Geoffrey S. Van Thiel, MD/MBA

Transcription

1 1 Geffrey S. Van Thiel, MD/MBA Hip Arthrscpy Labral Repair/Debridement with Femrplasty Initial Jint Prtectin Guidelines: 1-4 weeks pst-p Jint Prtectin Patient Educatin: Avid active lifting r flexing and rtating the hip fr 2-3 weeks Assistance t mve the invlved LE is required fr all transfers fr 1 week D nt sit with hip flexed t 90 deg fr greater than 30 min fr 2 weeks Lay n stmach fr 2-3 hurs/day t decrease hip tightness anterirly (patients with lw back pain may mdify psitin) Weight bearing restrictins: FFWB x 2 weeks if n MFx (Micrfracture), x 6 weeks with MFx PT educate patient n FFWB with 20 lbs pressure Brace (if prescribed by Dr. Van Thiel) is used fr 2 weeks: ROM set at 0 deg extensin and 60 deg flexin fr walking Wear brace fr sleeping, n change in ROM Pst Operative ROM restrictins: ROM are guidelines, painfree range nly Flexin limited t 90 and Abd limited t 30 deg x 2 weeks In 90 deg. flexin supine: IR limited t 0 deg and ER t 30 deg x 3 weeks Prne IR t neutral. Prne ER limited t 20 deg x 3 weeks Prne hip extensin t 0 deg x 3 weeks Pst Operative Therapy guidelines: Patient seen 1-3x/week x weeks Rehabilitatin key t prevent stiffness and pst-p scarring Frm and cntrl are key t prevent cmpensatry patterns and sft tissue irritatin Patient may prgress at different rates, please use clinical decisin making t guide patient care Time frames may be mdified depending n patient s preperative fitness level Phase I ( 1-5 days pst p) Wund care: Observe fr signs f infectin. Mdalities: PRN fr pain and inflammatin (Crytherapy, IFC) Patient educatin, WB and Brace: See abve Manual therapy interventins: Beginning superficial day 1 fr edema cntrl and scar mbilizatin. Mnitr adductrs mm grup fr rapid develpment f mm tne. Jint mbilizatins: nne at this phase ROM: PROM Perfrmed by therapist within prtcl and patient tlerance week Bike is an excellent tl with a raised seat t decrease hip flexin PROM within abve listed ROM limits including: Circumductin: Hip flex 70/knee 90, mve thigh in small CW/CCW circular mtins.

2 2 Avid rtatin f the hip int IR/ER. Neutral Circumductin: knee ext, abd patient leg t 20 deg, small circles CW/CCW. Supine hip flexin t max f 90 degrees until p/ 2 weeks. Avid anterir hip pinching. N caudal glides until 3 weeks pst-p Supine abductin: direct abd t max f 30 deg, neutral rtatin Supine ER: Hip flex 70/knee 90, slwly ER t max f 30 deg Supine IR: Hip flex 70/knee 90, slwly IR t max f 20 degrees aviding any pinching in the grin r back f hip Prne IR: knee flex 90, IR slwly as tlerated Prne ER: knee flex 90, gently stretch t max f 20 (aviding ant hip pain) Prne ext: knee flex 90, slwly extend hip t 0 deg maximum Prne n elbws r press ups: slw extensin f lumbar spine beginning by prpping n elbws and prgressing t press ups as tlerated ROM: nne first week, gradually intrduce in Phase II p/ week 2-3 painfree nly aviding tendnitis Strengthening: Ismetrics beginning pst p day 1-day 7 Gluet sets, quad sets and TrA Ismetrics supine r prne Ankle AROM Upright statinary bike with high seat fr AROM (n recumbent bike) Phase II (5 days t 6 weeks) Rehab Gals by cmpletin f phase: Prgress ROM t 75% f uninvlved SLR Abd gluet med x 10 reps at 4/5 w/ cmpensatin Prgress t FWB withut assistive device Prximal stability, prper mm Precautins: firing patterns Avid hip flexr tendnitis Avid anterir capsular pain and pinching with ROM. D n push thrugh pain fr strengthening r ROM. Phase III (6 weeks t 12 weeks) Rehab Gals by cmpletin f phase: Symmetrical ROM Strength hip flexin 70% and all ther hip mtins 80% f uninvlved Nrmal gait withut Trendelenburg Sign Precautins: Cntinue t avid sft tissue flare ups that delay prgress Prmte nrmal mvement patterns t avid cmpensatin with higher level activities D n push thrugh pain Phase II (5 days -6 weeks pst p) Wund care: Cntinue Phase I Mdalities: Cntinue Phase I Weight bearing: If n MFx may begin t prgress WB within painfree levels Brace: Wrn until s/p 6 weeks. MD may D/C earlier. May remve brace during therapy. Crutches: Begin t wean frm crutches at 2 weeks. Avid rapid DC f crutches t avid tendnitis f the hip flexr musculature.

