Hip Fracture Rehabilitation: A Physiotherapist’s Guide to Recovery
September 29, 2026
Hip fracture rehabilitation is an important part of recovery after a hip fracture, helping patients rebuild strength, balance, walking ability, and confidence.
Unlike some injuries where people can continue moving around with a little discomfort, a hip fracture often changes everything overnight.
One day you are walking independently, going to work, climbing stairs, visiting family, or doing household chores. The next day, even standing up from a chair can feel impossible.
In my clinic and rehabilitation settings, I have seen many people after hip fracture surgery. One thing I hear again and again is:
“Doctor, will I be able to walk normally again?”
“Doctor, I’m scared of falling again.”
“My leg feels weak and heavy.”
“I don’t trust my hip yet.”
These concerns are completely understandable.
A hip fracture is not just a broken bone. It can affect your confidence, mobility, balance, strength, and independence.
The good news is that with proper rehabilitation, many people can make meaningful progress. Physiotherapy plays an important role in helping people get back on their feet, regain confidence, and return to their daily activities. Early movement and physiotherapy are important parts of recovery after hip fracture surgery.
Understanding the Hip
Before we talk about rehabilitation, let’s understand the area involved.
The hip is one of the largest and strongest joints in the body.
It is a ball-and-socket joint formed by:
- The head of the femur (thigh bone)
- The acetabulum (hip socket)
The hip is surrounded by powerful muscles that help you:
- Walk
- Stand
- Climb stairs
- Sit down
- Get out of bed
- Maintain balance
I usually explain it to patients like this:
“Your hip is like the main pillar supporting your body weight. When that pillar is injured, almost every movement becomes difficult.”
That is why hip fractures can have such a big impact on daily life.
What Is a Hip Fracture?
A hip fracture is a break in the upper part of the femur near the hip joint.
Most hip fractures occur after:
- Falls
- Slips
- Road traffic accidents
- Sports injuries
- Weak bones associated with osteoporosis
In older adults, even a simple fall at home can sometimes result in a hip fracture.
Many patients require surgery before rehabilitation begins. Depending on the fracture and the patient’s condition, treatment may involve:
- Screws
- Plates
- Intramedullary nails
- Partial hip replacement
- Total hip replacement
After surgery, rehabilitation becomes an important part of recovery.
For more information about rehabilitation after another type of fracture, see our Elbow Fracture Rehabilitation guide.
What Patients Usually Complain About
When patients first start physiotherapy after a hip fracture, they rarely complain only about pain.
Most of the time, they complain about what they can no longer do.
Patients often tell me:
“Doctor, I am afraid to put weight on my leg.”
“I can’t walk properly.”
“My leg feels weak.”
“Getting out of bed is difficult.”
“I feel unstable when I stand.”
Common problems can include:
- Hip pain
- Difficulty walking
- Weakness
- Balance problems
- Fear of falling
- Difficulty climbing stairs
- Difficulty standing from a chair
- Reduced endurance
- Reduced confidence
- Difficulty with daily activities
Many people are surprised by how much strength they lose during their hospital stay and recovery period.
A patient-focused hip fracture rehabilitation plan can address these common difficulties step by step.
Why Is Physiotherapy Important After a Hip Fracture?
Many patients ask me:
“Doctor, if the surgery is successful, why do I still need physiotherapy?”
My answer is always simple:
“Because surgery fixes the bone. Physiotherapy helps you get your life back.”
After a hip fracture, rehabilitation can help address weakness, stiffness, balance difficulties, walking problems, and reduced confidence.
Physiotherapy may help:
- Improve walking
- Improve balance
- Restore strength
- Improve confidence
- Support independence
- Improve functional mobility
- Help with daily activities
- Reduce the risk of future falls
Early mobilization and structured rehabilitation are important components of recovery after hip fracture.
For additional evidence-based guidance, see the NICE hip fracture management guideline.
Physiotherapy Goals After Hip Fracture
Whenever I work with a patient recovering from a hip fracture, our goals are:
- Reduce pain
- Improve mobility
- Improve walking ability
- Improve balance
- Improve strength
- Improve confidence
- Increase independence
- Return to normal activities
Every exercise we prescribe should move the patient closer to these goals.
