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Hip Arthroscopy Labral Repair

Hip Protocols
Hip Conditions

16 Weeks Divided into 4 Phases to Alleviate Hip Pain and Restore Your Muscles in to Working Order.

1

Initial Phase

During this phase:
  1. Diminish pain and inflammation
  2. Protect integrity of repaired tissue
  3. Prevent muscular inhibition, and
  4. Restore ROM within the restrictions
2

Intermediate Phase

During this phase:
  1. Protect integrity of repaired tissue
  2. Restore full hip ROM
  3. Restore normal gait pattern
  4. Progressively increase muscle strength
  5. Improve neuromuscular control, balance, and proprioception
  6. Initiate functional exercises maintaining core and pelvic stability
3

Advanced Phase

During this phase:
  1. Restoration of muscular endurance and strength
  2. Restoration of  cardiovascular endurance
  3. Optimize neuromuscular control
4

Sports Specific Phase

During this phase:
  1. Restoration of muscular endurance and strength
  2. Restoration of  cardiovascular endurance
  3. Optimize neuromuscular control, balance, and proprioception

Phase 1: Initial

Week 1 (2 Treatments)
Exercises:
  1. Upright Stationary Bike—no to minimal resistance with max time 20 minutes
  2. Ankle Pumps (10x every hour)
  3. Lay on Stomach (minimum of 20 min. 3x/day)
  4. Quad Sets (hold 10 sec.) 10x
  5. Gluteal Sets (hold 10 sec.) 10x
  6. Transverse Abdominus Isometrics (hold 10 sec.) 10x
    • Place your first 2 fingers just inside your pelvic bone
      Take a deep breath in and out, relaxing your abdominal muscles
    • At the end of your exhale, draw in your belly button toward your spine (simulate a kegel exercise)
    • You should feel tension under your fingers without bulging and there should be no movement of the spine or pelvis (hold the contraction through 10 normal breaths)
  7. Pelvic Tilts (hold 10 sec.) 10x
  8. Cat and Camel 2×10
  9. Step Ups with Uninvolved Leg First using Bilateral Crutches 2×10
  10. Isometric Hip Abduction and Adduction (hold 10 sec.) 10x
  11. Active Internal Rotation (don’t push into a pinching sensation)
    • Bring your hip to 70° and slowly rotate foot out 2×10
  12. Piriformis Stretch with hip flexion @ 70° in sidelying (hold 30 sec.) 3x
  13. Uninvolved Knee to Chest
    • Lie on your back and lift non‐surgical knee to chest (hold 30 sec.) 3x
      14) Quad Stretch
    • Lie on your stomach and bring ankle towards buttocks (hold 30 sec.)
Manual Therapy:
  1. Passive Supine Hip Roll
  2. Circumduction @45° of Hip Flexion in a clockwise and counterclockwise direction
  3. STM focusing on quads, TFL, ITB, glutes, adductors, and low back
  4. Passive Hip Abduction/Adduction
  5. Game Ready Vasopneumatic Icing
Goals:
  1. Maintain ROM Restrictions
    • Hip Flexion 90° x 10 days, 120° x 3 weeks
    • Hip Extension 0° x 3 weeks
    • Hip External Rotation 0° x 3 weeks
    • Hip Abduction 25° x 2 weeks, 45° x 3 weeks
    • No Hip Internal Rotation and Adduction limits
  2. Maintain Weight Bearing Restrictions using Bilateral Crutches
    • Partial Weight Bearing (<20 lbs.) x 3 weeks
  3. Do not push through pain
  4. Avoid Sitting @90° of Hip Flexion x 2 weeks
Week 2 (2 Treatments)
Exercises:
  1. Heel Slides 2×10
  2. Short Arc Quads 2×15
  3. Quadraped Rocking 2×10
  4. Small Arc Bridges 2×10
    • Only lift buttocks off of surface and squeeze glutes
  5. Active Reverse Butterflies 10x
    • Lie on your back with knees bent and feet flat shoulder width apart
    • Bring knees towards each other leaving feet in place
    • Squeeze knees (hold 5 sec.)
  6. Supine Hip Abduction to 25° and Adduction 2×10
    • Push into heel with sliding leg in and out to avoid using hip Flexors
  7. Piriformis Stretch supine with hip flexion @ 70° (hold 30 sec.) 3x
    • Use pillows between legs for support
Manual Therapy:
  1. Passive Supine Hip Roll
  2. Circumduction @ 45° of Hip Flexion in a clockwise and counterclockwise direction
  3. STM focusing on quads, TFL, ITB, glutes, adductors, and low back
  4. Passive Hip Abduction/Adduction
  5. Game Ready Vasopneumatic Icing
Goals:
  1. Maintain ROM Restrictions
    • Hip Flexion 90° x 10 days, 120° x 3 weeks
    • Hip Extension 0° x 3 weeks
    • Hip External Rotation 0° x 3 weeks
    • Hip Abduction to 25°
    • No Hip Internal Rotation and Adduction limits
  2. Maintain Weight Bearing Restrictions using Bilateral Crutches
    • Partial Weight Bearing (<20 lbs.) x 3 weeks
  3. Do not push through pain
  4. Avoid Sitting @90° of Hip Flexion
Week 3 (2 Treatments)
Exercises:
  1. Standing Hip Abduction with Internal Rotation 2×20
  2. Bridges with theraband around thighs 2×20
  3. Long Arc Quads with 5 sec. holds 2×20
  4. Active Hip IR with hip flexion @ 90° 2×15
  5. Piriformis Stretch in sidelying with hip flexion @ 90° (hold 30 sec.) 3x
  6. Hamstring Stretch
    • In a long sit position with your feet straight out in front of you, reach toward your feet (hold 30 sec.) 3x
  7. Aquatic Therapy (once sutures are closed) beginning with water walking and progressing to water jogging with flotation device
Manual Therapy:
  1. STM focusing on quads, TFL, ITB, glutes, adductors, and low back
  2. Passive Hip Abduction/Adduction, Internal Rotation
  3. Gentle Joint Mobs for pain relief and mobility if needed
  4. Game Ready Vasopneumatic Icing
Goals:
  1. Maintain ROM Restrictions
    • Hip Flexion 120° by 3 weeks
    • Hip Extension 0° x 3 weeks
    • Hip External Rotation 0° x 3 weeks
    • Hip Abduction to 45°
    • No Hip Internal Rotation and Adduction limits
  2. Maintain Weight Bearing Restrictions using Bilateral Crutches
    • Partial Weight Bearing (<20 lbs.) x 3 weeks
  3. Do not push through pain

