How soon aftger surgery Can You Resume Physical Therapy?

Undergoing surgery is a significant physiological event that initiates a complex healing process. Whether the procedure is minor or major, the recovery period is marked by cellular repair, inflammation resolution, and gradual tissue regeneration. For many patients, a key question arises: When is it safe to resume hands-on therapies such as physiotherapy or osteopathy after surgery?
This article explores the general phases of post-surgical healing, key considerations for resuming manual therapies, and uses anterior hip replacement—a common orthopaedic surgery—as a practical example.

General Principles of Post-Surgical Healing

Phases of Tissue Healing

The body’s response to surgery closely mirrors its reaction to injury. Healing typically unfolds in three overlapping stages:

1. Inflammation (0–7 days): Cellular debris is cleared, and the immune response prepares the area for repair.

2. Proliferation (7–21 days): New tissue begins forming, including collagen and blood vessels.

3. Remodelling (3 weeks–12 months): Scar tissue matures and strengthens; tissue gradually returns to functional integrity.

Key Factors Affecting Recovery Time

The exact timeline for healing depends on several variables:

• Type and complexity of surgery (e.g., soft tissue vs orthopaedic)

• Age and general health of the patient

• Pre-existing conditions, such as diabetes or autoimmune disorders

• Post-operative care including wound management and rehabilitation

In general, soft tissue procedures tend to heal within 6 to 8 weeks, while major joint surgeries may require 3 to 12 months for full recovery.

When to Resume Manual Therapies Post-Surgery

Manual therapies such as osteopathy and physiotherapy can play an integral role in post-surgical recovery. However, timing is crucial to avoid interfering with healing or causing complications.

Immediate Post-Operative Phase (0–2 weeks)

During this period, treatment should be limited to:

• Wound care

• Pain and inflammation management (under medical supervision)

• Basic breathing and circulation exercises

Manual therapy is generally not appropriate during this early phase unless specifically recommended by the surgical team.

Early Recovery Phase (2–6 weeks)

With medical clearance, gentle, non-invasive interventions can begin:

• Light mobilisation of surrounding areas (not the surgical site)

• Education on posture, movement strategies, and ergonomics

• Addressing compensatory strain in unaffected areas (e.g., spine or opposite limb)

Functional Rehabilitation Phase (6+ weeks)

By this stage, scar tissue is maturing and soft tissues are generally safe to handle. This is typically the point at which:

• Osteopaths may begin targeted treatment around the surgical site

• Joint mobilisation and muscle activation can be safely introduced

• Postural rebalancing and gait retraining become key focus areas

Case Example: Anterior Approach Total Hip Replacement

Overview

Anterior hip replacement is a common orthopaedic procedure in which the hip joint is accessed from the front of the body, allowing for muscle preservation and typically faster recovery. It is increasingly favoured due to:

• Reduced post-operative pain

• Earlier mobility

• Shorter hospital stays

Recovery Timeline

• Day 1–3: Mobilisation begins, often under physiotherapy supervision

• Weeks 1–2: Wound care and walking with aids (e.g., crutches)

• Weeks 3–6: Progressive weight-bearing and movement re-education

• Weeks 6–12: Muscle strengthening and balance restoration

• 3–6 months: Return to regular daily activities and light sport

• 6–12 months: Full recovery and joint integration

When Is Osteopathy Appropriate?

For most patients, osteopathic treatment can begin around the 4–6 week mark, provided there are no complications and the surgical team gives clearance. The focus may include:

• Addressing compensatory strain patterns in the lower back, pelvis, or contralateral hip

• Gently improving range of motion in the recovering hip

• Supporting postural and gait re-training

• Enhancing overall movement quality and reducing stiffness

Conclusion

The timing of manual therapy following surgery must be carefully calibrated to the body’s healing timeline. While each patient’s journey is unique, a general understanding of surgical recovery phases can guide safe and effective care planning. For procedures like anterior hip replacement, osteopathy may be safely reintroduced from 4–6 weeks post-surgery, focusing on holistic restoration of function and well-being.

As always, collaboration between the osteopath, surgeon, and patient is essential to tailor rehabilitation strategies to the individual's recovery pace and needs.

References

1. Khan, F. et al. (2021). Postoperative Rehabilitation After Total Joint Arthroplasty: Evidence-Based Guidelines. Journal of Orthopaedic Research.

2. Menkowitz, T. et al. (2020). Enhanced Recovery After Hip Replacement Surgery: Clinical Pathways and Manual Therapy. International Journal of Orthopaedics.

3. National Institute for Health and Care Excellence (NICE). (2022). Postoperative Care in Adults. London: NICE Guidelines.

4. Mauffrey, C., McGuinness, K., Parsons, N. (2019). The Role of Manual Therapy in Postoperative Recovery: A Review. BMJ Open.