Rehabilitation after hip surgery involves distinct phases of recovery. The goal is to allow the best environment for tissue healing while maximizing long-term function. The guidance of a physical therapist, in consultation with your physician, is essential to an effective recovery.

View our Rehabilitation Guidelines (PDF).

Typical Recovery Process

This is an example of a typical recovery process, and should not be used to direct your rehabilitation after surgery. Each procedure and patient presents a unique set of circumstances, and progressions should be based on your individual responses, exam findings, and progress.

Immediate Post-Operative Phase (0-2 Weeks)

Goals of Phase
  • Decrease post-operative swelling/inflammation
  • Decrease pain
  • Prevent post-operative stiffness and adhesions
  • Restore basic muscle activation patterns
  • Normalize gait pattern with assistive device
Passive Range of Motion (Within Pain‑Free Range)
  • Precautions x 4 weeks
    • Avoid aggressive “Stretching”
    • Flexion 0-90º
    • Extension limited to 0º x 4 weeks for routine capsular closure, x 6 weeks if plication performed
    • No external rotation > 20º in prone
  • Circumduction at 30º initially, including circumduction at greater degrees of flexion when able
  • Upright stationary bike (elevated seat, low/no resistance)
  • Opposite knee to chest stretch (early hip flexor stretch)
  • Prone knee flexion/quadricep stretch
  • Prone positioning progressing toward prone prop position
Edema Control and Muscle Activation
  • Glute set progression (supine then prone)
  • Quadriceps setting
  • Ankle pumps
  • SAQ
  • Transverse abdominis activation
Gait Training
  • Emphasize foot flat WBAT pattern with use of bilat crutches
  • Avoid all treadmill ambulation including use of anti-gravity treadmill
  • Review stair negotiation technique (up w/ good, down w/ bad)
Criteria to Advance
  • Minimal to no pain at rest
  • <3/10 pain on VAS with initial therapeutic exercise
  • Normalized gluteal, quadricep, and transverse abdominis activation
  • No increase in pain with prone positioning

Early Post-Operative Phase

Goals of Phase
  • Decrease post-operative pain and inflammation
  • Improve muscular strength & endurance for ambulation and ADLs
  • Normalize gait pattern without use of assistive device
  • Restore range of motion necessary for ADLs and ambulation
    • Ensure adequate hip extension once appropriate
    • No extension > 0º x 4 weeks for routine closure, x 6 weeks if capsular plication performed
Range of Motion
  • Continue circumduction
  • Initiate and progress upright stationary bike with elevated seat height per tolerance
  • Supine bent knee fall outs/ins within protected, pain free range of motion
  • Quadruped heel sits within pain free range of motion at 4 weeks
  • Begin scar and soft tissue mobilization as necessary once incisions well healed
  • Progress prone positioning time and progress toward prone prop position
  • Prone quadriceps stretch
  • Lunge position hip flexor stretch when appropriate (@ 4 or 6 weeks)
  • Submaximal abduction and adduction isometrics
  • Prone internal and external rotation isometrics in prone
  • Bridges to 0º extension
  • Quadruped hip extension to 0º
  • Long-arc knee extension
  • Standing hip abduction with IR
  • Standing TKE with gluteal muscle activation
  • Bilateral Leg press with < 90º of hip flexion (progress toward SL)
  • Mini squats/sit to stands
  • Partially-loaded active external rotation within pain free ROM
Gait Training
  • Avoid use of all treadmill devices for gait retraining
  • Wean from assistive device after 4 weeks once pattern normalized
Criteria to Advance
  • No reactive pain with exercise or complaints of pain at rest
  • Able to demonstrate > 30 seconds of single leg balance without loss of pelvic stability
  • Patient reports ability to sit > 30 minutes without exacerbation of pain
  • Patient reports pain free community ambulation without assistive device
  • > 10 repetitions of prone hip extension without compensations or altered activation pattern

