hip arthroscopy rehabilitation part one

rosc opy
hip arth
T he ide f or
atio n gu
ilit ists
re hab erap MCSP
d th Grant t,
tien ts an By Louise therapis K
pa tered
io
Phys siocure
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ar Hip-
P 01
ali st Ch ug ust 2
peci ri ght A
Hip S Copy

•  About the author
•  About this guide
hip •  Anatomy of the hip
•  What is a hip arthroscopy?
•  What might the surgeon do in the hip?
•  Labral repair or resection

nts
•  Pincer decompression
•  CAM decompression

e
Cont •  Other surgical techniques
•  Possible complications of surgery
•  Getting ready for your operation
•  Pre-op assessment record
•  Post-operative advice
•  Post-operative range of movement advice
•  Precautions and considerations following surgery
•  Awareness of negative findings that may impact on rehab
•  Rehabilitation exercises following hip arthroscopy
•  Six week reassessment record
•  Twelve week reassessment record
•  Rehabilitation pathway
•  Rehabilitation summary charts
•  References
•  Acknowledgements

hip INTRODUCTION
Louise Grant is a Chartered Physiotherapist who qualified
in 1992. Since the year 2000, she has jointly owned
PHYSIOCURE, a private physiotherapy clinic. She is a

r
member of the Health Professions Council, The Society of

o
Orthopaedic Medicine, The Acupuncture Association of

auth
Chartered Physiotherapists, PhysioFirst and the
Association of Chartered Physiotherapists in Sports
Medicine. In 2005, Louise additionally qualified as a
Modern Pilates Instructor.
t the

Louise is a private, independent hip specialist
physiotherapist who works with patients undergoing hip
arthroscopy, and in the management of femoral
acetabular hip impingement (FAI). She also sees other
types of hip surgery and conditions. She has written this
Abou

guide to assist in patient’s rehabilitation.

Copyright-PHYSIOCURE

hip This guide is not intended to replace your surgeon’s
protocol, but to be used alongside it. Louise has
gathered together various hip arthroscopy guides/
protocols from around the world, research papers and

e
books, her learning from attending international hip

guid
conferences and from individual teaching from top hip
arthroscopy surgeons, to personally formulate this
amalgamation of material. She has also collected data
recording patient’s experiences of hip arthroscopy
rehabilitation. Please note, this guide is general, and
can not cover every eventuality.
t this

Louise has personal experience with living with
femoral acetabular impingement (FAI) and has had a
hip arthroscopy herself. Louise’s hip condition is in no
means simple, and she understands fully the emotional
Abou

rollercoaster some patients experience in recovery.
Practical advice has been added into this guide from
her Occupational Therapist mother who lived with hip
dysplasia and had a early hip replacement, age 50.
Louise has used this information to produce a useful
guide aiming to aid patients and therapists in hip
arthroscopy rehabilitation.


hip

e
guid
Disclaimer – the author is not
responsible for any person’s using
this guide or for their interpretation
t this
of it. Hip arthroscopy rehabilitation
should be done under the care of a
suitably qualified Chartered
Abou

Physiotherapist or equivalent
therapist.


hip It is important to note that any rehabilitation guide
needs to be modified and adapted for the patient
individually. Patient’s undergoing hip arthroscopy, vary.
Has the surgery been complex or simple? Some are

e
sports people who have a sudden onset of hip pain.
Some, patients have had pain for many years, before

guid
they are diagnosed with femoral acetabular
impingement. Therefore, people using this guide will be
at different levels of fitness, have different pain scenarios
and disability. Hence, staging a guide that is time framed
is not always realistic, and can cause some patients huge
t this
distress when they feel they are not meeting time bound
goals, so please remember the ‘weeks’ are only meant as
a guide. It is important to be realistic with patients, judge
their fitness, capabilities and operation findings. Some
patient’s goal will be getting to level two/three stage
Abou

exercises. If a non-athletic patient is painfree, with good
symmetrical range of movement and power, is back at
work/hobbies, and is happy with this recovery, do not
push them to do exercises aimed at elite sports people.
There are criteria to be met, and relevant tasks to be
performed satisfactorily before moving onto a
harder level in this guide.


