Preoperative
Goals:
- Improve strength and ROM within patient tolerance
- Decrease pain and reduce muscular spasms/tightness
- Patient independent with crutches both NWB and WBAT
- Patient is independent with beginning post op therapeutic exercises
Treatment:
- ROM all planes within patient tolerance (pain minimized)
- Active assist and active
- Therapeutic exercise specific to patient’s functional deficits.
- Not to push patient into increased symptoms
- Gait training with crutches/walker
- Include NWB for first 2 days post op
- Progress to WBAT
- Include stairs and safety precautions
- Show patient HEP starting on post op day 1.
- Setting exercise
- Quadriceps
- Hamstrings
- Flexors
- Extensors
- Abductors
- Adductors
- Ankle pumps/circles
Postoperative Day of Surgery
Goal:
- Safe ambulation NWB with assistive device
- Initiation of HEP (Home Exercise Program)
Treatment:
- Start post op HEP
- Hip Arthroscopy – Debridement Protocol Continued
Postoperative Week 1
Goal:
- Safe ambulation WBAT with assistive device
- Initiate outpatient therapy
- Initiate Active Assist ROM program
- Progress therapeutic exercises
- Maintain physical Health of noninvolved body parts
- Control pain/inflammation/myofascial restrictions
Treatment:
- WBAT with assistive device
- Start Therapy
- Initiate inferior glide and posterior glide mobilizations
- Pool therapy if the portals are closed
- Progress HEP
- Clam shells, reverse clam shells, abducted reverse clamshells
- Closed Chain Bridging
- Weight shifts
- Beginning balance work
- Avoid SLR
- Consider exercise bike (standard…do not use recumbent) at 0-minimal resistance
- General training for UE, trunk, uninvolved LE, to assist in maintaining physical health
- Modalities & manual therapy to assist in controlling pain, inflammation, and soft tissues
Postoperative Week 2 – 4
Goal:
- Improve muscular strength
- Regain normalized joint arthrokinematics
Treatment:
- Progress patient off crutches as gait normalizes
- Progress ROM with gradual end range stretching within patient tolerance
- Begin PRE’s as tolerated
- Closed chain single limb bridging
- Open chain AROM exercises all planes against resistance (applied above the knee)
- Continue bike if tolerated (DO NOT USE RECUMBENT)
- Progress pool exercises
- Avoid – impact or repetitive twisting activities
- Continue UE and trunk exercises
- Modalities & manual therapy to assist in controlling pain, inflammation, and soft tissues
Postoperative Week 5 – 6
Goals:
- Improve functional strength and functional endurance
Treatment:
- Continue flexibility exercises
- Progress resistive and functional training program
- Add Elliptical as tolerated
- Increase single limb stance and add balance pads, plyoback, etc to improve proprioception
- Progress closed chain and open chain exercises
- Continue UE and trunk work
- Modalities and manual therapy to assist in controlling pain, inflammation, and soft tissues
Postoperative Week 7 – 10
Goals:
- Restore patient to normalized function
Treatment:
- Function/activity specific training
- May begin high impact activities
- In the case of Arthritic patient, do not push to gain ROM. Stay within pain free ROM