The strength and return-to-activity phase, after your early physiotherapy.
We commonly see patients who have finished their hospital physiotherapy but find the leg still feels weak — the range of movement has returned, yet they are limping, cautious about loading the joint, or have plateaued.
We also see patients before surgery who want to prepare, since the strength carried into a joint replacement affects how quickly function returns afterward (prehabilitation).
Others present wanting to return to a specific activity — walking, golf, hiking, tennis or the gym — and are unsure how hard they are allowed to push, or when.
We also see patients after shoulder replacement, ACL reconstruction, knee arthroscopy and other orthopaedic surgery, where the same prehabilitation-then-strength approach applies.
Many also carry diabetes, osteoporosis or excess weight alongside the joint replacement, all of which affect healing and long-term outcomes.
The acute phase — wound healing, early range of movement, walking aids — is managed by the surgeon and hospital physiotherapist. The phase that follows is where strength has to be rebuilt, and it is often where structured exercise stops: only about half of patients continue after formal rehabilitation ends. We take on that phase, and the prehabilitation before it.
Prehabilitation. The strength carried into surgery predicts how quickly function returns afterward. Prehabilitation improves knee function before surgery and through the first three months after a total knee replacement, and higher-intensity preoperative training improves early functional recovery (Calatayud et al., 2017). Where surgery is 6–12 weeks away, this is the highest-value window to train. Jessica Coombe (AEP) builds a targeted program for the time available.
Rebuilding strength after early physiotherapy. Once range of movement returns, the limiting factor is quadriceps and hip strength, which stay suppressed for months without deliberate loading. We progress from bodyweight to resistance under supervision — enough to rebuild muscle without overloading healing tissue. This is progressive strength work, distinct from the gentle range exercises of the first fortnight.
Staged return to activity. Returning to golf, hiking, tennis or the gym is a graded process with defined load targets, so it is clear what is safe at each stage rather than left to guesswork.
Metabolic and bone factors. Diabetes, osteoporosis and excess weight affect both healing and long-term joint outcomes. Dr Isobelle Smith can manage the metabolic and bone side, and our dietitian Isabelle (Bell) Smith can address protein intake — muscle is rebuilt from it, and low protein is associated with slower recovery.
Early physiotherapy does an essential job — protecting the repair, restoring range of movement, and re-establishing safe walking. It is not designed to rebuild loaded strength or return you to full everyday function; that phase is longer and requires progressive resistance that early rehabilitation does not usually include. The two work together: physiotherapy restores safe movement, and exercise physiology rebuilds strength and returns you to normal daily life. We are happy to coordinate with your surgeon and physiotherapist.
Before surgery if you can — prehabilitation improves recovery. After surgery, we take over once your surgeon and hospital physiotherapist clear you to progress to strengthening, and we work within their restrictions.
Early physiotherapy is essential for protecting the repair and restoring range of movement. It is not designed to rebuild loaded strength or return you to full daily function; that phase is longer and needs progressive resistance. The two work together.
Yes. We work to your surgeon’s post-operative protocol and restrictions, and coordinate with your physiotherapist.
It varies with the joint, the surgery and your starting strength. Range of movement usually returns first, while rebuilding strength and confidence takes longer — this is the phase we focus on, and we set realistic timeframes at your assessment.
No referral is required to book. If you have a chronic condition, your GP may be able to refer you under a chronic disease management plan for a Medicare rebate — ask us and we can explain how it works.
The Endocrine & Wellbeing Clinic
Phone: (02) 9870 3256
Locations: Balmain (inner west Sydney) and Telehealth Australia-wide
Affiliated with: ESSA (Exercise and Sports Science Australia), ANZBMS, Endocrine Society of Australia
This page is not a substitute for individual medical advice. Book a consult for assessment specific to your situation.
All future appointments will be at 100 Elliott Street Balmain 2041