‘3D’ Normal hip joint.
hip The labrum (red),
forms a ‘skirt’
around
the rim

e h ip
of th
omy

Rim of acetabulum

Femoral head
Anat

Femoral Neck

Greater trochanter

A hip arthroscopy is when the surgeon uses ‘keyhole’
hip surgery to enter the hip joint. Normally, this involves
making two small incisions in the upper thigh area, but
on some occasions, a surgeon may choose to use

hip
additional incisions (portals). One of the incisions is for

py?
the camera, and the other is for the operating tool. The
operated leg is usually in traction throughout the
procedure to enable access to the central
t is a
osco compartment of the joint. This is carefully controlled
and monitored. The traction is gently released for when
the surgeon accesses the peripheral compartment. The
surgeon will then carefully move the leg with the
camera in situ to check there is no impingement.
Wha
arthr

Bruising and swelling are normal post-surgery.

Side of thigh
Front
of Some people are
thigh surprised to see
where the
incisions are, they
presume they would
Incisions be higher up.


hip
You will have already been examined, xrayed
and possibly had an arthrogram/scan by the
the
the
surgeon; and a proposed treatment plan

hip?
discussed.(Ref 1).However, further examination
of the joint takes place, when the surgeon looks
surg t might
into the joint with their camera. They will then
do in
fully assess the joint and decide on the
appropriate procedure. See the following pages
for common surgical techniques..
eon
Wha

Copyright PHYSIOCURE

hip

This is a picture of a labral tear. There are different
ir o r
debr ction/
classifications of tears (Ref 2). It will depend on the

ent
type of tear and quality of the labrum as to whether
the surgeon repairs or resects /removes. (Ref 3)
repa

idem
rese
l
abra
Hip L


hip
Below is a picture of a pincer deformity. The extra bone
can cause impingement in the hip. The surgeon may
remove/resect this boney deformity to alleviate

ity
‘pinching’ in the hip.

ction
f o rm pincer
Red indicates
labrum
rese
er de

Pinc

Green indicates
boney overcoverage
around the rim. A local
area =pincer, a global
area = coxa profunda.

hip A CAM deformity can be found at the femoral
neck, it can restrict hip movement and cause
impingement. This can be resected during
surgery and the area ‘decompressed’. Some

CAM
people have a ‘mixed’ CAM and pincer

ssion
deformity. (Ref 4,5)

Red indicates
CAM labrum
mpre
deco


Green indicates
boney ‘bump’ on the
femoral neck, this
can vary in size and
situation.

hip

Removal of a loose body – These are free-

l
gica
es
floating catilage fragments usually originating
from traumatic injury, degenerative conditions or
synovial proliferative disorders.

niqu Microfracture/chondroplasty – Holes are made
r sur
in the subchondral plate, in local contained areas ,
producing a marrow clot. The cells from this
change into a fibrocartilaginous material.
tech

Psoas tendon release
Othe

Removal of adhesions
Ligamentum Teres Reconstruction
Labral Grafting

(Ref 6,7,8,9,10,11)

With any surgery, there are complications and
hip
things to consider….
•  Infection, DVT, delayed wound healing,

tions ible
p
swelling, bruising.

y
of hi •  Avascular necrosis of the femoral head,

rger
fracture, heterotopic ossifications,
Poss
adhesions.
•  Failure to resolve pre-operative
py su
symptoms, increased pain, damage to
labrum or cartilage, traction related pain.
•  Sciatic and lateral cutaneous nerve
injuries, pudendal nerve problems,
plica
osco

impotence, pressure sores.
•  Instrument breakage, extravasation of
irrigation fluid.
com
arthr

For more information visit www.isha.net
Your surgeon will discuss complications in
more detail.

hip

f or
Preparing yourself before surgery can help

ation
make your recovery easier.
Your physiotherapist can help you with –
eady
•  Showing you pre-op exercises to maintain
your muscle tone and overall function .
oper
•  Explanation of the post-op exercise routine
and advice. Remember new exercises can
in g r

make you ache.
•  Practice crutch walking.
your

•  Assessing and measuring your hip before
surgery to establish pre-op function.
Gett