3 3 Manual therapy interventins: cntinue t prgress sft tissue mbilizatin t prevent stiffness anterir hip Jint Mbilizatins: at 3 weeks, may begin nly if clear deficit is present. D nt want t decrease passive stability f the hip in nt limited: Gentle scillatins grade 1-2 fr pain Caudal glide during flexin t decrease pinching during ROM Psterir/inferir glides at week 4 D nt stress anterir capsule fr 6 weeks with jint mbilizatins ROM: Cntinue with limited ROM as nted in guidelines until apprpriate 2 r 3 weeks pst p. Gradually prgress A/PROM after this time wrking twards gal f 75% f uninvlved LE by end f Phase II. Avid anterir hip jint pinch r pain. PROM may be prgressed t als include: Kneeling n stl and active IR/ER initially within ROM limits Quadruped rcking: Hands/knees psitin, pelvis level, slwly rck frwards/backwards frm hands t knees. Once ROM restrictins lifted, patient may begin t rck back bringing seat t heels Half kneeling pelvic tilts: Kneeling n invlved leg, slwly perfrm psterir pelvic tilt t stretch the anterir hip Strengthening: Gradual prgressin f strengthening thrughut phase within painfree mtin: Belw are guidelines nly, varius strengthening activities may be included in phase II and III. Supine Bridging Sidelying Prgresins Prne Phase II(5 days t 6 weeks) Hklying hip IR/ER maintaining level pelvis Pelvic clck (12-6, 3-9 and diagnals) Supine lwer trunk rtatins TrA ismetric with bent knee fall uts and ismetrics with marching Supine FABER slides with TrA ismetricinvlved heel starts in FABERS psitin Duble at medial leg malleli bridge, and bridge slide with up add t knee level ismetric w/pillw r ball, bridge with abductin with Theraband r Pilates ring Sidelying clams with neutral spine and pelvis. Reverse clams. Add Theraband fr resistance r Pilates ring fr ismetric. Prne alternate knee flexin with TA ism Prne hip midrange IR/ER with level pelvis Prne hip ext with knee ext/flex Prne alternate UE/LE extensin Phase III(6 weeks t 12 weeks) Supine prgressin f TrA stabilizatin with UE/LE ext bridge with single knee kicks and single bridge Half side plank taps- Hips 0 ext, knees flex Half side plank hldssame, hld 30 sec t 3 min Mdified side plank hlds- tp leg ext Prne Full side hip planks-le ext ext n exercise ball Prne alternate UE/LE n exercise ball

4 4 Prne Plank Quadruped Half Kneeling Gait Squat/Lunge Balance Slide Bard Cardivascular Prgram Mdified prne plank- knees bent Full prne plank- elbws and feet Full /half plank n BOSU r with Quadruped anterir/psterir pelvic tilts Quadruped lateral slides Quadruped arm and leg raises with alternate arm and neutral pelvis/spine leg raises- add Kneeling n invlved: ½ kneeling pelvic clcks ½ kneeling weight shifts-neutral spine, shift frward fr gentle stretch anterir hip within hip ext limit x week 3 Standing side t side weight shifting Standing anterir/psterir weight shifting- stagger stance Exercise ball wall sits with ball behind lw back Partial squat with feet shulder width apart and slight te in psitin. Squat t 30 degrees at knees Frward, lateral and reverse lunges - lunge twards invlved Split squat in limited range f mtin ½ resistance kneeling upper shulder girdle strengthening while maintaining neutral spine/hip psitining ½ kneeling trunk rtatins-clasp hands and rtate Retr trunk walking Side stepping with r withut band Retr walking with resistance Duble band leg squats/wall slides- t 70 deg flex Duble leg squat with weight shift Sidestep w/band Bulgarian split squats Single leg squats- 30 deg prgress t 70 Split squats r lunges with rtatin f trunk- bilat UE Single leg balance with level pelvis Hip rtatin. hiking- Add can add medicine ball rll up ball/band. wall with Speedskaters pp LE Single leg stand, ism abd pp LE press int wall flex t 20 deg nne Unilateral Lat slides Lateral lunges Lateral Slides Reverse lunges Statinary Bike w/ resistance x 20 min. Increase duratin by 5 week 2 Elliptical may begin s/p 6 weeks N TM ambulatin until 12 weeks p/

5 5 Phase IV: (12 weeks 16 weeks) ROM: Symmetrical ROM. Strengthening: Gradually prgress strength challenges and agility activities painfree level nly. Nrmalize LE strength with all activities withut cmpensatin r Trendelenburg sign. Begin lw level agility activities prgressing twards higher level challenges. Plymetrics: Treadmill: Running: Prir t initiating plymetrics patient shuld be able t cmplete a single leg press 1.5x bdy weight. May begin with walking n treadmill gradually prgressing t running aviding symptm flare r tendnitis. Guideline fr return t running: Prir t returning t running patient shuld be able t cmplete the 10 Rep Triple which includes: single leg squats w/ kinetic cllapse frnt step dwns w/ kinetic cllapse sidelying Abd SLR against resistance grade minimum f 4/5 all reps

6 6