Intermediate Phase

Goals of Phase
  • Restore full ROM and flexibility
  • Regain adequate muscular strength & endurance for progression of IADLs
  • Progress activity level without exacerbation of intra- or extra-articular irritation/pain
  • Normalize dynamic lower extremity and lumbopelvic control during functional activities
Range of Motion and Flexibility
  • FABER slides progressing toward FABER/figure 4 position
  • Thomas position hip flexor stretch if necessary
  • Include IT band stretches only if necessary and no recreation of groin pain
  • Continue stretching/flexibility from previous phases
  • Half-kneeling hip flexor stretch with rotation opposite
  • Progress to Thomas position anterior hip stretch
  • Walking spider man stretch
  • Inch worms
  • Side-lying hip abduction
  • Step ups
  • Side and prone planks
  • Side stepping with band resistance
  • Single leg balance with perturbations
  • Upper extremity assisted single leg mini squats
  • Lateral step downs
  • Single leg romanian dead lifts
  • Standing stork turns/band resisted external rotation
Endurance and Cardiovascular Training
  • Progress stationary bike duration and resistance per tolerance
  • Elliptical trainer (initially no incline and low resistance)
  • Avoid all treadmill or anti-gravity treadmill walking
Low-Intensity Plyometric Training
  • Avoid all plyometrics until 10 weeks post-op
  • Begin with low intensity < bodyweight bilat hopping on shuttle
  • Ladder drills
    • Forward 2 feet in each box
    • Lateral 2 feet in each box
    • Forward 1 foot in each box
    • In-in/out (shuffle)
  • 2-foot line jumps/hops front/back
  • 2-foot dot hops
  • Alternating traveling single-leg hop and holds
  • Short step height bilateral box jumps
Criteria to Advance
  • Full ROM without pain or signs/symptoms of impingement
  • Symmetrical FABER position
  • 5/5 strength in all planes without reproduction of symptoms
  • Patient is able to ambulate > 15 minutes at quick pace without pain
  • Hip Outcome Score: ADL subscale score > 85%
  • No errors on lateral step-down test
  • No pain/symptom provocation and good control with completion of plyometric program

Late Phase (Running and Return to Sport Phase > 12 Weeks Post-Op)

Goals of Phase
  • Return to running without asymmetries
  • Regain adequate cardiovascular endurance for desired recreational activities and/or sport
  • Restore and maximize lower extremity power
  • Continue to progress intensity and volume of progressive resistance exercises
  • Gradually return to previous gym-based resistance training exercises if appropriate
    • Avoid seated abductor/adductor strengthening machines
    • Avoid squats and lunges below 90˚
    • Avoid “maxing out” or resistance preventing completion of < 6 repetitions
Cardiovascular Training
  • Progress stationary bike to spin/road bike if desired
  • Progress elliptical intensity and duration
  • Initiate Structured walk/jog program
Example Program
Step Warm Up Jog Walk Reps Cool Down
1 5 min 1 min 3 min 5 5 min
2 5 min 1 min 2 min 7 5 min
3 5 min 2 min 1 min 7 5 min
4 5 min 3 min 1 min 5 5 min
5 5 min 5 min 1 min 4 5 min
6 5 min 20 min continuous run 5 min
  • Run no more than every other day
  • Jogging should be initiated outdoors if possible
  • No hills or incline and no speed work should be included until completion of program
  • Progress distance and initiate speed training only after completion of walk/jog program
Plyometric Training
  • Progress intensity and volume of bilateral lower extremity plyometrics
  • Example exercises
    • Forward/backward skips
    • Single foot line hops
    • Single foot dot hops
    • Single foot step/box jumps
Agility and Sports Specific Training
  • Anterior-posterior shuttle drills
  • Lateral shuffle/shuttle drills
  • Carioca
  • Progress ladder footwork drills
  • Box drills
  • Planned cutting drills progressing toward reactive change in direction drills
  • Begin sport specific skill work (> 4 months post op)
Criteria for Return to Sport Clearance
  • Physician clearance
  • No sign/symptoms of impingement with clinical testing
  • HOS ADL subscale score > 95%
  • HOS Sport subscale >90%
  • No reactive pain or symptoms with agility and sport specific skills
  • >90% limb symmetry on single-leg hop tests
    • SL forward hop for distance
    • SL medial hop for distance
    • SL lateral hop for distance
    • SL triple hop for distance
    • SL triple crossover hop for distance
  • < 10% difference on 10 RM unilateral leg-press
  • If criteria are not achieved return to full sport participation should be delayed and patient should continue with rehabilitation to address remaining functional limitations