•  Record your pre-op pain and symptoms to
be able to gauge appropriate post-op
progress.


hip
Shade in the areas on this body chart where you
have your pre-op pain. Scale the pain from 0-10
(0 is no pain and 10 is the worst pain

ent
rd
imaginable). Do this, as you may possibly forget
what you actually did feel like before surgery !

reco
essm
p ass
Pre-o

hip Diary page – write down here how you are
feeling in yourself and the things you are
currently finding a problem in day to day life.

ent
rd
reco
essm
p ass
Pre-o

hip Ask your physio to record these pre-op hip
measurements for you, so you can monitor your
progress. (ref 12)

ent
rd
reco
essm
Hip Right Left

Flexion

Abduction
p ass

Adduction

Faber
Pre-o

Int rot (neutral)

Ext rot (neutral)

Trendelenberg
test (ref 13)

Pre-op -Exercise record sheet (Your therapist can select exercises from this guide)

19

hip

f or
Items to help in your recovery –

ation
•  Elbow crutches (essential) . Check if your
insurance company provides these. If not,
eady
these can be purchased at the hospital.
•  Ice packs (essential). Ice is used to reduce
oper
swelling, bruising and provide pain relief.
These can be bought on the internet or at
in g r

the hospital. Get two, so one is always ready.
•  Non-slip shower mat (essential). You must
your

be careful that you do not jar your hip, so
think of safety aspects.
Gett

•  Exercise bike (advisable). As this is
recommended for daily use, and you can
not drive to the gym for a couple of weeks,
think about having a bike at home.


hip Items to help in your recovery –
•  Shower stool, grab rails, raised toilet seat,

f or
easy reach grabber, and long handled shoe

ation
horn –
although these items are not essential, they can
eady
really assist in making independence much
easier and may help prevent you jarring or
overstretching the hip.
oper
•  Swiss ball, wobble board, inflatable balance
cushion.
in g r

•  Elastic resistance exercise band, ankle
weight.
your

•  Soft football, pilates ‘circle’, foam roller.
Gett

•  Scar massage oil.
•  Small rucksack and flask - useful as you
can’t carry things in your hands.
•  A couple of spare pillows – useful for
supporting your leg in different positions.


hip

f or
ation
Items to take with you to the hospital –
•  Loose fitting jogging trousers (your leg may be
swollen after the operation).
eady
•  Comfortable, flat, supportive non-slip shoes.
oper
•  Nightwear, spare underwear and toiletries.
•  Phone and charger (headphones)
in g r

•  Medications, hip xray (if you have been given
this by consultant), elbow crutches (if you are
your

having to provide your own).
•  Book, magazines, (earplugs!!!eye mask!!) etc..
Gett

•  Avoid taking any valuables, jewelry.
•  Glasses…you will be required to remove contact
lenses.


For 2-6 weeks (6-8 weeks for a microfracture) you
hip
will be partial weight bearing on elbow crutches.
You need to give the bone and soft tissues the
best environment to heal in. The joint may be

f or
quite sore at first and it is important to let this

ation
settle. Therefore, no lifting, twisting,
overstretching, jarring or movements/activities
eady
that provoke the pain. Look around your home to
see what you can do now to make post-op
recovery easier. Consider organizing your home
oper
so you can easily reach things, so you are not
having to bend down to a low drawer or
in g r

overreach into a high cupboard. Check there are
no trip hazards. When it comes to eating, if you at
home alone, a high stool at the kitchen worktop
your

would mean you could safely prepare food and
eat it in the same place as you can not carry a
Gett

plate. Alternately, you could put food in a sealed
plastic container and have a flask/drink
container which could go in your rucksack…and
thus your food and drink can be transportable.
Consider stocking up on some easy freezer
meals. Enlist help if you can with children/pets/
laundry/cleaning/gardening/shopping, etc…

hip Using elbow crutches –
Walking – partial weight bearing is
approximately half of your body weight

tive
ce
going through the operated leg, whilst you
take a step with the non-operated leg.
Some surgeons specify less weight than

advi
pera
this, some more…so check with the
surgeon.
Begin by standing straight, in a good
posture, with weight fully through your non-
operated leg and partial through the
o

operated leg. Place both crutches a short
Post-

distance in front of you, then place the foot
of your operated leg level with the crutches,
keeping the foot flat on the floor. Next,
putting your weight through the crutches
and partially through the operated foot,
step through with the non-operated foot.
Take your weight fully through the non-
operated leg as you position the crutches
and operated leg for the next step..and so
on.


