Routine Arthroscopic Procedure
(Loose body removal, labral debridement, chondroplasty, synovectomy, ligamentum teres debridement)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.
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- Crutches are usually discontinued at 5-7 days, once gait is normalized
- Initiate supervised physical therapy, postop day 1 or 2.
- Isometrics, co-contractions, closed chain exercises.
- Initiate stationary bike as symptoms allow.
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- Seat raised to avoid uncomfortable hip flexion.
- Low resistance with the emphasis on fluid range of motion.
- Pool program initiated when sutures removed and portals healed.
(approximately 10 days; sutures removed at 1 week)
- Rehab deliberate for the first 2-3 months, then initiate functional progression as symptoms allow.
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- (2 vs. 3 months dictated by nature of pathology).
- 2 months: loose fragment, simple labral tears, ruptured ligamentum teres.
- 3 months: tenuous preserved labrum (i.e. thermal treatment for stabilization); or extensive articular damage.
- "Honeymoon period"
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- At 1 month most patients feel like they are doing better than they really are (regardless of eventual outcome).
- Probably due to expectations of surgery being more disabling.
- Risk of overdoing it!
- Delaying functional progression based on tolerance to 2-3 months more reliable with less risk of setback.
- Functional progression more liberal for athletes with close supervision.
Week 1Phase 1
Initial Exercises (Weeks 1-3)
Glut sets
Seated weight shifts, lateral
Quad sets
Seated knee extensions
Hamstring sets
Ankle pumps
Pelvic tilt
Adductor isometrics
Trunk rotation
Heel slides, active-assisted range of motion
Double leg bridges
Log rolling
Standing adduction without resistance
Prone on elbows
Standing extension without resistance
Prone knee flexion
Other Exercises Week 1
- Standard stationary bike without resistance at 3 days post-op (10 min. if tolerated)
- Upper body ergometer, upper body strengthening
Pain dominant hip mobilization - grades I, II
Week 2Phase 1
In Addition to Previous Exercises (Weeks 1-3)
1/4 Mini squats
Abduction isometrics
Standing heel lifts
Weight shifts - anterior/posterior
Theraband resistance on affected side - Flexion (start very low resistance)
Hip flexion, IR/ER in pain-free range
Theraband resistance on affected side - Extension (start very low resistance)
Theraband resistance on affected side - Abduction (start very low resistance)
Superman
Theraband resistance on affected side - Adduction (start very low resistance)
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)
Double leg bridges to single leg bridges
Clamshells (pain-free range)
Stiffness dominant hip mobilization - grades III, IV
Dead bug
Leg raise - Abduction
Quadriped 4 point support, progress 3 point support, progress 2 point
Leg raise - Extension
Seated physioball progression - hip flexion
Shuttle leg press 90 degree hip flexion with co-contraction of adductors
Other Exercises Week 3
- 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
Goals of Phase 1
Criteria for progression to Phase 2
Forward walking over cups and hurdles (pause on affected limb), add ball toss while walking
Lateral walking over cups and hurdles (pause on affected limb), add ball toss while walking
Weeks 4-5Phase 2
Intermediate Exercises (Weeks 4-5)
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
Other Exercises Week 4-5
- Gradually increase resistance with stationary bike
- Initiate elliptical machine
- Leg raise - Adduction
- Pool water exercises - flutterkick swimming, 4 way hip with water weights, step-ups
Clamshells with theraband
Week 6Phase 2
Intermediate Exercises (Week 6)
Leg press (gradually increasing weight)
Superman on physioball - 2 point on physioball
Other Exercises Week 6
- Single leg balance - firm to soft surface with external perturbation (ball catch, sports specific/simulated ex.)
- Knee extensions, hamstring curls
Goals of Phase 2
Criteria for progression to Phase 3
Physioball hamstring exercises - hip lift, bent knee hip lift, curls, balance
Weeks 7-8Phase 3
Advanced Exercises (Weeks 7-8)
Side steps over cups/hurdles (with ball toss and external sports cord resistance), increase speed
Step-ups with eccentric lowering
Single leg body weight squats, increase external resistance, stand on soft surface
Lunges progress from single plane to tri-planar, add medicine balls for resistance and rotation
Other Exercises Weeks 7-8
- Full squats
- Single stability ball bridges
Goals of Phase 3
Criteria for progression to Phase 4
Theraband walking patterns - forward, sidestepping, carioca, monster steps, backward, 1/2 circles forward/backward - 25yds. Start band at knee height and progress to ankle height
Weeks 9-11Phase 4
Sports specific training rehab clinic based progression
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 height and ankle height
Single leg pick-ups, add soft surface
Weeks 12 & BeyondFinal Phase
Sports specific training rehab clinic based progression
Criteria for full return to competition
Other Exercises Weeks 12 & Beyond
- Running progression
- Sport specific drills
- Traditional weight training
