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.

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