Using elbow crutches – Stairs – Hold onto the
banister with one hand and the other should have
hip
your crutch (place your other crutch horizontally
in the crutch hand, as shown in the photo).

tive
UP STAIRS -

ce
1.  Non-operated leg steps up.
2. 
advi
Operated leg next onto the same step.
pera
3.  Crutch goes last.
DOWN STAIRS –
1.  Crutch first.
o

2.  Operated leg.
Post-

3.  Non-operated leg onto the same step.


hip

Using elbow crutches –

tive
SITTING DOWN –

ce
Walk right up to the chair, turn carefully around

advi
so your bottom is facing the chair. Remove both
pera
crutches from your arms and place in one hand,
so your hand is gripping the hand supports
across the top and you can still support yourself
safely. Next, with your other hand reach back and
place hand on the chair arm. Slowly lower
o

yourself carefully down into the chair.
Post-

STANDING FROM SITTING-
Move your bottom to the edge of the chair. Both
feet on the floor. With one hand, place on top of
the crutch handles, the other on the chair armrest.
Push up from the armrest. Once in standing, put
your crutches in the correct position.


hip
PAIN –
Pain, bruising, swelling and stiffness of the hip is normal

tive
ce
after the operation. You will be given medication to take
home following your surgery and repeat prescriptions
can be organized via your GP. It is advisable to take your

advi
pera
painkillers to keep any pain to a minimum to help your
rehabilitation, ensure a good nights sleep and enable
relaxation of the leg. The anti-inflammatories will help
the joint settle, and it is usually advised that these are
taken for at least two weeks. Be aware that some patients
o

can feel no pain straight after surgery and some feel like
Post-

they have ridden a horse! (due to the bolster used in the
traction procedure). It is normal to feel muscle soreness
in the leg from the traction, and sometimes knee or
ankle pain. Remember, as your activity level increases,
then there may be temporary increased soreness. So it
may not be wise to be weaning off your painkillers at the
same time as coming off your crutches/starting work/
increasing exercise levels, etc…


hip PAIN continued –
Drink plenty of water and have a healthy diet,

tive
including fresh fruit and vegetables, as the medication

ce
can make your ‘insides’a bit sluggish! See your GP if
constipation or stomach upset is a problem with the
medication. Getting enough rest and relaxation is
advi
pera
important in settling pain and ice is useful too(Ref
14,15,16). When using an ice pack, wrap it in a damp
tea towel to protect the skin. Leave it on for 10-20
minutes but be cautious of numb areas after surgery,
do not use ice on these areas. Keep checking the skin
o

to avoid ice burn/frost bite. Your physio can also help
Post-

with the pain – they may offer acupuncture and gentle
massage (avoid wound).Keep a diary, recording all the
positive progress you are making…some days may be
‘bad’ days, this is normal. Listen to your body, there
maybe a reason that the pain has increased. Maybe
you overdid something the previous day, or have come
off your painkillers too soon or too suddenly? Learn
from this and make modifications, don’t try and battle
through pain..take things slowly (Ref 17).


hip WOUND CARE –
You will have dressings on your wounds after surgery
and will be told if your stitches are dissolvable or not.

tive
With the latter, you will advised by the nurse on the

ce
ward when these need to be removed (usually 7-10
days post op). This can be arranged at your GP

advi surgery. There may be a small amount of blood that
pera
stains the dressings. This is normal, however, if it is
more than this, please contact the ward or the
consultant to report this. It is very important to keep
the wound dry until it has fully healed, to prevent
o

infection. You will be supplied with waterproof
dressings from the ward to ensure this when
Post-

showering. Alternatively, waterproof dressings can be
purchased from your chemist. Do not have a bath or
commence hydrotherapy until your wounds are fully
healed. Scar massage must only be started once the
wounds are fully healed and strong enough to cope
with this. Check with your physiotherapist when this is
suitable and ask them to show you the correct
massage technique.


