IN SHORT
A hip fracture can lead to significant weakness in the affected leg, making walking, standing, and everyday activities more difficult - even after surgery to repair the broken bone.
Recovery involves more than bone healing. Time spent in bed or a chair can weaken the muscles needed to stand, walk, and move safely. Rebuilding leg strength, balance, and endurance takes time and consistent exercise.
An individualized strengthening program that follows the surgeon's weight-bearing instructions can help older adults regain mobility, improve everyday function, and work toward greater independence - even after Medicare-covered physical therapy ends.
A hip fracture can change everyday life in an instant. Getting out of bed, standing from a chair, or walking to the bathroom may suddenly become painful and difficult.
Even after surgery, rebuilding the strength, balance, and endurance needed for everyday activities takes time. Regaining independence involves more than healing the bone. It also means rebuilding the strength needed to move with greater confidence.
Understanding Hip Fractures and ORIF in Older Adults
A hip fracture is a break in the upper portion of the thighbone (femur), near the hip joint. In older adults, these fractures often happen after a fall, particularly when osteoporosis has weakened the bones.
ORIF stands for open reduction and internal fixation. During this procedure, a surgeon repositions the broken bone and uses hardware, such as screws, plates, or rods, to hold it in place while it heals.
ORIF is used for certain types of hip fractures. Other fractures may require a partial or total hip replacement. This article focuses on recovery after hip fracture repair with internal fixation.
Why Weight-Bearing Instructions Matter
After surgery, some people are allowed to put weight through the affected leg as tolerated. Others may have restrictions based on the fracture and the stability of the repair.
These instructions guide when and how standing, walking, and strengthening exercises begin. A physical therapist should follow the surgeon's weight-bearing guidance and adjust the exercise program as recovery progresses.
Why Hip Fractures Lead to Leg Weakness
A hip fracture can make standing and walking painful and difficult. After surgery, a person may spend more time in bed or a chair, walk less, and stop their usual exercise routines.
When activity decreases, muscles can weaken quickly. The hips, thighs, glutes, and calves may lose strength, making everyday movements increasingly challenging.
These muscles help support the body during standing, walking, and transfers. When they become weaker, getting up from a chair may require more effort. Walking may become slower and less steady, and everyday activities may begin to require help from a family member or caregiver.
This creates a difficult cycle: pain makes movement harder, reduced activity contributes to weakness, and weakness makes everyday movement even more challenging.
Breaking that cycle requires a gradual, individualized approach to rebuilding strength and mobility as healing allows.
Why Walking Alone May Not Be Enough After a Hip Fracture
After hip fracture surgery, walking helps maintain endurance, but it may not provide enough resistance to rebuild weakened leg muscles. Reduced activity during recovery can lead to further strength loss, making standing, climbing stairs, and walking more difficult.
Progressive strength training helps rebuild the leg strength needed for everyday movement, while balance training supports safer mobility. A walker or wheelchair may still be necessary during recovery, depending on the person's abilities and medical guidance.
Learn why walking alone may not protect leg strength and how targeted strength training helps older adults maintain independence.
Read more: [Walking Doesn't Keep You Walking: Why Leg Strength Matters as We Age]
Exercise After Hip Fracture Surgery Must Be Individualized
Many older adults become afraid to exercise after a hip fracture. They may worry that moving too much will damage the surgical repair or cause another fracture.
That fear is understandable, especially when movement has been painful. However, prolonged inactivity can contribute to muscle weakness, reduced endurance, and greater difficulty with everyday activities.
The right exercise program depends on the fracture, surgical repair, healing progress, weight-bearing instructions, and the person's overall health.
A physical therapist can help determine which exercises are appropriate and how to progress safely. An individualized program may include exercises performed lying down or seated, followed by standing, balance, and walking activities as the person's abilities and medical guidance allow.
The goal is not to push through pain or rush recovery. It is to gradually rebuild strength while protecting the healing bone and surgical repair.
Why Recovery May Continue After Medicare Therapy Ends
After hip fracture surgery, Medicare-covered physical therapy helps older adults regain strength and mobility. But therapy can end while a loved one is still struggling to walk, stand from a chair, or manage everyday activities.
Healing the fracture does not automatically restore the leg strength, balance, and endurance lost during recovery. The end of Medicare-covered therapy does not necessarily mean recovery is complete.
