• Routine Arthroscopic Procedure
  • Phase I (Weeks 1-3)
  • Phase II (Weeks 4-6)
  • Phase III (Weeks 7-8)
  • Phase IV (Weeks 9-11+)
• Microfracture
  • Phase I (Weeks 1-3)
  • Phase II (Weeks 4-6)
  • Phase III (Weeks 7-8)
  • Phase IV (Weeks 9-11+)
• Iliopsas Release
  • Phase I (Weeks 1-3)
  • Phase II (Weeks 4-6)
  • Phase III (Weeks 7-8)
  • Phase IV (Weeks 9-11+)
• Labral Repair
  • Phase I (Weeks 1-3)
  • Phase II (Weeks 4-6)
  • Phase III (Weeks 7-8)
  • Phase IV (Weeks 9-11+)
• Femoroplasty
  • Phase I (Weeks 1-3)
  • Phase II (Weeks 4-6)
  • Phase III (Weeks 7-8)
  • Phase IV (Weeks 9-11+)
• Acetabuloplasty
  • Phase I (Weeks 1-3)
  • Phase II (Weeks 4-6)
  • Phase III (Weeks 7-8)
  • Phase IV (Weeks 9-11+)

Iliopsas Release

This protocol should be used as a guideline for progression and should be tailored to the needs of the individual patient.

• Weight bearing as tolerated - use crutches to normalize gait.
• • May be needed for 2-4 weeks

• Gentle emphasis on passive extension exercises.

• Aggressive hip flexion strengthening delayed 6 weeks.

• Functional progression as tolerated.

• Resumption of full activities allowed as tolerated after 3 months.

• Always use pharmacologic prophylaxis against heterotopic ossification (unless contraindicated).
• • Quiz patient
  • Must initiate and maintain immediately postop

Week 1Phase 1

Initial Exercises (Weeks 1-3)

Seated weight shifts, lateral

Seated knee extensions

Hamstring sets

Ankle pumps

Adductor isometrics

Glut sets

Double leg bridges

Log rolling

Prone on elbows

Pelvic tilt

Heel slides, active-assisted range of motion

Quad sets

Prone knee flexion

Trunk rotation

Standing flexion without resistance

Standing abduction without resistance

Pain dominant hip mobilization - grades I, II

Standing adduction without resistancel

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Other Exercises Week 1

• Standard stationary bike without resistance at 3 days post-op (10 min. if tolerated)
• Upper body ergometer, upper body strengthening

Standing extension without resistance

Week 2Phase 1

In Addition to Previous Exercises (Weeks 1-3)

Theraband resistance on affected side - Extension (start very low resistance)

Theraband resistance on affected side - Flexion (start very low resistance) ONLY IF TOLERATED

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Other Exercises Week 2

• Wall mini-squats
• Physioball mini-squats with cocontraction
• Pool exercises (water walking, range of motion, march steps, lateral steps, backward walking, mini-squats, heel raises, hamstring and hip flexor stretches)

Week 3Phase 1

In Addition to Previous Exercises (Weeks 1-3)

Stiffness dominant hip mobilization - grades III, IV

Stiffness dominant hip mobilization - grades III, IV (cont'd)

Leg raise - Extension

Double leg bridges to single leg bridges

Shuttle leg press 90 degree hip flexion with co-contraction of adductors

Clamshells (pain-free range)

Dead bug

Leg raise - Abduction

Lateral walking over cups and hurdles (pause on affected limb), add ball toss while walking

Quadriped 4 point support, progress 3 point support, progress 2 point

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Other Exercises Week 2

• Continue stationary bike with minimal resistance - 5 min. increase daily
• Active range of motion with gradual end range stretch within tolerance
• Leg raise - Adduction
• Single leg sports cord leg press (long sitting) limiting hip flexion

Seated physioball progression - hip flexion

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Goals of Phase 1

• Restore range of motion
• Diminish pain and inflammation
• Prevent muscular inhibition
• Normalize gait

Forward walking over cups and hurdles (pause on affected limb), add ball toss while walking

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Criteria for progression to Phase 2

• Minimal pain with phase 1 exercises
• Minimal range of motion limitations
• Normalized gait without crutches

Weeks 4-5Phase 2

Intermediate Exercises (Weeks 4-6)

Standing theraband/pulley weight - Adduction

Crunches

Standing theraband/pulley weight - Flexion

Bosu squats

Standing theraband/pulley weight - Extension

Standing theraband/pulley weight - Abduction

Sidestepping with resistance (pause on affected limb), sports cord walking forward and backward (pause on affected limb)

Single leg balance - firm to soft surface

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Other Exercises Week 4-5

• Gradually increase resistance with stationary bike
• Initiate elliptical machine
• Pool water exercises - flutterkick swimming, 4 way hip with water weights, step-ups

Clamshells with theraband

Weeks 6Phase 2

Intermediate Exercises (Weeks 4-6)

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Other Exercises Week 6

• Single leg balance - firm to soft surface with external perturbation (ball catch, sports specific/simulated ex.)
• Knee extensions, hamstring curls

Leg press (gradually increasing weight)

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Goals of Phase 2

• Restore pain-free range of motion
• Initiate proprioception exercises
• Progressively increase muscle strength and endurance

Physioball hamstring exercises - hip lift, bent knee hip lift, curls, balance (cont'd)

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Criteria for progression to Phase 3

• Minimum pain with phase 2 exercises
• Single leg stance with level pelvis

Physioball hamstring exercises - hip lift, bent knee hip lift, curls, balance.

Week 9-11Phase 4

Sports specific training rehab clinic based progression

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Other Exercises Weeks 9-11

• All phase 3 exercises
• Pool running (progress from chest deep to waist deep), treadmill jogging
• Step drills, quick feet step-ups (4-6 inch box) forward, lateral, carioca
• Plyometrics, double leg and single leg shuttle jumps
• Theraband walking patterns 1 rep of six exercises x 50yds, progress to band at knee

Single leg pick-ups, add soft surface exercises x 50yds, progress to band at knee height and ankle height