İhsan ErenAnkle pumps
Lying on your back or sitting, move your ankles up and down. This supports the circulation in your legs and can be done from the first days after surgery.
10–20 reps every hourDay 1When the guideline recommends a physiotherapy assessment and getting up: the day after surgery
Age 80Average age of patients in hip fracture rehabilitation studies; 80% are women
40Studies in the Cochrane review of mobility-focused rehabilitation (4,059 people)
6 monthsLength of a home exercise programme that improved function even after rehabilitation
The first days after surgery
The UK hip fracture guideline recommends surgery on the day of admission or the day after, a physiotherapy assessment and getting up out of bed on the day after surgery, and then mobilisation at least once a day. The aim of rehabilitation is to regain mobility and independence so that the person can return to the home they lived in before the fracture.
How much weight you can put on your leg and which movements to avoid depend on the type of fracture and the operation you had. Follow your surgeon's advice on this.
What is worked on at home?
- Getting out of bed, standing up from a chair and getting on and off the toilet
- Walking safely with a frame, then with a stick
- Strengthening the hip and leg muscles
- Balance and turning, and coping with a fear of falling
- Going up and down stairs
- Making the home safe against falls
Exercise after leaving hospital
A 2022 Cochrane review of 40 studies and 4,059 people found that exercises focused on walking, balance and everyday tasks improve mobility. In programmes after discharge from hospital, strength and endurance exercises also helped; the improvement in this period was small but meaningful, and the evidence was of high certainty.
In a US study of 232 patients, people who had completed standard rehabilitation were given a 6-month home exercise programme. At the end of the programme their daily function was better than that of the group without exercise, and the difference was still there 3 months later.
A hip fracture is often the combined result of a fall and osteoporosis. Alongside rehabilitation, it is important to have your bone health assessed and to prevent falls: have a look at the osteoporosis and fall prevention guides.
Exercises at home
Six exercises for recovery
The first three exercises are done in bed, the last three standing or on a chair. Your surgeon and physiotherapist will tell you when to start each exercise and how much weight you can put on your leg. Stop if the pain gets clearly worse.
Towel press
Lie on your back with a rolled-up towel under the knee of your operated leg. Press the back of your knee into the towel to tighten the muscle at the front of your thigh, hold for 5 seconds and relax.
10 reps, 3 times a dayHeel slides
Lie on your back. Slide the heel of your operated leg along the bed to bend your knee as far as is comfortable, then slowly straighten it. Stay within the movement limits your surgeon has given you.
10 reps, 2–3 times a dayStanding hip abduction
Stand upright holding on to the kitchen counter. Keeping the knee straight and your toes pointing forwards, lift your operated leg out to the side and lower it slowly. Do not lean your body to the side.
10 reps, twice a daySit-to-stand from a chair
Sit in a sturdy chair with armrests. Pushing up with your hands and spreading your weight over both legs, stand up, then sit down with control. Use your hands less as it gets easier.
5–10 reps, twice a dayHeel raises holding the counter
Hold on to the kitchen counter with both hands. Rise up onto your toes, pause for a moment and lower slowly. Strengthens the calf muscles and helps balance.
10 reps, twice a dayVideo
Balance and falls videos
From the YouTube channel of US physical therapists Bob Schrupp and Brad Heineck.
Standing balance exercise for older people
Balance exercises done holding on, which get harder step by step.
Getting up safely after a fall
How to get up safely after a fall, without panicking.
Frequently asked questions
When can I walk after surgery?
Most patients get up with a walking frame and a physiotherapist the day after surgery. The UK hip fracture guideline recommends a physiotherapy assessment and getting up on the day after surgery unless there is a medical reason not to, and then mobilisation at least once a day. Your surgeon will decide how much weight you can put on your leg.
Does carrying on with exercise at home really make a difference?
Yes. A Cochrane review of 40 studies showed that exercises focused on walking, balance and everyday tasks after leaving hospital clearly improve mobility. In a US study of 232 patients, a 6-month home exercise programme improved function further, even in patients who had already completed rehabilitation.
Was my fracture treated with a replacement or with screws, and does it matter?
Yes. Depending on the type of fracture, it may be fixed with screws or a nail, or part of the hip may be replaced. If you had a replacement, you may need to avoid some positions for a while. Ask your surgeon which movements are safe for you; for more detail, see the joint replacement guide.
What should I do to avoid another fracture?
Hip fractures usually happen when a fall and osteoporosis come together. Ask for your bone health to be assessed, do balance and strengthening exercises regularly and make your home safe against falls.
When to seek help right away
Contact your surgeon or a doctor without delay if you have:
- Pain in the groin or thigh that keeps getting worse, or being unable to put weight on the leg again
- Redness or discharge from the wound, fever or chills
- Swelling, pain and redness in the calf (this may be a blood clot)
- Sudden shortness of breath or chest pain (call 112)
- New confusion or drowsiness
Sources
- National Institute for Health and Care Excellence. Hip fracture: management (CG124). London: NICE; 2011, updated 2023.
- Fairhall NJ, Dyer SM, Mak JCS, et al. Interventions for improving mobility after hip fracture surgery in adults. Cochrane Database Syst Rev. 2022;9:CD001704.
- Latham NK, Harris BA, Bean JF, et al. Effect of a home-based exercise program on functional recovery following rehabilitation after hip fracture: a randomized clinical trial. JAMA. 2014;311(7):700-708.
- The Chartered Society of Physiotherapy. Mobility strategies are effective in adults after hip fracture surgery.