Time frame: Weeks 0-3
Goals:
-Protect repair
-Avoid hip flexor irritation (no sitting 90 deg hip flexion, avoid actively
-Lifting leg, not properly activating deep core muscles, etc.)
-Control and decrease pain, inflammation, swelling, or effusion
-Avoid adhesion formation with passive motion and soft tissue mobilization
-Hip brace x 2 weeks
-20# Weight bearing with foot flat gait pattern x 3 week
–ROM restrictions x 3 weeks (abduction to 45 deg, no extension >0, no ER)
-A theraband circle around the feet can reduce ER past neutral at rest
Exercises:
Initial exercises:
-Stationary bike (no resistance, seat high, no recumbent bike)
-Log rolls
-Hip circumductions
-Soft tissue mobilizations
-Seated or long sitting hamstring stretch
-Isometrics (focus on TA/obliques/multifidi prior to all. Also special focus on gluteals and abductors)
-Prone lying 2-3 hours a day
Week 2 exercises:
Continue all week 1 exercises
-Quadruped cat and camel
-Standing abduction with IR
-Quadruped rockback (with slight posterior pelvic tilt)
-Quadruped hip extensions (within motion limitations, being careful when approaching full ext in the presence of core weakness)
-Quadruped bird dogs (if demonstrating appropriate muscle firing patterns)
Week 3 exercises:
Continue all week 1 and 2 exercises
-Double leg bridges
-Stool rotations (within ROM restrictions)
-Physioball rollouts
Criteria to progress:
-Well-controlled postoperative pain
-No frontal/sagittal plane deviations of hip and pelvis when ambulating
-Physician clearance
Time frame: Weeks 3-6
Goals:
-Protect repair
-Wean from crutches
-Normalize gait pattern
-Initiate closed chain and weight shift exercises
-Continue with phase 1 exercises as appropriate
Exercises:
Week 4 exercises:
-Wean from crutches
-Stationary bike (no resistance, seat high, no recumbent bike)
-Double leg bridges with abduction
-½ Kneeling weight shifts
-½ Kneeling single arm row/single arm extension (with sport cord or theraband)
-Standing hip abduction isometrics (against wall or foam roller)
-Hip hikes (off edge of step)
Week 5 exercises:
-Sidelying clam shells (pain free ROM, add/progress TB resistance according to firing pattern)
-Standing lateral and forward/backward weight shifts
-Single leg stance and balance progression
-Quadruped fire hydrant
-½ Kneeling upper body lifts/chops with sport cord (no torso or hip rotation)
-Double leg ¼ squats
-Forward step-ups
Week 6 exercises:
-Forward shift to romanian dead lift
-Modified prone plank (knees to elbows)
-Therapy ball hamstring curls
-Side step-ups
-Split lunge
-Y balance reaching
Criteria to progress:
-Discontinued use of crutches and no gait deviations
-Minimal pain following activities
-Physician clearance
Time frame: Weeks 7-12
Goals:
-Prevent compensation due to fatigue
-Begin resisted biking
-Progress strengthening exercises from double to single leg
-Focus on return to prior activities without pain or irritation
-Progress lower extremity strength and endurance
Exercises:
-Continue all appropriate exercises from phase II (PT will instruct)
-Bridge with alternating knee extensions (progress to SL bridge when appropriate)
-Half prone plank/pillar bridge (progress to full/bosu when appropriate)
-Side stepping in squat/athletic position (progress to TB)
-Double leg body weight squats
-Single leg ¼ squat
-Forward/lateral/reverse lunges
-Side plank
-Resisted stool rotations (begin week 8)
Cardiovascular Exercises:
-Elliptical trainer (start with 5 minutes, increase 5 minutes each week)
-Resisted biking
Criteria to progress:
-No pain with ADLS
-Normal Gait Pattern
–Patients returning to sport activities must pass “SPORT TEST” before progressing to Phase IV
Phase IV:
Time frame: Months 3-6
Goals:
-No complaints of pain or weakness
-Running progression
-Safe return to sport or patient’s functional activities
-Maintenance of strength, endurance, and proprioception
-Patient education with regards to any possible limitations
Exercises:
-Balance squats with rotations
-Retro walking with resistance band
-Lunge with trunk rotations (with sport cord or physioball)
-Begin running progression and single plane agilities
- Quick feet
- Backpedaling
- Side shuffles
- Double leg plyos (i.E., Broad jumps, 4-square hops, a and d skips)
Sport specific exercises
-Begin advanced/multi directional agilities (not before week 16)
- Z and w cuts
- Cariocas
- Transition to single leg plyos
-Maintenance program for strength, endurance, and proprioception
