Hip Arthroscopy Post-op Rehabilitation Guide Labral Repair / Osteoplasty / Capsule Repair / Microfracture February 2014

Transcription

1 Hip Arthrscpy Pst-p Rehabilitatin Guide Labral Repair / Osteplasty / Capsule Repair / Micrfracture February 2014 The Gundersen Health System Sprts Medicine Hip Arthrscpy Rehabilitatin Prgram is an evidence-based and sft tissue healing dependent prgram allwing patients t prgress t vcatinal and sprts-related activities as quickly and safely as pssible. Individual variatins will ccur depending n patient respnse t treatment. Avid pain when perfrming and exercises. If micrfracture is present, hld all WB activities/exercises until 6-8 weeks and MD apprval. Please cntact us at ext if yu have questins r cncerns. Phase I: 0 4 weeks Gals WB Brace Mdalities Recmmendatins Guidelines fr prgressin based n tlerance Criteria fr prgressin t Phase 2: Minimal pain with phase 1 exercise Minimal pinching with Prper muscle firing patterns fr initial exercises Prgress t phase 2 strengthening exercises nce full WB is allwed Immediate pst-perative phase / Prtectin and /Mbility Prtect integrity f repaired tissue Restre within restrictins Diminish pain and inflammatin Prevent muscular inhibitin Labral repair / Capsule Repair / Osteplasty / Micrfracture: Hip Flexin t tlerance (d nt push thrugh pain); minimal ER and extensin x 2 weeks; n ther limitatins Labral Repair / Capsule Repair / Osteplasty: wk 0-2: FFWB/PWB ( 20 lbs.) wk 2+: WBAT, weaning frm crutches by 3-4 weeks Micrfracture: FFWB/PWB ( 20 lbs.) x 6-8 wks; prgressing t WBAT and weaning frm crutches by 8 weeks (MD apprval) Nt all patients will use a pst-perative brace. Wk 4: discntinue brace if utilized. Crytherapy Precautins: D nt push thrugh pain Maintain and WB restrictins Week 1 Statinary Bike (n resistance) prgress up t 20 minutes (x 6 wks) Passive / Circumductin (x 6 wks) Ismetrics QS, Glut sets, Transverse Abdminis Gentle Stretching Quad, HS Sft Tissue Mbilizatin/Lymphatic massage (as needed) Prne Psitin/Stmach Stretch (up t 15+ minutes) Aquatic Therapy (as needed per MD/PT) Week 2 Quadruped Rcking (limited WB with micrfx) Cat/Camel Stretch (limited WB with micrfx) Hip Flexr Stretch (uninvlved knee t chest) Week 3 A Prne IR/ER, Prne Hip Extensin, Prne HS Curl A Supine hk lying Reverse Butterfly/IR Standing Hip Abductin Duble Leg Bridging Week 4 A Stl Rtatins A Supine hk lying Butterfly/ER A/AA FABER Slides Leg Press / Partial Squats

2 Phase II: 5-8 weeks Gals WB Mdalities Recmmendatins Guidelines fr prgressin based n tlerance Criteria fr prgressin t Phase 3: Full range f mtin Painfree / nrmalized gait pattern N jint / muscle irritatin/pain Prgressing with functinal exercise withut pain and gd neurmuscular cntrl Intermediate / Stability Phase Prtect integrity f repaired tissue Restre full Restre nrmal gait pattern Prgressively increase muscle strength, neurmuscular cntrl, balance, prpriceptin Prgress t full Labral Repair / Capsule Repair / Osteplasty: WBAT wean frm crutches Micrfracture: FFWB/PWB ( 20 lbs.) x 6-8 wks; prgressing t WBAT and weaning frm crutches by 8 weeks (MD Apprval) Crytherapy Precautins: Avid ballistic r frced stretching N treadmill Avid hip flexr, adductr, r pirifrmis inflammatin Avid jint irritatin Week 5 Weight Shifting Frward/Backward, Side/Side Side Planks Prne Planks Single Leg Balance / Stability Exercise Multi Hip Machine Prne Resisted Hip Extensin SL Clam (traditinal and neutral) SL Hip Abductin in IR/ER Prne Heel Squeezes Advance Bridge Prgressin and Lumbpelvic Stabilizatin Exercise (physiball bridge, single leg bridge) Week 6 Statinary Bike (with resistance) (ptential t begin utdr bike) Manual Hip Mbilizatin (as needed) Single Leg Dead Lift Step Up / Step Dwn Frward / Lateral Lunge Lateral Shuffles/Walking Single Leg Partial Squat Elliptical Runner Week 7 8 Diagnal Agility/Strengthening Additinal Rtatinal Activity/Strengthening (i.e. eurglide, y-balance, functinal lunge psitins, etc.)

