Physiotherapy After Surgery in BC: When Rehab Starts, What It Covers and Who Pays

You have had surgery, or you have a date for one, and you want to know when physiotherapy fits in. The short answer is that your surgeon sets the rules for what the repaired area can do, and your physiotherapist builds your rehab inside those rules. This post explains when rehab starts, what each stage covers, what you can do before the operation, and who pays.

Your surgeon's protocol sets the timing

Surgeons usually give a written set of instructions for the weeks after an operation. It says what you can and cannot do with the repaired area, how much weight it can take, and when each limit changes. The distal radius fracture protocol from Brigham and Women's Hospital is one published example. It stages recovery by what the bone and tissue can handle at each point.

Your physiotherapist reads that protocol at your first visit and works inside it. If you were not given one, ask your surgeon's office for it. A physiotherapist who has the protocol can plan your exercises around the limits that matter, and can tell you what to ask the surgeon when your recovery does not match the plan.

Some people start moving the day of surgery. Our post on blood clot precautions after joint replacement explains why early walking is part of the surgical plan and what your surgical team manages. Other operations call for a period of protection first, such as a cast, a sling or a brace, and outpatient physiotherapy starts when the surgeon says it can.

What post-op rehab covers, stage by stage

The exact steps differ by operation, and your protocol sets the dates. The order is similar across most of them.

The first stage protects the repair. You keep the surrounding joints moving so they do not stiffen, and you learn how to move, sit, sleep and walk without loading the repair. In the second stage, movement returns in the repaired joint, within the range your surgeon allows. Strength comes third, built up with load that your physiotherapist raises as the tissue tolerates it. The last stage is the return to what you did before: work tasks, stairs, running, a sport. It is paced by how your body responds to each step.

Skipping a stage to go faster can set a recovery back. In our clinic, the key visits are the ones where your physiotherapist checks swelling, range of movement and strength against the protocol and decides whether you move to the next step.

Prehab can add something before the operation

If you have a surgery date weeks away, you can start rehab before it. This is called prehab. A 2024 systematic review and meta-analysis in Disability and Rehabilitation found that exercise before knee and hip replacement improved function, pain, quality of life, strength and range of motion. The same authors noted that most of the trials had a high risk of bias and that more high-quality research is needed before prehab can be recommended as routine.

A 2025 meta-analysis in Frontiers in Medicine found that prehab reduced pain after knee replacement at one, three and six months, with little effect on hospital stay. Prehab is also a chance to learn the exercises you will repeat afterward and to plan your home: who helps, how stairs work, what equipment you need. Our posts on knee replacement prehab and hip replacement prehab cover that in detail. The BC surgical wait times page shows how long you may be waiting for a date.

Guides for specific operations

We have written longer guides for several operations:

• ACL reconstruction, including the return-to-sport criteria in our ACL return to sport post.
• Meniscus tear surgery or physiotherapy, for the decision before the operation.
• Rotator cuff injury: physiotherapy or surgery.
• Wrist fracture rehab, after a cast or surgical fixation.
• Knee and hip replacement prehab and rehab.

If your operation is not on this list, the structure above still applies. Your protocol and your physiotherapist's assessment decide the steps.

Who pays for rehab after surgery

Who pays depends on how you were injured or why you had surgery.

If a crash caused the injury, rehab after the operation belongs to your ICBC recovery. ICBC's page on the first 12 weeks of recovery lists 25 approved treatments for physiotherapists, and you need your ICBC claim number. After that, ICBC's extension process applies. Our ICBC physiotherapy hub explains each step. For an injury at work, your WorkSafeBC claim carries the treatment.

For planned surgery, such as a joint replacement, rehab is usually paid privately or through an extended health plan. The BC government's supplementary benefits page describes MSP support for those who qualify, with a combined limit of 10 visits each calendar year across several therapies. Our posts on MSP physiotherapy coverage and extended health benefits go through what to check with your plan. Session prices are on the rates page.