Read the full article to understand why Medicare therapy can end while your loved one still needs help and what options may be available for continued strengthening and recovery.
Read more: [Medicare Physical Therapy Ended. What Happens Now?]
Bone Health and Preventing Future Fractures
Many hip fractures in older adults occur after a fall or relatively minor injury, particularly when osteoporosis has weakened the bones.
A hip fracture may be an opportunity to discuss bone health with a healthcare provider. An osteoporosis evaluation, fracture-risk assessment, and fall-prevention strategies may help reduce the risk of future fractures. Factors such as leg strength, balance, medications, vision, and safety around the home may also need attention.
Building Strength Takes Time After a Hip Fracture
Recovering from a hip fracture takes time. Healing the bone and rebuilding leg strength are different processes. Even after the fracture has healed, an older adult may still struggle with standing from a chair, climbing stairs, or getting in and out of the shower.
Walking again does not mean the affected leg has regained the strength needed for independent living. Reduced activity during recovery can lead to significant muscle weakness. Rebuilding strength, balance, and endurance takes consistent exercise and progressively challenging strengthening activities.
Progress may take several months or longer, depending on the fracture, surgical repair, overall health, and activity level before the injury.
Read the full article to learn why rebuilding strength takes time, what affects recovery, and why walking again is only part of the process.
Read more: [Why Does Regaining Function Take 6-12 Months?]
Frequently Asked Questions
How can I help my parent regain strength after hip fracture surgery?
Talk with their healthcare provider about what movement and exercise are appropriate for their stage of healing and weight-bearing instructions. A physical therapist can assess strength, balance, and mobility and develop an individualized program to help your parent work toward everyday functional goals.
Why is my parent still having trouble walking after hip fracture surgery?
Healing the bone does not automatically restore the strength lost during a period of reduced activity. Weakness in the hips, thighs, glutes, and calves can make standing, walking, and other daily movements more challenging. Rebuilding strength and balance may help improve physical function.
When can I start strengthening exercises after hip fracture surgery?
The timing depends on the type of fracture, the surgical repair, healing progress, and weight-bearing instructions. A physical therapist can help determine which activities are appropriate within the medical team's guidance.
How long does it take to regain strength after a hip fracture?
Bone healing and regaining strength are different processes. Rebuilding strength, balance, and endurance may take several months or longer. Recovery varies from person to person.
Can I continue physical therapy after Medicare-covered therapy ends?
Yes. Older adults may choose private-pay physical therapy for continued strengthening and balance training after Medicare-covered therapy ends. Tandem Strength & Balance provides individualized, in-home physical therapy to help people continue working toward their functional goals.
How Tandem Strength & Balance® Can Help
For many older adults, the need to build strength continues after the fracture has healed and insurance-covered therapy has ended. Families may still be looking for help with walking, standing, balance, and everyday activities.
Tandem Strength & Balance® provides private-pay, in-home physical therapy focused on functional leg strength, balance, and continued exercise.
With more than 25 years of experience, our physical therapists work one-on-one with each client, developing an individualized program around their abilities and the activities that matter most to them.
Whether the goal is moving around the home with greater confidence or maintaining the ability to live independently, we help clients continue working toward those goals.
Healing the fracture is the beginning. Building strength helps you keep moving forward.
Get Strong. Stay Strong. Stay Independent.
Research References
1. Physical Therapy Management of Older Adults With Hip Fracture: Clinical Practice Guidelines. Journal of Orthopaedic & Sports Physical Therapy, 2021. Recommendations include progressive resistance exercise, balance training, and functional mobility training. Read the guidelines .
2. Clinical Practice Guideline for Postoperative Rehabilitation in Older Patients With Hip Fractures. Annals of Geriatric Medicine and Research, 2021. Reviews rehabilitation approaches following hip fracture surgery. Read the study .
3. Management of Hip Fractures in Older Adults: Evidence-Based Clinical Practice Guideline. American Academy of Orthopaedic Surgeons (AAOS), 2021. Provides recommendations for hip fracture management in older adults. Read the guideline .
4. Hip Fracture: Management. National Institute for Health and Care Excellence (NICE). Recommendations address postoperative mobilization, rehabilitation, and coordinated care after hip fracture. Read the guideline .