Total Hip Replacement (Posterior Approach) Recovery Exercises – Ask Doctor Jo

Total Hip Replacement (Posterior Approach) Recovery Exercises – Ask Doctor Jo

Hey everybody it’s Doctor Jo, and today I’m going to show you some stretches and exercises for a total hip replacement posterior approach. So let’s get started. So let’s start off by reviewing the precautions that you’re not supposed to do. This, you should not do. So hip flexion past 90 degrees which is about right here, is a no-no. So no bending down to tie your shoes. No bringing your knee up to make that hip bend. You don’t want to go past that 90 degrees because that puts a lot of pressure on that incision site and all those muscles they have to go through to put that replacement in. And you also don’t want to cross your leg over the other leg, so that takes out crossing your legs this way. However a lot of people think that you’re not supposed to do that either, but that’s okay. You’re not going to be able to do that in the beginning, but you’re just not supposed to cross the leg over. That rotating outward is ok, the rotating inwards, that internal rotation this way, is another no-no. That one’s bad as well because again as you can see when I rotate in, it puts pressure that incision. It’s usually about right there, and it’s a big one, so no hip flexion past 90, no adduction across your body, and no internal rotation. Those are the ones that you shouldn’t do. You should wait until you’re clear by your doctor, usually that’s at six to eight weeks, but I would say just don’t do until your doctor says it’s okay. Alright, so I’m going to show you some exercises that are early on some isometric type exercises. These are just to get the muscles activated, but not doing big motions yet. So the first one is just going to be a quad set. For the quad set, you’re activating that quad muscle, squeezing that muscle, but not really making a movement. I like to have a little roll underneath the knee because i feel like it gives you a target. So what you’re trying to do is push that knee down in that roll where you’re squeezing these muscles as tight as you comfortably can for about three to five seconds. If you see my foot, I kind of pulled that up to that activates the calf muscle as well as the quad muscle, just to get those muscles moving. So you might not have that much bend in the knee yet because I think people often forget to, that even though they’re working the hip, all those muscles come down into the knee too, so a lot of times you’re going to have some knee tightness and some knee pain as well. So even if it’s up here, that’s okay just make sure you have a nice squishy rolls so you can push down into it. The next one is going to be a hamstring set. So again make sure that you’re not breaking that hip flexion of 90 degrees, but just prop your knee up a little bit, put your heel down, and what you’re doing is pushing the heel down into the floor, and that’s activating that hamstring muscle. So push down, hold about as much as you can, or as hard as you can for three to five seconds, and then relax. So do about 10 of each of these and then you can start working up your sets and your times holding, but just three to five seconds out there and then relax. After that then you’re going to do glute sets or glutes squeezes, and that’s activating those butt muscles because again that’s right where they could do a lot of that surgery in there, so you want to be able to squeeze those butt muscles. You can do them lying on your stomach or you can just do them sitting down like this, but you’re squeezing in, kinda like you have to go to the bathroom really badly and you’re trying to hold it, three to five seconds, and then relax. Sometimes those muscles don’t want to activate so you, if you want to tap it a little bit when you squeeze, sometimes that helps, but again holding three to five seconds, doing that 10 times. The next one is going to be squeezing into a ball for adduction strengthening. Again make sure you if you want to sit in a chair that might be easier so you don’t break your precautions, but you can do it here as long as it’s comfortable. Take a ball or something, but it’s going to give a little bit but just so your knees are slamming together, and then squeeze in. Give that three to five seconds and then relax, doing about 10 of those. Squeeze, squeeze, and hold and relax. Okay now don’t squeeze to where is painful because these muscles are pretty tender right now, but just squeeze til you feel some tension, and then relax, and then the more you do, then the easier it’ll get, and then you can squeeze a little bit longer. And then the next one is going to be pushing out into abduction. So if you’ve got a belt or some kind of tight rope, this is not those bands, you don’t want it to be a resistive band where it gives way, but you want to be something tight, and then you’re going to push out into the belt with both legs. Almost like you’re opening up like a clamshell or a butterfly, and then three to five seconds for those as well, so just pushing out, and then relaxing. Then you’re gonna do some ankle pumps. Ankle pumps are always good. I like to prop my foot up on something so that heel has room to bend. If you just have it flat, it’s a little bit harder to pump that ankle, but I would say if you only do one exercise the ankle pumps pushing down and pulling up is the most important because what that does is it makes that calf muscle work like a pump and get that fluid out of your leg because even though your surgery’s up here, a lot of times that fluid has nowhere to go when you’re up and moving, and so it goes down into your leg, knee, foot, and then you get that swelling in there. Sometimes that swelling is painful, so just ankle pumps. You can do a lot of these several times a day just pumping up and down, and pumping up and down, and that’s working those muscles helping to work that fluid out there and getting those muscles strong again as well, so again I don’t think you can do too many of these. You don’t wanna make your muscles were they’re so sore you can’t do anything, but you can definitely do a lot more of these throughout the day. And then that also helps make sure you don’t get a blood clot, so very very very important. And the last thing in general is some gate training, and so the important part of that is to make sure that you’re walking with equal weight on both sides, and sometimes that’s really really hard. So what’s important is don’t get off your walker or cane if you can’t walk normally because then that’s going to give you bad habits along the way, so I’ll show you standing up. So for the gait training, when you’re walking normally, your heel hits first and then you roll through on your toes. After a surgery, hip surgery, knee surgery, a lot of times our calf muscle becomes tight and we kind of hit like this, and we don’t hit our heel first and then what that does is that it makes us kind of limp on that leg. So if you’re limping on the leg, you still need an assistive device because if you’re walking around like this, then your muscles are going to get that bad habit. You’re gonna have a really hard time walking normally again. So it’s really hitting the heel first, rolling through the toes, squeeze those butt muscles to keep your hip from popping out, and then step through. If you’re stepping and going over like that, that means those muscles aren’t quite ready yet, so really concentrate on squeezing those hips and butt muscles as you put weight through that leg, so heel toe, step and step through. So even if you have to say “heel, toe, step through,” that’s important because that gait training, that walking normally, is one of the most important parts. So there you have it, those are your stretches and exercises for a total hip replacement posterior approach. If you have any questions, leave them in the comments section. If you’d like check out some other videos, go to And remember, be safe (make sure you follow all those precautions), have fun, and I hope you feel better soon.


