Weeks 1- 6:
Phase 1 – Rehabilitation Goal: Protect the joint and avoid irritation
ROM Restrictions:
* Perform PROM in patient’s PAIN FREE Range
FLEXION: Limited to: 90 degrees x 2 weeks (may go higher in the CPM)
EXTENSION: Limited to: 0 degrees x 3 weeks
EXTERNAL ROTATION: Limited to: *30 degrees @ 90 degrees of hip flexion x 3 weeks
*20 degrees in prone x 3 weeks
INTERNAL ROTATION: Limited to: *20 degrees @ 90 degrees of hip flexion x 3 weeks
*No limitation in prone
ABDUCTION: Limited to: 30 degrees x 2 weeks
Weight Bearing Restrictions:
20% FOOT FLAT Weight Bearing-for 2-3 weeks (non-Micro-fracture)
Gait Progression:
- Begin to D/C crutches at 3 weeks. Do NOT progress to one crutch
- Patient may be fully off crutches and brace once gait is PAIN FREE and NON-COMPENSATORY
PT Pointers:
- Provide patient with education on initial joint protection to avoid joint and surrounding soft tissue irritation
- Begin initial passive range of motion within post operative restrictions
- Initiate muscle activation and isometrics to prevent atrophy
- Progress range of motion promoting active range of motion and stretching
- Emphasize proximal control of hip and pelvis with initial strengthening
- Initiate return to weight bearing and crutch weaning
- Normalize gait pattern and gradually increase weight bearing times for function
Precautions:
- NO Active lifting of the surgical leg (use a family member/care taker for assistance/utilization of the non-operative leg) for 3 weeks
- DO NOT push through pain
- Pivoting or rotating hip during ambulation / NO open chain or isolated hip muscle activation, unless isometric.
Treatments:
- Stationary bike (20 min, Increase time at week 3 as patient tolerates) Daily, Weeks 1-6
- Soft tissue mobilization (specific focus to the adductors, TFL, Iliopsoas, QL and Inguinal ligament) Complete daily 20-30 minutes per session, Weeks 1-6
- Isometrics-quad, glutes, TA, Daily, Weeks 1-2
- Diaphragmatic breathing, Daily, Weeks 1-2
- Quadruped-rocking, pelvic tilts, arm lifts, Daily, Weeks 1-3
- Clams/reverse clams, Daily, Weeks 1-3
- TA activation with bent knee fall outs. Daily, Weeks 1-3
- Anterior capsule stretches: prone hip ER, Daily, Weeks 3-6
- Bridging progression 5x/week, Weeks 2-6
- Prone hip ER/IR, hamstring curls 5x/week, Weeks 2-6
Phase 2 – Rehabilitation Goal: Non-compensatory gait and progression (Approximately Weeks 4-10)
PT Pointers:
- Return the patient to community ambulation and stair climbing without pain using normal reciprocal gait pattern
- Continue to utilize manual techniques to promote normal muscle firing patterns and prevent soft tissue irritation
- Progress strengthening exercises from double to single leg
- Promote advanced strengthening and neuromuscular re-education focusing on distal control for complex movement patterns
- Progress the patient to phase 3 rehabilitation with appropriate control and strength for sport specific activities
Treatments:
- Progress off crutches starting Week 3
- Continuation of soft tissue mobilization to treat specific restrictions 2x/week, Weeks 3 – 10
- Joint Mobilizations posterior/inferior glides 2x/week, Weeks 5-10
- Joint Mobilizations anterior glides 2x/week, Weeks 7-10
- Prone hip Extension, 5x/week, Weeks 3-5
- Tall Kneeling and 1/2 kneeling with core and shoulder girdle strenghtening, 5x/week, Weeks 3-6
- Standing weight shifts: siide/side and anterior/posterior, 5x/week, Weeks 3-4
- Backward lateral walking, no resistance, 5x/week, Weeks 3-4
- Standing double leg 1/3 knee bends 5x/week, Weeks 4-6
- Advanced double leg squat, 5x/week, Weeks 6-10
- Forward Step ups, 5x/week, Weeks 6-10
- Modified plans and modified side plans, 5x/week, Weeks 6-10
- Elliptical (begin 3 min as tolerated) 3x/week, Weeks 6-10
Phase 3 – Rehabilitation Goal: Return to pre-injury level (weeks 10-18)
PT Pointers:
- Focus on more FUNCTIONAL exercises in all planes
- Advance exercises only as patient exhibits good control (proximally and distally) with previous exercises
- More individualized, if the patients demand is higher than the rehab will be longer
Treatments:
- Continue soft tissue and joint mobilizations PRN, 2x/week, Weeks 8-12
- Lunges forward, lateral, split squats, 3x/week, Weeks 8-10
- Side steps and retro walks with resistance (begin with resistance more proximal) 3x/week, Weeks 8-16
- Single leg balance activities: balance, squat, truck rotation, 3x/week, Weeks 8-16
- Planks and side planks (advance as tolerated) 3x/week, Weeks 8-16
- Single leg bridges (advance hold duration) 3x/week, Weeks 8-16
- Slide board exercises, 3x/week, Weeks 10-16
- Agility drills (if pain free) 3x/week, Week 16
- Hip rotation activities (if pain free) 3x/week, Weeks 10-16
Phase 4 – Rehabilitation Goal: Return to Sport (weeks 16-32)
PT Pointers:
- It typically takes 4-6 months to return to sport, possible 1 year for maximal recovery
- Perform a running analysis prior to running/cutting/agility
- Assess functional strength and obtain proximal control prior to advancement of phase 4
Treatments:
- Running, Week 16, in alter G, then Weeks 20-32
- Agility, Weeks 16-32
- Cutting, Weeks 20-32
- Plyometrics, Weeks 24-32
- Return to sport specifics, Weeks 24-32
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.
