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Hip Labral Repair / Osteoplasty / Capsular Repair

Hip Labral Repair/ Osteoplasty/ Capsular Repair

 

ROM:

-Flexion: 90 degrees for 6 weeks

-Abduction: 25degrees for 3 weeks

-External Rotation: 0 degrees for 3 weeks

-Internal Rotation: No limits

Manual:

-Begin scar mobilization day 1

-Passive ROM with partner 2x/day

-STM/ myofascial release/ e-stim as tolerated

Weight Bearing:

TDWB of 20lbs until 3 weeks and then as

tolerated. (8 weeks restricted WB if

microfracture is performed)

Phase I: Initial Exercise:
Week 1-2:
  • – Soft tissue mobilizations/ MFR as tolerated
  • – Modalities as needed for pain/ swelling control
  • – Ankle pumps
  • – Gluteal, quad, HS, trans ab isometrics
  • – Initiate stationary bicycle with minimal resistance
  • – Passive ROM with emphasis on IR and circumduction
  • – Passive supine hip roll into IR
Week 2-3:
  • – Quadriped rocking
  • -Standing hip IR stretch on stool
  • – Heel slides
  • – Hip abduction/ adduction isometrics
  • – Uninvolved knee to chest
  • – Resisted prone IR/ER
  • – Discontinue use of Bledsoe brace at end of week 2
Week 3-5:
  • – Clamshell
  • – 3 way leg raises into abduction, adduction and extension
  • – Double leg bridges with tubing
  • – Water jogging
  • – Kneeling hip flexor stretch
Phase II: Intermediate Exercises:
Week 5:
  • – Initiate squats in upper ranges, side bridge
  • – Stationary bicycle with resistance/ outdoor biking
  • – Swimming
  • – Manual treatments to include long axis distraction and A/P mobilizations
  • – Introduce single leg balancing on augmented surfaces (dyna-disc/airex)
Week 6-9
  • – Continue with manual treatments to restore full mobility of joint/ soft tissue
  • – Advanced bridging (single leg/ swiss ball)
  • – Single leg cord rotation
  • – Skating movements (slideboard/ pilates skaters)
  • – Lateral stepping
  • – Progress unilateral strengthening with care for appropriate mechanics (lateral step downs/ supported unilateral squat)
Phase III: Advanced Exercises:
Weeks 9-13
  • – Decrease frequency to 1x/wk as able to demonstrate good strength, mobility and pain free performance of gym specific program
  • – Initial agility drills (sport cord forward/retro run, walk/jogs, multiplanar lunges)
Phase IV: Sport Specific Training:
Weeks 17-25
  • – Sport specific training ( Z/W-cuts/ cariocas/ sport specific drills)
  • – Patients will have a functional test before being released by MD for return to competition
Phase I

Ankle Pumps: 5 minutes, 3-4 times/day

Quad sets: Sitting up or leaning back on elbows, tighten the thigh muscles by trying to pull the kneecap toward you and straighten the knee as much as possible. Concentrate on making the inner thigh muscle (VMO) contract. Hold as tight as possible for 5 seconds, then relax the muscle. 20 repetitions 2x/ day.

Hamstring Sets: Bend knee and push heel into table to tighten muscle behind leg. 20 repetitions 2x/day.

Transverse abdominal isometrics: Draw belly button in towards spine. Do not move pelvis. Maintain contraction while breathing.

Stationary Biking with minimal resistance: Use your good leg to facilitate the movement of your surgical side. 1-2 times/day for 20 minutes each time.

Passive ROM (assisted): 2x/day

  • a. Flexion- lying on your back have your partner bend knee toward chest within ROM limits. 20 repetitions
  • b. Internal Rotation- lying on your back have partner flex hip to 90degrees, rotate thigh so that ankle moves away from the body. 3 sets of 50 repetitions.
  • c. Abduction- lying on back with leg straight have partner bring leg away from your midline. 20 repetitions
  • d. Prone Internal Rotation- lying on stomach with knee bent to 90degrees, have partner bring ankle away from body. 20 repetitions. Repeat for external after week 3
  • e. Extension- lying on stomach have partner lift leg up from the knee. 20 repetitions.

