A Physiotherapy Plan After Fracture or Surgery

Principles of recovery

• Early, safe movement is usually better than prolonged rest, as directed by the team.
• Protect the healing bone or joint: follow weight-bearing and movement restrictions exactly. Weight-bearing instructions (for example, "touch down," "partial" or "full") and positions to avoid (after a hip replacement, for instance) matter.
• Progress gradually: increase time, distance, repetitions or resistance a little at a time, not all at once.
• Little and often: several short sessions a day are better than one long one for an older body.
• Mild muscle ache is expected; sharp, severe or increasing pain, swelling or a "wrong" feeling is not.

Before you start: questions for the surgeon and physiotherapist

• What exactly was done, and how long will healing take?
• How much weight can go through the limb, and for how long?
• Which movements and positions must I avoid?
• Which exercises should we do now, how often, and when will they progress?
• Which walking aid is best and when can it change? See walking frame after hip or knee surgery and stick or walker: which one does my parent need.
• How should we manage swelling, wound care and bathing?
• What will recovery look like at two weeks, six weeks and three months?
• When can my parent climb stairs, sit on the floor, travel, return to prayer or hobbies?
• What signs mean we should call you or go to hospital?
• Do we need physiotherapy at home, in a clinic or online?

Ask the physiotherapist to demonstrate each exercise and to watch your parent doing it; ask for a written or video plan; see preparing for a doctor's visit with a parent.

Typical stages

Timelines vary with the injury, operation, age and health.

### Stage 1: The first days (in hospital or just after discharge)

Goals: protect the area, control pain and swelling, prevent complications, begin to get up. - Breathing exercises and gentle coughing to keep the chest clear; see breathlessness: positions and breathing techniques that help. - Ankle pumps and circulation exercises every hour while awake to reduce clot risk. - Gentle muscle activation of the thigh and buttock, as taught. - Bed mobility: turning, sitting up and moving to the bed edge, the safe way; see bed transfer techniques, how to lift and transfer safely and bed height and getting out of bed. - Sitting out in a firm chair, and standing with the walker and help, as allowed; see helping an elderly parent stand from a chair. - Short walks to the toilet and around the room, with support. - Positioning: pillows and supports to maintain safe positions; see positioning a bedridden parent and leg elevation pillow guide.

### Stage 2: The first weeks at home

Goals: safe independence in basic activities, regaining range of motion and walking. - Daily routine: wake, wash, dress, walk, eat, rest, exercise, rest, walk, with exercises spread through the day. - Range of motion exercises of nearby joints, within limits. - Strengthening: simple sit-to-stand from a firm chair with arms (if allowed), leg raises, hip and knee exercises, and arm strengthening for walking aids; see resistance band routine for seniors. - Walking practice: short distances several times a day, with the aid, in a clear, well-lit path; increase gradually; see how to use a walking frame correctly and walking frame buying guide. - Seated cycling on a pedal exerciser for knee and hip motion and endurance, when allowed; see pedal exerciser after surgery and pedal exerciser guide. - Daily tasks: practise using the toilet, shower chair, stairs (if needed) and dressing with aids; see after hip surgery: bathroom setup, dressing aid guide and reacher grabber guide.

### Stage 3: Building strength and balance (weeks to months)

Goals: improved strength, endurance, balance and confidence; reduced reliance on aids as advised. - Progressive strengthening with bands, light weights or body weight, as the physiotherapist directs; see strength after 60: how much is enough and dumbbells guide for seniors. - Balance training: standing with feet together, tandem stance, weight shifting, single-leg stance with support; see balance exercises for seniors and balance pad guide. - Walking programme: longer, regular walks on varied surfaces; see walking programme for older adults. - Stairs and steps with a rail, as taught; see stairs, steps and thresholds and using a walking stick on stairs and slopes. - Reducing the aid: from frame to stick, only as the physiotherapist judges; see when to move from stick to walker and how to choose a walking stick.

### Stage 4: Maintenance and return to life

Goals: keep strength and fitness, prevent further falls and fractures, return to valued activities. - Regular exercise: two to three strength sessions and daily walking or similar activity; see exercise at home for seniors: a starter guide and exercise for osteoporosis. - Bone health treatment where indicated; see osteoporosis home care guide.

Safe home exercises: examples

Do only those the physiotherapist has approved for your parent's injury or operation; start with few repetitions, rest between sets, breathe normally (do not hold your breath), and stop if there is sharp pain, dizziness, chest pain or breathlessness.

• Ankle pumps: lying or sitting, move the feet up and down.
• Quadriceps (thigh) squeezes: lying or sitting with the leg straight, tighten the thigh and press the knee down, hold for a few seconds.
• Heel slides: lying on the back, slide the heel toward the buttock and back.
• Sit-to-stand: from a firm chair with arms and a non-slip floor, stand and sit slowly.

Photos or videos from the physiotherapist help with technique. For general stretching principles, see stretching for stiff older bodies and chair exercises for seniors.

Walking aids and home setup

• Use the aid prescribed, fitted to the right height: elbows slightly bent, aid close to the body; see walking stick height fitting, two-wheeled walker guide and rollator buying guide.
• Walk safely: look ahead, not down; take even steps; turn slowly in a circle rather than twisting; avoid wet or uneven floors; see flooring, rugs and trip hazards.
• Home: clear paths, night lights, raised seats, grab bars, a shower chair; see bathroom safety checklist for seniors, grab bar buying guide, shower chair buying guide and motion night lights for seniors.
• Supervision at first for stairs, showers and walking outdoors, and an alert device if alone; see home safety for seniors living alone and panic pendant buying guide.

Pain, swelling and fear

• Pain: some discomfort with exercise is normal, but exercise should not leave your parent in severe pain for hours. Plan exercises when pain relief (as prescribed) is working; tell the team if pain stops progress; see chronic pain in older adults: a whole-person approach.
• Swelling: common for weeks; elevate, move and rest as advised; report sudden or one-sided calf swelling with pain or warmth (possible clot).
• Fear of falling is common and can limit recovery; gradual practice with support, a confident helper and clear goals help; see balance exercises for seniors.

Goals and tracking

• Write goals with your parent, specific and meaningful: "walk to the bathroom alone by two weeks," "climb five steps by six weeks," "visit the temple by three months."
• Track: walking distance or time, sit-to-stand repetitions, pain and swelling, aids used, falls or near-falls, mood; see care diary and handover notes.
• Review with the physiotherapist every one to two weeks at first, and adjust the plan.
• Find the right therapist: a registered physiotherapist experienced with older adults, preferably able to visit home or teach family members; see physiotherapist gait assessment and occupational therapy home assessment.

Red flags: stop and get help

Call 112 or go to hospital for: - Chest pain, sudden breathlessness or coughing blood (possible clot). - A swollen, red, painful calf or thigh. - Fainting or collapse. - A new fall with severe pain, deformity or inability to bear weight. - Heavy bleeding or a wound that opens. - Fever with a hot, red, swollen, pus-draining wound or joint. - Sudden weakness, numbness, speech difficulty or face droop. - New loss of bladder or bowel control after spinal injury or surgery.

Call the surgeon or physiotherapist the same day for: new or worsening pain, new swelling, a clicking or "giving way" sensation, loss of progress, a fall without injury, wound redness or discharge, unusual numbness, or if a movement restriction was accidentally broken.

When to ask a professional

Ask the surgeon about restrictions and healing, a physiotherapist for the exercise plan and aids, an occupational therapist for daily tasks and home changes, a dietician for protein and bone nutrition, and the doctor for pain and bone health. Seek urgent help for red flags.