Recovery
Physiotherapy after surgery: when to start and what to expect at each stage
Knee (ACL), shoulder (rotator cuff), hip or spine: how physiotherapy after surgery works stage by stage, what to bring from your surgeon and which signs to watch for.
Short answer: physiotherapy after surgery (knee, shoulder, hip or spine) happens in stages: first protect what was repaired and manage pain and swelling, then regain mobility, then strength and control, and finally return to your activities. When to start and what is allowed is decided by your surgeon; the physiotherapist works within that protocol and moves from one stage to the next based on criteria (how your body responds), not just the calendar.
Why do physiotherapy after surgery?
Surgery repairs a structure (a ligament, a tendon, a joint, a disc), but function —moving, bearing weight, climbing stairs, raising your arm, getting back to sport or work— is regained through an active process. Physiotherapy aims to:
- Restore range of motion without putting the repair at risk.
- Rebuild strength, control and balance in the area and the rest of the body.
- Give you education: what to do at home, what to avoid and which signs to watch for.
- Support a gradual return to your activities.
The stages of post-operative rehabilitation
The timing of each stage varies a lot depending on the surgery and the person. This table describes goals, not fixed weeks.
| Stage | Main goal | What it usually includes | Criteria to progress (assessed by the team) |
|---|---|---|---|
| 1. Protection | Protect the repair, manage pain and swelling | Education, positioning, gentle permitted movement, muscle activation, use of aids (crutches, sling) as indicated | Pain and swelling under control; surgeon's restrictions respected |
| 2. Mobility | Regain the permitted range of motion | Therapeutic exercise, manual therapy when appropriate, home exercises | Expected range of motion for that phase; walking or arm use without major compensations |
| 3. Strength and control | Rebuild strength, stability and coordination | Progressive loaded exercise, balance, motor control | Enough strength and control, with no adverse reaction when load increases |
| 4. Return to activity | Get back to work, sport or your routines | Exercises specific to your activity, progression of impact or movements | Functional criteria agreed with the medical team and, for sport, clearance from the surgeon |
By type of surgery: what changes
Every surgeon and technique has its own protocol. The following is a general guide; your actual plan is defined at the assessment and with your surgeon's instructions.
Anterior cruciate ligament (ACL) and knee
- Common priorities: controlling swelling, regaining knee extension and flexion, and reactivating the quadriceps.
- Returning to running, jumping or sports with changes of direction is gradual and is decided by strength and control criteria, not by time alone.
- See the service: knee pain and injuries.
Rotator cuff and shoulder
- Tendon repairs need protection time: restrictions on active movement and use of a sling are common, as indicated by the surgeon.
- Mobility and strength are regained in that order, following the protocol.
- See the service: shoulder pain and injuries.
Hip (including hip replacement)
- There may be movement precautions (certain positions to avoid) depending on the surgical approach: ask your surgeon which ones apply to you.
- Work focuses on walking, hip and leg strength, balance and daily activities (sitting down, standing up, climbing stairs).
- See the service: hip pain.
Spine (lower back or neck)
- Instructions vary widely depending on the surgery (decompression, fusion, disc herniation). Follow the load, bending or twisting restrictions you are given.
- The plan usually includes posture and movement education, progressive walking, trunk control and a gradual return to your tasks.
- See the service: back pain and neck pain.
What to bring from your surgeon to the first session
| Document or information | Why it matters |
|---|---|
| Operative report or discharge summary | To know what was repaired and with which technique |
| Surgeon's protocol or instructions | Load and movement restrictions, use of braces or immobilizers |
| Date of surgery and next follow-up | To know which stage you are in |
| Imaging and reports (X-ray, MRI) | Clinical context |
| Current medications | To take pain, anticoagulation or other factors into account |
| Your goals | Work, sport, daily life: where the plan is heading |
Warning signs: contact your doctor without waiting for the next session
- Fever, redness, warmth or discharge from the wound.
- Pain that increases markedly or does not ease with what you were prescribed.
- Swelling, pain and warmth in the calf, or shortness of breath.
- New loss of strength or sensation or, after spine surgery, changes in bladder or bowel control.
- A feeling that something "gave way" or a sudden change in movement.
How we approach post-operative rehabilitation at Esencial
- 60-minute assessment: we review your documents, the surgery, your current condition and your goals.
- Stage-based plan coordinated with your surgeon's instructions: therapeutic exercise as the foundation and manual therapy when it helps.
- Home exercises with follow-up in the patient portal (my exercises).
- Reassessment at each stage: we progress by criteria, with no fixed packages.
More about our approach: integrative physiotherapy in El Poblado.
Frequently asked questions
When should I start physiotherapy after surgery? Your surgeon decides, based on the procedure and how you are doing. In many orthopedic surgeries rehabilitation starts early, but the exact timing and restrictions are set by the medical team; the physiotherapist works within that protocol. Do I need a doctor's referral for post-operative physiotherapy at Esencial? Esencial does not require a referral for private care, but after surgery it is important to bring your surgeon's instructions: type of surgery, load and movement restrictions, and the date of your follow-up. How long does rehabilitation after surgery take? It depends on the type of surgery, the tissue repaired, your condition before surgery and how you respond. That is why we do not give fixed weeks: progress is measured by criteria (pain, swelling, mobility, strength, control) that are reviewed at each reassessment. Is it normal to feel pain during physiotherapy after surgery? There may be mild, controlled discomfort while regaining mobility or strength. Severe pain, pain that gets worse, or pain with fever, redness, wound discharge or marked leg swelling should be checked by your doctor. What should I bring to my first session after surgery? The operative report or discharge summary, your surgeon's instructions and restrictions, relevant imaging or reports, your list of medications, your brace or immobilizer if you use one, and comfortable clothing that allows access to the operated area. Do you treat post-surgical patients in English? Yes. The assessment and sessions can be done in English.
Book your assessment
If you are about to have surgery or have already had it, start with a clear plan. Book your 60-minute assessment via WhatsApp or at /es/agenda. Private, one-to-one (1:1) care at Torre Médica El Tesoro 2, El Poblado, Medellín. We also see patients in English.
This content is for educational purposes and does not replace an assessment by your doctor, surgeon or physiotherapist.
Sources: Law 528 of 1999 (Supersalud legal database); WHO fact sheet "Rehabilitation" (https://www.who.int/es/news-room/fact-sheets/detail/rehabilitation); Esencial FAQ (accessed Nov 4, 2026).