  • Judith Williams says:

    I had a knee op and the foot on that side leans in towards the instep so it makes me still limp. When I saw the heel to toe step I immediately tried it. Fantastic. I'm gonna tell my physio about it as she said I may need a built in insole because my foot isn't level. I'm incorporating that step into my exercises I've been given. Thank you😙

  • Ninfa V. says:

    You are Wonder Dr.Jo thanks✌💖nice day:)

  • Lisa says:

    thank you Dr Jo it's very helpful

  • Marrissa Gonzales says:

    thanks for this

  • Tseng Yi chieh says:

    The most useful video yet. Thanks for showing what not to do.

  • uranus aziz says:

    thank you Dr. I had my operation 5 months ago post. approach. What is the beast exorcise to loss weight fast as I'm over weight and I still have muscle weakness

  • gaming king says:

    Hi, i have been operated 13 years ago and i am doing well but i never walked normally, no one can tell me what can i do to avoid limping, do u have any exercice ? Thank u 🙂

  • handyn333 says:

    Thanks for the video the one thing I did not want was a limo unfortunately I had a prosthetic fracture in my inner femor bone 1 week after THR surgery recovery has been hell and it cause meniscus tears in my knee now I have so much weakness I that leg when I put pressure on out out hurts causing more to limp..My hips don't hurt anymore but what can I do about the tears and recovery and strengthen that area. I believe I would be walking fine of out were not for that any advice will give insight… Thank You

  • Nancy Lamb says:

    Hey Jo, how is a post op protocol for a labral tear and FAI repair but not replacement different than what you show here?

  • Tamara Nuthurdei says:

    What would you consider the earliest point to introduce the active (no resistance) side lying clam shell post THA (posterior/lateral approach)? Likewise at what point post THA would you use the theraband resistance during hook lying clam shells (same approach)? 6 weeks? Thanks


    Thanks you this programs

  • zulfiqar ali says:

    I have a question , is adduction activities precaution in both posterior and anterrior approaches​ or just in posterior ?

  • Bamcis100 says:

    Can you do a video for total hip replacement after ANTERIOR approach ?

  • Lissie Walkin says:

    do these exercise apply to a posterior lateral and an anterior lateral approach too?

  • Darth Vapor Lounge says:

    6 day from my surgery and try to make all the exercises…hope thase are good advices….lot of pain for moment!!!! LIKE!!!!

  • Mujahed Shaikh says:

    hip replacement 1 year ago but yet i m not fit yet plz help me and which exercises i do???? & how long time i m not able bike riding

  • Apple Apple says:

    Doctor Jo I got left total hip replacement last May 25, my problem is the LTHR part is clubfoot this exercises fit for me also?

