One of the most common questions people have before and after surgery is when should I start physical therapy and how often should I be going. The answer is not always straightforward because every surgery has its own timeline, tissue healing requirements, and movement restrictions. Understanding these differences can help you recover faster, avoid setbacks, and return to your prior level of function with more confidence.
The most important first step in planning your post surgical physical therapy is communication. Before your surgery even happens, your first phone call should be to your surgeons office or surgical care team. Specifically, you want to ask when patients typically start physical therapy after the type of surgery you are having.
This conversation matters more than most people realize. Your surgeon has already completed imaging, evaluated the extent of tissue damage, and created a detailed surgical plan. Based on that plan, they know when the repaired or reconstructed tissue can safely tolerate the stress that physical therapy introduces. Physical therapy is essential to recovery, but starting too early or too late can impact outcomes.
Why Timing Matters After Surgery
Physical therapy is designed to restore movement, strength, stability, and function. However, healing tissue has limits. The goal is to introduce the right amount of movement and load at the right time.
For some surgeries, early motion is critical to prevent stiffness and loss of function. For others, delaying therapy protects healing tissue and prevents complications.
A great example of early physical therapy is knee surgery such as ACL reconstruction or total knee replacement. In most cases, surgeons recommend starting physical therapy within two to three days after surgery and sometimes even sooner. Early therapy helps prevent excessive stiffness, improves circulation, reduces swelling, and sets the foundation for restoring normal walking and knee motion.
Although there are strict limits on how much load you can place through the knee initially, research consistently shows that patients who begin physical therapy early after ACL or total knee surgery often experience faster recovery, improved range of motion, and better long term outcomes.
On the other hand, surgeries involving the shoulder or total hip replacement often require more healing time before formal physical therapy begins. These areas may need a period of protection to allow surgical tissue to stabilize. Starting therapy too early in these cases can increase swelling, inflammation, and in some cases compromise the surgical repair. Your surgeon will determine when it is appropriate to begin based on the procedure performed and your individual healing response.
How Often Should You Go to Physical Therapy After Surgery
Frequency of physical therapy visits depends on the type and extent of your surgery, your personal goals, and how your body responds to treatment.
For a less extensive surgery such as a meniscectomy, which involves trimming damaged cartilage in the knee, a common plan may include physical therapy two times per week for about three weeks followed by one time per week for another three to four weeks. This typically results in around ten to eleven total visits.
During this time, physical therapy focuses on reducing swelling and inflammation, restoring range of motion, rebuilding strength, and gradually returning you to daily activities and recreational movement.
More complex surgeries such as ACL reconstruction or total knee replacement require a longer commitment to rehabilitation. Many ACL patients attend physical therapy two times per week for approximately three months before transitioning to weekly visits depending on progress. Total knee replacement rehabilitation often follows a similar timeline.
The reason for this extended care is that healing and remodeling of surgical tissue takes time. In the case of ACL reconstruction, the graft must integrate and mature while the surrounding muscles regain strength and coordination. Patients typically do not return to running until around four months post surgery and only if there is no lingering swelling, daily activities are pain free, and dynamic strength testing demonstrates proper knee control.
What to Expect During Post Surgical Physical Therapy
Physical therapy after surgery is not just about exercises. Early sessions often focus on swelling control, pain management, restoring motion, and retraining basic movement such as walking or stair navigation. As healing progresses, therapy shifts toward strength training, balance work, and functional movements that prepare you for real life demands.
Later phases of rehabilitation involve dynamic strength, coordination, and sport or activity specific training. This is especially important for patients returning to running, hiking, skiing, or recreational sports.
Be Your Own Advocate During Recovery
One of the biggest takeaways from this discussion is the importance of being an active participant in your recovery. Ask questions about your surgery, your restrictions, and your rehabilitation timeline. Understanding why certain movements are allowed or restricted helps you stay compliant and confident.
Another key takeaway is being proactive about scheduling your physical therapy. It is strongly recommended to book your physical therapy appointments before your surgery. Waiting until after your surgeon clears you to start therapy can delay care by weeks due to scheduling availability. Those early weeks are critical and delays can slow progress, increase stiffness, and prolong recovery.
Planning Ahead Improves Outcomes
When physical therapy begins at the right time and at the right frequency, patients often experience smoother recoveries, fewer complications, and faster returns to daily activities and recreation. Thoughtful planning and communication with your healthcare team play a major role in these outcomes.If you are preparing for surgery or recently had a procedure and have questions about when to start physical therapy or how often to attend, understanding these principles can help you make informed decisions and avoid unnecessary delays in care.