Surgical care in the UK is generally excellent up to the point of discharge. What follows is far more variable. Most people leave with wound-care advice, a lifting restriction with an expiry date, and a follow-up appointment — but no rehabilitation plan for the months between "the wound has healed" and "back to full function".
That gap matters. Tissue heals, but scars tether, muscles that were cut or stretched stop recruiting normally, guarding patterns establish themselves, and deconditioning accumulates. People frequently arrive months or years later with back pain, a core that will not engage, pulling around a scar, or a persistent sense that things have never been the same.
This is particularly true after gynaecological, abdominal and pelvic surgery, where the pelvic floor and abdominal wall are directly involved and almost never rehabilitated.
Surgery we commonly rehabilitate after
Hysterectomy
Abdominal, vaginal or laparoscopic. The pelvic floor loses some of its support structure, and prolapse and continence symptoms can develop afterwards. Rehabilitation is rarely offered and frequently needed.
Prolapse repair
Pelvic floor rehabilitation after surgery is important — the operation restores anatomy but does not restore muscle function, and the factors that caused the prolapse are still present.
Caesarean section
Major abdominal surgery with almost no routine rehabilitation. See c-section recovery.
Laparoscopy
Including for endometriosis. Port sites tether, and guarding patterns established before surgery frequently persist afterwards. See endometriosis physiotherapy.
Prostate surgery
Continence rehabilitation with a well-defined pathway and good evidence. See prostate surgery rehabilitation.
Hernia repair
Abdominal wall function, scar mobility and graded return to lifting — particularly important for physical occupations.
Colorectal surgery
Bowel function, defaecation mechanics and continence after bowel surgery, including after stoma reversal.
Orthopaedic surgery
Spinal, hip and knee surgery, where graded loading and return to function follow standard rehabilitation principles.
What rehabilitation involves
Assessment
What operation you had and how it was performed, your current symptoms and limitations, and what you need to get back to. Then examination of scar mobility, abdominal wall recruitment, pelvic floor function where relevant, and movement quality.
Scar mobilisation and desensitisation
Restoring glide between tissue layers, and reducing hypersensitivity or numbness. Effective long after surgery — scar tissue continues to remodel in response to appropriate loading for years.
Reactivating inhibited muscle
Muscles that were cut, stretched or painful commonly stop recruiting normally. Restoring that recruitment usually has to come before any strengthening, which is why loading straight away often does not work.
Pelvic floor rehabilitation
Included as standard after gynaecological, pelvic, colorectal and abdominal surgery, where support structures and nerve supply may be affected.
Pressure management
How you breathe and brace during effort, so load is distributed rather than directed at a healing repair. Particularly important after hernia and prolapse surgery.
Graded return to loading
A staged progression through lifting, impact and activity with criteria for advancing — replacing the standard six-week restriction that expires with no guidance on what comes next.
Return to work and sport
Specific to what you actually do, whether that is lifting patients, carrying tools, or returning to running and the gym.
When to start, and prehabilitation
Gentle work — breathing, positioning, safe ways to move in and out of bed, and general mobility — can start immediately after surgery. These reduce pain and complications rather than risking the repair.
Direct scar work and progressive loading wait until the wound has fully healed, usually around six weeks, and always in line with your surgical team's advice. A first rehabilitation appointment at six to twelve weeks is typical.
Prehabilitation — physiotherapy before planned surgery — is worth considering where you have the time. Entering surgery fitter and stronger, with the correct pelvic floor contraction already learned, consistently makes recovery easier. This is best established after prostate surgery, but the principle applies broadly.
And as elsewhere in this field, there is no expiry date. Patients frequently arrive years after surgery with tethered scars and a core that has never worked properly since, and they improve.
Contact your surgical team rather than a physiotherapist for: fever, a wound that is red, hot, opening or discharging, sudden severe pain, heavy bleeding, or calf pain and swelling.
Frequently Asked Questions
When can I start physiotherapy after surgery?
Gentle breathing, positioning, safe movement and general mobility work can begin immediately, and these reduce pain and complications rather than risking the repair. Direct scar work and progressive loading normally wait until the wound has fully healed, usually around six weeks, and always in line with your surgical team's advice. A first rehabilitation appointment at six to twelve weeks is typical.
Do I need pelvic floor physiotherapy after a hysterectomy?
It is frequently worthwhile and rarely offered. Hysterectomy removes part of the pelvic floor's support structure, and prolapse and continence symptoms can develop afterwards. Rehabilitation addresses pelvic floor function, scar mobility and abdominal wall recruitment, and it reduces the likelihood of those problems becoming established.
Is it too late to rehabilitate an old surgical scar?
No. Scar tissue continues to remodel in response to mobilisation and loading for a long time, and patients treated years or even decades after surgery regularly gain meaningful improvement in tethering, pulling, sensitivity and abdominal function. Older scars may respond more slowly, but they do respond.
What is prehabilitation?
Physiotherapy before planned surgery — building strength and fitness, learning the correct pelvic floor contraction, and understanding what recovery will involve, all while you are comfortable and not post-operative. It consistently makes recovery easier, and the evidence is strongest before prostate surgery, though the principle applies to abdominal, gynaecological and orthopaedic surgery too.
My six-week restriction has expired but I still feel weak. Is that normal?
Yes, and it reflects a gap in standard post-operative advice. A six-week restriction marks the point at which tissue has healed enough to tolerate more load — it does not mean strength, muscle recruitment and confidence have returned. Those need a graded programme, which is exactly the stage most people are never given.
Will physiotherapy interfere with my surgical repair?
No, when it is appropriately timed and progressed. Early work is deliberately gentle and focused on breathing, positioning and safe movement. Loading is introduced only once the wound has healed and in line with your surgical team's guidance, and progressed according to how you respond rather than to a fixed schedule.
Clinically reviewed by Jency Sudha, Consultant Pelvic Health Physiotherapist & Biofeedback Specialist — last updated 26 July 2026
The information on this page is for general guidance and does not replace individual clinical assessment. If your symptoms are new, worsening, or accompanied by bleeding, fever or severe pain, contact your GP or NHS 111.
Recovery Does Not End When the Wound Heals
The months between healing and full function are where rehabilitation makes the difference — and where it is usually missing.
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