Posterior Capsular Plication Physical Therapy Protocol

 

HIP ARTHROSCOPY:

POSTERIOR CAPSULAR PLICATION

PHYSICAL THERAPY PROTOCOL: DR. VONDA WRIGHT

Post-operative Period

0 to 3 weeks:
1. 1 to 2 visits per week, 5 times a week home program
2. Stationary bicycle, no resistance, keep seat high enough to avoid painful hip flexion beyond 60°, 20 minutes 5 times a week
3. Gluteal sets, quad sets, heel slides, calf pumps
4. Passive ROM of hip (NO INTERNAL ROTATION, NO FLEXION BEYOND 60° FLEXION, NO ADDUCTION BEYOND 10° ABDUCTION)
5. Posterior hip dislocation precautions (avoid internal rotation, hip flexion, hip adduction) for 6 weeks
6. Isometric strengthening – transverse abdominus, hip abduction/adduction (in neutral position with hip extended)
7. Double and single leg balance with eyes open and eyes closed
8. Cryotherapy program, 3 to 5 times a day, 30 minutes each after exercises
9. Continue crutches 30% weight-bearing on involved lower extremity

3 to 6 weeks:
1. 2 to 3 visits per week, 5 times a week home program
2. Continue all exercises in previous phase (as described above)
3. Add light resistance to stationary bike – continue flexion limitation at 60°
4. Start weaning crutches beginning at ________ weeks. Begin by advancing weight-bearing for 50% for ½ week, then 75% for the remaining ½ week, then go to 100% while using crutches for ½ week. Emphasis should be full weight-bearing without crutches 2 weeks after beginning wean with NO LIMP. If needed, one crutch (in opposite arm) or a cane can be used to transition to a normal gait
5. Straight leg raises (supine, prone, lateral (affected side down and up) – Limit adduction to 0° of abduction
6. Water/pool work may begin to include:

A. Walking
B. Jogging (chest high water)
C. Swim with pool buoy

7. Crutches should be weaned off by the end of this stage, and gait should be normal – if not, contact Dr.Wright

6 weeks to 3 months:
1: 2 to 3 visits per week 5 times a week home program
2. Continue all exercises in previous phase (as described above)
3. Kneeling hip flexor stretch, manual long axis distraction, manual anterior mobs, double leg bridges with tubing, double 1/3 knee bends, double leg cord rotations
4. Sidelying clams and bent knee fall outs, short lever hip flexion (standing)
5. Uninvolved knee to chest, piriformis stretching
6. Supine hip roll IR, standing hip IR (stool)
7. Add to water/pool work swimming with fins, bounding/plyometrics
8. Increase resistance to stationary bike – lower seat as ROM increases
9. Begin seated rowing, elliptical, and/or stairclimber
10. Begin exercises including mini-squats and wall slide mini-squats
11. Toe raises with weights, step-ups (begin with 2 inches and progress to full step)
12. Trunk strength

A. Transverse abdominus
B. Side supports
C. Trunk and low back stabilization

13. ROM should be normal by the end of this stage- if not, contact Dr. Wright

3 to 5 months:
1. 2 to 3 visits to 5 times a week home program. May need physical therapy supervision for functional training
2. Continue all exercises in previous phase (as described above)
3. Dynadisc, advanced bridging (swiss ball, single leg), side supports, single leg cord rotation, skaters/side stepping (pilates or slideboard), single knee bends (lateral step downs), single leg windmills, lunges, side to side lateral agility, forward or backward running with a cord
4. Quadruped rocking
5. Focus rehabilitation towards more closed chain exercises including leg presses, step-ups, mini-squats, and hamstring curls with light weights, high repetitions. Repetitions should be smooth and slow and NOT explosive. May begin jump rope exercises
6. Begin slow jogging on even ground (avoid treadmill and no cutting, jumping or pivoting)
Criteria for Return to Sports/Full Activities:
1. Normal muscle strength in the involved lower extremity
2. Jog and full speed run without a limp
3. Full range of motion
4. Satisfactory clinical examination

________________________________________
Vonda J. Wright, MD 412-432-3651

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Date

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