3 Phase III 9-12 weeks Gals Mdalities Advanced Strengthening Phase Restratin f muscular endurance / strength Restratin f cardivascular endurance Optimize neurmuscular cntrl Crytherapy as needed Recmmendatins Criteria fr prgressin t phase 4: Precautins: Avid hip flexr, adductr, and pirifrmis inflammatin Avid jint irritatin Avid ballistic r frced stretching / strengthening N treadmill use N cntact activities Cardivascular fitness equal t preinjury level Demnstratin f initial agility drills with prper bdy mechanics Week 9 + Cntinue prgressin f lumbpelvic stabilizatin Cntinue prgressin f functinal strengthening Sprtcrd Training Week 12 + Return t Running Prgram (with MD apprval) Begin/Prgress Agility Drills - frward / retr run - carica, side shuffle - sprt specific mvement

4 Phase IV 16+ weeks Sprts Specific Training / Return t Sprt Gals Restratin f muscular endurance / strength Restratin f cardivascular endurance Optimize neurmuscular cntrl / balance / prpriceptin Return t sprt Independent in maintenance prgram Recmmendatins Testing wks Return t sprt/ wrk guidelines Week 16+ Cntinue strength and cnditining prgram Cntinue Return t Running Prgram Cntinue t prgress Agility Drills/Plymetrics Sprt Specific Drills (with MD apprval) Develp return t sprts plan Functinal testing per MD apprval MD apprval Full painfree Ability t perfrm all sprt specific drills at full speed withut pain Apprpriate perfrmance with functinal testing

5 References Pierce CM, LaPrade RF, Wahff M, et al. Ice hckey galtender rehabilitatin, including n-ice prgressin, after arthrscpic hip surgery fr femracetabular impingement. J Orthp Sprts Phys Ther 2013;43(3): Giphart JE, Stull JD, LaPrade RF et al. Recruitment and activity f the pectineus and pirifrmis muscles during hip rehabilitatin exercises. Am J Sprts Med 2012;40(7): Philippn MJ, Decker MJ, Giphart JE et al. Rehabilitatin exercise prgressin fr the gluteus medius muscle with cnsideratin fr ilipsas tendinitis. Am J Sprts Med 2011;39(8); Wahff M, Ryan M. Rehabilitatin after hip femracetabular impingement arthrscpy. Clin Sprts Med 2011;30: Enseki KR, Martin R, Kelly, BT. Rehabilitatin after arthrscpic decmpressin fr femracetabular impingement. Clin Sprts Med 2010;29: Blgla LA, Uhl TL. Electrmygraphic analysis f hip rehabilitatin exercises in a grup f healthy subjects. J Orthp Sprts Phys Ther 2005;35(8): Stalzer S, Wahff M, Scanlan M. Rehabilitatin fllwing hip arthrscpy. Clin Sprts Med 2006; Enseki KR, Marin RL, Dravitch P et al. The hip jint: arthrscpic prcedures and pstperative rehabilitatin. J Orthp Sprts Phys Ther. 2006;36(7): Garrisn JC, Osler MT, Singletn SB. Rehabilitatin after arthrscpy f an acetabular labral tear. N Am J Sprts Phys Ther. 2007;