Hip Arthroscopy Rehabilitation

Partial Psoas Release with or without FAI Component/ Labral Debridement

General Guidelines:

• Normalize gait pattern with brace and crutches
  • Stress extension phase of gait
• Weight-bearing as per procedure performed
• Continuous Passive Motion
  • 4 hours/day or 2 hours if on stationary bike for 2 bouts of 20-30 minute sessions
  • Usually in more pain

Rehabilitation Goals:

• 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

Precautions following Hip Arthroscopy: (Debridement/Iliopsoas Release)

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

Guidelines:

Weeks 0-2

• CPM for 4 hours/day
• Bike for 20 minutes/day (can be 2x/day)
• Scar massage to portals and hip flexor tendon
• 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
• Stool rotations/prone rotations
• Quadruped rocking for hip flexion
• Sustained stretching for psoas with cryotherapy (2 pillows under hips)
• Stool hip flexor and adductor stretch
• Gait training PWB with bilateral crutches
• Modalities

Weeks 2-4

• Continue with previous therex
• Progress Weight-bearing
  • Wean off crutches (2 » 1 » 0) if gait is normalized
• Progress with hip ROM
  • External Rotation with FABER
  • BAPS rotations in standing
• 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 (4-5 weeks)
    
• Step downs
  
• Clam shells » isometric side-lying hip abduction
  
• 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
  

Weeks 4-8

• Continue with previous therex
• Progress with ROM
  • Hip Joint mobs with mobilization belt
    • 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 5)

Weeks 8-12

• Progressive hip ROM
• Progressive LE and core strengthening
• Endurance activities around the hip
• Dynamic balance activities
• 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
• 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