These goals help guide each stage of hip fracture rehabilitation according to the patient’s individual needs.
Phase 1: Early Recovery After Hip Fracture Surgery
Early hip fracture rehabilitation focuses on safe movement, pain management, and gradually returning to basic activities.
Goals
- Protect healing tissues
- Improve circulation
- Prevent complications
- Begin safe movement
Physiotherapy often starts soon after surgery, depending on the patient’s medical condition, surgical instructions, and weight-bearing restrictions.
In many hospitals, patients are encouraged to start moving and standing as early as medically appropriate.
I often tell patients:
“The sooner we safely start moving, the better your recovery usually goes.”
Exercises Commonly Used in Early Rehabilitation
Ankle Pumps
Moving the feet up and down.
Deep Breathing Exercises
These exercises can help maintain normal breathing and support general recovery after hospitalization.
Gluteal Squeezes
Tightening the buttock muscles.
Quadriceps Sets
Tightening the thigh muscles.
Heel Slides
Sliding the heel towards the body while lying down, when appropriate.
Assisted Bed Mobility Training
Learning how to move safely in bed and change positions.
These simple exercises may not look impressive, but they can be important during the first stage of recovery.
Phase 2: Mobility and Walking Training
During hip fracture rehabilitation, walking practice is gradually progressed according to the patient’s strength, balance, and medical restrictions.
This is often the stage where patients begin regaining confidence.
Many patients remember the first time they stand after surgery.
Some are excited.
Some are nervous.
Some are afraid they might fall.
That reaction is completely normal.
Goals
- Improve walking
- Improve confidence
- Improve transfers
- Progress weight-bearing as medically permitted
Walking and Mobility Training
Sit-to-Stand Training
Learning to stand safely from a chair.
Walking With a Walker
A walker may provide additional support while the patient develops strength, balance, and confidence.
Weight-Shifting Exercises
These exercises can help improve balance and control.
Marching in Standing
This can help improve lower-limb control when appropriate.
Supported Standing Practice
Helps rebuild confidence in the operated leg while maintaining safety.
Stair Training
Stair training is introduced when the patient is medically ready and able to perform it safely.
I have seen many patients who were terrified during their first standing session. A few weeks later, they were walking confidently with much less assistance.
Phase 3: Strengthening and Balance
This is usually the stage where patients begin feeling stronger.
Walking improves.
Balance improves.
Daily activities become easier.
As hip fracture rehabilitation progresses, strengthening exercises become increasingly important for walking and daily activities.
Goals
- Improve muscle strength
- Improve endurance
- Improve balance
- Improve walking quality
Strengthening Exercises
Straight Leg Raise (SLR)
A common strengthening exercise that may be introduced when appropriate.
Hip Abduction Exercise
Strengthens important hip stabilizing muscles.
Hip Extension Exercise
Can help develop the strength needed for functional movement and walking.
Mini Squats
Build lower-limb strength when medically appropriate.
Seated Knee Extensions
Targets the quadriceps muscles.
Step-Ups
Helps prepare for activities such as climbing stairs.
Theraband Hip Strengthening
Provides progressive resistance as strength improves.
Bridging Exercise
Strengthens the hips and core muscles.
Progressive strengthening and balance exercises can be important components of rehabilitation after hip fracture.
For another guide related to lower-limb rehabilitation and movement problems, see our Knee Pain guide.
Phase 4: Functional Rehabilitation and Return to Daily Life
This is my favorite stage.
Why?
Because now we stop focusing only on exercises and start focusing on life.
Goals
- Improve independence
- Improve endurance
- Improve confidence
- Return to daily activities
Functional Activities
Functional Walking Practice
Practicing walking with a focus on safe and efficient movement.
Community Walking
Gradually preparing the patient for walking outside the home.
Obstacle Walking
Practicing safe movement around obstacles when appropriate.
Balance Training
Improving balance during everyday movement.
Tandem Standing
A balance exercise that can be progressed according to the patient’s ability.
