Recovery

Rehabilitation after hip surgery involves distinct phases of recovery. The goal is to allow the best environment for tissue healing while maximizing long-term function. The guidance of a physical therapist, in consultation with your physician, is essential to an effective recovery.

Typical Recovery Process

This is an example of a typical recovery process, and should not be used to direct your rehabilitation after surgery. Each procedure and patient presents a unique set of circumstances, and progressions should be based on your individual responses, exam findings, and progress.

Immediate Post-Operative Phase (0-2 Weeks)

Overall Goals
  • Decrease post-operative swelling/inflammation
  • Decrease post-operative pain
  • Prevent post-operative stiffness and adhesions
  • Restore basic muscle activation patterns
  • Normalize gait pattern with assistive device
Passive Range Of Motion (Within Pain Free Range)
  • 0-90 maximum ROM in this phase
  • Circumduction at 30º flexion and progress to 70º flexion per tolerance
  • Supine IR/ER log rolling in resting position of comfort (30º flexion, slight abduction)
  • Progress to prone IR/ER when patient tolerates prone positioning
  • Upright stationary bike (1/2 to full revolution with elevated seat height, no resistance)
Flexibility
  • Opposite knee to chest (early hip flexor stretch)
  • Prone Prop (20 min 2x per day)
  • Prone knee flexion (once prone) (early quad/anterior hip flexibility)
Edema Control & Muscle Activation
  • Glute set progression (supine then prone)
  • Quad sets
  • Ankle pumps
  • Short-arc quads
  • Transverse Abdominis (TrA) contractions (in supine)
  • Prone terminal knee extension (once tolerating prone position)
  • Avoid active hip flexion straight leg raise
Gait Training
  • Initiate reduced weight-bearing Alter G training until gait pattern normalized
  • Avoid full weight-bearing ambulation on treadmill
Criteria To Progress To Next Phase
  • Minimal to no pain at rest
  • Neutral, pain-free hip extension range of motion
  • Normalized glute, quad, TrA activation (sustained contraction w/out adjacent muscle activation, verbal or manual cueing)
  • No increased pain with prone positioning

Early Post-Operative Phase (2-6 Weeks)

Goals
  • Restore adequate hip extension range of motion for gait
  • Decrease post-operative pain/inflammation
  • Improve muscular strength and endurance for ambulation and ADLs
  • Restore range of motion necessary for ADLs
Range Of Motion Exercises
  • Continue circumduction
  • Continue stationary bike with elevated seat and no resistance
  • Quadruped heel sits
  • Butterfly/reverse butterfly
  • Grade 1-2 joint mobilizations with belt
Flexibility
  • Begin scar mobilization as tolerated
  • Prone quadriceps stretch
  • Prone prop positioning
  • Heel cord stretch
  • Hamstring stretch
  • Lunge-position hip flexor stretch
  • Standing ITB stretch
Muscle Activation/Strengthening (Progressing To Resistance As Tolerated)
  • Isometric adduction
  • Isometric abduction
  • Isometric prone IR/ER
  • Prone hip extension over pillows
  • Assisted to active supine hip abduction
  • Assisted to active heel slides
  • Quadruped hip extension
  • Bilateral bridges
  • Knee extension/LAQ/knee extensor isometrics
  • Standing TKE
  • Standing hip abduction with IR
  • Single leg balance
  • Bilateral leg press ( < 90º hip flexion)
  • Sit to stands/mini-squats
  • Partially-loaded active external rotations
Gait Training
  • Continue reduced weight-bearing Alter G training until gait pattern normalized
  • Avoid full weight-bearing ambulation on treadmill until normalized gait pattern is achieved.
Criteria To Progress To Next Phase
  • No reactive pain with exercise; or anterior pain at rest
  • Patient reports ability to sit greater than 30 min without increasing pain
  • Able to demonstrate 30 sec of single leg stance balance without contralateral pelvic drop or pain
  • Able to ambulate without antalgic or compensatory patterns by 4 weeks
  • Patient verbalized pain free community ambulation without AD

Intermediate Phase (6-12 Weeks)

Goals
  • Restore adequate hip, knee, foot kinetic chain biomechanics
  • Maintain full ROM and flexibility
  • Restore adequate muscular strength and endurance for progression to IADLs
  • Progress activity (ADLs and rehab) without intra-articular or extra-articular irritation
Range Of Motion
  • Continue range of motion and joint mobs from previous phases
  • Active FABER slides
Flexibility
  • Continue stretching/flexibility from previous phases
  • Half-kneeling hip flexor stretch with rotation opposite
  • Progress to Thomas position anterior hip stretch
  • Walking spider man stretch
  • Inch worms
Strengthening
  • Unilateral leg press
  • Forward step ups (6-8 inch step)
  • Split squats and lunges
  • Single leg Romanian deadlifts
  • Side and prone planks
  • Side-lying hip abduction
  • Bridge progression (march, kick, single leg on theraball)
  • Side stepping with band resistance
  • Single leg balance with perturbations/steamboats
  • Lateral step downs (progress up from 2 inch box)
  • Hip hikes (progress up from 2 inch box)
  • Sport cord rotations
Cardiovascular Training
  • Upright bicycle with resistance
  • Elliptical trainer (8 weeks)
Plyometrics (10-12 Weeks)
  • Bilateral shuttle jumps/jog
  • 4-6 inch double-leg hop downs
  • Alter G reduced weight-bearing bilateral/unilateral hops
Criteria to Progress to Running and Return To Sport Phase
  • Able to ascend and descend a flight of stairs without
  • Able to ambulate 30 minutes without pain or compensatory strategies
  • Full AROM without pain or impingement symptoms
  • 5/5 strength in hip and lower extremity
  • Achieve a score of 14 on FMS
  • Y Balance score within 3 cm of contralateral leg

Running and Return To Sport Phase (12-16+ Weeks)

Goals
  • Normalize running and agility mechanics
  • Maximize power
  • Sufficient cardiovascular endurance for sport/occupation
Flexibility
  • Seated FABER pretzel stretch
  • Hurdle steps
Strengthening/Power
  • Continue to advance unilateral strengthening
Plyometrics
  • Bilateral to unilateral, sagittal/frontal plyometric progression
  • Broad jump/bounding
Cardiovascular
  • Initiate reduced WBing alter G walk/jog at 12 weeks
  • Progress to treadmill jogging
  • Continue elliptical trainer
  • Continue upright stationary bicycle with interval training
Agility
  • Ladder drills
  • Cones
  • T drills
  • Shuttle runs
  • Incorporate sport specific drills/equipment
Criteria for Return to Sport
  • No signs of FAI with clinical testing
  • 90% on Hip Outcome Score or 90% Global Rating Scale
  • < 10% side to side difference with:
    • Single-leg hop
    • Single-leg triple hop
  • No compensation with return to sport activities