Hip Arthroscopy Labral Repair
Hip Protocols

16 Weeks Divided into 4 Phases to Alleviate Hip Pain and Restore Your Muscles in to Working Order.
Initial Phase
During this phase:
- Diminish pain and inflammation
- Protect integrity of repaired tissue
- Prevent muscular inhibition, and
- Restore ROM within the restrictions
Intermediate Phase
During this phase:
- Protect integrity of repaired tissue
- Restore full hip ROM
- Restore normal gait pattern
- Progressively increase muscle strength
- Improve neuromuscular control, balance, and proprioception
- Initiate functional exercises maintaining core and pelvic stability
Advanced Phase
During this phase:
- Restoration of muscular endurance and strength
- Restoration of cardiovascular endurance
- Optimize neuromuscular control
Sports Specific Phase
During this phase:
- Restoration of muscular endurance and strength
- Restoration of cardiovascular endurance
- Optimize neuromuscular control, balance, and proprioception
Phase 1: Initial
Exercises:
- Upright Stationary Bike—no to minimal resistance with max time 20 minutes
- Ankle Pumps (10x every hour)
- Lay on Stomach (minimum of 20 min. 3x/day)
- Quad Sets (hold 10 sec.) 10x
- Gluteal Sets (hold 10 sec.) 10x
- 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)
- Place your first 2 fingers just inside your pelvic bone
- Pelvic Tilts (hold 10 sec.) 10x
- Cat and Camel 2×10
- Step Ups with Uninvolved Leg First using Bilateral Crutches 2×10
- Isometric Hip Abduction and Adduction (hold 10 sec.) 10x
- Active Internal Rotation (don’t push into a pinching sensation)
- Bring your hip to 70° and slowly rotate foot out 2×10
- Piriformis Stretch with hip flexion @ 70° in sidelying (hold 30 sec.) 3x
- 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.)
- Lie on your back and lift non‐surgical knee to chest (hold 30 sec.) 3x
Manual Therapy:
- Passive Supine Hip Roll
- Circumduction @45° of Hip Flexion in a clockwise and counterclockwise direction
- STM focusing on quads, TFL, ITB, glutes, adductors, and low back
- Passive Hip Abduction/Adduction
- Game Ready Vasopneumatic Icing
Goals:
- 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
- Maintain Weight Bearing Restrictions using Bilateral Crutches
- Partial Weight Bearing (<20 lbs.) x 3 weeks
- Do not push through pain
- Avoid Sitting @90° of Hip Flexion x 2 weeks
Exercises:
- Heel Slides 2×10
- Short Arc Quads 2×15
- Quadraped Rocking 2×10
- Small Arc Bridges 2×10
- Only lift buttocks off of surface and squeeze glutes
- 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.)
- Supine Hip Abduction to 25° and Adduction 2×10
- Push into heel with sliding leg in and out to avoid using hip Flexors
- Piriformis Stretch supine with hip flexion @ 70° (hold 30 sec.) 3x
- Use pillows between legs for support
Manual Therapy:
- Passive Supine Hip Roll
- Circumduction @ 45° of Hip Flexion in a clockwise and counterclockwise direction
- STM focusing on quads, TFL, ITB, glutes, adductors, and low back
- Passive Hip Abduction/Adduction
- Game Ready Vasopneumatic Icing
Goals:
- 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
- Maintain Weight Bearing Restrictions using Bilateral Crutches
- Partial Weight Bearing (<20 lbs.) x 3 weeks
- Do not push through pain
- Avoid Sitting @90° of Hip Flexion
Exercises:
- Standing Hip Abduction with Internal Rotation 2×20
- Bridges with theraband around thighs 2×20
- Long Arc Quads with 5 sec. holds 2×20
- Active Hip IR with hip flexion @ 90° 2×15
- Piriformis Stretch in sidelying with hip flexion @ 90° (hold 30 sec.) 3x
- Hamstring Stretch
- In a long sit position with your feet straight out in front of you, reach toward your feet (hold 30 sec.) 3x
- Aquatic Therapy (once sutures are closed) beginning with water walking and progressing to water jogging with flotation device
Manual Therapy:
- STM focusing on quads, TFL, ITB, glutes, adductors, and low back
- Passive Hip Abduction/Adduction, Internal Rotation
- Gentle Joint Mobs for pain relief and mobility if needed
- Game Ready Vasopneumatic Icing
Goals:
- 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
- Maintain Weight Bearing Restrictions using Bilateral Crutches
- Partial Weight Bearing (<20 lbs.) x 3 weeks
- 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
Exercises:
- Standing Hip Abduction with ER and IR bringing leg in a 45° angle back 2×20 each
- Standing Hip Adduction 2×20
- Standing Hip Extension (when anterior hip capsule is closed) 2×20
- Supine Active Groin Stretch (hold 30 sec.) 3x
- Standing Hip Flexion (small arcs) 2×20
- Start with heel behind back and slowly bring heel in front as tolerated
- Prone quad stretch with towel (hold 30 sec.) 3x
- 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
- Figure 4 stretch (hold 30 sec.) 3x
- Hip ER and IR active ROM in sit
- Shuttle squats with minimal weight and only 25% weight bearing through affected leg 2×20
- Partial and Oblique Sit-ups 2×15 each
Manual Therapy:
- STM focusing on quads, TFL, ITB, glutes, adductors, and low back
- Passive ROM for all hip motions into painfree ranges
- Manual Traction/Joint Mobs for pain relief and mobility if needed
- Game Ready Vasopneumatic Icing
Goals:
- Restore Full Hip PROM for all motions with mild stiffness into ER
- Maintain Weight Bearing Restrictions using Bilateral Crutches
- Partial Weight Bearing (25%)
- Do not push through pain
Exercises:
- Upright stationary bike with resistance (30-45 min.)
