Physiotherapy: getting stronger, step by step

Physiotherapy doesn't only start playing a role after surgery. For symptoms such as FAI, exercise therapy is often the first treatment, well before any surgery is even discussed. For some people, this is already enough. You can arrange a short introductory session with the physiotherapist before surgery: a useful way to map out your mobility and strength beforehand and to practise using crutches.

While you're still on the ward, the physiotherapist will already visit you to give the first instructions. Before you leave the clinic, a nurse will teach you how to stand up and walk safely with crutches. Exercise therapy with your own physiotherapist usually starts within a few days of the operation.

In this phase, rest and protecting the joint come first. You'll walk with two crutches at first, but most people can bear full weight on the hip straight away — the crutches are mainly there to support your balance, not to limit weight-bearing. You'll reduce from two crutches to one, and eventually to none, once you can walk steadily and without a limp. Lots of hip rotation and prolonged sitting (longer than 2 hours at a stretch) are still avoided; deep flexion is allowed, but take care beyond 90 degrees.

One thing to note: straight after surgery, the hip flexor muscle (the iliopsoas) is particularly sensitive. Exercises that place heavy load on this muscle, such as lifting a straight leg, are deliberately skipped in this phase.

Guideline for moving on to the next phase (usually after 4 to 6 weeks): walking steadily without crutches, climbing stairs without aids, and a short, shallow squat without much pain.

The load from daily activities and work is built up further, and the focus shifts to building strength around the hip. Around week 8, you'll have a follow-up appointment with your orthopaedic surgeon. Heavy strength training is still avoided until 3 months after the operation.

Guideline for moving on to the next phase (usually after 8 to 12 weeks): walking steadily and symmetrically without crutches, being able to stand on one leg for 30 seconds, and having the same hip mobility as before the operation.

You now build strength and stamina in a more targeted way, and take the first steps towards heavier work or sport, where applicable. Demanding exercises such as deep squats or training with a lot of added weight are still avoided until 12 weeks after the operation.

The final phase is tailored to your particular sport or activity. On average, you'll need around 9 months to return to your previous level of sport, although this varies considerably from person to person: an endurance athlete is often ready for this phase sooner than someone who takes part in an explosive contact sport. Building up something like running, for example, follows a gradual schedule over several weeks, with progressively longer running intervals.

There are no fixed thresholds that apply to everyone for the exact moment of return to sport. Your physiotherapist therefore mainly watches for three things as training is built up: sufficient mobility, pain-free movement, and no increasing stiffness around the hip after a training session. You're also welcome to discuss how you feel psychologically about returning — for example, anxiety about a new injury — with your physiotherapist.

The timeframes above are averages, not fixed deadlines. Exactly what was treated during your operation, how your body responds, and your personal goals all help determine the pace. Your physiotherapist adjusts your programme based on pain, swelling and recovery, in consultation with your orthopaedic surgeon.

Would you like to see the full rehabilitation protocol, with week-by-week exercise schedules and the tests used for return to sport? This is available as a download — useful to discuss with your physiotherapist too.