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Rehabilitation After a Hip Fracture

By Alex Moroz, MD, Associate Professor of Rehabilitation Medicine, Vice Chair of Education, and Residency Program Director, New York University School of Medicine

Rehabilitation is begun as soon as possible after hip fracture surgery, often within a day. The initial goals are to help people retain the level of strength they had before the fracture (by keeping them mobile and by preventing loss of muscle tone) and to prevent problems that result from bed rest. The ultimate goal is to restore their ability to walk as well as they were able to before the fracture.

As soon as possible, sometimes within hours of surgery, people are encouraged to sit in a chair. Sitting reduces the risk of pressure sores and blood clots and eases the transition to standing. They are taught to do daily exercises to strengthen the trunk and arm muscles and are sometimes taught exercises to strengthen the large muscles of both legs. Usually within the first day after surgery, they are encouraged to stand on the uninjured leg, often with the assistance of another person or while holding onto a chair or a bed rail. While doing these exercises, people are directed to touch only the tips of the toes of the injured leg to the floor. Putting their full weight on the injured leg is often encouraged on the second day after surgery but depends on the kind of fracture and repair.

Just the Right Height

For people who are recovering from a leg injury or surgery, using a cane that is the correct height is important. A cane that is too long or too short can cause low back pain, poor posture, and instability. The cane should be held on the side opposite the injured leg.

Ambulation (walking) exercises are started after 4 to 8 days as long as people can bear full weight on the injured leg without discomfort and can balance well enough. Stair-climbing exercises are started soon after walking is resumed. In addition, people may be taught how to use a cane or another assistive device and how to reduce the risk of falls.

For some months (usually 1 to 3) after discharge, measures are needed to prevent injury. People should do daily exercises to strengthen the muscles of the affected leg and the torso. They are advised not to lift or push heavy objects or sit in a chair for long periods of time and not to stoop, reach, or jump. When sitting, they should not cross their legs. Occupational therapists teach people how to do their daily activities safely while their hip is healing. For example, people should keep their hip aligned correctly (not twisted), sit on a high stool when washing dishes or ironing, and use long-handled devices (such as reachers and long-handled shoe horns) so that they do not have to bend over often. Even after the hip has healed, they are advised to avoid some sports and strenuous activities.

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