Hip Arthroscopy with Labral Repair

ONE PATIENTS STORY TO TREATMENT AND RECOVERY

“Orthopedic injuries can only bear a certain amount of weight. With this machine, we can gauge how much weight and be compliant with the doctor’s orders. The patient can exercise without as much pain.”
Trent Leonard, Rehabilitation Service Manager, Life Care Center

 
 

Hip Arthroscopy with Labral Repair Protocol for Rehab Professionals

 

IMMEDIATE POST-OPERATIVE PHASE: 0-2 WEEKS

Overall Goals:

  • Decrease post operative swelling/inflammation
  • Decrease post operative pain
  • Prevent post operative stiffness and adhesions
  • Restore basic muscle activation patterns
  • Normalize gait pattern with assistive device
 
 

Passive Range of Motion (within pain-free range):

  • 0-90 maximum ROM in this phase
  • Circumduction at 30 deg flexion and progress to 70 deg flexion per tolerance
  • Supine IR/ER log rolling in resting position of comfort (30 deg flexion, slight abduction)
  • Progress to prone IR/ER when patient tolerates prone positioning
  • Upright stationary bike (1/2 to full revolution with elevated seat height, no resistance)

Flexibility:

  • Opposite knee to chest (early hip flexor stretch)
  • Prone prop (20 min 2x per day)
  • Prone knee flexion (once prone)
    (early quad/anterior hip flexibility)

Edema Control & Muscle Activation: 

  • Glute set progression (supine then prone)
  • Quad sets
  • Ankle pumps
  • Short arc quads
  • Transverse abdominus (TrA) contractions (in supine)
  • Prone terminal knee extension (once tolerating prone position)
  • Avoid active hip flexion straight leg raise

Gait Training:

  • Initiate reduced weight bearing on AlterG Anti-Gravity Treadmill until gait pattern normalized
  • Avoid full weight bearing ambulation on treadmill

Criteria to Progress to Next Phase: 

  • Minimal to no pain at rest
  • Neutral, pain free hip extension range of motion
  • Normalized glute, quad, TrA activation (sustained contraction without adjacent muscle activation, verbal or manual cueing)
  • No increased pain with prone positioning

EARLY POST-OPERATIVE PHASE: 2-6 WEEKS

Goals:

  •  Restore adequate hip extension range of motion for gait
  • Decrease post operative pain/inflammation
  • Improve muscular strength and endurance for ambulation and ADLs
  • Restore range of motion necessary for ADLs

Range of Motion Exercises:

  • Continue circumduction
  • Continue stationary bike with elevated seat and no resistance
  • Quadruped heel sits
  • Butterfly/reverse butterfly
  • Grade 1-2 joint mobilizations with belt 

Flexibility: 

  • Begin scar mobilization as tolerated
  • Prone quadriceps stretch
  • Prone prop positioning
  • Heel cord stretch
  • Hamstring stretch
  • Lunge position hip flexor stretch
  • Standing ITB stretch

Muscle Activation/Strengthening (progressing to resistance as tolerated):

  • Isometric adduction
  • Isometric abduction
  • Isometric prone IR/ER
  • Prone hip extension over pillows
  • Assisted to active supine hip abduction
  • Assisted to active heel slides
  • Quadruped hip extension
  • Bilateral bridges
  • Knee extension/LAQ/knee extensor isometrics
  • Standing TKE
  • Standing hip abduction with IR
  • Single leg balance
  • Bilateral leg press (< 90 deg hip flexion)
  • Sit to stands/mini-squats
  • Partially loaded active external rotations

Gait Training: 

  • Continue reduced weight bearing AlterG training until gait pattern normalized
  • Avoid full weight bearing ambulation on treadmill

Criteria to Progress to Next Phase:

  • No reactive pain with exercise; or anterior pain at rest
  • Patient reports ability to sit greater than 30 min without increasing pain
  • Able to demonstrate 30 sec of single leg stance balance without contralateral pelvic drop or pain
  • Able to ambulate without antalgic or compensatory patterns by 4 weeks
    -  Patient verbalized pain free community ambulation without AD

INTERMEDIATE PHASE: 6-12 WEEKS

Goals:

  • Restore adequate hip, knee, foot kinetic chain biomechanics
  • Maintain full ROM and flexibility
  • Restore adequate muscular strength and endurance for progression to IADLs
  • Progress activity (ADLs and rehab) without intra-articular or extra-articular irritation

Range of Motion:

  • Continue range of motion and joint mobs from previous phases
  • Active FABER slides

 Flexibility:

  • Continue stretching/flexibility from previous phases
  • Half kneeling hip flexor stretch with rotation opposite
  • Progress to Thomas position anterior hip stretch
  • Walking spider man stretch
  • Inch worms

Strengthening:

  • Unilateral leg press
  • Forward step ups (6-8 inch step)
  • Split squats and lunges
  • Single leg Romanian deadlifts
  • Side and prone planks
  • Side-lying hip abduction
  • Bridge progression (march, kick, single leg on theraball)
  • Side stepping with band resistance
  • Single leg balance with perturbations/steamboats
  • Lateral step downs (progress up from 2 inch box)
  • Hip hikes (progress up from 2 inch box)
  • Sport cord rotations

Cardiovascular Training: 

  • Upright bicycle with resistance
  • Elliptical trainer (8weeks)

Plyometrics (10-12 weeks): 

  • Bilateral shuttle jumps/jog
  • 4-6” double leg hop downs
  • AlterG Anti-Gravity Treadmill reduced weight bearing bilateral/unilateral hops

Criteria to Progress to Running and Return to Sport Phase: 

  • Able to ascend and descend a flight of stairs without pain
  • Able to ambulate 30 minutes without pain or compensatory strategies
  • Full AROM without pain or impingement symptoms
  • 5/5 strength in hip and lower extremity
  • Achieve a score of 14 on FMS
  • Y Balance score within 3 cm of contralateral leg

RUNNING AND RETURN TO SPORT PHASE: 12-16+ WEEKS

Goals:

  • Normalize running and agility mechanics  
  • Maximize power
  • Sufficient cardiovascular endurance for sport/occupation

Flexibility:

  • Seated FABER pretzel stretch
  • Hurdle steps

Strengthening/Power:

  •  Continue to advance unilateral strengthening

Plyometrics:

  • Bilateral to unilateral, sagittal/frontal plyometric progression
  • Broad jump/bounding

Cardiovascular:

  • Initiate reduced weight-bearing on the AlterG Anti-Gravity Treadmill (walk/jog at 12 weeks)
  • Progress to treadmill jogging
  • Continue elliptical trainer
  • Continue upright stationary bicycle with interval training

 Agility: 

  • Ladder drills
  • Cones
  • T drills
  • Shuttle runs
  • Incorporate sport specific drills/equipment

Criteria for Return to Sport:

  • No signs of FAI with clinical testing
  • 90% on Hip Outcome Score or 90% Global Rating Scale
  • <10% side to side difference with:
    - Single leg hop
    - Single leg triple hop
  • No compensation with return to sport activities