Single-Leg Balance Progressions
Introduced only when appropriate and safe.
Carrying Tasks
Practicing functional activities that are relevant to the patient’s daily routine.
Household Activity Training
Gradually returning to appropriate household tasks.
Outdoor Walking Practice
Building endurance and confidence for outdoor mobility.
Many patients tell me this is the stage where they finally start feeling like themselves again.
Good functional movement is also important when managing other mobility problems such as Back Pain.
Balance Training After Hip Fracture
One thing I never ignore after a hip fracture is balance.
Many people become fearful of falling again.
That fear is understandable.
I have seen patients become so worried about another fall that they stop moving altogether.
Part of rehabilitation is helping people regain confidence while improving balance safely.
Balance exercises may include:
- Standing balance drills
- Weight shifting
- Tandem standing
- Dynamic balance exercises
- Walking over different surfaces
Balance training is an important part of reducing mobility limitations and improving functional recovery after hip fracture.
Consistent hip fracture rehabilitation can help patients work toward better mobility, balance, and confidence.
Home Exercise Program
I always tell my patients:
“The clinic helps you recover, but your daily practice at home is where a lot of the improvement happens.”
A home exercise program may include:
- Ankle pumps
- Heel slides
- Quadriceps sets
- Gluteal sets
- Straight leg raises
- Hip abduction exercises
- Walking program
- Sit-to-stand practice
- Balance exercises
The exact exercises and frequency should be based on the individual’s fracture, surgery, weight-bearing restrictions, medical condition, and physiotherapist’s recommendations.
Small amounts of exercise performed consistently can be more manageable than doing too much at once.
You can also read our Wrist Fracture Rehabilitation guide for information about rehabilitation after another common fracture.
Regular participation in hip fracture rehabilitation can help support gradual improvements in strength, mobility, and confidence.
How Long Does Recovery Take After a Hip Fracture?
One of the most common questions I hear is:
“Doctor, when will I walk normally again?”
The answer depends on several factors, including:
- Age
- Type of fracture
- Type of surgery
- Overall health
- Strength before the injury
- Mobility before the injury
- Weight-bearing restrictions
- Consistency with rehabilitation
Recovery after a hip fracture can take several months, and the timeline varies from person to person.
Many people require physiotherapy for weeks or months while rebuilding strength, balance, endurance, and walking ability.
From my experience, people who stay active within their medical restrictions, follow their exercise program, and remain patient with the process can make meaningful progress.
The progress of hip fracture rehabilitation varies from person to person depending on age, overall health, fracture type, surgery, and mobility before the injury.
When Should You Contact a Physiotherapist?
After a hip fracture or hip fracture surgery, rehabilitation should be individualized.
A physiotherapist can assess:
- Walking ability
- Muscle strength
- Balance
- Range of movement
- Transfers
- Stair ability
- Functional independence
- Need for walking aids
Contact your healthcare professional promptly if you experience new or worsening severe pain, significant swelling, fever, wound problems, chest pain, difficulty breathing, or any other concerning symptoms after surgery.
Final Thoughts
A structured hip fracture rehabilitation program can support the gradual return to walking and everyday activities.
A hip fracture can be one of the most challenging injuries a person experiences.
It can affect movement, confidence, independence, and everyday life.
As a physiotherapist, I have worked with many hip fracture patients, and one thing I have learned is that recovery is rarely about the fracture alone.
It is about helping people walk again.
It is about helping them trust their body again.
It is about helping them return to their family, their community, their hobbies, and their normal routine.
The surgery repairs the fracture.
Physiotherapy helps rebuild the person.
With the right rehabilitation program, regular exercise, patience, and determination, many people can work toward regaining strength, confidence, independence, and an active lifestyle.
Medical Disclaimer: This article is for educational purposes only and should not replace professional medical advice. Hip fracture rehabilitation should be individualized based on the type of fracture, surgery, weight-bearing restrictions, medical condition, and guidance from your healthcare team.
Written by Dr Areej Nadeem PT
College of Physiotherapy
JPMC Karachi