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Full Thickness Gluteus Medius Repair with or without Labral Repair

The intent of this protocol is to provide guidelines for your patient’s therapy progression. It is not intended to serve as a recipe for treatment. We request that the PT/PTA/ATC should use appropriate clinical decision making skills when progressing a patient. The exercises listed are not all inclusive, you can modify exercises as long as you maintain the appropriate precautions. Please obtain documentation of the exact procedure that was performed from our office. Please contact Dr. Burleson if there are any questions about the protocol or your patient’s progression

Please keep in mind common problems that may arise following hip arthroscopy: Hip flexor tendonitis, adductor tendonitis, sciatica/piriformis syndrome, ilial upslips and rotations, LB pain from QL hypertonicity and segmental vertebral rotational lesions. If you encounter any of these problems, please evaluate, assess and treat as you feel appropriate maintaining Dr. Burleson’s precautions and guidelines at all times. Gradual progression is essential to avoid flare-ups. If a flare-up occurs, back off with therapeutic exercises until it subsides.

Please reference the exercise progression sheet for timelines and use the following precautions during your treatments. Thank you for progressing all patients appropriately and please fax all progress notes to Dr. Burleson’s office or hand deliver the patient. Successful treatment requires a team approach. Please contact Dr. Burleson at any time with your input on how to improve the therapy protocol.

 

General Guidelines/Precautions following surgery

-Weight bearing: Partial-thickness tear: 2 crutches, 20 pounds weight bearing for the first 6 weeks postoperatively Full-thickness tear: 2 crutches, 20 pounds weight bearing for the first 8 weeks postoperatively

-ROM: NO Active hip abduction and IR and NO Passive hip ER and adduction for the first 6 weeks postoperatively

-Do not push through pain or pinching, gentle stretching will gain more ROM.

-Use Continuous Passive Motion (CPM) 4 hours/day or stationary bike on zero resistance 2 hours/day ONLY for patients who have also had an arthroscopic procedure inside the hip joint

-Manage scarring around portal sites

-General precautions: Hip flexor tendonitis, Trochanteric bursitis, synovitis, scar tissue around portals

-Therapy should begin 6 weeks post-op

 

Weeks 6-8 postop

-CPM for 4 hours/day or upright bike (no resistance) for 2 hours/day for patients who have had gluteus medius repair AND arthroscopy inside the hip joint

-ROM: PROM hip IR; AAROM: hip ER, abduction, adduction; AROM: hip flexion, extension -Upright bike: NO RESISTANCE (must be painfree, begin 1⁄2 circles, progress to full circles)

-Soft tissue mobilization: Gentle to scar and hip flexor, ITB

-Gait training: Weight bearing as tolerated for partial-thickness gluteus medius tears 20 pound weight bearing for full-thickness gluteus medius tears

-Strength:

-Hip isometrics

(Begin at 6 weeks): extension, adduction

(Begin at 8 weeks): sub max pain free hip flexion

-Quad sets, Hamstring sets, Lower abdominal activation

-Modalities for pain control, swelling

 

Weeks 8-10 postop

-Continue with previous exercises

-Gait training: Weight bearing as tolerated, work on symmetry

-ROM: progress A/PROM in all directions -Upright bike: progress resistance as tolerated

-Soft tissue massage: PRN (scar, iliopsoas, TFL, ITB, piriformis, QL, lumbar paraspinals, hip adductors)

– Strength

-Hip abduction: Isometrics to isotonics (see addendum for progression)

-Progress isometric resistance

-Quad and hamstring isotonic exercise

-Quadruped rocking -Stretching

-Manual hip flexor stretching (gentle, no pain)

-Modified Thomas position, or pillows under buttock

-Modalities for pain control, swelling

 

Weeks 10-12 postop

-Gait: Work on symmetry

-Continue with previous exercises

-ROM: progress A/PROM in all directions -Soft tissue massage: PRN (scar, iliopsoas, TFL, ITB, piriformis, QL, paraspinals, hip adductors, gluteus medius) -Strength

-Progress core strengthening

-Initiate hip flexion and extension strengthening progression (see addendum)

-Hip IR/ER using stool under knee (make sure to hold onto object for support).

-Upright bike with resistance

-Begin Elliptical training

-Stretching: Manual and self hip flexor stretching

-Modalities for pain control, swelling

 

Weeks 12-14 postop

-Gait: Normalize without AD

-ROM: progress A/PROM all directions -Soft tissue massage: PRN (scar, iliopsoas, TFL, ITB, piriformis, QL, paraspinals, hip adductors, gluteus medius)

-Strength

-Progress LE and core strength and endurance as able

-Begin proprioception/balance activity (2 legs to 1 leg, stable to unstable)

-Begin closed chain strengthening such as leg press -Side stepping with theraband

-Single leg squats, step-ups, lunges -Stretching: Manual and self hip flexor stretching

-Modalities for pain control, swelling

 

Weeks 14-16 postop

-Gait: Normalize without AD

-ROM: progress A/PROM all directions

-Soft tissue massage: PRN (scar, iliopsoas, TFL, ITB, piriformis, QL, paraspinals, hip adductors, gluteus medius)

-Strength:

-Progress LE and core strengthening

-Increased emphasis on single leg strength moves

-Unilateral leg press, hip hikes, eccentric step downs

-Progress balance and proprioception

-Stretching: Manual and self (hip flexor, hip adductors, glute, piriformis, TFL, ITB)

 

Weeks 16-18 postop (Advanced Rehabilitation)

Criteria for progression to this level

-Full ROM -Painfree, normal gait pattern

-Hip flexor strength 4/5 or better –

-Hip abd, add, ext and IR/ER strength of 4+/5 or better

-Strength:

-Progress core, hip, LE strength and endurance

-Lunges (multi angle) -Plyometric progression (Must have good control with all exercises first)

-Forward/Backward running program (Must have good control with all exercises first)

-Agility drills (Must have good control with all exercises first)

–Stretching: Progress self and manual stretches

PRECAUTIONS

-No contact activities until cleared by MD

-No forced (aggressive) stretching