Definition
- Restores function after injury, surgery or degenerative disease
- Goal directed and progressive
- Paced by tissue healing and the stability of fixation or reconstruction
Management
Range of motion
- Early motion limits stiffness, adhesions and loss of cartilage nutrition
- Progress from passive to active assisted to active as healing permits
- Continuous passive motion has a limited role
- Protected motion in a brace or safe arc after rotator cuff repair or ligament reconstruction
Strengthening
- Targets disuse atrophy and arthrogenic inhibition, prominent in quadriceps after knee surgery or effusion
- Isometric exercise early and when joint motion is restricted
- Isotonic exercise with concentric and eccentric phases
- Isokinetic exercise at fixed angular velocity, mainly in rehabilitation centres
- Closed chain exercise places less shear on ACL grafts
- Eccentric loading is central to tendinopathy management
Proprioception
- Balance, perturbation and sport specific drills restore neuromuscular control
- Lowers reinjury risk after ankle sprain and knee ligament injury
Weight bearing and gait aids
- Stick held in the hand opposite the affected hip reduces joint reaction force
- Status set by the surgeon, from non weight bearing through touch and partial to full
- Partial weight bearing sometimes quantified with scales
- Early weight bearing as tolerated after hip fracture fixation and arthroplasty in older patients
- Older patients often cannot comply with restrictions
Modalities
- Hydrotherapy unloads joints once wounds have healed
- Cryotherapy and compression control pain and swelling
- Heat, ultrasound and electrotherapy have limited supporting evidence
- Neuromuscular electrical stimulation assists quadriceps activation
- Bracing, taping and orthoses
Prehabilitation
- Preoperative exercise and education before arthroplasty and ligament reconstruction
- Full range of motion and a quiet knee before ACL reconstruction lowers arthrofibrosis risk
Enhanced recovery
- ERAS combines education, opioid sparing analgesia, local infiltration and tranexamic acid
- Mobilisation on the day of surgery and planned discharge
- Shortens arthroplasty length of stay without more complications or readmissions
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.