Hip Arthroscopy Rehabilitation Protocol

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1 Hip Arthroscopy Rehabilitation Protocol Phase I: Healing Phase (0-2 Weeks) Goal: Protect Incision, Reduce Inflammation, Allow Tissues to Heal, and Rest Wound Care: Keep Incision covered with sealed dressing for 48 hours. Then, cover stitches with large Band- aid to keep clean, dry and protected until the stitches are removed in the office at follow- up. Medications: 1) Aspirin 325 mg twice a day for prevention of blood clots 2) Celebrex 200 mg or Mobic 7.5 twice a day for Inflammation 3) Percocet 5/ tablets every 4-6 hours for pain Hip Brace: Wear the hip brace during the day and sleeping, but remove the brace for hygiene and showering. The brace protects the hip from unwanted motion and positions that could re- injure the hip. Avoid: 1) Hip Flexion past 90 degrees 2) Internal and External Rotation of the Hip 3) Impact Activities (i.e. Jumping and running) Weight- bearing Status: = Full Weight- bearing for Diagnostic Hip Arthroscopy and Labral Debridement without repair = Toe- touch Weight- bearing extended 6 weeks for Labral Repair, Gluteal Tendon Repair, Femoral Osteochondroplasty, and Chondral Microfracture treatment Home Exercises: 1) Mobility using Crutches for Stabilization and support 2) Gluteus Activation 3) Passive Circumduction: Avoiding pinching for pain- free ROM a. 6 minutes at 30 degrees Hip Flexion (3 minutes clockwise, 3 minutes counterclockwise) b. 6 minutes at 70 degrees Hip Flexion (3 min CW, 3 min CCW) 4) Manual Soft Tissue Therapy targeting Iliopsoas, ITB & TFL, Adductors and Gluteus Medius

2 Phase II: Early Home or Basic Outpatient Rehab (2-6 Weeks) Goal: Restore and Increase Pain- free ROM, Reduce Inflammation, Enhance proper muscle activation and neuromuscular re- education Hip Brace: Wear the hip brace during the day and sleeping to continue protecting the hip, but remove the brace for hygiene and showering. Avoid: 5) Hip Flexion past 90 degrees 6) Internal and External Rotation of the Hip 7) Impact Activities (i.e. Jumping and running) Therapeutic Exercises: 1) Mobility using Crutches for Stabilization and support 2) Gluteus Activation, Passive Circumduction & Manual Soft tissue therapy (as outlined previously) 3) FABER slide progression with PT- assistance 4) Cat/Camel in quadraped 5) Hook- lying Butterflies and Reverse Butterflies 6) Quadraped Posterior Rock 7) Prone lying Belly Time 8) Gluteus Activation progression (continue until activation is symmetric) 9) Transverse abdominus Combine with pelvic tilt 10) Isometric Abductors/Adductors supine and prone with IR/ER 11) Double- leg Bridges within pain- free ROM 12) Scar Mobilization as needed

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4 Phase III: Intermediate Outpatient Rehab (6-10 Weeks) Goal: Progress to full weight- bearing, Improve Gait, Stability, Balance and Neuromuscular re- education! 3x/week for 4-6 weeks Progression: - Hip- brace is discontinued - Motion may begin to gently progress with flexion past 90 degrees and gentle increases in IR/ER - Continue Phase II Mobility/Flexibility exercises and stretches - Avoid positions that cause pinching or Pain - All repetitions should be controlled and slow, NOT Explosive - Correct and Discourage Compensatory maneuvers (anterior weight shifting, pelvic drop, valgus collapse) - Advance Balance and proprioception with single leg stance to uneven/unstable surfaces (Air- ex, Bosu, Dynadisc) - Cardio activities may include Elliptical, stationary/mobile bike, and swimming - Avoid Walking over 1 mile, crunches/sit- ups, and weights over 20 lbs - Upper body conditioning can include suspension- type exercises

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10 Walking Spiderman Stretch Criteria for Progression to Phase IV: = Ability to complete all Phase III exercises without increased pain, swelling or irritation = Demonstrate full Pain- free ROM with hip flexion to 115 degrees = Full Weight- bearing without pain and no assistive devices and able to ambulate 15 minutes without pain or fatigue

11 Phase IV: Advanced Outpatient Rehab (10-16 Weeks) Goal: Progressively improve Balance, Strength, Mobility, Endurance and Conditioning! 2-3 x/week until Ready to Return to Sport Progression: - Continue Strethces, Mobilizations and scar tissue massages from Phase I, II, and III - Adding Plyometrics keeping knees behind toes with all exercises Return to Sport Criteria: 1) No signs of Pain with clinical testing with Dr. Ellison 2) 90% on Hip Outcome Score 3) Less than 10% side- to- side difference with Single leg Stance & Single Leg Hop 4) No Compensatory movements, including pelvic drop, knee valgus, or excessive anterior weight shift

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