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This protocol is addressed to the therapist as a general outline for patients after hip arthroscopy. Depending on the exact diagnosis and the procedures performed, there are variations of the therapy protocol. Do not hesitate to contact us to discuss the progress of these patients.

Rehabilitation after hip arthroscopy is different than traditional therapy for open hip surgeries, (like total joint replacement or fracture stabilization). Traditional physical therapy after open hip surgery emphasizes gait training, with weight-bearing restrictions and hip dislocation precautions.

The goals of patients undergoing hip arthroscopy are more advanced. Patients undergoing hip arthroscopy procedures are quite athletic and want to return to sports. Early weight bearing and range of motion are important. Progressive strengthening programs are started within a few weeks and cross training activities are encouraged early in the rehabilitation process.

Many patients undergoing hip arthroscopy have performed “prehabilitation” with a therapist. Many of the same exercises used preoperatively are used in a progressive manner. The better conditioned the patient is preoperatively the faster the patient improves postoperatively. The therapist must assess and identify the patient’s goals and expectations. The physical therapist’s assessment is as important as the medical assessment.

The diagnosis, the surgery performed and the preoperative activity level of the patient determine the outcome. In athletes this requires “holding back” as some athletes try to progress too rapidly and can actually inhibit their rehabilitation.

[yellowbox] Phases of Recovery [/yellowbox]

  • Initial Phase
    • Goals: Decrease soreness and swelling, gently increase range of motion to tolerance, inhibit further muscle atrophy.
      • Day of surgery
        • Isometric glut sets, calf pumps
        • Cold therapy
      • Postoperative days 1-7
        • Dressing change on postop day #1-3
        • Partial (25-30lbs) Weight Bearing with crutches or walker
          • Labral debridement – 5-7 days only
          • Osteoplasty (bone resection) – 2 weeks
          • Microfracture – 4 weeks
        • Postoperative exercises
          • Isometrics: Quad, gluts, hamstring, adductors/abductors.
          • Active assisted range of motion in all planes (do not push through painful endpoints)
          • Hip mobilization – straight plane distraction, inferior glides, posterior glides.
          • Closed chain bridging, weight shifts, balancing drills
          • Open chain standing abduction, adduction, flex/ext without resistance
  • Intermediate Phase
    • Goals: Regain and improve strength, regain normal joint kinematics
      • Postoperative weeks 2 – 3
        • Normalize gait – eliminate limp.
        • Continue to increase range of motion with gradual sustained end-range stretches (still as pain tolerates).
        • Begin progressive resisted exercises as tolerated.
          • Closed chain single leg bridging
          • Open chain above knee resistive Theraband or pulley exercise in flexion, extension, adduction, abduction and hamstring curls as tolerated
          • Stationary Bike as tolerated
          • Pool exercises when wounds healed
  • Advanced Phase
    • Goals: Increase functional strength and endurance
      • Postoperative weeks 4-6
        • Continue flexibility exercises
        • Continue progressive resistive strengthening exercises
          • Closed chain exercises as tolerated: multiplane strength exercises, hamstring curls, knee extensions
      • Gradual progression of activities
        • Functional activities
        • Sport-specific activities
        • Return to sporting activity (with clearance from physician and physical therapist)

[yellowbox]Distraction Mobilization Techniques[/yellowbox]

In athletes with painful hip disorders, distraction mobilization techniques are effective both preoperatively and postoperatively. Distraction reduces the compressive forces across the articular surfaces. This counterforce often provides significant relief to an inflamed and irritated joint. Over time, these counter-reactive forces promote a cartilage-healing environment in the hip that is an excellent adjunct to the traditional hip range-of-motion and strengthening exercises. Distraction mobilization techniques for the hip:

  • Straight-plane distraction: The patient is supine. The therapist grasps the lower leg above the ankle and applies a manual traction force. An assistant can provide counter-traction by stabilizing the torso. The traction vector should be applied with the hip in various degrees of flexion and abduction. Best results are accomplished with progressive and sustained distraction for 10-15 seconds is performed. Remind the patient to relax so that joint distraction can be accomplished. 5 repetitions.
  • Inferior Glide distraction: Patient supine with the hip and knee flexed 90 degrees. The therapist rests the patient’s lower leg on the therapist’s shoulder. A manual distraction force is applied to the proximal anterior thigh by interlocking both hands and then applying pressure, distracting in a distal direction. 5 repetitions.
  • Posterior Glide distraction: Patient supine with the hip and knee flexed 90 degrees. The applied force is directed downward on the knee such that posterior translation of the femoral head is accomplished. The therapist should be positioned directly over the knee such that the therapist’s body weight can be used to gently apply a posterior force. 5 repetitions. This exercise should not be performed in patients with posterior instability or a history of dislocation.

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