Warning signs to report to your surgeon

Call your surgeon's office the same day for increasing redness, heat or drainage at the incision, a fever, calf pain or swelling that is new, or pain that is getting worse in spite of rest. Chest pain or sudden shortness of breath is a call to 911. A physiotherapist will tell you to contact the surgical team when findings at a visit point that way.

This article is general information, not personal medical advice. A regulated practitioner can confirm whether the patterns described apply to you.

Sources

• Brigham and Women's Hospital: Distal Radius Fracture Rehabilitation Protocol
• Effectiveness of prehabilitation on outcomes following total knee and hip arthroplasty for osteoarthritis: a systematic review and meta-analysis, Disability and Rehabilitation, 2024
• Prehabilitation is effective in relieving pain after knee arthroplasty, but has little effect on length of stay and knee function: a meta-analysis, Frontiers in Medicine, 2025
• ICBC: Accessing treatment during your first 12 weeks of recovery
• ICBC: If your recovery takes longer than 12 weeks
• Province of BC: MSP supplementary benefits
• Province of BC: Surgical wait times

Frequently asked questions

How soon after surgery can I start physiotherapy?

Your surgeon decides. Some operations call for movement and walking on the day of surgery, with a hospital physiotherapist or nurse guiding you. Others call for a period of protection in a cast, sling or brace before outpatient rehab begins. Ask your surgeon's office for the written protocol and the date that outpatient physiotherapy is allowed to start.

Do I need my surgeon's referral to book post-op physiotherapy at Launch Rehab?

No. Launch Rehab does not require a referral to book physiotherapy. You do help your physiotherapist by bringing the surgeon's written protocol and the discharge summary to the first visit, since the protocol sets the limits that your plan has to respect. Some extended health plans ask for a referral before they reimburse, so check your plan booklet.

What should I bring to my first physiotherapy visit after surgery?

Bring the surgeon's written protocol, the discharge summary or operative report if you have one, your medication list and your Personal Health Care Card number. For an ICBC claim, add your claim number and adjuster's name; for WorkSafeBC, your claim number. Wear loose clothing that lets the physiotherapist see and reach the surgical area without disturbing a dressing.

Is it normal for rehab to hurt after surgery?

Some discomfort is expected as movement returns, and your physiotherapist adjusts the exercises to how you respond. Pain that rises over the following days, new swelling that does not settle, or redness and heat near the incision belong with your surgeon. Tell your physiotherapist how each session felt the next day, since that guides the next step.

Can I get physiotherapy through a hospital program instead of a private studio?

Some health authority programs offer outpatient physiotherapy after surgery. HealthLink BC's listing for the physiotherapy program at Burnaby Hospital says a physician or health care provider referral is required and that services may vary per location. Ask your surgeon's office or the program about its intake, and book a private studio in the meantime if you want to start sooner.

How long does rehab after surgery last?

The length depends on the operation, the tissue repaired, your age and health, and how you respond at each stage, so no single timeline applies. Your surgeon's protocol sets the limits, and your physiotherapist reviews your range, strength and function to decide each step. Our ACL reconstruction post shows how one operation stages its timeline in detail.

Will ICBC pay for rehab after surgery for a crash injury?

ICBC's first 12 weeks page lists 25 approved treatments for physiotherapists, and you need your ICBC claim number. After 12 weeks, ICBC has an extension process for further treatment. At Launch Rehab, ICBC physiotherapy requires pre-approval and carries no charge for approved visits, according to our rates page. Specialty services may carry a fee, so ask before you book.

Who leads rehab when a kinesiologist is involved?

A physiotherapist usually leads the early stages, when the repair is protected and your range of movement is being restored. A kinesiologist can supervise the later strength and return-to-activity work once your physiotherapist and surgeon agree you are ready. Our knee replacement post describes how a physiotherapist and kinesiologist split the job.