Also called: Broken hip recovery; hip fracture rehabilitation; getting walking again after a hip pinning or half hip replacement
Exercise is the main treatment
Strength
Balance
Stretch
A fall onto thin bone, surgery, then weeks of bed and chair. Muscle is lost at one to two per cent a day in bed, the operated leg is protected and weak, balance confidence collapses - and the osteoporosis and fall risk that caused it are still there.
How common: About 300,000 hip fractures a year in the US, nearly all in people over 65; only about half regain their previous walking ability
What it is
A hip fracture in an older adult is a sentinel event. It signals both low bone density and a fall risk that were present beforehand, and the outcomes reflect that: a substantial proportion of people never return to their previous level of mobility, and mortality in the year afterwards is high.
The good news is that a great deal of the disability is from the deconditioning rather than from the fracture. Extended, progressive rehabilitation continued well beyond the standard period improves function substantially - and the underlying osteoporosis and fall risk are both treatable, which is the part most often left undone.
What it feels like
- The operated leg feeling weak, unreliable and shorter or different
- Needing a frame or sticks where none were needed before
- Real fear of falling again, which limits everything
- Getting out of a chair and climbing stairs having become major undertakings
- Reduced confidence and reduced world - going out less, doing less
What causes it
Most people have more than one of these at once, and they feed each other. Read the
list looking for the two or three that sound like your week rather than for the one
true answer — the ones that describe you are the ones worth acting on.
- Rapid muscle loss during the hospital stay
- Bed rest costs muscle at one to two per cent a day, and an older person having surgery is also inflamed and often eating poorly. A week in bed produces a step change in strength.
- Protective weight bearing on the operated leg
- Understandably, people avoid loading the operated side. That avoidance produces a persistent strength and confidence deficit that lasts long after healing.
- Pre-existing weakness and frailty
- Most hip fractures happen to people who were already losing strength and balance. The fracture reveals that, it does not create it.
- Loss of balance confidence
- Fear of falling after a fracture is near-universal and it independently predicts poorer recovery. It shortens the stride, reduces activity and increases the risk of the next fall.
- Untreated osteoporosis
- The bone was thin enough to break from a standing fall and it still is. A large proportion of people never receive bone treatment after a hip fracture, which leaves the risk of the next one unchanged.
- The fall risk factors that are still present
- Medications, vision, home hazards, orthostatic hypotension. Whatever caused the fall is generally still there unless someone has looked.
- Rehabilitation ending too soon
- Standard rehabilitation typically ends within weeks. Extended progressive programmes continued for six months or more produce substantially better function.
- Poor nutrition and low protein
- Appetite is poor after surgery and requirements are raised. Protein and energy supplementation improves outcomes in this group specifically.
- Cognitive impairment and delirium
- Delirium is common after hip fracture surgery and is associated with worse rehabilitation outcomes. It is often preventable and treatable and is worth watching for.
- Vitamin D deficiency
- Common in this population, associated with muscle weakness and falls, easily corrected.
Who tends to get it
- Anyone who has had a hip fracture, particularly over seventy-five
- People whose osteoporosis has not been treated afterwards
- Anyone who was already frail, weak or falling before the fracture
- People with cognitive impairment, in whom outcomes are poorer
- Anyone whose rehabilitation ended within a few weeks
What makes it worse, and what settles it
Makes it worse
- Stopping rehabilitation when the standard programme ends
- Avoiding weight bearing on the operated leg beyond what was advised
- Sitting for most of the day at home, which continues the deconditioning
- Leaving osteoporosis untreated, which leaves the next fracture on the table
- Not reviewing the medications and hazards that contributed to the fall
Settles it
- Extended progressive resistance training continued for six months or more, which improves function well beyond standard care
- Balance training, which addresses the other half of the fall risk
- Practising getting up from the floor and from a chair specifically
- Getting osteoporosis assessed and treated - this is the step most often missed
- A falls assessment covering medications, vision, blood pressure on standing and home hazards
What actually helps
The short version: A fall onto thin bone, then surgery, then weeks of bed and chair. Muscle is lost at 1-2% a day in bed, the operated leg is protected and weak, balance confidence collapses, and the underlying osteoporosis and fall risk that caused it are still there
Strength work: Chair Workout - seated sit-to-stand, marching and heel-toe raises from the first days home; Walking with the frame or stick as prescribed, a little further each day; Legs: Quads; Glutes: Max; Glutes: Med - the muscle that stops the hip dropping when you step; Legs: Calves: Gastrocnemius; Full Body later
Stretching: Hips: Flexors - gently, respecting any hip precautions; Legs: Calves; Feet, Toes, Ankles
Massage: Scars & Adhesions once healed; Legs for heaviness; never the calf if it is swollen or painful
Also worth doing: Follow the surgeon's weight-bearing and movement precautions exactly; protein at every meal and a nutrition review; a bone medicine and a bone density scan - a hip fracture is a diagnosis of osteoporosis; a home hazard check; keep going for a year, not six weeks
What the evidence says: Systematic reviews and randomized trials show home-based, progressive exercise continued after formal rehabilitation ends improves walking, mobility, independence and fear of falling after hip fracture, and a year-long home program restored mobility to prefracture levels in a randomized trial. The standard six weeks of therapy is where most people stop, and it is too short.
The names above are the Targets qFIT tracks —
the Muscle Guide explains what each one does, and
Quick Add switches on the Exercises you
already have.
The qFIT routine for this
Ready-made routineComeback: After Illness, Surgery or a Cast
qFIT already has this one built. It runs massage first, then stretching, then
strength — the order that works on a body that is already sore — and every
activity in it carries the reason it is there.
The button below opens your Checklist with this routine already selected, so instead
of your whole list you land on just its Categories, Targets
and Exercises, each with its checkbox, ready to tick as you work through
them.
Have more than one problem? Tick yours under My Problems on
My Profile and your Checklist's Routine list gains
Recommended for my problems — every routine for the problems you picked, merged
into one. Your picks stay private; that filter is the only thing they feed.
Get it checked if…
Calf pain or swelling, chest pain or breathlessness - clot until proven otherwise; wound redness, discharge or fever; sudden new hip pain, a leg that looks shorter or turned out, or a clunk - the fixation may have failed
And whatever the body part: chest pain or unusual breathlessness on
exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and
unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or
one calf that is swollen, warm and painful. Any of those, stop and get assessed.
How it usually goes
Recovery takes six to twelve months and extended progressive training makes a large difference to where it ends up - the difference between walking independently and needing help is often the difference between six weeks of rehabilitation and six months. Treating the osteoporosis substantially reduces the risk of the next fracture and is the single most under-delivered part of hip fracture care. Both halves are worth asking for explicitly rather than waiting to be offered.
Prevalence basis: CDC hip fracture data; hip fracture outcome cohorts
Others the same routine covers
These share the Comeback: After Illness, Surgery or a Cast routine, so the work is the same. If one of them also
sounds like you, that is a reason to expect more from it, not less.
This is general information, not a diagnosis, and it cannot examine you.
If it matches you, use it to ask better questions of a clinician rather than to replace one.