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HIP ARTHROSCOPY REHABILITATION

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