  • Kim Kies says:

    It's not clear whether forward bends and crossing legs, etc. are okay after 6 months post-op. If the doctor says you can do what you want without pain, is it then okay to do any movements including forward bends and yoga, etc.

  • Dave C says:

    Hey Doctor Jo, really good video, I learned a few new things. I'm on day 5 post-surgery so very in-tune with what I need to do and your video definitley helped me. Thanks!

  • Sonia Shukla says:

    had a THR surgery before 1 year still having pain

  • Ibrahim Garyaqaan says:

    Thanks dr jo

  • Marrissa Gonzales says:

    Thanks a lot Dr Jo I undergone a total hips.cementless arthroplasty at my right hips way back sept 16 2014 exactly 3 yrs ,but still i cant walk properly is this one suitable for me,thanks again

  • Der Sonne says:

    I think I had the posterior approach. Anyway how can you lie down on the floor if you've posterior approach since it requires bending down your body? Thanks for the exercises video, really appreciate! 👍🏻

  • St Na says:

    Hi Dr. Jo. My wife, age 53, has had this surgery, Anterior MIS, about 4 ago. She is Ok, except some limbing as the OS explained he used a larger implant beacause he wanted to be Ok for the age of osteoporosis. It makes her feeling bad at the moment, but he promised it will get better. He recomended some orthotics in the shoes for limbing. I suppose she is permitted to do these exercises. But I don't know if there are some exercises to help her in limbing. The OS recommended some movement of the pelvis and also to change the legs when she is standing up. A PT told me that there are some special exercises for bad posture when standing up, in cases like these, but I don't know which ones. I hope you post some exercises for cases like my wife and people who limb, to protect their back from limbing. Thanks! And you are making a great job helping so many people with myoskelet problems, there are so many!!! 🙂

  • Lucinda says:

    Thank you sooo much. Really clear, great information! <3

  • The Prof 28 says:

    Hi I had a double hip replacement 4 weeks ago and I was wondering what your take on walking at this stage, ie amount of times a day?, I'm currently walking with my crutches once a day for about 25 mins, I'm Now ready to get rid of my crutches and begin to walk in aided, my Physio has said if I feel ok then go for it, what do you think?

  • Cours Kiné says:

    hello Dr jo, i sorry for my verry bad english pls, i have some questions pls, about the mouvements in a posterior aproche, can we do mouvement like a lateral rotation? abduction? ans extension? is this 3 mouvements can provoque a dislocation or not if we do them in all the interval of the joint (i mean to the extream like à normal joint )? or we have to do them only for a some degrees?

    my auther question is about the forbiden mouvements, they are forbiden in interval after a surgy or for the entier life?

    thank you so much

  • Lakshmi U says:

    I had it done it on both hips 2 years ago. Don't know how else to decrease my low back pain and the lateral edge of sacrum pain. Can i use tennis ball on my low back?

  • Sleek S says:

    Had my total hip replacement on Dec. 8th 2017. After surgery now I have a foot drop 😣 any solution?

  • Carole Miller says:

    Hi Dr Jo. Your video is extremely helpful. I only wish I had seen it sooner! I was 2 was post surgery ( posterior) & was able to do more weight baring & use a cane. Unfortunately, a few days after my dr visit, I went to pick up a Xmas ornament from a lower table & had a hip displacement. Ouch! The ER was able to get it back in, but obviously I regressed in my recovery. There is not much literature on what to do after a displacement. I have, thus, been fearful to move much. It is 4 weeks since displacement & it seems that I should be doing your recommendations. I am worried that the displacement has negatively impacted on my recovery. I was not referred to PT. I am an active person, but don’t want to overdo now that I feel better & want to follow exercises that will strengthen my gait. I would appreciate any advice from you!
    Thank you so much!

  • Ayela Fizza says:

    Hi my age is 22 and i had my THR 4weeks ago….can u plz show what not to do in future to avoid dislocatiom and can i sit on floor for yoga

  • munazza asghar says: mom is 70 yrs old…her hip ball break…and she is suffereing from cancer too.thats why dr..doing not operate her..kindly tell me excersie for her..that her hip ball again re join

  • Keshav Kedia says:

    what about 2 years those restrictions we still have to follow after 2 years of thr?

  • ezzaldin khalaf says:

    Im afraid of dislocation

  • Ann Kent says:

    Hi Jo
    I'm in the UK and nearly four weeks post op and regularly doing your e,exercises. I'm confused about precautions. Is it ok to bring unoperated leg up towards waist or bend over that leg?