ADDITIONAL ADVICE –
hip
•  Do not run/jump or do high impact sport for 6
weeks (13 weeks for microfracture) post surgery.
Some patients may be advised not to run at all, if

tive
they have a particular hip condition.

ce
•  Driving is at the discretion of the consultant.

advi
Clutch use may flare up symptoms in the early
pera
stages of recovery and it is essential that an
emergency stop can be fully performed before
driving is resumed.
•  A lot of consultants ban the use of treadmills
o

forever post surgery –check this with yours.
Post-

•  Check the appropriateness of the use of the rower
and breast stroke swimming post surgery with the
consultant and physio with your particular hip
problem – it may not be advisable.
•  Pay attention to good posture, do not sit in low soft
settees, do not cross your legs or sit with your legs
up on the settee in a twisted position. An ‘open
seat angle’, where the angle of the hips is more
than 90 degrees is recommended. A good
mattress is favourable, check yours isn’t sagging.

ADDITIONAL ADVICE

hip
continued -
Take good care of your hip for the first 8-12 weeks
following surgery, or longer if you have pain or

tive
degeneration, or have been told to take rehabilitation

ce
slower. These are some activities to be careful with –
•  Getting in/out of bed - assist and support your leg

advi
when it is painful and weak initially following
pera
surgery.
•  Keep your knees together when getting in/out of
the car and bed.
•  Limit stair climbing, prolonged walking, standing,
o

sitting.
Post-

•  Avoid heavy lifting and repetitive bending,
twisting or sudden/uncontrolled movements.
•  Caution with squatting, crouching and lying on
your operated side.
•  Take consideration with intercourse positions –
see the medical website , Herman and Wallace –
orthopaedic considerations for intercourse.
•  Do not provoke pain, if any exercises are
painful..STOP and report to your physio, who
will modify your program.

ADDITIONAL ADVICE continued –
hip Returning to work –
This subject needs to be discussed pre-operatively
with your consultant/GP/physio and employer. It is

tive
ce
important that the positions and tasks you need to
carry out at work are analyzed realistically to avoid
any set-backs in recovery. With the UK consultants I

advi
pera
work with, their patients tend to have 2-6 weeks off
work in sedentary jobs. A longer time off is usual in
more manual jobs.It depends on the type of surgery
you have had, the condition of the joint and other
factors that indicate how long recovery might take. It
o

can vary.If you are in a sitting job, you need to make
Post-

sure you are going to be able to sit comfortably
before returning to work. This means giving the hip
adequate time to recover after surgery and
rehabilitate. A workplace assessment may need to be
done by your employer to check your desk and chair
ensure a correct posture. A staged return is often a
good idea. Feedback from my patients on this matter
is that once you are back at work, it is hard to find
time to do rehab exercises. This is why I have
included sitting/ standing exercises in my guide that
could be done ‘slottted’ in here and there in the day.

Labral repair and
hip
capsular plication/repair considerations –
Some surgeons have a hip flexion up to 90’ limit for

e
10 days then 120’ until 4 weeks post-op, and a hip

e
rang
abduction 25’ limit for 3 weeks. Hip extension and

dvic
external rotation gentle or nil for first 3 weeks (to
avoid stress on capsule and labrum) – check your
surgeon’s guidelines…it will differ from surgeon to
surgeon .
ent a
ative

No isometric or loaded hip flexion for the first two
weeks. After that period, avoid if painful and
introduce only when safe to do so, to avoid hip
flexor tendinitis.
o pe r
ovem

Use night splints in internal rotation for capsular
plication/repair for 4 weeks.
All hip arthroscopies –
Post-

Do not push into painful movements, especially with
of m

arthritic hips and it is important to ALWAYS avoid
aggressive hip extension.
(ref 18,19,20,21)


