Gluteus Medius Repair Protocol

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.

Precautions:

• 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.

Exercise program:

• 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.

Exercise program:

• 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.

Exercise Program:

• 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.
• Stairmaster.

Phase IV (Post op Week 12):

Goals:

• Optimize strength, balance, proprioception, and endurance.

Exercise Program:

• Initiate and progress single leg stance.
• Progress closed chain strengthening.
• 4 way hip with theraband resistance standing on involved LE.
• Continue core stabilization.
• Stairmaster.
• 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.

Exercise Program:

• 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.

Discharge formal physical therapy. Continue gym program. Return to sport at approximately 6 months pending Physician release.