  • Sandro Nunes says:

    How long after the surgery can we try walking without the cane? Is it just a matter of having the muscles ready and holding the weight as you’ve shown? Of there is any precaution we need to have before, like not putting to much weight on the replaced hip…?

  • DoublebubblediscoqueenhAhA says:

    Hi Dr. Jo! Love your videos! I am 48 years old 5 weeks post-op posterior approach. I have a tilted pelvis post-op which makes my operated side feel longer. My doctor said I don’t need PT to just walk. Any exercises you can suggest that could even out my pelvis that doesn’t break my 90 degree restrictions??


    Hyy doctor,
    My father age is about 58 has hip replacement surgery ( hemi aurthoplasty) after operation 2 week they can not walk properly just like foot drop. What to do please advise me

  • Riverside Country Club says:

    Thanks Dr Joe for the info ! I had posterior total hip replacement on my right side. I think everything is prob going well considering my surgery, it's been 17 days today…it kinda feels as if my incision site is tight maybe lil numb. I'm sure it's just my muscles trying to stretch again .,

  • B Thomas says:

    Hi Dr. Can you ever stretch past 90 degrees? For example, is this non flexibility just for the first 3 months or after 1 year?

    Also – have you heard of the biarticulated (tripolar) hip replacement 98%? Seems like you can get much greater flexibility with that replacement. Thank you.

  • Alana Raner says:

    How do you get up and down on the floor, without breaking the 90* angle?

  • Kaleem Muhayuddin says:

    How to conclude that my muscles are much stronger to move the hip joints at any angle if i had bilateral hip replacement? Please answer me as soon as possible.

  • Dee Dolly says:

    Hi guys, I'm 22 and had a total hip replacement exactly a week ago ( last Tuesday ). I'm a stomach sleeper, does this mean I can NEVER sleep on my stomach again?? Or is this just for the recovery stage? Also, I feel as though my operated leg is much longer, advice?? Loved the video

  • Joni LeViness says:

    Hi Dr. Jo, i'm thrilled that i found you on youtube, you're so clear on instructions I'm already feeling a big difference with your cane and gait training instructions.

  • Joni LeViness says:

    As to this video i'm hoping to get an anterior approach, would these exercises be appropriate as well? Or are there better ones? Sx in about 6 to 8 weeks. I've been dealing with this pain since 2009 but really bad for the past 3 to 4 years, I finally went to a surgeon and the x ray shows that my ball is very flat and i've lost 1/2" on my left leg. I've tried a cane sporadically but was doing it wrong. My question is, with the poor muscle use as well as underused will using the cane properly help undo some of the damage i may've already done?

  • Dario Simone says:

    Nice , I like

  • peacheslyn treasure says:

    Hi Doctor am to to a hip replacement surgery this year but am scared that my life will not be normal again I walk with a limp now due to weakness of muscle am also doing physical therapy now please help me with my concern

  • Thony Asinas says:

    hip replacement done 6/7/19 i feel better now

  • Teddy Arthur-cooke says:

    Hello Doctor Jo
    Please I had an Accident on 20th of June 2019 and my surgery was done on 22nd of June 2019 I had a fracture of tigh.
    please doctor Jo my surgery has been 3weeks 5 day which exercise should I strat doing please thank you

  • Nagendra Nandivada says:

    How to treat hip bursitis in patients with partial hip replacement

  • Nagendra Nandivada says:

    I have completed 5 months now and I am limping, I walk with a cane. My X-ray showed bursitis in my right hip which had partial hip replacement.

  • Ishaq Ahmad says:

    I had non operative hip dislocation and reduction without surgery. what precaution for my please guide me. these precautions for life time or limited time.

  • jae_trg'zz7 GONZALEZ says:

    Ive been having pain all over my pubic area and below like for example squeezing something between my thighs will cause it to hurt in different spots which ends up making my legs feel kinda shaky

  • Hans Weichselbaum says:

    Very good video. The best I've come across so far. Thank you!
    I can't seem to find any information on the time span one needs to be careful on non-crossing your legs and the 90° angle restriction. I really would love to reach my toes again. I couldn't touch them for at least three months before the operation!

  • AskDoctorJo says:

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  • Janette Raven says:

    Love you Dr Joe. Just had surgery in NZ, and there is a lot more information here than I was given by the hospital. Do you have any recommendations for very tight psoas? I am 10 days post surgery, walking w normal gait and 1 crutch, mostly for balance, maintaining all exercise w no difficulties.

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