Phase I Post-op (day 1 through 4 weeks):Goals:
- Protect integrity of the reconstructed labrum.
- Restore ROM within restrictions.
- Normalize gait pattern beginning with bilateral axillary crutches 20% weight bearing for 4 weeks. Progress to WBAT at 4 weeks. May then wean from crutches when pain free gait without limp.
- Prevent muscular inhibition gluteus medius and maximus.
- Limit hip flexion to 90 degrees for the first 2 weeks post-op then gradual progression as tolerated.
- If microfracture maintain 20% WB for 6 weeks post-op with normal gait pattern.
- Stress IR ROM greater than ER ROM, no aggressive ER stretching.
- No SLR supine.
- Ankle pumps, quad sets, glut sets.
- Heel slides.
- Isometric hip ADD bolster between knees.
- Partial curl up.
- Standing hip ABD, EXT, marching to 90 degrees no resistance.
- Stationary bike low resistance 90 degrees hip flexion maximum.
- PROM emphasis on hip IR in supine with 0 degrees hip flexion.
- Prone active hip IR/ER.
- Hip ABD isometrics.
- Standing hip IR with knee on stool.
- Supine hip ABD slides.
- Hip flexor, hamstring, and quad stretch. Avoid any active hip flexor activity with hamstring stretch.
- Progress core strengthening.
- Water walking chest deep if incisions are well healed. Standing hip march, ABD,EXT in water when available.
- Wall squats 30 degrees knee flexion.
- Heel lifts.
- Isometric terminal knee extension.
- Continue PROM emphasis on hip IR in supine with 0 degrees hip flexion.
- Sidelying hip ABD/ER “clams”.
- Sidelying hip ABD and prone hip EXT AROM.
- Bridge with tubing at knees.
- Kneeling hip flexor stretch.
Phase II Post-op (Weeks 5-6):Goals:
- Restore full ROM.
- Increase strength.
- Normalize gait pattern.
- Progress closed chain strengthening.
- Leg press.
- Mini squats.
- Single leg balance.
- Forward step ups.
- Lateral step ups.
- Continue to progress core strength i.e. plank.
- Swim with flutter kick.
Phase III Post-op (Weeks 7-15):Goals:
- Restore cardiovascular endurance.
- Maximize strength, balance, and proprioception.
- Continue progressive strengthening.
- Side step with theraband resistance.
- Lunges progressing to walking lunges at 8 weeks post-op.
- Aerobic stepping as tolerated at 12 weeks post-op.
- Aquajogging when available at 12 weeks post-op.
Phase IV Post-op (Week 16):Before beginning Phase IV 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 V Post-op (week 20):Before beginning Phase V 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 ½ to 7 months pending Physician release.