Phase I Post-op (day 1 through 3 weeks):

Goals:
  • Protect integrity of the repaired labrum.
  • Restore ROM within restrictions.
  • Normalize gait pattern beginning with bilateral axillary crutches 50% weight bearing for 2 weeks. Progress to WBAT at 2 weeks. May then wean from crutches when pain free gait without limp.
  • Prevent muscular inhibition gluteus medius and maximus.
Precautions:
  • 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.
Exercise program
Week 1
  • 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.
Week 2
  • 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.
Week 3
  • Sidelying hip ABD/ER “clams”.
  • Sidelying hip ABD and prone hip EXT AROM.
  • Bridge with tubing at knees.
  • Kneeling hip flexor stretch.
  • Aquajogging when available.

Phase II Post-op (Weeks 4-6):

Goals:
  • Restore full ROM.
  • Increase strength.
  • Normalize gait pattern.
Exercise program:
  • 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 7-11):

Goals:
  • Restore cardiovascular endurance.
  • Maximize strength, balance, proprioception.
Exercise Program:
  • Continue progressive strengthening.
  • Side step with theraband resistance.
  • Stairmaster.
  • Lunges progressing to walking lunges.
  • Aerobic stepping as tolerated at 10 weeks post-op.

Phase IV Post-op (Week 12):

Before beginning Phase IV a 12 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 V Post-op (week 16):

Before beginning phase V a 16 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 4 ½ to 5 months pending Physician release.

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