Stronger Before, Stronger After – How Rehabilitation Pilates Can Transform Hip Replacement Recovery
- Sep 25, 2025
- 3 min read
Updated: Sep 26, 2025
With over 20 years of experience in the health and fitness industry, Aileen Kilshaw is the founder of Aforce Training and Exercise Performance Wellness Ltd. (EPW). Combining her expertise in injury rehabilitation and education, she takes a personalised approach to help individuals and teams move better, feel better, and perform better.
Every year, thousands of people in the UK undergo hip replacement surgery. For many, it’s a life-changing procedure, restoring mobility, easing pain, and opening the door to a return to a more active lifestyle. Yet what often gets overlooked is just how much preparation and rehabilitation matter to maximise the outcome.
Recent UK research, including the Joint PREP feasibility study (2024), shows that patients who start building strength and resilience before surgery prehabilitation experience smoother recoveries. Surveys of NHS hospitals also reveal that while almost all offer pre-operative education, only a minority consistently provide structured prehab. That gap is a golden opportunity for clients to take charge of their journey. [1]
Why prehab matters
Hip replacement is not just a surgery, it’s a marathon for your body. Evidence from UK and international randomized controlled trials (RCTs) shows that:
Early mobilisation (walking and functional activity within 24 hours) speeds recovery and shortens hospital stay.
Bed-based exercises alone don’t add much, but functional, progressive strengthening makes a real difference in the medium and long term.
Behaviour-change physiotherapy programmes designed to help people stick to activity improve post-operative outcomes across NHS settings.
The message is clear. Preparing body and mind for surgery sets the stage for faster recovery, greater independence, and longer-lasting results.
Where Pilates fits in
Pilates, both mat-based and reformer-based, is uniquely positioned to support prehab and rehab. Its principles controlled movement, breath, alignment, and gradual load progression mirror the evidence-based elements of successful hip protocols.
Unlike generic “exercise sheets,” rehab Pilates can offer:
Targeted strengthening for hip stabilisers and glutes.
Core integration to support gait and balance.
Adaptability for pre and post-surgical stages (with modifications for precautions).
A sense of empowerment, clients feel they are doing something positive, not just waiting for surgery or passively recovering.
Examples of prehab & rehab Pilates exercises
Mat pilates
Bridging: Strengthens glutes and hamstrings, supports pelvic control. Progressions include single-leg bridging (introduced only post-clearance).
Clamshells: Side-lying hip abduction work, targeting the glute medius key for walking stability.
Modified side-kicks: Low-range lateral leg lifts for hip mobility and control.
Supine marching: Gentle core and hip flexor activation without overloading the joint.
Reformer pilates
Footwork series: Resistance-controlled squats in the supine position are excellent for building symmetrical strength with reduced joint load.
Leg circles (low range): Improves hip mobility and circulation, within a comfortable range.
Bridging on the carriage: Adds graded resistance for progressive glute strength.
Seated arm work with core engagement: Encourages upright posture and trunk stability, supporting return to daily activities.
Each exercise can be scaled from tiny, supportive movements in early rehab to more dynamic, functional challenges as recovery advances.
A holistic recovery journey
Enhanced Recovery After Surgery (ERAS) protocols used in the NHS already encourage early movement, multimodal pain management, and patient education. But what’s missing for many patients is the personalised, engaging movement pathway that Pilates provides.
By combining prehab strength and conditioning, mindful Pilates practice, and structured rehab progression, clients don’t just recover, they rediscover confidence in their body and what it is capable of.
Final thought
Hip replacement can give people their life back. But the greatest gains don’t happen on the operating table, they happen in the weeks before and after, when the patient commits to building strength, mobility, and resilience. Pilates is more than exercise. It’s a bridge between surgery and a return to living fully.
If you’re preparing for or recovering from hip replacement surgery and are based in South West London, get in touch with Aileen at EPW. A qualified rehab Pilates professional will understand both the clinical and practical sides of your journey.
Prehab is your head start. Rehab Pilates is your companion for the long run.
Read more from Aileen Kilshaw
Aileen Kilshaw, Sports Rehabilitator and Pilates Specialist
Aileen Kilshaw is a leading expert in injury rehabilitation and Pilates, driven by the mantra. "Move better, feel better, perform better." With a degree in Sports Rehabilitation, qualified teacher status, and a range of specialist certifications in Pilates and fitness, she combines her expertise with a passion for movement. Aileen is dedicated to building lasting relationships with clients and teams, ensuring the best possible outcomes, whatever the goal may be.
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