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Hip Arthroscopy Rehabilitation
Partial Psoas Release with or without FAI Component with Labral refixation
General Guidelines:
- Limited ER to 20 degrees (2 weeks)
- No hyperextension (4 weeks)
- Normalize gait pattern with brace and crutches
- Weight-bearing as per procedure performed
- Continuous Passive Motion Machine
- 4 hours/day or 2 hours if on bike on stationary bike for 2 bouts of 20-30 minute sessions
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/FAI: (Refixation/Osteochondroplasty)
- 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 flexion, careful of external rotation, and aggressive extension
Guidelines:
- Weeks 0-2
- NO EXTERNAL ROTATION > 20 degrees
- CPM for 4 hours/day
- Bike for 20 minutes/day (can be 2x/day)
- Scar massage
- Hip PROM as tolerated with ER as tolerated
- Supine hip log rolling for internal rotation/external rotation
- Progress with ROM
- Introduce stool rotations/prone rotations
- Hip isometrics - NO FLEXION
- Abduction, adduction , extension, ER
- Pelvic tilts
- Supine bridges
- NMES to quads with SAQ
- Quadruped rocking for hip flexion
- Sustained stretching for psoas with cryotherapy (2 pillows under hips)
- Gait training PWB with assistive device
- Modalities
- Weeks 2-4
- Continue with previous therex
- Progress Weight-bearing (week 3)
- Week 4: wean off crutches (2 » 1 » 0)
- Progress with hip ROM
- Bent knee fall outs (week 4)
- Stool/prone rotations for ER (week 3-4)
- 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
- Hip Hiking (week 4)
- Begin proprioception/balance training
- Balance boards, single leg stance
- Bike / Elliptical
- Scar massage
- Bilateral Cable column rotations (week 4)
- Treadmill side stepping from level surface holding on » inclines (week 4)
- Aqua therapy in low end of water
- Weeks 4-8
- Continue with previous therex
- Progress with ROM
- Standing BAPS rotations
- External rotation with FABER
- Hip Joint mobs with mobilization belt
- Lateral and inferior with rotation
- Prone posterior-anterior glides with rotation
- Hip flexor, glute/piriformis, 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)
- Progress with proprioception/balance
- Bilateral » unilateral » foam » dynadisc
- Progress cable column rotations -unilateral »foam
- Side stepping with theraband
- Hip hiking on Stairmaster
- Weeks 8-12
- Progressive hip ROM
- Progressive LE and core strengthening
- Endurance activities around the hip
- Dynamic balance activities
- 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
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