Post-Operative Rehabilitation Protocol

Hip Labral Repair

Debridement and or labral repair of the hip

 Phase one: Goal is to protect and minimize pain and inflammation, initiate early motion
Weight bearing precautions:

  • Debridement:  WB as tolerated
  • Labral repair or osteoplasty:  TTWB for 3 weeks (may be up to 6 weeks if specified by MD)
  • **Symmetrical gait pattern is important.  D/C of crutches is based on symmetrical gait pattern NOT PAIN LEVEL

ROM Precautions:

  • ROM:  Flex 90° (10 days -2 weeks)
  • Ext. 10° (10 days -2 weeks)—for labral repair only
  • Abd. 25°  (10 days -2 weeks)—for labral repair only
  • ER and IR: Gentle for 3 weeks

Limit sitting at 90 degrees or more due to anterior impingement
Lie prone 1 to 2 hours a day  (work up to this amount)

Phase 1 (weeks 1-4) 1 2 3 4 5 6
             
Passive supine hip roll into IR        
Isometrics gluts, quads, HS, TrA    
Bike no resistance high seat    
PROM emphasize prone lying, IR, Circumduction)    
Heel Slides    
Piriformis stretch
Uninvolved knee to chest    
Grade 1 hip jt. Mobs    
Manual long axis traction  
C-R stretch for IR/ER  
Water walking with flotation (if no pain)  
3 way leg raises (abd, ext, add)    
Water jogging with flotation device (if no pain)    

Phase 2: Transitioning to strength

To move from phase 1 to 2: Rom must be 75% or equal to that of the other side. Must be able to perform hip abduction for Glut. Medius without TFL or Quadratus lumborum compensation.

Phase 2 (weeks 5-7) 1 2 3 4 5 6 7 8 9
                   
Double 1/3 knee bends (partial squats)              
Bike with resistance            
Manual A/P mobilizations            
Hip Flexor stretch (off bed, with chair, or kneeling) Kneeling preferred            
Involved knee to chest, adductor stretch            
Seated resisted IR/ER (in less than 90 degrees flexion)            
Leg press            
Double leg bridge            
Single leg bridge        
Freestyle swimming (non competitive)            
Wall Sits with abductor band              
Elliptical / Stair climber          
Side stepping with abductor band            

Phase 3: To transition to this phase no trendelenburg gait present and full ROM with minimal complaints of pain. If not full ROM (symmetrical to other side) by 10 weeks then terminal stretches allowed with moderate pain is acceptable. Patients with labral repair may take 4 months to get full ER and IR.

Phase 3 (weeks8-12) 1 2 3 4 5 6 7 8 9
                   
Standing Resisted Hip ER            
Lunges and lunges with trunk rotation            
Core ball stabilization progression            
Fwd / Bkwd / Sideways with walking cord            
Golf Progression (Not for 3 months with repair)            
Water Bounding / Plyometrics                
Initial Agility Drills – single plane (eccentric control and shock absorption is important to instruct patient)                

Phase 4: Need good psoas and piriformis flexibility and no trendelenburg sign

Can run at 4 months

Phase 4 (weeks 12+) Sport specific training 9 13 17 21 25
           
Z-cuts/ W-cuts
Cariocas / Ghirardelli's
Sports Specific Drills
Functional Testing – Sportcord test    

Hip Rehab is important because the surgery corrects the mechanical deficits but the functional deficits are corrected in therapy.

Good form with exercises and core stabilization are key to a good outcome. Glut. Medius and maximus must function without compensation from hip flexors or quadratus lumborum to avoid anterior impingement

Pre-operative:

  • Stretch hip flexors
  • Strengthen glut. Medius and maximus
  • Core stabilization and transverse strengthening
  • Stretch hip into ER and IR