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MSK Rehabilitation, Patient Guide

Post-surgery rehab: knee and hip replacement, ACL and shoulder surgery

Written by Elliot Stubbs, BSc (Hons) Physiotherapy, 13 years in MSK practice. Updated 14 October 2026.

Rehab after orthopaedic surgery usually moves through clear phases: protecting the repair and getting moving in the first weeks, then rebuilding range and strength, then returning to the activities you care about. Your surgeon's and hospital's protocol always comes first, including any precautions you've been given. Private gym-based rehab can sit alongside your NHS physio to add more supervised strength work, not replace it.

What does rehab after surgery actually involve?

Surgery fixes or replaces a structure, but it doesn't rebuild the muscles around it. Afterwards, nearby muscles weaken quickly, joints stiffen and confidence takes a knock. Rehab gets all of that back, at a pace the healing tissue can handle.

Every hospital has its own protocol. It might say how much weight you can put through the leg, how far you're allowed to bend, whether you wear a brace or sling, and when you can drive. A good rehab plan works inside those rules. If anything in this guide differs from what your surgical team told you, follow your team.

The phases of a structured rehab plan

Timings vary a lot between people and procedures, but most plans follow a similar shape:

Early phase (roughly the first few weeks). Managing pain and swelling, looking after the wound, walking with whatever aid you've been given, and gentle exercises to get the muscles working and the joint moving within your limits.
Building phase (often weeks 6 to 12, sometimes longer). Steadily increasing range of movement, weaning off walking aids when your team agrees, and starting proper strength work: sit-to-stands, step-ups, bridges and balance work, progressing as the joint settles.
Return phase (from around three months onwards). Heavier and more specific strength work, longer walks, stairs without thinking about it, and a gradual return to hobbies, work or sport.

Progress, not the calendar: moving to the next phase should depend on what your body can do and what your surgeon allows, not just how many weeks have passed. Some people move faster, many take longer, and both can be normal.

Knee replacement rehab

After a knee replacement, the two big early goals are getting the knee to bend and, just as important, getting it fully straight. Swelling and stiffness are normal for weeks, and the thigh muscle (quadriceps) is usually very weak to begin with.

Many people are walking with a stick or crutches in the first few weeks and managing most everyday tasks within a few months. It's common for the knee to keep improving, and to feel warm or swollen after a busy day, for up to a year or so. Strength work for the thigh, hip and calf helps with walking, stairs and getting up from a low chair.

Hip replacement rehab

Hip replacement rehab focuses on walking well again, strengthening the buttock and thigh muscles, and getting back to stairs, the car and longer walks.

Some surgeons give hip precautions, which are rules about avoiding certain positions, such as bending the hip past a right angle, crossing your legs or twisting, for a set period while the joint settles. Others don't use them. If you've been given precautions, every exercise in your plan should respect them until your surgical team says otherwise. Many people find they can walk without aids within a few weeks to a couple of months, with strength and stamina continuing to build over the following months.

ACL reconstruction and shoulder surgery

ACL reconstruction is a long, staged rehab, and a return to pivoting sports such as football is commonly not considered until around nine months to a year, depending on your surgeon and how you meet strength and movement milestones. Our separate ACL rehab guide covers it in more detail.

Shoulder surgery, such as a rotator cuff repair or stabilisation, often starts with a period in a sling and very controlled movement. Strengthening comes later, and full recovery can take several months or longer.

How private gym-based rehab can complement NHS physio

Your NHS post-op physio plays a key part, especially in the early weeks, and you should keep those appointments. Some people want more supervised strength work, or support once NHS sessions finish and they still aren't back to what they want to do.

That's where private gym-based rehab can help. Sessions here take place in a fully equipped gym with 1:1 guided rehab, so exercises can be progressed properly with real equipment, and you're coached through them rather than handed a sheet. Elliot works full-time in an NHS role assessing complex musculoskeletal conditions, so working within a hospital protocol is familiar ground. Bring any paperwork or exercise sheets from your hospital, and the plan is built around them.

Treatment typically includes:

Progressive strength work matched to your stage and your surgeon's limits.
Range of movement and walking practice, including stairs, kerbs and getting up from the floor where appropriate.
Balance and confidence work, which often lags behind strength.
Manual therapy where it helps you move more comfortably, alongside exercise rather than instead of it.
Activity planning for getting back to walking, gardening, golf or whatever matters to you.

What can you do now?

Do the exercises your hospital gave you, little and often, unless you've been told otherwise.
Keep moving through the day. Short, regular walks usually beat one long one early on.
Take pain relief as advised by your team so you can do your exercises.
Use ice or elevation for swelling if your team has suggested it, and protect the wound.
Write down questions for your next review rather than guessing what's allowed.

When to contact your surgical team or get urgent help

Contact your surgical team or ward urgently, or call 111, if: the wound becomes increasingly red, hot or swollen, leaks fluid or pus, or starts to open; you have a fever or feel generally unwell; you have pain, swelling, warmth or tenderness in your calf, which can be a sign of a blood clot; you have a sudden increase in pain, or the leg or arm looks a different shape or length; or you develop new numbness, tingling or weakness. Call 999 if you are short of breath, have chest pain or cough up blood, as this can mean a clot has reached the lungs. Also call 999 or go to A&E if you can't move the joint or bear weight after a fall or a sudden clunk.

If you're ever unsure whether something is normal, it's always better to ring your hospital team than to wait for a routine appointment.

Post-surgery rehab in Wymondham and Norwich

If you're in Wymondham, Norwich or South Norfolk and recovering from a joint replacement, ACL reconstruction or shoulder surgery, Elliot sees patients at Suggs Gym on Tuesday evenings. No GP referral is needed. You can check the assessment and follow-up prices and book an assessment when your surgical team is happy for you to start additional rehab.

Frequently asked questions

How long does rehab take after a knee replacement?

It varies from person to person. Many people are managing most everyday activities within about three months, but it's common for the knee to keep improving in strength, swelling and comfort for up to a year or so.

Can I have private physio alongside my NHS physio after surgery?

Often, yes. Private gym-based rehab can add more supervised strength work alongside your NHS sessions or carry on after they finish. It should always follow your surgeon's protocol, so it's worth letting your hospital team know and bringing any exercise sheets or precautions to your first session.

When can I start rehab after a hip replacement?

Hospital physio usually starts very soon after the operation, often the same or next day. Additional gym-based rehab is usually best once your wound has healed and your surgical team is happy, and it must follow any hip precautions you've been given.

Is pain normal during rehab after surgery?

Some discomfort during and after exercise is expected and usually settles. Pain that is much worse the next day, steadily increasing swelling, or a sudden jump in pain should be checked with your physio or surgical team.

Do I need a GP referral for post-surgery physio?

No. You can book a private physiotherapy assessment directly. You don't need a GP referral, though it's sensible to check with your surgical team that they're happy for you to start additional rehab.

This guide is general information written by a physiotherapist, not a substitute for individual assessment or the advice of your surgical team. Always follow your surgeon's and hospital's protocol, and if you're unsure about any of the warning signs above, seek medical advice rather than waiting for an appointment.