Hip Arthroscopy Rehabilitation

Labral Debridement with or without FAI Component

General Guidelines:

• Normalize gait pattern with brace and crutches
• Weight-bearing 20 pounds
• Continuous Passive Motion Machine
  • 4 hours/day or 2 hours if on stationary bike for 2 bouts of 20-30 minute sessions

Physical Therapy Frequency:

• Seen post-op Day 1
• Seen 2x/week for first month
• Seen 2x/week for second month
• Seen 2-3x/week for third month
• Seen 1-2x /week for fourth month

Milestone Goals:

• Increase range of motion
• Strengthening
• Decrease/prevent hip flexor tendinitis

Precautions following Hip Arthroscopy/FAI: (Debridement/Osteochondroplasty)

• Weight-bearing will be determined by procedure
• Hip flexors tendonitis
• Trochanteric bursitis
• Synovitis
• Manage scarring around portal sites
• Increase range of motion focusing on rotation and flexion

Guidelines:

• Weeks 0-2
  • CPM for 4 hours/day
  • Bike for 20-30 minutes/day (can be 2x/day)
  • Scar massage
  • Hip PROM  as tolerated
  • Supine hip log rolling for rotation
  • Bent Knee Fall Outs
  • Hip isometrics -  NO FLEXION
    • ABD/ADD/EXT/ER/IR
  • Pelvic tilts
  • Supine bridges
  • NMES to quads with SAQ with pelvic tilt
  • Stool rotations /prone rotations
  • Stool stretch for hip flexors and adductors
  • Quadruped rocking for hip flexion
  • Sustained stretching for psoas with cryotherapy (2 pillows under hips)
  • Gait training PWB with bilateral crutches
  • Modalities
• Weeks 2-4
  • Continue with previous therex
  • Progress Weight-bearing
  • Wean off crutches (2 » 1 » 0) when gait is normalized
  • Progress with hip ROM
  • External Rotation with FABER
  • BAPS rotations in standing
  • Hip flexor and ITB – manual and self
  • Glut/piriformis stretch
  • Progress core strengthening (avoid hip flexor tendonitis)
  • Progress with hip strengthening – isotonics all directions except flexion
  • Start isometric sub max pain free hip flexion(3-4 wks)
  • Step downs
  • Clam shells » isometric side-lying hip abduction (may be done in supine position with Theraband if side lying is painful)
  • Hip hiking (week 4)
  • Begin proprioception/balance training
  • Balance boards, single leg stance
  • Bike / Elliptical
  • Scar massage
  • Bilateral Cable column rotations
  • Aqua therapy in low end of water (no treading water) if available
• Weeks 4-8
  • Elliptical
  • Continue with previous therex.  Progress bike time and resistance.
  • Progress with ROM   
    • Hip Joint mobs with mobilization belt into limited joint range of motion
    • Lateral and inferior with rotation
    • Prone posterior-anterior glides with rotation
    • Hip flexor and It-band Stretching – manual and self
  • Progress strengthening LE
    • Introduce hip flexion isotonics (Be aware of hip flexion tendonitis)
    • Multi-hip machine (open/closed chain)
    • Leg press (bilateral » unilateral)
    • Isokinetics: knee flexion/extension
  • Progress core strengthening (avoid hip flexor tendonitis)
    • Prone/side planks
  • Progress with proprioception/balance
    • Bilateral » unilateral » foam » dynadisc
  • Progress cable column rotations –unilateral »foam
  • Side stepping with theraband
  • Hip hiking on Stairmaster
  • Treadmill side stepping from level surface holding on » inclines (week 4) when gluteus medius is with good strength
• Weeks 8-12
  • Progressive hip ROM
  • Progressive LE and core strengthening
  • Endurance activities around the hip
  • Dynamic balance activities
  • Begin light plyometrics
• Weeks 12-16
  • Progressive LE and core strengthening
  • Plyometrics
  • Treadmill running program
  • Sport specific agility drills
• 3,6,12 months Re-Evaluate (Criteria for discharge)
  • Hip Outcome Score (any minimal score)
  • Pain free or at least a manageable level of discomfort
  • MMT within 10 percent of uninvolved LE
  • Biodex test of Quadriceps and Hamstrings peak torque within 15 percent of uninvolved
  • Single leg cross-over triple hop for distance:
    • Score of less than 85% are considered abnormal for male and female
  • Step down Test