•  Prevent hip flexor tendonitis.
•  Be aware of ‘normal’ and ‘abnormal’ post-op pain.
hip
•  Check for trochanteric bursitis, sacroiliac joint
d and lumbar spine dysfunction.

tions • 
ns an

h ip
Prevent, manage capsulitis / synovitis.

py
•  Manage scarring around portal sites.
• 
osco
Adhere to instructions given by the surgeon on
wing
idera

use of crutches – do not come off too soon.
autio

•  Adhere to instructions given by the surgeon
regarding medication and rehabilitation plan and
arthr
any movement restrictions.
follo
cons

•  Attend post-operative appointments with your
Prec

surgeon so they can monitor your recovery.
•  Attend post-operative physiotherapy so they can
address any rehabilitation problems and assist
you in your recovery.
•  Expect new pains and adjustments occurring in
the rest of the body.
•  Be mindful of the other hip, especially if it is
possible that may also need surgery at a later
date.

hip
ss of
impa gs
ct on
b
Centre edge angle
Presence of advanced
indin
below 20 degrees

reha
OA changes
rene

(dysplasia)
tive f
Awa

Generalized
hyperlaxity in patients Low pre-op modified
may

with instability harris hip score (MHHS)
nega

symptoms
that

Pain and a negative hip
arthroscopy

Information courtesy of Prof Schilders

hip

•  Early stage rehabilitation

tion •  Patient on elbow crutches,

wing
partial weight bearing.

y
•  Aim to decrease pain and

scop
inflammation, promote
bilita
healing and protect
repaired tissues.
follo
•  A whole body approach to
rthro
aid circulation, relaxation,

Level
early joint mobility,
Re h a

maintenance of muscle
tone, correct posture and to
cises

prevent musculoskeletal

one
hip a

compensatory issues in
other parts of the body.
•  Ensure hip joint neutral
exer

position is achieved in
various postures and equal
weight bearing through
ischial tuberosities in
sitting.


hip
•  Week 1(day1-7)

tion
wing
•  Week 2(day 8-14)

y
scop
•  Week 3(day 15-21)
bilita
follo
•  Week 4 (day 22-28)
rthro

Level
•  Please note, some people
Re h a

may need to stay at week 1
cises

for longer, or week 2, etc..It
is important to progress at a

one
hip a

speed that is appropriate to
you. Pushing with exercises
that are too hard or provoke
exer

pain is not advisable. The
time frames in this
handbook are meant as a
general guide and may
need to be modified to suit
the individual.


LEVEL ONE
hip
Week 1 exercises
1. Circulatory exercises – ankle pumps.
tion
wing
y
Point one foot and at the same time flex the

scop
other foot back at the ankle, as shown below.
Repeat 10 times hourly while immobile.
bilita

Aim – to pump blood to encourage circulatory
follo
flow whilst immobile.
rthro
Re h a
cises
hip a
exer


LEVEL ONE
Week 1 exercises
hip
Static contractions, hold 5 seconds, 10 reps,
every 3 hours. Aim – to maintain muscle tone

tion while immobile.

wing
y
2. Quadriceps - Straighten one knee and tighten /

scop
tense the muscles on the front of your thigh.
bilita
follo
rthro
Re h a

cises
hip a

3. Hamstrings – Bend one knee to approx 45
degrees. Push heel gently down into the bed to
tense the muscle at the back of the thigh.
exer

LEVEL ONE
hip Week 1 exercises
Static contractions, hold 5 seconds, 10 reps, 2 times

tion
a day. Aim – to maintain muscle tone while immobile.

wing
y
4. Transversus Abdominis (T.Abs) – Lie on your

scop
back with your hips and knees bent to approximately
45 degrees (as in exercise 5). Place a small pillow or
bilita
folded towel under your head if needed. It is important
follo
that you feel relaxed and comfortable.
Next, keeping your bottom in contact with the bed/
rthro
floor, tuck your tailbone under so you flatten your
Re h a

back against the bed/floor..then tilt the other way,
arching your lower back gently..this is called a pelvic
cises

tilt. Do this a few times as it will help to gently mobilise
your lower back. Now, position your pelvis so your
hip a

lower back is in what we call ‘neutral’, this is the
position in between the two movements you have just
done and your lower stomach should be level north-
exer

south, east-west. Finally… without losing this position,
gently pull your lower tummy muscles (T.Abs) in, as if
you are pulling your navel towards your spine. Your
upper body should still be relaxed and you should try
to breathe normally as you do so.
As we go through this guide, we will exercise
this muscle in various positions. (Ref 22).

