Physiotherapy Tips for Hip Fracture Rehabilitation in Older Adults

Laura Mejía Zapata is a physical therapist at the María Cano University Foundation in Medellín, Colombia. She also earned a master's degree in Geriatric Physiotherapy from the CEU Cardenal Herrera University in Valencia, Spain.

Below, he will provide us with a valuable contribution on the protocol for hip fracture rehabilitation in the elderly, which, unfortunately, is one of the most common causes of immobility and disability in the elderly.

 Why is hip fracture a common injury in older adults?

In old age, people are at greater risk of hip fractures because bones tend to weaken over the years due to osteoporosis.

Other factors, along with osteoporosis, can also cause hip fractures. For example, medication use, poor vision, balance problems, and reduced mobility, among others.

That's why it's so important to educate yourself on how to prevent falls in older adults , and thus avoid dangerous accidents that could leave them disabled. 

Having said all this, let's go with Laura Mejía Zapata, who points out that rehabilitation after hip surgery is divided into 3 phases:

First phase of hip rehabilitation

It lasts 21 days and aims to:

1. The first two days will be spent in the hospital, and the patient will be discharged provided there are no post-surgery complications.
2. The first few days will also be dedicated to reducing pain and inflammation through ice, elevation, and rest.
3. Once this first phase is advanced, gait retraining will begin, and the scar will be cared for by performing muscle-strengthening exercises.

Exercises for this phase:

1. Walking with a walker:

First using the operated leg and then the healthy one. (This is for beginners.)

2. In more advanced people, crutches will be used :

You will walk with them for 2 minutes, making sure to place the crutch on the arm opposite the operated leg.

3. Mobility exercises with Functional Elastic Band:

• Hip flexions will be performed with your own body weight.
• With your back straight, firmly support the operated leg and help support your weight with the opposite leg.
• In a seated position, the elastic band will be placed on the foot and the hip will be flexed with the knee bent.
• In a horizontal position with an elastic band on the thigh, the leg will be flexed and stretched.

4. Pilates ball exercises:

• In a horizontal position, with your legs on the Pilates ball, you will flex and stretch, moving the ball inwards and outwards.
• In a horizontal position, place the ball between both legs and ankles. Raise both legs and rest. (This exercise can be performed twice a day: morning and night.)

5. Muscle strengthening exercises to prevent muscle atrophy:

• In a horizontal position, raise the operated leg and hold it in the air for a few seconds, then rest. Ideally, do 3 sets of 10 repetitions. Hold the raised leg for 10 seconds.
• Abduction exercises: In a seated position, place the elastic band between both legs and gently open and close them. Perform three sets of 10 seconds.
• Adduction exercises: In a seated position with your knees bent, place a medium-sized ball between your legs and try to squash it for 10 seconds, then rest. Three sets of 10 seconds each are recommended.
• Using two crutches for support, raise your healthy leg and shift your weight onto the operated leg. Try to stay in this position for three seconds before resting and changing feet. Try to keep your hip firm without letting it roll over. Recommended number of sets: 10 in the morning and 10 in the afternoon.
• Possible amount of exercise: 2 times a day
• Duration: 20 minutes
• 15 minutes of ice after performing the exercises

General precautions to take after hip surgery

• You should not cross your legs for any reason during the first year after surgery, not even while sleeping.
• Do not sleep on the affected side, but rather with your legs parallel with a cushion in between to avoid bad posture and increased pain.
• If you are going to sleep on your back, the affected leg should be elevated with a pillow or towel to prevent external rotation, which can damage the surgery.
• To go up and down the stairs, you should hold onto the handrail. First, raise your good leg, then your affected leg. To go down, do the same, but in reverse, to cushion the weight of the descent.

How to care for the scar after surgery?

To prevent joint mobility from being affected after hip surgery, adhesions to the skin should be avoided starting two weeks after the stitches are removed.

It's important to keep it hydrated and perform self-massages. Keep in mind that hip rehabilitation lasts between 6 months and 1 year until the muscle/joint part is fully improved.

Second phase of hip rehabilitation:

It lasts between 21 and 40 days and aims to:

1. Reduce pain and control inflammation
2. Achieve improved joint mobility from 90 to 110 degrees
3. Walking correctly with a crutch

The exercises for this phase will be muscle strengthening.

• Gently self-massage your quadriceps with oil to release muscle tension. Do this in the area near and around the scar.
• An elastic band will be placed on the popliteal area of ​​the operated leg and the leg will be bent and stretched.
• In a horizontal position on your back and using a Pilates ball, bend and stretch your legs.
• In a seated position with a pillow for support, place a 1kg weight on your foot, raise it and lower it in 3 sets of 10 repetitions.
• Isometric bridge: 3 sets of 10 repetitions
• Be aware of your gait: heel, toes, left leg - right arm. Right leg - left arm. Bending your knees.

Care and precautions

• You should sleep with your legs bent and supported by a pillow. Avoid external rotation as much as possible.
• Massage into the scar, around it, and on the sides 3 to 4 times a day. Oil-free to prevent adhesions.

Third phase of hip rehabilitation

It lasts between 6 months and 1 year, and its objectives include:

1. Keep pain and inflammation under control
2. Re-educate walking
3. Strengthen hip muscles
4. Strengthen the hip and knee muscles

 Exercises for this stage

• Flexion-extension of the knee with one's own weight.
• Hip abduction with medium ball.
• In a side position, lift your leg and return to the starting position with both legs together. Start with the affected leg and perform 3 sets of 15 repetitions.
• In the prone position, extend your leg and lower it.
• In the supine position, lift the affected leg and make circles. Rest and change legs.

Hydrotherapy: Alternative Treatments for Phase 3 Hip Rehabilitation

Hydrotherapy offers exercises that can help restore walking more quickly. Since the body is lighter in the water, there is no excessive strain on the joints, and exercises can be performed with greater intensity and variety.

• Walk by taking a step first with the operated leg and then with the other.
• Swim from one side of the pool to the other.
• Lean on the edge of the pool, bend your knee and lift it up
• Ankle plantarflexion from one side of the pool to the other.

All of the exercises described above should always be performed under the supervision of a surgeon, orthopedist, and physical therapist, who will know how to tailor the treatment to each patient individually.

Laura Mejía Zapata's latest recommendations

Each person is different and experiences different outcomes. Full recovery typically takes a year. However, some patients may take less or more time, depending on their age, lifestyle, diet, emotional state, and their support relationships at this stage.

In the case of an older adult, you must be more patient and very creative in creating the treatment to ensure greater adherence to the therapy, and always include the family or caregivers in charge of the older adult.

Because this fracture is one of the most common among the elderly and the one that causes the most disability, we must educate our patients to avoid falls and relapses.

Likewise, helping them work on their balance and proprioception, so they have the best quality of life, or even better, than they had before the accident that caused the fracture and led to surgery.

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