Phase 2: Intermediate

Precautions during this phase:

Avoid hip flexor, adductor, and piriformis irritation

Avoid joint irritation which could occur by too much force, volume, & not enough rest

Avoid ballistic or aggressive stretching

No treadmill use

Week 4 (2 Treatments)
Exercises:
  1. Standing Hip Abduction with ER and IR bringing leg in a 45° angle back 2×20 each
  2. Standing Hip Adduction 2×20
  3. Standing Hip Extension (when anterior hip capsule is closed) 2×20
  4. Supine Active Groin Stretch (hold 30 sec.) 3x
  5. Standing Hip Flexion (small arcs) 2×20
    • Start with heel behind back and slowly bring heel in front as tolerated
  6. Prone quad stretch with towel (hold 30 sec.) 3x
  7. Involved Knee to Chest Stretch (hold 30 sec.) 3x
    • Hold under the knee with both hands and lift up and in to chest in a scooping motion
  8. Figure 4 stretch (hold 30 sec.) 3x
  9. Hip ER and IR active ROM in sit
  10. Shuttle squats with minimal weight and only 25% weight bearing through affected leg 2×20
  11. Partial and Oblique Sit-­ups 2×15 each
Manual Therapy:
  1. STM focusing on quads, TFL, ITB, glutes, adductors, and low back
  2. Passive ROM for all hip motions into painfree ranges
  3. Manual Traction/Joint Mobs for pain relief and mobility if needed
  4. Game Ready Vasopneumatic Icing
Goals:
  1. Restore Full Hip PROM for all motions with mild stiffness into ER
  2. Maintain Weight Bearing Restrictions using Bilateral Crutches
    • Partial Weight Bearing (25%)
  3. Do not push through pain
Week 5 (2 Treatments)
Exercises:
  1. Upright stationary bike with resistance (30-­45 min.)
  2. Sidelying Clams (with 2 pillows between legs and contraction felt in buttock region) 2×20
  3. Partial Squats (0⁰‐30⁰ of knee flexion) with TRX bands 2×20
  4. Hip Abduction followed by Hip External Rotation in sidelying 2×20
  5. Weight Shifts side to side and front to back 2×10 with 30 sec. holds
  6. Shuttle squats and Heel Raises Bilaterally with minimal weight 2×20 each
  7. Hip Abduction and Extension Exercises with Multi Hip Machine with light weight 2×20
  8. Standing Hip Flexion to 90⁰ 2×20
  9. Stool Rotations into Hip IR and ER 2×20
    • Rotate the leg that is resting on the stool outward without moving your trunk and theraband attached to the ankle
  10. Prone Hip Extension with Knee Bent and Straight 2×20 each
  11. Wall Sits with Theraband around thighs (hold 60 sec.) 3x
  12. Bridges with Alternate Leg Extensions 2×20
Manual Therapy:
  1. STM focusing on quads, TFL, ITB, glutes, adductors, and low back
  2. Passive ROM for all hip motions into painfree ranges
  3. Manual Traction/Joint Mobs for pain relief and mobility if needed
  4. Game Ready Vasopneumatic Icing
Goals:
  1. Restore Full Hip PROM for all motions with mild stiffness into ER
  2. Maintain Weight Bearing Restrictions using Bilateral Crutches and progressing to One Crutch if soreness does not increase (If soreness increases, return to previous level for 1‐2 days)
