HIP ARTHROSCOPY – PHYSICAL THERAPY PROTOCOL

o Labral Repair
o Femoroplasty/Acetabuloplasty
o Cartilage Procedure
o Gluteal Repair

Phase I: Weeks 0 to 5

Goals:
• Reduce swelling and pain (ice, rest, elevation)
• Begin range of motion without resistance
• Initiate muscle activation and isometrics
• Normalize gait
• Avoid irritation of hip flexors, IT band, trochanteric bursa, TFL, low back, and anterior capsule
• Avoid treadmill walking
• Limit weight-bearing for 2-3 weeks with isolated labral repair
• Limit weight-bearing for 6-8 weeks with cartilage procedure

Range of motion exercises:
• Maintain ROM restrictions:
o Limit hip flexion to 120 degrees (until day 14)
o Limit hip extension to neutral (until day 14)
o Limit hip internal rotation to neutral (until day 14)
o Limit abduction to 45 degrees (until week 4)
• Passive range of motion:
o Circumduction: start circumduction with hip flexion at approximately 70 degrees
o Supine abduction / adduction / ER / side lying flexion / prone ER
o CPM machine if provided
• Active / Active Assist range of motion
o Stationary bike without resistance 20 mins/time 2x/day (no recumbent bike); add resistance gradually week 3
o AROM begin week 3 as tolerated
• Soft tissue mobilizations:
• Target superficial fascia and deep tissues with massage, pettrissage, strumming, release techniques
o Focus on hip flexors, TFL, IT band, ASIS, adductors, medial hamstrings, pelvic floor, piriformis, gluteals, external rotators, PSIS, SI joint
• Joint mobilization:
o Begin caudal glides at week 3
o Begin posterior/inferior glides at week 4 to decrease posterior capsule tightness
o Do not stress anterior capsule for 6 weeks

Strengthening Exercises:

o Isometrics
• Quad sets (AVOID SLR’s for 4-6 weeks)
• Gluteal sets
• Hamstring sets
• Abduction / adduction / ER / IR isometrics

o Open Chain (start at week 3)
• Prone hip extension
• Sidelying or standing gluteus medius
• Quad, hamstring dynamic strengthening

Criteria for advancement to Phase II:
• Flexion to 120 degrees
• 75% of passive combined flexion/internal rotation compared to contralateral hip
• Mild discomfort only with ambulation

Phase II (weeks 5 to 10):

Goals:
• Eliminate swelling
• Full active and passive ROM
• Normal gait (able to walk 1 mile)
• Promote normal movement patterns and prevent compensation from other muscle groups and other joints

Swelling:
• Ice, massage
• Modalities – Ultrasound, electrical stimulation

Range of Motion/Soft Tissues:
• Thomas stretch
• Flexion/internal rotation, flexion/external rotation stretch
• IT band work
• Soft tissue mobilization
• Focus on any lumbar spine, pelvic imbalances

Strength, Cardiovascular Work:
• Leg press with light weight, high repetitions
• Mini squats
• Double knee bends to 90 degrees
• Single knee bends to 70 degrees
• Lateral agility with sport cord
• Theraband (abduction/adduction)
• Hamstring curls
• Stationary bike, elliptical trainer, swimming (may start at week 3)

Proprioception, Balance:
• Double leg / single leg stability on balance board
• Single leg balance on unstable surface (e.g. foam)

Criteria for Advancement to Phase III:
• No residual swelling
• Full active, passive ROM
• Ascending, descending stairs normally without pain or compensation
• Single knee bend to 70 degrees without compensation

Phase III – Advanced Strengthening (10-16 weeks)

Goals:
• Restore multi-directional stability
• Plyometric strength

Strength, Agility, Balance:
• Double knee bends with resistance
• Forward / backward jog with sport cord
• Lateral agility exercises
• Jump-land training
• Cardio training (low impact)
• Continue balance and stability exercises outlined in Phase II
START sport-specific drills after 14-16 weeks