- Sidelying Clams (with 2 pillows between legs and contraction felt in buttock region) 2×20
- Partial Squats (0⁰‐30⁰ of knee flexion) with TRX bands 2×20
- Hip Abduction followed by Hip External Rotation in sidelying 2×20
- Weight Shifts side to side and front to back 2×10 with 30 sec. holds
- Shuttle squats and Heel Raises Bilaterally with minimal weight 2×20 each
- Hip Abduction and Extension Exercises with Multi Hip Machine with light weight 2×20
- Standing Hip Flexion to 90⁰ 2×20
- 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
- Prone Hip Extension with Knee Bent and Straight 2×20 each
- Wall Sits with Theraband around thighs (hold 60 sec.) 3x
- Bridges with Alternate Leg Extensions 2×20
Manual Therapy:
- STM focusing on quads, TFL, ITB, glutes, adductors, and low back
- Passive ROM for all hip motions into painfree ranges
- Manual Traction/Joint Mobs for pain relief and mobility if needed
- Game Ready Vasopneumatic Icing
Goals:
- Restore Full Hip PROM for all motions with mild stiffness into ER
- 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%)
- Do not push through pain
Exercises:
- Elliptical Machine (15 min.)
- Faber Slides 2×10
- Slowly slide heel up along opposite leg while allowing knee to fall outward
- Standing Quad Stretch (hold 30 sec.) 3x
- Standing Iliotibial Band Stretch (hold 30 sec.) 3x
- Standing Hamstring Stretch (hold 30 sec.) 3x
- With your knees straight, reach toward the floor
- Single Leg Stance on Even Surface (hold 30 sec.) 3x
- 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
- Squats with TRX Bands 2×20
- Standing Hip Flexion to 120⁰
- Prone Bilateral Hamstring/Adductor Curls with 8# dumbbell 2×20
- 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
- Sitting Groin Stretch (hold 30 sec.) 3x
- Step Ups and Step Downs (start with 2 inch step) 2×20
- Lateral Step Ups and Downs (start with 2 inch step) 2×20
- Single Leg Bridges 2×20
- Standing Single Leg Heel Raises 2×20
- TKE’s with blue sports cord 2×20
- Quadraped Alternate Arm and Leg on swiss ball 2×20
- Planks on Knees (hold 30 sec.) 3x
- Stool Rotations with Theraband (start with red) 2×20
Manual Therapy:
- STM focusing on quads, TFL, ITB, glutes, adductors, and low back
- Passive ROM for all hip motions into painfree ranges
- Manual Traction/Joint Mobs for pain relief and mobility if needed
- Game Ready Vasopneumatic Icing
Goals:
- Restore Full Hip PROM for all motions
- 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%)
- Do not push through pain
Exercises:
- Elliptical Machine (30 min.)
- Kneeling Hip Flexor Stretch (hold 30 sec.) 3x
- Single Leg Stance on Uneven Surface (hold 30 sec.) 3x
- Forward and Lateral Lunges 2×20
- Hip Hikes 2×20
- Foam roll oscillations over ITBand and Quads (5 minutes)
- Single Leg Squats with minimal weight on Shuttle 2×20
- Quadraped Alternate Arm and Leg 2×20
- TKE’s with black sports cord 2×20
- Plank Pikes with knees on ball 2×20
Manual Therapy:
- STM focusing on quads, TFL, ITB, glutes, adductors, and low back
- Passive ROM for all hip motions into painfree ranges
- Manual Traction/Joint Mobs for pain relief and mobility if needed
- Game Ready Vasopneumatic Icing
Goals:
- Restore Full Hip PROM for all motions
- 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%)
- 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
Exercises:
- Elliptical Machine (30-45 min.)
- Wii Balance Activities
- Booty Rippers 2×20
- High Knee Steps 2×20
- Reverse Lunges 2×20
- Monster Walks Both Directions 2×20
- Single Leg Balance on Bosu with eyes closed
- 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
- Hip Flexion on Multi Hip Machine with light weight and small arc 2×20
- Plank Pikes with feet on ball 2×20
Manual Therapy:
- STM focusing on quads, TFL, ITB, glutes, adductors, and low back
- Manual Traction/Joint Mobs for mobility if needed
- Game Ready Vasopneumatic Icing
Goals:
- Restore Full Hip AROM for all motions
- Improve neuromuscular control, balance, and proprioception
- Initiate functional exercises maintaining core and pelvic stability
- 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
Exercises:
- Karaoke 2×20
- Single Leg Squat on TRX bands 2×20
- Bridge on TRX bands 2×20
- Mountain Climbers 2×20
- Single Leg Balance on Bosu Ball with Medicine Ball Trunk Rotations 2×20
- Multiplane Lunges 2×20
- Shuttle Runs 2×20
- 60° Knee Bends with sports cord 2×20
- Planks (hold 30 sec.) 3x
Exercises:
- Jump Rope (5-10 Minutes)
- Cutting @ 45° (5 Minutes)
- Zig Zags (5 Minutes)
- Jogging ( 10-‐20 Minutes)
- Mountain Climbers on TRX bands 2×20
- Box Jumping Forward and Back 2×20
- Box Jumping Laterally 2×20
- High Knee Lunges with Speed 2×20
- Multiplane Lunges with Trunk Rotation 2×20
- Planks on TRX bands (hold 30 sec. 5x)
Goals:
- Hip Elexion strength > 85% of the uninvolved side
- Full Pain-‐free Hip ROM
- Ability to perform sports specific drills at full speed
- 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.