0 to 3 weeks:
- 1 to 2 visits per week, 5 times a week home program
- Stationary bicycle, no resistance, keep seat high enough to avoid painful hip flexion, 20 minutes 5 times a week.
- Gluteal sets, quad sets, heel slides, calf pumps
- Passive ROM of hip (avoid external rotation, emphasize internal rotation)
- Isometric strengthening – transverse abdominus, hip abduction/adduction
- Uninvolved knee to chest, piriformis stretching with hip horizontal adduction (NOT EXTERNAL ROTATION)
- Double and single leg balance with eyes open and eyes closed
- Supine hip roll IR, standing hip IR (stool), quadruped rocking
- Cryotherapy program, 3 to 5 times a day, 30 minutes each after exercises
- Continue crunches 30% weight bearing on involved lower extremity
3 to 6 weeks:
- 2 to 3 visits per week, 5 times a week home program
- Continue all exercises in previous phase (as described above)
- Add light resistance to stationary bike – lower seat as increased ROM allows
- Piriformis stretching
- Start weaning crutches beginning at 3-4 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.
- Straight leg raises (supine, prone, lateral (affected side down only) – avoid hip abduction
- Sidelying clams and bent knee fall outs, short lever hip flexion (seated)
- Water/pool work may begin to include:
- Walking
- Jogging (chest high water)
- Swim with pole buoy (Avoid frog-kick, flutter OK)
- 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:
- 2 to 3 visits per week 5 times a week home program
- Continue all exercises in previous phase (as described above)
- Kneeling hip flexor stretch, manual long axis distraction, manual A/P mobs, double leg bridges with tubing, double 1/3 knee bends, double leg cord rotations
- Add to water/pool work swimming with fins, bounding/plyometrics
- Increase resistance to stationary bike – lower seat as ROM increases
- Begin seated rowing, elliptical, and/or stair climber
- Begin exercises including mini-squats and wall slide mini squats
- Toe raises with weights, step ups (begin with 2 inches and progress to a full step)
- Trunk strength
- Transverse abdominus
- Side supports
- Trunk and low back stabilization
- 10. ROM should be normal by the end of this stage – if not contact Dr. Wright
3 to 5 months:
- 2 to 3 visits to 5 times a week home program. May need physical therapy supervision for functional training
- Continue all exercises in previous phase (as described above)
- 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
- 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
- Begin slow jogging on even ground (avoid treadmill and no cutting, jumping, or pivoting).
5 to 8 months:
- 2 to 3 visits 3 to 5 times a week home program. May need physical therapy supervision for functional training
- Continue all exercises in previous phase (as described above)
- Begin advanced strengthening with weights including leg presses, squats, leg curls and lunges
- Initiate plyometric program as appropriate for patient’s functional goals
- May begin functional training exercises including fast straight running, backward running, cutting, cross- overs, carioca, etc.
- Begin gradual return to previous sports/activities/work duties under controlled conditions
- Full return to sports/activities/full work duties are pending Dr. Wright’s approval based upon the following criteria:
Criteria for Return to Sports/Full Activities:
- Normal muscle strength in the involved lower extremity
- Jog and full speed run without a limp
- Full range of motion
- Satisfactory clinical examination
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