Web view3406 Laramie Dr., Bozeman, MT 59718 ph: 406.587.0122. Hip Arthroscopy with Labral Repair Home Program. Michael S. Ferrell, MD. General: Brace at all times

Hip Arthroscopy with Labral Repair Home Program

Michael S. Ferrell, MD

General:

Brace at all times except showering, home exercises, CPM, set at 0-75 degrees flexion x3 weeks. Capsular Plication (see below), brace set 15-75 degrees x6 weeks.

Avoid community ambulation >30 minutes at a time

Avoid prolonged sitting, including car rides >30 minutes

Weight-bearing: 25% of body weight toe touch weight bearing with crutches, step-to gait pattern x 3 weeks. If microfracture or capsular plication, weight bearing restriction x6 weeks. Labral reconstruction with allograft weight bearing restrictions and brace x4 weeks.

Massage incisions daily in all directions once sutures removed to prevent scarring. Also perform self- massage to the muscles in the front and side of hip as instructed by your physical therapist.

Avoid twisting, pivoting, and carrying over 10# for the first 6 weeks.

No Treadmill for 10 weeks.

Capsular Plication:

No CPM, Brace is set 15-75 degrees x6 weeks

No active or passive hip extension x12 weeks

No external rotation or abduction beyond 30 degrees x6 weeks

Make sure patient is ambulating “step-to” to avoid extension at the hip, toe-touch to keep hip flexed

No Prone laying x4 weeks; use pillows under knees when laying supine

No prone exercises x6 weeks

Surgical Precautions (weeks 0-3):

1. Do not flex at the hip past 90 degrees (ie bend at waist, sit in low chair with knees higher than waist) x2 weeks

2. Do not rotate the surgical limb inwards 20 degrees with hip bent or outwards more than 30 degrees (ie keep the toes pointed forward, especially when rolling in bed)

3. Do not move the limb away from the side of your body more than 30 degrees4. Do not extend at the hip for 6 weeks

3406 Laramie Dr., Bozeman, MT 59718 ph: 406.587.0122

CPM Machine (weeks 0-3):

1. Use 4-6 hours per day (can be broken up) 2. Set between 30 deg hip flexion to start3. Increase as tolerated to 90 degrees the first day, not to exceed 90 degrees

Swimming:

You may begin swimming with a pull buoy once incisions are closed. Please follow pool program instructions.

Upper Body Exercises:

You may resume upper body exercises with weight bar, dumbbells, and machines at lower resistances at approximately 6 weeks. No Olympic Lifting until after week 12.

Exercises Weeks 0-3:

Quadriceps SetsLie on your back with legs straight. Contract your quadriceps (muscles in the front of your thighs). Perform 15 reps, holding 10 seconds, 3 times per day.

BridgingPlace heels on the floor with knees bent. Draw your belly button into your spine and contract your buttocks. Avoid holding your breath. To neutral only. Hold 5 seconds at the top. Perform 15 reps, 3 times per day.

Isometric Hip AdductionIn the supine position, put a pillow between your knees. Squeeze the pillow gently and hold for 10 seconds. Complete 10 reps 2-3 times per day

Abdominal Bracing


On your back with knees best, as above, with spine in relaxed position (neutral), contract your deep abdominal muscles without moving your spine. Attempt to draw in your belly button without sucking in. Complete 15 reps, holding 10 seconds, 3 times per day.

Gluteal Sets

Lie on your back. Contract your gluteal muscles. Attempt to do this without contracting your hamstrings (muscles in the back of the thighs). Perform 15 reps, holding 10 seconds, 3 times per day.

Quadruped rock backsBegin in a neutral position on all fours. Begin to slowly shift your weight and rock backward towards your heels tell you begin to feel a slight stretch in your gluts. Do not exceed a 90 degree angle at your hips until after 2 weeks from surgery. Perform 15 reps, 3 times per day.

Care giver motion:

Log roll IRWhile lying on your back have your non-surgical leg placed aside so it will not get in the way. Have someone gently grasp your surgical leg above and below the knee and very carefully roll your leg inward so your toe is pointing towards your other leg. Perform for 5 minutes 3 times per day.

Circumduction


Passive clockwise and counter-clockwise ROM at the hip at 30 and 70 degrees flexion. Perform 2 minutes each, 3 times per day.

Stationary Bike Begin the upright bike for 10 min at no resistance daily. Can increase up to 20 mins, 2x/day as the hip allows.