    • Partial Weight Bearing (50‐75%)
  3. Do not push through pain
Week 6 (2 Treatments)
Exercises:
  1. Elliptical Machine (15 min.)
  2. Faber Slides 2×10
    • Slowly slide heel up along opposite leg while allowing knee to fall outward
  3. Standing Quad Stretch (hold 30 sec.) 3x
  4. Standing Iliotibial Band Stretch (hold 30 sec.) 3x
  5. Standing Hamstring Stretch (hold 30 sec.) 3x
    • With your knees straight, reach toward the floor
  6. Single Leg Stance on Even Surface (hold 30 sec.) 3x
  7. Active Circumduction in Faber Position (2 minutes in each direction)
    • Perform small rotational movements in clockwise and counterclockwise directions with affected leg’s foot on opposite inner thigh
  8. Squats with TRX Bands 2×20
  9. Standing Hip Flexion to 120⁰
  10. Prone Bilateral Hamstring/Adductor Curls with 8# dumbbell 2×20
  11. Single Leg Dead Lift 2×10
    • Standing on affected leg with leg forward, bend forward and reach for the ground
    • Keep hips level and do not let hips rotate
  12. Sitting Groin Stretch (hold 30 sec.) 3x
  13. Step Ups and Step Downs (start with 2 inch step) 2×20
  14. Lateral Step Ups and Downs (start with 2 inch step) 2×20
  15. Single Leg Bridges 2×20
  16. Standing Single Leg Heel Raises 2×20
  17. TKE’s with blue sports cord 2×20
  18. Quadraped Alternate Arm and Leg on swiss ball 2×20
  19. Planks on Knees (hold 30 sec.) 3x
  20. Stool Rotations with Theraband (start with red) 2×20
Manual Therapy:
  1. STM focusing on quads, TFL, ITB, glutes, adductors, and low back
  2. Passive ROM for all hip motions into painfree ranges
  3. Manual Traction/Joint Mobs for pain relief and mobility if needed
  4. Game Ready Vasopneumatic Icing
Goals:
  1. Restore Full Hip PROM for all motions
  2. Progress Weight Bearing from one crutch to no assistive device if soreness does not increase (If soreness increases, return to previous level for 1-­2 days)
    • Full Weight Bearing (100%)
  3. Do not push through pain
Week 7 (2 Treatments)
Exercises:
  1. Elliptical Machine (30 min.)
  2. Kneeling Hip Flexor Stretch (hold 30 sec.) 3x
  3. Single Leg Stance on Uneven Surface (hold 30 sec.) 3x
  4. Forward and Lateral Lunges 2×20
  5. Hip Hikes 2×20 
  6. Foam roll oscillations over ITBand and Quads (5 minutes)
  7. Single Leg Squats with minimal weight on Shuttle 2×20 
  8. Quadraped Alternate Arm and Leg 2×20 
  9. TKE’s with black sports cord 2×20
  10. Plank Pikes with knees on ball 2×20
Manual Therapy:
  1. STM focusing on quads, TFL, ITB, glutes, adductors, and low back
  2. Passive ROM for all hip motions into painfree ranges
  3. Manual Traction/Joint Mobs for pain relief and mobility if needed
  4. Game Ready Vasopneumatic Icing
Goals:
  1. Restore Full Hip PROM for all motions
  2. Progress Weight Bearing from one crutch to no assistive device if soreness does not increase (If soreness increases, return to previous level for 1-­2 days)
    • Full Weight Bearing (100%)
  3. Do not push through pain

