Physio after surgery: what to expect, stage by stage

The early weeks: protect, move and settle the swelling

The first stage is about recovering from the operation itself. After a hip or knee replacement, nurses and physiotherapists usually help you get up and walk soon after surgery, with crutches or a frame at first (NHS, 2024). Most people go home within 1 to 4 days of a knee replacement (NHS, 2026a) and 1 to 3 days of a hip replacement (NHS, 2024). After ACL reconstruction, most people go home the same day (NHS, 2025a).

Before you leave, NICE says you should be given advice on your rehabilitation. That might be a home exercise plan, or supervised group or one to one outpatient sessions if you need them (NICE, 2020). The NHS is clear that doing these exercises early helps long term strength and movement in the joint (NHS, 2024; NHS, 2026a).

In this stage the goals are simple: walk little and often, keep the swelling down, get the joint moving within the limits you have been given, and use your walking aids properly. After ACL surgery, for example, getting the knee fully straight is an early priority, and one NHS rehab leaflet aims for this within 3 weeks (Chelsea and Westminster Hospital NHS Foundation Trust, 2024).

Physio after surgery: typical timeframes for common operations

These figures come from NHS guidance. Everyone recovers at a different rate, and your own surgical team's advice overrides anything here.

Sources: NHS (2024; 2025a; 2026a) and Chelsea and Westminster Hospital NHS Foundation Trust (2024).

Physiotherapy after knee replacement

The NHS advises keeping the leg raised to reduce swelling, not sleeping with a pillow under the knee, not kneeling on the new knee until your doctor says you can, and avoiding heavy household jobs such as vacuuming or carrying shopping for the first 3 months (NHS, 2026a). Getting the knee to bend and straighten is a big part of early rehab, which is why the exercises matter so much.

Physio after hip replacement

Many people are given hip precautions, such as not bending the hip past 90 degrees, not crossing the legs, avoiding low chairs and not lifting heavy objects until told it is safe (NHS, 2024). A Royal College of Surgeons recovery guide suggests that by around 12 weeks, sports such as golf and tennis may be possible (Royal College of Surgeons of England, n.d.). Check this with your surgeon first.

Rehab after ACL surgery

ACL rehab is the longest of the three. The NHS says you will usually have regular physio for a few months and that it can take up to a year to play sport again (NHS, 2025a). One NHS trust's programme describes a minimum of 9 to 12 months of rehab, with static cycling from about 4 weeks, jogging from about 4 months once you pass return to run criteria, and contact sport from 9 months at the earliest, only after passing strength, hop and movement tests. Return to pivoting contact sport averages 12 to 18 months (Chelsea and Westminster Hospital NHS Foundation Trust, 2024). Our ACL rehabilitation follows the same idea: progress is based on what your knee can do, not just the date.

Strengthening and getting back to normal

Once the wound has healed and the swelling is under control, rehab shifts towards strength, balance and confidence. This is where a lot of people stall: walking feels fine, so the exercises stop, but the muscles around the joint are often still weaker than the other side.

A good strengthening stage builds up gradually and is matched to your goal, whether that is the shops, a physical job or five a side football. For people returning to sport, objective testing helps take the guesswork out of when you are ready. We use return to play profiling to measure strength and hop performance against the other leg before clearing someone for training.

Some extra pain and swelling after a harder session is common, but if it keeps building, it is a sign to ease off and tell your physio. The Chelsea and Westminster leaflet describes this kind of swelling and pain as a sign of overload during the loading phases (Chelsea and Westminster Hospital NHS Foundation Trust, 2024).

Why following your surgeon's restrictions matters

Every surgeon and operation is slightly different. A meniscal repair done at the same time as an ACL reconstruction, for example, can mean longer on crutches (Chelsea and Westminster Hospital NHS Foundation Trust, 2024). The type of hip replacement and how it was done can change which precautions apply to you. Your surgeon knows exactly what was done inside the joint, so their limits on weight bearing, bending, bracing and driving come first.

A private physio should work within those limits, not around them. If you think you are ready to do more, ask your surgical team rather than pushing ahead on your own.

Private physio after an NHS operation: when to start and what to bring

You don't have to choose between NHS and private physio. Some people use private sessions alongside their NHS rehab for extra support, and others come to us once their NHS sessions have ended but they are not yet back to what they want to do. If you are still under NHS physio, let both physios know so the plans don't clash.

There is no single right time to start. Rehab begins in hospital and the early weeks should follow your discharge plan. A private assessment can help at any point after that, particularly if progress has stalled or you have a specific goal.

To get the most from your first appointment, bring:

• Your discharge letter or operation note, if you have one
• Any rehab protocol, exercise sheet or restrictions from your surgeon or hospital physio
• Dates of your operation and any upcoming follow-up appointments
• A list of the medicines you take, including any blood thinners
• Shorts or loose clothing so we can see the joint and the wound area
• Your walking aids or brace, if you are still using them

Frequently asked questions

When should I start physio after surgery?

Physio usually starts in hospital soon after your operation, and before you go home you should be given advice on exercises and rehabilitation. The NHS says doing these exercises early helps long term strength and movement. A private physio assessment can be useful at any point after discharge, especially if progress has stalled, but the early weeks should follow the plan your hospital team gave you.

How long does physio take after a knee replacement?

The NHS says it may take several months or longer to fully recover from a knee replacement. Most people use crutches or sticks at first and can try walking without an aid from about 6 weeks. Driving is usually at least 6 weeks after a total knee replacement, and returning to work is usually about 6 to 12 weeks, depending on your job.

How long after a hip replacement can I drive and go back to work?

NHS guidance says to wait at least 6 weeks before driving and to check with your doctor that you are fit to drive. Most people return to work after about 6 weeks, although a physically demanding job may take longer. Overall recovery usually takes several months, and you should follow any hip precautions your surgeon gave you.

How long is rehab after ACL surgery?

ACL rehab is long. The NHS says you will usually have regular physio for a few months and that it can take up to a year to play sport again. One NHS trust describes at least 9 to 12 months of rehab, with jogging from about 4 months and contact sport from 9 months at the earliest, only after passing strength, hop and movement tests.

Can I have private physio after an NHS operation?

Yes. You can have private physio alongside your NHS rehab or after your NHS sessions have finished. At The Treatment Table you don't need a GP referral, and the first assessment is £45. Bring your discharge letter and any rehab protocol or restrictions from your surgeon, and let both physios know so your plans work together rather than clash.