LEVEL ONE
hip
Week 1 exercises
Static contractions, hold 5-10 seconds, 10 reps, 2

tion
times a day. Aim – to maintain muscle tone while

wing
immobile.

y
scop
5. Hip Abductors – Lie on back, hips and knees
bilita
bent to approx 45 degrees. Tie a belt around your
lower thighs. Use the techniques in exercise 4 to
follo
find a neutral spine and to gently contract the
T.Abds. Gently push out sideways against the belt.
rthro
Make sure this does not provoke pain. Keep a
Re h a

neutral pelvic position throughout. If you find
getting down to the floor a problem with these
cises

following exercises, lie on the bed. Safety comes
hip a

first.
exer

Caution - with
trochanteric
bursitis

LEVEL ONE
Week 1 exercises
hip
Static contractions, hold 5 seconds, 10 reps, every
3 hours. Aim – to maintain muscle tone while

tion immobile.

wing
y
6.Gluteals – Gently squeeze together your buttock

scop
muscles. This can be done in the position shown in
bilita
exercise 5, or in sitting, or laid on your front, or in
standing….whichever is the most comfortable. If
follo
lying on your front, place your feet in the position
rthro
shown in the picture, heels in neutral, ensure a
neutral lumbar spine, and gently contract your T.Abs
Re h a

before squeezing your bottom. This exercise can be
cises

improved by palpating your side hip bones to give
you feedback to check you are not gliding or rotating
hip a

around the hip joint or pelvis as you contract your
gluts. The hip joint and pelvis should stay in neutral.
Then progress to individual glut (buttock) squeezes.
exer

Therapists – please
read Sahrmann’s
work (ref 22)

LEVEL ONE

hip
Week 1 exercises
Gentle stretches – Hold 10-20 seconds, 5 reps, 2
times a day. Aim- to maintain muscle length without

tion
wing
provoking inflammation/pain.

y
7. Quadriceps – Lie on your front with a folded towel

scop
under your forehead so your head is supported and
bilita
not in a twisted position. Engage your T.Abs in a
follo
neutral spine. Bend one knee bringing the heel of the
foot towards the bottom. A stretch in the front of the
rthro
thigh should be felt. Your lower back should not
Re h a

hollow, your T.Abs and gluts should be maintaining
neutral spinal and pelvic position. If you can not
cises

comfortably lie on your front, try a pillow under your
hips and/or ankles.
hip a
exer


LEVEL ONE
Week 1 exercises
hip
Gentle stretches – Hold 10-20 seconds, 5 reps, 2 times
a day. Aim- to maintain muscle length without provoking

tion
inflammation/pain.

wing
y
8. Iliotibial band and hip abductor stretch – Lie on your

scop
non-operated side on the bed, near the edge, with the
bilita
underside knee/hip bent. Pillow under head. Straighten
the top leg. If a gentle stretch is felt in this position, do
follo
not progress to the next stage. Hold in the gentle stretch
position. To progress this exercise, gently let the foot of
rthro
the top leg hand over the side of the bed, as shown in the
Re h a

picture.
cises
hip a
exer

Warning – do not do
if this causes any
‘nipping’/pain in
the groin.


LEVEL ONE
hip
Week 1 exercises
Gentle stretches – Hold 10-20 seconds, 5 reps, 2
tion
wing
times a day. Aim- to maintain muscle length without

y
provoking inflammation/pain.

scop
9. Adductors – sit (not on a low seat), feet on the floor,
bilita

using your hands to support the operated leg, gently
follo
take it out to the side. DO NOT LET IT ROTATE
OUTWARDS. Only a small careful movement should be
rthro
done at this early stage. A GENTLE stretch should be
Re h a

felt in the inner thigh.
cises
hip a
exer

Warning – do not do
if this causes any
soreness/pain in
the groin.

