HIP ARTHROSCOPY REHABILITATION

August 13, 2018

GENERAL GOALS:

• Non-antalgic gait (No pain with ambulation)
• Increase passive ROM of the affected hip
• Compliance with instructed weight bearing
• No pain at rest
• Modalities PRN
• Home therapy education
• Soft tissue manipulation around portal sites once healed (after week 2)
• AVOID THE FOLLOWING:
  • Excessive external rotation
  • Exercises beyond fatigue/pain
  • Strenuous hip flexion (e.g. straight leg raises)
  • Greater trochanteric bursitis
  • Sacroilitis
  • Hip flexor tendonitis

 

GUIDELINES (WEEKS 0-2)

• Partial weight bearing (50%) with crutches
• CPM 4hrs/day (can lower to 2 hours/day if on stationary bike at least 20 minutes/day)
• Stationary bike 20 minutes/day; can increase to 2x/day if patient able to tolerate
• Passive ROM exercises of affected hip
• Supine log rolling
• Iliopsoas stretching (AVOID EXCESSIVE EXTENSION!)
• Stool rotations (Hip AAROM ER/IR)
• Modalities as needed
• Hip isometric exercises
  • NO FLEXION EXERCISES o ABDUCTION, ADDUCTION, EXTENSION, EXTERNAL

 

GUIDELINES (WEEKS 2-4)

• Include all regimens from weeks 0-2 may advance weight bearing to full weight bearing as tolerated by the patient
• Wean off crutches over 1-2 weeks. Do not advance or remove crutches if patient still ambulates with an antalgic gait
• Increase ROM exercises
• Gluteal and piriformis stretching
• Core strengthening (AVOID iliopsoas tendonitis)
• Step downs
• Scar massage at portal sites
• Treadmill side stepping from level surface holding on to side rail (WEEK 4)
• May begin aqua therapy in low end water at WEEK 4 once portal sites are healed
  • NO SWIMMING/TREADING
• Clam shells
  • Isometric side-lying hip abduction
• Bike/Elliptical (may start elliptical at weeks 3-4)
• Proprioception training (start on week 4)
  • Balance boards, single leg stance
• Continue with isometrics EXCEPT flexion
  • May being isometric sub maximum pain free hip flexion at 4 weeks

 

GUIDELINES (WEEKS 4-8) INCLUDE ALL THERAPY REGIMENS FROM WEEKS 0-4

• Increase ROM
• Hip flexor and IT band stretching
• LOWER EXTREMITY STRENGTHENING
  • Hip flexor isometric exercises
  • Leg press (avoid deep flexion)
• Knee flexion and extension isokinetics
• Core strengthening: PLANKS
• LE proprioception exercises (Avoid torsion)
• Hip hiking on stairmaster

 

GUIDELINES (WEEKS 8-12) INCLUDE ALL THERAPY REGIMENS FROM WEEKS 4-8

• Hip endurance activities
• Dynamic proprioception exercises
• Increase LE strengthening
• Continue to improve HIP ROM

 

GUIDELINES (WEEKS 12-16) ALL OF THE ABOVE

• Continue LE strengthening
• Sport-specific drills
• May begin treadmill running
• Plyometrics

 

CRITERIA FOR DISCHARGE

• Step down test
• Pain free or at a manageable level of discomfort
• Biodex testing
  • Quads and hamstrings within 15% of unaffected side
• Single leg cross-over triple hop for distance
  • < 85% of normal side considered abnormal