further advice?
Recovery is rarely a perfectly straight line, but new or rapidly worsening symptoms should not simply be pushed through. Contact your surgical team, GP or physiotherapist if pain, swelling, movement or function is moving in the wrong direction rather than gradually improving. Seek urgent medical attention for symptoms such as sudden breathlessness or chest pain, marked one-sided calf swelling, a hot increasingly red joint with fever, sudden loss of function, or other symptoms your surgical team has told you require urgent review.
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This article provides general information and does not replace advice from your own surgeon, physiotherapist or medical team. Recovery varies between individuals and any specific restrictions or weight-bearing instructions from your surgical team should take priority.
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