Exercises Weeks 3-6:

Knee to chest- hip flexor stretchWhile laying on your back, pull your NON-SURGICAL KNEE to your chest. Hold for 30 seconds. Repeat 3 times, 2 times per day. DO NOT DO IF PLICATION PERFORMED

Active butterfliesStart position hook-lying with feet together. Slowly allow knees to fall out and hold 10 seconds then return. DO NOT FORCE. Perform 15 reps, 2 times per day. DO NOT DO IF PLICATION PERFORMED

Reverse Butterflies


Start position hook-lying with feet shoulder width apart. Slowly allow knees to fall in and hold 10 seconds then return. Perform 15 reps, 2 times per day. DO NOT DO IF PLICATION PERFORMED

FABER SlidesDo with therapist’s assistance first. Slide heel up table along other leg and allow knee to fall outwards with good control and pelvic stability. Perform15 reps, 2 times per day. DO NOT DO UNTIL 12 WEEKS IF PLICATION PERFORMED.

BridgingPlace heels on the floor with knees bent. Draw your belly button into your spine and contract your buttocks. Avoid holding your breath. Hold 10 seconds at the top. Perform 20 reps, 2 times per day.

Psoas MarchingOn back, hook lying. Relax spine and abdominal muscles. With knee bent, flex hip to 90 degrees and lower back down. Alternate legs. Repeat 15 reps each leg, 2 times per day.

Clam ShellsLying on side with knees bent as shown, rotate knee up and away from lower leg. Repeat 3 sets of 15 reps, 2 times per day.


Half Side PlanksLie on side with knees bent, upper body propped up on elbow. Make sure body is in a straight line. Lift hips towards ceiling. Hold as long as you can with good form. Repeat 2 times each side, 2 times per day.

Prone Quad StretchPosition yourself onto your stomach and pull foot toward buttock as far as you are able with a rope/belt/dog leash. Perform 5 reps at 30 sec holds, 2 times per day. DO NOT DO WITH PLICATION PATIENTS UNTIL WEEK 6

Quadruped FULL rock backsBegin in a neutral position on all fours. Begin to slowly shift your weight and rock backward towards your heels. DO NOT FORCE. Perform 15 reps, 2 times per day.


Quadruped hip extensionWhile on your hands and knees, extend your leg back with your knee straight. Do not lift higher then you can hold your pelvis / low back flat. Hold for 5 seconds and complete 15 reps. 2 times per day.

Mini Squats Start by facing a counter/chair (something to help with balance) Have equal weight placed upon both legs. Start off by rocking the hips backwards like you were about to sit in a chair. Bend the knees slightly to perform a small squat then press back up. Perform 10 reps for 3 sets, 2 times per day.

Stool Internal RotationBegin standing on your unaffected leg on the ground and your effected leg bent and placed upon a stool.Begin by gently rolling your heel outwards away from the body, then inward. Keep your trunk stable and do not have extra rotation within the body. Perform 15 reps at 10 sec holds, 2 times per day.

Standing Hip Abduction

Standing on NON-SURGICAL leg, lift leg away from body with foot slightly pointed inwards. Perform 15reps with 5 sec hold, 2 sets, 2 times per day. Only perform with surgical hip.


Care giver motion:

CircumductionPassive clockwise and counter-clockwise ROM at the hip at 30 and 70 degrees flexion. Perform 2 minutes each, 3 times per day.

Stationary BikeContinue the upright bike for 20 min at no resistance. May increase to 30 minutes 2x/day as the hip allows.

Pool Program

Deep Water Aqua Jogging with Floatation Vest/Belt: 10 minutes

Waking Forward, Backward, Sideways: 4 minutes each

Gentle Kicking on Back: 10 minutes

Standing Hip Abduction: 3x10 repetitions

Swimming with Pull Buoy (if your means of cardiovascular exercise)


Exercises Weeks 6+:

Standing Quad StretchWhile standing (you may need to hold onto a wall), pull foot toward buttock. Stretch should be felt in the front of the thigh. Perform 3 reps at 30 sec holds, 1 time per day.

Half Kneel Hip Flexor Stretch

In half kneeling, tighten buttocks and abdomen, and lean forward without arching lower back. Stretch should be felt in the front of hip and thigh. Perform 3 repetitions at 30 seconds holds, 1 time per day. DO NOT DO WITH PLICATION PATIENTS UNTIL 12 WEEKS.

Piriformis Stretch

While sitting, cross one ankle over opposite knee. Lean forward keeping back straight. Stretch should be felt in buttocks. Perform 3 repetitions at 30 seconds holds, 1 time per day.


Seated hamstring stretchSitting on the edge of the table with your leg straight. Lean forward to stretch your hamstrings. Hold your back straight when you lean forward. Hold 20-30 seconds, 1 time a day

Bridge with Progression to Single Leg Bridge (8 weeks)Place heels on the floor with knees bent. Draw your belly button into your spine and contract your buttocks. Avoid holding your breath. Hold 10 seconds at the top. Perform 20 reps, 1 times per day. Progress to single leg bridge when able to perform keeping pelvis level and minimal hamstring activation (ie should feel in buttocks).

Clam ShellsLying on side with knees bent as shown, rotate knee up and away from lower leg. Use resistance band (no shown). Repeat 3 sets of 15 reps, 1 times per day.