Phase 3: Advanced

Precautions during this phase:

Avoid hip flexor, adductor, and piriformis irritation

Avoid joint irritation which could occur by too much force, volume, & not enough rest

Avoid ballistic or aggressive stretching

No treadmill use

Week 8 (2 Treatments)
Exercises:
  1. Elliptical Machine (30-45 min.)
  2. Wii Balance Activities
  3. Booty Rippers 2×20
  4. High Knee Steps 2×20
  5. Reverse Lunges 2×20
  6. Monster Walks Both Directions 2×20
  7. Single Leg Balance on Bosu with eyes closed
  8. Star Grid (5 sets x 3)
    • Standing on affected leg, tap with your unaffected foot in a 12, 10/11, 9, 8/7, and 6 o’clock positions with your left foot and in a 12, 1/2, 3, 4/5, 6 o’clock positions with your right foot
  9. Hip Flexion on Multi Hip Machine with light weight and small arc 2×20
  10. Plank Pikes with feet on ball 2×20
Manual Therapy:
  1. STM focusing on quads, TFL, ITB, glutes, adductors, and low back
  2. Manual Traction/Joint Mobs for mobility if needed
  3. Game Ready Vasopneumatic Icing
Goals:
  1. Restore Full Hip AROM for all motions
  2. Improve neuromuscular control, balance, and proprioception
  3. Initiate functional exercises maintaining core and pelvic stability
  4. Restore muscular strength and endurance

Phase 4: Sports Specific

Precautions during this phase:

Avoid hip flexor, adductor, and piriformis irritation

Avoid joint irritation which could occur by too much force, volume, & not enough rest

Avoid ballistic or aggressive stretching

No treadmill use

Weeks 9-12 (4 Treatments)
Exercises:
  1. Karaoke 2×20
  2. Single Leg Squat on TRX bands 2×20 
  3. Bridge on TRX bands 2×20
  4. Mountain Climbers 2×20
  5. Single Leg Balance on Bosu Ball with Medicine Ball Trunk Rotations 2×20 
  6. Multiplane Lunges 2×20
  7. Shuttle Runs 2×20 
  8. 60° Knee Bends with sports cord 2×20 
  9. Planks (hold 30 sec.) 3x
Weeks 12-16 (4 Treatments)
Exercises:
  1. Jump Rope (5-­10 Minutes)
  2. Cutting @ 45° (5 Minutes)
  3. Zig Zags (5 Minutes) 
  4. Jogging ( 10-­‐20 Minutes)
  5. Mountain Climbers on TRX bands 2×20
  6. Box Jumping Forward and Back 2×20
  7. Box Jumping Laterally 2×20
  8. High Knee Lunges with Speed 2×20
  9. Multiplane Lunges with Trunk Rotation 2×20
  10. Planks on TRX bands (hold 30 sec. 5x)
Goals:
  1. Hip Elexion strength > 85% of the uninvolved side
  2. Full Pain-­‐free Hip ROM
  3. Ability to perform sports specific drills at full speed
  4. Return to competition
Protocol Disclaimer:

These are to simply be used as guidelines. This information is provided for informational and educational purposes only. Specific treatment of a patient should be based on individual needs and the medical care deemed necessary by the treating physician and therapists. I take no responsibility or assume no liability for improper use of these protocols. Consult your treating physician or therapist for specific courses of treatment.