Piriformis stretch: Lying on your back with the hip and knee flexed to 90degrees stretch the involved thigh across the body toward the opposite shoulder. 20 second hold 5x; 2x/day

Passive Supine hip roll: lie on your back with legs straight. Cross your uninvolved leg over your involved and use uninvolved to rotate leg inward. 5 second hold, 20 times

Quadruped Rocking: On your hands and knees shift your body weight forward on your arms then back to your legs. Also shift side to side and diagonally. 3 sets of 20 reps. 1-2x/day

Standing Hip IR: Place knee of involved leg on a stool. Rotate hip without moving your trunk to turn stool so the foot moves outward from the body/ inward toward the body

Heel Slides: Lying on your back place a strap around your foot and pull strap with arms to slide heel towards your buttocks keeping heel on mat. Progress toward active movement. 20reps

Hip abduction/adduction isometrics: Lie on back with strap around knees and push against strap without moving leg. Remove belt and place a ball between knees- squeeze without moving legs. 10 reps hold 10 seconds 1-2 times/day

Uninvolved knee to chest: Lie on back and pull uninvolved leg toward your chest keeping involved leg flat on table to feel stretch in front of involved hip. 20reps 5 sec. hold

Prone IR/ER (resisted): Lie on stomach with knee bent to 90degrees. Have partner apply resistance at ankle while you push outward (IR) then inward (ER) be aware of restrictions

3-way straight leg raises: 3 sets of 20reps 2x/day

  • 1. Lying on uninvolved side, raise top leg up and slightly back without moving your trunk.
  • 2. Lying on involved side, top leg crossed over, raise bottom leg up 6-8 inches
  • 3. Lying on stomach raise your involved leg up 6-8 inches

Water Jogging: In deep water using an aquajogger, jog in place (bicycle pedaling motion) 10-30 minutes 3-5x/week

Bridging with Tubing: Lie on back with band around knees with hips and knees bent. Raise hips while keeping knees apart. Slowly lower without letting knees come together. 3sets/ 20reps

Kneeling hip flexor stretch: ½ kneeling position with the involved knee on the floor. Tighten stomach muscles and gently tilt pelvis back then lean forward until stretch is felt in front. 30second hold and repeat 5 times/ 2x/day.

Leg Press (limited weight): Light weight, perform while maintaining weight bearing restrictions. 3 sets of 20 repetitions.

Short lever hip flexion/ Straight leg raise (SLR): While sitting, lift involved leg up 2-3 inches. Progress to SLR as tolerated. (Avoid hip flexor aggravation when performing) 2×10

Phase II

<pMini-squats: Stand with feet shoulder distance apart and weight evenly distributed between both feet. Using a table for balance and support, slowly bend both knees like you are going to sit in a chair by extending your hips behind you. Try to bend your upper body forward through the hips to keep your body weight centered over your feet. Go up and down slowly while trying to keep your thigh muscle tight the entire motion. Repeat 20 times, 3 sets

Side Bridge: lie on involved side with knees bent resting on your elbow. Lift hips up and hold 5 seconds, then slowly lower. (advance to legs straight) 3 sets of 20 reps

Stationary bike with resistance: Increase resistance slowly while maintaining 60-80 RPM. 30-45min/day

Swimming with fins: Place short fins on your feet for resistance. Flutter kick with a kick board. 10-30min. 3-5x/week.

Single leg stance on uneven surface: Start with pole for support. Advance by touching the ground with uninvolved @ 9,10,12,1 and 3 o’clock positions. 3 sets

Advanced bridging (single leg/ swiss ball): Using only involved leg, squeeze buttocks and lift hips/trunk slowly. 3×20 Lie on back with both legs on ball, squeeze buttocks and lift

Single leg cord rotation: Stand on the involved leg, perform an upper body row with the right arm followed by trunk rotation to the right. Repeat with left arm and left trunk rotation. 3×20

Side Stepping: With theraband around ankles bend at knees (squat) and sidestep in each direction holding squat. 3 sets of 20.

Single leg squat: Perform a single leg squat to 60degrees of knee flexion. Be aware of mechanics, keeping knee over 2nd toe and avoiding genu valgus loading (knocked knees) 3 sets 20-30

Eliptical trainer/ stair climber: Begin with light resistance, progress intensity after achieving 20 min. 3x/week

phase III

<pLunges: Step forward with involved leg and transfer weight forward while lowering your back knee to floor. Keep involved heel on the ground. 3 sets of 20 reps

Water Bounding/ plyometrics: In chest deep water, perform bounding. Focus on absorption with landing. 10sets 1-2 minutes 3-5x/week

Lateral agility with cord: Maintain an athletic stance while stepping/ jumping laterally. Absorb onto the involved leg as you return to the starting position. 3 sets 50reps 3x/wk

Forward/ Backward running with cord: Jog/ run in place, absorbing your weight as you land on each leg. Repeat for 1 minute. 3 sets 1x/day

Running Progression:

  • Phase1: walk 4min/ run 1 min for 10-20min 3-4x/week
  • Phase 2: walk 3 min/ run 2 min for 10-20 min 3-4x/week
  • Phase 3: walk 2 min/ run 3 min for 10-20 min 3-4x/week
  • Phase 4: walk 1 min/ run 4 min for 10-20 min 3-4x/week

Chop downs/ Back Pedaling: Jog forward, stutter step to a stop, absorb and push off smoothly into a back pedal.

Side Shuffles: Start with feet shoulder width apart. Maintaining an athletic stance shuffle to the right then left.

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