Half Side PlanksLie on side with knees bent, upper body propped up on elbow. Make sure body is in a straight line. Lift hips towards ceiling. Hold as long as you can with good form. If able to h0ld 30 seconds, perform with top leg abducted (as shown). Repeat 2 times each side, 1 times per day.

Forward Planks

From stomach with knee bent, propped up on elbows, lift hips towards ceiling so that body is in a straight line. Do not arch lower back. Make sure abdomen and glutes are tight. Hold as long as you can maintaining good form. Progress to legs straight if able to hold knee bent position for 1 minute. Perform 1x per day.

Prone Heel kick

Begin by lying on your stomach with your knee bent. Raise your heel to the ceiling keeping your hip touching the table. Do not arch back. Perform 15 reps at 2 sec holds, 2 times a day.


Double Limb SquatsStand with your feet hips width apart, toes pointed forward. Keep your knees over your ankles and sit back as though reaching for a chair behind you. Stand tall and contract your buttocks and quads. Perform 10-15 reps at 3 sets, 1 time per day

Single Leg SquatsStart with poles (as shown, for balance), stand on one leg with other leg in front, keep weight towards heel and sit back as if sitting in a chair. Only squat as deep as you are able to keep hips level and avoid knee from collapsing towards inside of foot. Progress away from poles and depth of squat. Perform 10 reps each leg, 3 sets, 1 time per day.

Reverse LungesStarting with feet together, take a step back and bend both knees. Knees should be lined up in direction of feet. Perform 15 reps, 2 sets, 1 times per day.

Single Leg BalanceBalance on involved leg. Begin with eyes open and then attempt with eyes closed. Hold 10-20 sec. Relax. Repeat 3 times. If possible you can utilize a BOSU ball or dyna-disc to make the surface more difficult. Perform 1x per day.


Resistance Band Side Stepping & Backwards Monster WalkSide-Step: Using mini-loop resistance band around ankles, feet straight ahead and knees bent, side step without allowing feet to come completely together. Make sure knee is always directly in line with 2nd and 3rd toes. Perform 20 steps to left and 20 steps to right.Monster Walk: Begin with feet together and take a backward step at a 45 degree angle, then step together. Knees stay bent and in line with feet. Perform 40 steps.

Single Leg Romanian Dead LiftBegin with feet together. While keeping stance knee straight, hinge at hip forward until trunk and back leg are flat (as shown). Return to upright position, initiating movement with buttocks. Repeat 10 times each leg, 3 sets, 1 time per day.

Stationary Bike 40 min 1x/day, gradually adding resistance, 5 times per week. -or-Elliptical Trainer @ week 6 (start with 10 minutes, add 5 minutes per week), no incline or resistance.


Pool Program

Deep Water Aqua Jogging with Floatation Vest/Belt: 10 minutes

Waking Forward, Backward, Sideways: 4 minutes each

Light Kicking on Back: 10 minutes

Swimming with Pull Buoy for cardio

Squats & Lunges: 3x10 repetitions

4-way Hip (Steamboats): 2x10 repetitions each direction

Swimming without Pull Buoy (Freestyle & Breast Stroke): 12 weeks

Jog Progression*: 12 weeks (see attached guideline)

Golf Progression**: 12 weeks (see attached guideline)

Plyometrics: 12 weeks, begin in pool, per therapist direction

Sports Specific Training (ie swinging, throwing, kicking, shooting): 12 weeks, per therapist direction

Return To Sports Training (minimum 16 weeks): must pass Functional Sports Testing with physical therapist prior to clearance. Patient can then participate in high level plyometrics and advanced speed/agility training with cutting drills. Dancers/Cheerleaders should pass Functional Sports Test prior to beginning jumps as part of dance training.


*Jog Progression

If you have pain during running, please stop. If limping or soreness occurs after running (in first 24-48 hours), do not progress to next phase until you can run without residual soreness or limp.

WeekWalk to Run Ratio

Sets/Total Time Frequency

1 4 minutes/1 minutes 4 sets = 20 minutes 4-5 times/week2 3 minutes/2 minutes 4 sets = 20 minutes 4-5 times/week3 2 minutes/3 minutes 4 sets = 20 minutes 4-5 times/week4 1 minutes/4 minutes 4 sets = 20 minutes 4-5 times/week5 5 minutes jogging 2 sets = 10 minutes 4-5 times/week

From 10 minutes Jog, Increase as toleratedIncline or speed work following 6 weeks running progression, if applicable

**Golf Progression

Weeks Club/Swing Volume Frequency1-2 Put, chip, ¼ swing 1 bucket 2x/week3-4 8-9 irons, ¾ swing 1 bucket 2x/week5-6 All irons, full swing, use cart 9 holes6+ All Clubs, may walk course 18 holes


Web view3406 Laramie Dr., Bozeman, MT 59718 ph: 406.587.0122. Hip Arthroscopy with Labral Repair Home Program. Michael S. Ferrell, MD. General: Brace at all times

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