Physical Therapy Exercises after Total Hip Replacement

Physical Therapy Exercises after Total Hip Replacement

Photo of a PT helping a woman on the stairs.
Your physical therapist can help guide you through rehabilitation after total hip replacement surgery. Francesco Ruggeri/Getty Images

If you have hip pain due to severe hip osteoarthritis, you may require a total hip replacement surgery to correct the problem.  You may benefit from physical therapy after your total hip replacement to help you regain mobility and to return to your previous level of function.

After your total hip replacement, you may work with a PT in many different settings - you may have therapy in the hospital, at home, or in the outpatient clinic.

One of the main components of your rehab program after a total hip replacement surgery is exercise.  Your physical therapist may prescribe different exercises to help accomplish different goals.  These may include:

The main goal of physical therapy and exercise after your total hip replacement is to regain functional mobility so you can return to your normal activities.

Here is an exercise program similar to one that a PT may prescribe for patients after total hip surgery. The program starts out with simple range of motion and isometric exercises and progresses with more challenging strengthening and balance exercises.

Remember to check in with your doctor before starting this, or any other exercise program.

Glute Sets

Glute sets are a simple exercise to perform in the immediate post-operative period.  The exercise gently contracts your buttock muscles, and it should be done while in the hospital after your total hip replacement surgery. 

To perform a glute set, simply lie on your back and tighten your buttock muscles.  Hold your muscles tight for a few seconds, and then relax.  Repeat the exercise 15-20 times several times per day.

Glute sets are a great way to "wake your hip muscles up" after hip surgery, and they can be used along with ankle pumps to prevent blood clots while resting in the hospital.

Cousin to the glute sets: the isometric gluteus medius strengthening exercise.

Quad Sets

Quad sets are a great exercise to do to get your quadriceps muscle on the top of your thigh working properly after a total hip replacement. Your quadriceps muscle straightens your knee joint, and it is essential to have strong quads for normal walking and stair climbing.

To perform the quad set, place a small towel roll underneath your knee while lying in bed. Gently press the back of your knee down into the towel roll while tightening up your quad. Hole the position for 5 seconds, and then release the contraction.

Repeat the quad set for 10 to 15 repetitions.

Bonus exercise: the Short Arc Quad.

Heel Slides after Total Hip Replacement

Heel slides are an easy way to start working on hip ROM. They can be performed in the hospital, at home, or in the outpatient rehab clinic. You can work on heel slides in various ways to get your hip moving in different directions, and you can start them right away after your surgery.

To perform heel slides, simply lie on your back. Slowly slide your heel up towards your buttocks.  Your heel should remain in contact with the bed as you slide. When you are sliding your heel up, your knee should bend and your hip should flex a bit. If you have had a posterior approach hip replacement, be sure not to bend your hip up more than 90 degrees, or else you could break your hip precaution rules and risk suffering a hip dislocation.

Perform 10 to 15 heel slides, and then work on sliding out to the side.

To do heel slides into hip abduction, simply lie on your back and slide your heel out to the side. Slide as far as your can within the limits of your comfort, and then return to the starting position. Be sure not to slide your leg too far in--crossing of your hips is a no-no after a posterior approach hip replacement.

Perform 10 to 15 repetitions of the heel slide into abduction.

Straight Leg Raises

Straight leg raise with an cuff weight around the ankle.
Place a cuff weight around your ankle to add full resistance to your straight leg raising exercise. Brett Sears, PT, 2013

Straight leg raises are a great way to strengthen the muscles in your legs after a total hip replacement. They can be done to strength the front, side, and back of your hip. To perform the straight leg raise exercise, lie on your back with one knee out straight and one knee bent. Tighten up your quad (like when performing the quad set exercise) on the straight knee, and slowly lift your leg off the bed. Be sure to keep your knee straight and lift your leg up about 12 to 15 inches from the bed. Perform 10 to 1 repetitions.

You can work your outer hip muscles, the gluteus medius, by performing straight leg raises on your side. Be sure to maintain proper total hip precautions by placing a pillow between your knees while lying on your side. Your physical therapist can show you how.

If you are having difficulty getting your leg up to do a proper straight leg raise, start by doing the short arc quad (SAQ) exercise. Place a towel roll or basketball underneath your knee, and slowly straighten your knee until your leg is straight. The back of your knee should remain against the bolster or ball. Perform 10 to 15 repetitions of the SAQ. After a few days, your ability to perform a straight leg raise should be much improved.


Photo of the bridge exercise.
Engage your abdominals and slowly lift your buttocks up. Brett Sears, 2011

Bridges are a great exercise to engage your hip muscles and start to gain control of your pelvis and core. To properly do a bridge, lie on your back with your knees bent and your feet flat on the floor or bed. Engage your abdominals, and then slowly lift your bottom up off the table. Perform 10 to 15 repetitions.

To make the bridge exercise more challenging, perform the exercise with your feet on a soft surface, like a pillow. Or, simply extend one knee to perform the single leg bridge. Warning: these are advanced hip exercises and should only be attempted when you have gained significant strength after your total hip operation.

Balance Exercises

Photo of a wobble board.
A wobble board can provide an unsteady surface on which to perform balance exercises. Rollover/Getty Images

After any joint replacement like a total hip or total knee arthroplasty, you may notice that your balance and awareness of the position of your joint is diminished. This is natural, and your PT can help you improve your sense of awareness with your new hip by prescribing balance and proprioception exercises.

Balance exercises to do after total hip replacement may include the single leg stance, the T-Stance, or the tandem stance or walk. Any double leg or single leg balance activity can be made more challenging by standing on a pillow or soft surface. A BAPS Board may be used in the PT clinic to improve proprioception.

A word of caution: balance exercises require you to create situations where you may be unsteady. Safety must be first and foremost on your mind; any balance exercise must be done with care to prevent falls.

Aerobic Exercise

Photo of active older couple riding bicycles.
Riding a bicycle can help improe aerobic capacity after toal hip artroplasty. Paul Bradbury/Getty Images

After your total hip replacement operation, you may notice that your endurance has suffered a bit while you were recuperating. To regain your aerobic endurance, your PT may prescribe exercises that challenge your cardiorespiratory system.

Aerobic exercises that you may do after your total hip replacement may include treadmill walking, stair climbing, or riding a bicycle. Remember, when biking the seat should be adjusted properly so you maintain total hip precautions. Your physical therapist can help ensure that your seat is adjusted to the right height for your condition.

A total hip replacement is a major operation that may require significant rehab after the surgery. Your physical therapist will likely prescribe exercises, like the ones in this step-by-step guide, to help improve your functional mobility after the operation.

If you have had a total hip replacement, speak with your doctor and PT to see which exercises are right for you to do so you can quickly and safely return to your previous level of activity.

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