Matthew T. Mantell, MD 128 Medical Circle Winchester, VA 22601 Phone: 540-667-8975 Email: mattmantellmd@gmail.com Web: www.mattmantellmd.com Hip Arthroscopy with Labral Repair and Osteoplasties PT Rehab Protocol Please do not hesitate to contact Dr. Mantell with questions or concerns. Rest is a vital component of recovery from hip arthroscopy. Less is more. Manual therapy (including modalities, dry needling, ART, etc.) is an important part of recovery. The initial weeks of therapy should focus on manual treatment and gait/crutch training. Utilize the exercise descriptions as a guide. They are not intended to serve as a substitute for clinical decision--- making; adjust within given guidelines and precautions as needed. Patients progression will vary widely. It is rare to have a patient progress through this rehab protocol without setbacks. Do not feel obligated to do every exercise in the protocol. Good recovery depends on the therapist and patient monitoring the effects of each particular exercise. If it hurts, don t do it! regardless of the time from surgery. LESS PAIN=MORE GAIN! 1
Initially, therapy sessions should be dedicated to manual techniques and gait/crutch training. Isometrics should be completed at home. Goals: o Diminish pain and inflammation o Protect integrity of repaired tissue o Restore Range of Motion (ROM) within restrictions o Prevent muscular inhibition o Circumduction is the most important exercise in this phase o Restore normal gait Precautions: PHASE 1: Weeks 1-2 Do not push through hip pain or pinching No distraction or joint mobilizations in this phase No scar massage using lotions until incisions are completely healed ROM restrictions for first 2 weeks (unless otherwise noted): None, but should stay in a comfortable range Weight bearing restrictions: o WBAT o Patient should walk with 2 crutches for a minimum of 2 weeks at all times and 4 weeks outside of the house o The goal is to protect the hip from overuse and to re--- establish a normal gait pattern. o May walk without crutches once patient no longer walks with pain or limp o Start slowly. Crutch weaning typically takes 2--- 4 weeks, but may take longer depending on the patient. Criteria for progression to the next phase: Minimal pain/pinching and swelling Proper muscle firing patterns for initial exercises Diminish pain and inflammation: PRICE Protection, Rest, Ice, Compression, Elevation Use these items together to reduce pain and swelling Icing is encouraged to be done in prone position if possible will allow for mild stretching of the hip flexors Modalities as indicated Ultrasound and Electric Stimulation
Exercises:
Other Exercises: 1. Posterior Pelvic Tilt 2. Gluteal Sets 3. Quad Sets Soft Tissue Massage Once a day: mobilize and gently flush out edema Stationary Biking with No Resistance Once a day for 20 minutes Upright stationary bikes only Set the seat high and avoid leaning forward to eliminate pinch in groin This is typically well--- tolerated. Stop if painful and reintroduce in 1--- 2 weeks. Passive Range of Motion (PROM) o Performed by therapist and caretaker o Follow ROM precautions o Stay in PAIN--- FREE range only. Do not force motions. o Patient should remain completely passive. Assisting with motion will cause soreness. o Perform once a day for 8 weeks
x x x I x counterclockwise). Have partner move leg in circular motion with knee straight. Start with small circles. Gradually increase range as you are able to tolerate. Do not force motion.
Stretching
Crutch Weaning Exercises Focus on avoiding/eliminating Trendelenburg/compensated Trendelenburg. Increase weight--- bearing by 25% every 1--- 3 days until you reach 100%. Continue using both crutches during this period. 1. Weight Shifting 2. Single Leg Balance 3. Forward and backward walking with balance pauses 4. Side--- stepping with NO resistance
PHASE 2: Weeks 3-6 Goals: Continue to reduce pain and inflammation Protect integrity of repaired tissue Continue to normalize ROM Prevent muscular inhibition Restore normal gait Precautions: Same as Phase 1 Criteria for progression to the next phase: Minimal pain/pinching and swelling Proper muscle firing patterns during completion of all exercises ROM > 85% of uninvolved side (minimal pain) Exercises: Continue all exercises from Phase 1 Add the following:
x
Soft Tissue Massage Continue as in Phase 1 Once incisions have healed completely, more aggressive scar massage can be completed using Vitamin E oil (or lotion of choice) Stationary Biking Begin adding resistance at Week 3. Start slowly. Do not increase time and resistance on the same day.
Passive Range of Motion Continue as in Phase 1 Stretching Continue all stretches in Phase 1 Add the following:
PHASE 3: Weeks 7-12 Goals: o Full active and passive range of motion o Normalize gait o Stationary bike with resistance. Work up to 30--- 45 minutes. o May begin elliptical trainer (low resistance, pain--- free) if tolerating bike with resistance. o Reformer Pilates. Footwork series, Skater series, hip extensions. o Increase leg strength to allow for: o Walking 1 mile o Ascending and descending stairs o Double knee bends without compensations o Single knee bend to 70 degrees of flexion without compensations o Resisted side--- stepping without pain Precautions: o DO NOT BEGIN ALL EXERCISES AT ONCE! ADD NUMBER OF EXERCISES IN A GRADUAL FASHION. o Do not push through hip pain or pinching. Watch for hip pain during or after new exercises. o No weight-- bearing restriction. o Add glute strengthening exercises first, then slowly add hip flexor exercises. o Joint mobilizations may be used as indicated. DO NOT OVERSTRETCH. o Proceed carefully with active hip flexor exercises as they may cause hip flexor tendonitis. No active hip flexor strengthening until 6--- 8 weeks post--- op. Criteria for Progression to the Next Phase: o No residual swelling present o Full active and passive range of motion o Ascending and descending stairs with involved leg without pain or compensation o Gait without deviations or pain after 1 mile of walking on level surface o At least 1 minute of double knee bends without compensations o Single knee bends to 70 degrees of flexion without compensations
Exercises:
Glut Max Progression:
Bridging Progression: Prone Planks:
Side Planks: (For advanced, do any combination of the following with forearm on Bosu)
Lunging Progression:
Hip Flexor Progression:
Side-lying Glut Med Progression:
Hip Hike Progression: (for advanced, do any of the following while standing on foam)
Single Knee Bends:
Side Stepping:
Balance Progression:
Stretching : Continue All Stretches, Add: Clock Exercise on Balance Board
Please note: Persons who do not participate in higher level activities may not need to advance to Phase 4. Activities that require advanced strengthening include: running, bounding sports, cutting and jumping sports, lacrosse, football, soccer, dance, hockey, golf, basketball, skiing and snowboarding, tennis and racquet sports. Exercise Suggestions: Dynamic Stretching Sequence: PHASE 4: Weeks 13+ Toe Swipes
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Other Exercise Suggestions: Walking Lunges with backward lean Over--- under hurdles Toy Soldiers Single Leg Closed Chain Progression Lateral Agility with cord Diagonal side--- to--- side with cord Forward box lunges with cord Speed Ladder and other agility drills