Provide patient with home exercise program
Weeks 1-4:
- Bike for 20 minutes/day (can be 2x/day)
- Scar massage
- Gait training PWB with assistive device
- Hip PROM
- Hip flexion to 90 degrees, abduction as tolerated
- No active abduction and IR
- No passive ER or adduction (6 weeks)
- Quadruped rocking for hip flexion
- Hip isometrics
- Extension, adduction, ER at 2 weeks
- Hamstring isotonics
- Pelvic tilts
- NMES to quads with SAQ
Weeks 4-6
- Continue with previous therapy
- Gait training PWB with assistive device
- 20 pounds through 6 weeks
- Progress with passive hip flexion greater than 90 degrees
- Supine bridges
- Isotonic adduction
- Progress core strengthening (avoid hip flexor tendonitis)
- Progress with hip strengthening
- Start isometric sub max pain free hip flexion(3-4 wks)
- Quadriceps strengthening
- Aqua therapy in low end of water
Weeks 6-8
- Continue with previous therapy
- Gait training: increase WBing to 100% by 8 weeks with crutches
- Progress with ROM
- Passive hip ER/IR
- Supine log rolling Stool rotation Standing on BAPS
- Hip Joint mobs with mobilization belt (if needed)
- Lateral and inferior with rotation
- Prone posterior-anterior glides with rotation
- Progress core strengthening (avoid hip flexor tendonitis
Weeks 8-10
- Continue previous therapy
- Wean off crutches (2 – 1 – 0)
- Progressive hip RO
- Progress strengthening LE
- Hip isometrics for abduction and progress to isotonics
- Leg press (bilateral LE)
- Isokinetics: knee flexion/extension
- Progress core strengthening
- Begin proprioception/balance
- Balance board and single leg stance
- Bilateral cable column rotations
- Elliptical
Weeks 10-12
- Continue with previous therex
- Progressive hip ROM
- Progressive LE and core strengthening
- Hip PREs and hip machine
- Unilateral Leg press
- Unilateral cable column rotations
- Hip Hiking
- Step downs
- Hip flexor, glute/piriformis, and It-band Stretching – manual and self
- Progress balance and proprioception
- Bilateral – Unilateral – Foam – Dynadisc
- Treadmill side stepping from level surface holding on progressing to inclines
- Side stepping with theraband
- Hip hiking on stairmaster (week 12)
12 Weeks and Over:
- Progressive hip ROM and stretching
- Progressive LE and core strengthening
- Endurance activities around the hip
- Dynamic balance activities
- Treadmill running program
- Sport specific agility drills and plyometrics
Other:
- Modalities
- Electric Stimulation Ultrasound Heat before/after Ice before/after
Please note that these instructions are general guidelines to be followed; however, any written or verbal instructions provided by Dr. Nwachukwu supersede the instructions below and should be followed.
