Phase I (Post-op through 4 weeks):Goals:
- Protect integrity of the repaired tissue.
- Restore ROM within restrictions.
- Normalize gait pattern using 2 crutches 20% WB.
- Prevent muscular inhibition.
- Limit hip flexion to 90 degrees for the first 6 weeks post-op then gradual progression as tolerated.
- Maintain 20% WB for 6 weeks post-op with normal gait pattern.
- No active hip ABD with gravity lessened until 4 weeks post-op (supine and standing).
- No active hip ABD against gravity (side-lying) until 8 weeks post-op.
- No resisted hip ABD until 10 weeks post-op.
- No passive IR with the hip flexed until 8 weeks.
- No single leg stance for 12 weeks.
- ankle pumps, quad sets, glut sets.
- Isometric hip Add bolster between knees.
- Glut sets.
- Heel slides.
- Supine hip IR/ER rolls with knee in full extension.
- partial sit up.
- Standing hip EXT, marching to 90 degrees no resistance.
- AROM long arc quad.
- PROM ER, ABD, EXT
- Hip flexor, hamstring, quad stretch
Phase II (4 weeks post-op):Goals:
- Restore functional ROM flexion, ABD, EXT, and ER.
- Increase strength.
- Normalize gait pattern.
- Continue flexibility program.
- Core stabilization.
- Continue PROM and progress flexion beyond 90 at 6 weeks post-op.
- Gait training WBAT at 6 weeks post op wean from assistive device pain free no limp.
- Stationary bike minimal resistance and high seat (max 90 degrees hip flexion).
- Supine hip ABD slides.
- Standing hip ABD.
- Supine hip flexion SLR.
Phase III (8 weeks Post-op):Goals:
- Restore cardiovascular endurance.
- Maximize strength, balance, proprioception.
- Initiate closed chain exercise as tolerated.
- Sidelying hip ABD/ER “clams”.
- Sidelying hip ABD and prone hip EXT AROM.
- Bridge with tubing at knees.
- Prone resisted hip IR/ER.
- Standing hip IR with knee on stool.
- Standing hip ABD and EXT with theraband resistance standing on uninvolved LE at 10 weeks.
- Kneeling hip flexor stretch.
- Continue progressive strengthening.
- Side-step with theraband resistance.
Phase IV (Post op Week 12):Goals:
- Optimize strength, balance, proprioception, and endurance.
- Initiate and progress single leg stance.
- Progress closed chain strengthening.
- 4 way hip with theraband resistance standing on involved LE.
- Continue core stabilization.
- Lunges progressing to walking lunges.
- Aerobic stepping as tolerated at 10 weeks post-op.
- Aquajogging if available.
Phase V (Post-op Week 16):Before beginning Phase V a 16 week functional test must be successfully completed.
- Continue progressive hip strength and flexibility as above.
- Progression to a graduated running progression.
- Progression to a graduated double leg plyometric program uniplanar.
Phase VI (Post-op week 20):Before beginning phase VI a 20 week functional test must be successfully completed.
- Continue progressive strength and flexibility.
- Continue progressive running
- Progressive agility work.
- Progress plyometrics to double leg multiplanar and single leg uniplanar.
- Return to sport progression.