LEVEL ONE
10. Exercise bike – the use of the bike post hip
arthroscopy varies from surgeon to surgeon, some
tion
wing
recommend immediately, some after 1 week, some

y
after 2, some after 4. Check your surgeon’s protocol.

scop
We advise our patients use the bike, with the seat high,
bilita
to encourage early ACTIVE ASSISTED range of
movement of the hip, the day after surgery. The bike
follo
should be set to zero resistance and the non operated
leg should do most of the work. Pedaling should be
rthro
done slowly, and the operated hip should not ‘hitch-
up’, it should feel relaxed during movement. Start by
Re h a

doing the bike ‘little and often’ eg. 5-10 minutes 2-3
cises

times a day, but you may increase this if it feels
comfortable and pain free. Increase SLOWLY by 5
hip a

minutes. Keep at the same time for a few days before
increasing time. Maximum would be 45 mins, 2 x a day.
No resistance until week 5-6.
exer

Warning – modify time
used, if this causes any
soreness/pain in the groin.
Try pedaling backwards!

LEVEL ONE
Week 1 exercises
hip

10. Exercise bike – continued ……
tion
wing
What do we do if for some reason the patient can not

y
go on an exercise bike?

scop
bilita
Some surgeons recommend pendular hip movement
rather than the bike at this stage. This exercise could be
follo
used for patients who can not use a bike .
rthro
•  Stand on a step with your non-operated leg, see
Re h a

photo on the next page. Holding on with both
hands, to a secure support. Let the operated leg
cises

hang in a heavy, relaxed fashion. Imagine your leg
to like a pendulum of a clock and gently swing it
hip a

forwards then back to neutral (no hip extension ).
Repeat 10-20 times every 2 hours.
exer

•  This movement can also be done in the pool as
long as the patient is safe to mobilise in this
environment and has waterproof wound dressings.
•  Water cycling can be done with floats assisting and
supporting – see separate hydrotherapy guide.


hip LEVEL ONE
Week 1 exercises

tion
wing
y
Pendular exercise –

scop
bilita
follo
rthro
Re h a
cises
hip a
exer

Neutral Forward


LEVEL ONE
Week 1 exercises
hip
Aim – maintain upper body flexibility.
11. Supine chest openings – Lie on your back with

tion
wing
your knees and hips bent to approx 45 degrees. Ensure

y
good symmetrical alignment of the legs and a neutral

scop
spine (see exercise 4). Bring your hands together in
bilita
front of you, in a prayer position. Connect your T.Abds
and as you breathe out, open out your arms as in the
follo
picture below. Only go as far as comfortable. It is
important to keep a neutral spine and not let your rib
rthro
cage lift up or your spine hollow. Hold as you breathe in.
Re h a

Then return to the start position as you breathe out.
cises

Repeat 5-10 times, 1-2 times a day, as required. Can
be progressed to lying on a fit roll (not in week 1-3).
hip a

Top tip – good for tightness
exer

caused from crutch use

Early stage Advanced stage

LEVEL ONE
Aim – maintain upper body flexibility.
12. Spinal extension – Lie on your front, prop yourself
tion
wing
up on your forearms. Slide your shoulder blades gently

y
down your back, gently tuck in your chin so you are

scop
lengthening down the back of your neck (do not allow
bilita
chin poke). Connect through your T.Abds, keep your
lumbar spine and pelvis neutral. Gently push your
follo
breastbone forwards as you breathe out so your thoracic
spine hollows(the bit between your lower neck and
rthro
lumbar spine). Hold the position as you breathe in, then
relax to the start position as you breathe out. Repeat
Re h a

5-10 times, as required, 1-2 times a day.
cises
hip a

Top tip – this part of
exer

spine can become
very stiff due to
body compensations
and use of crutches.
Incorrect this exercise also gently
-’hinging’ stretches the hip flexors

LEVEL ONE
Week 1 exercises
hip

13. PRONE LYING – try and spend one hour laid on

tion your front in the morning and one hour in the afternoon.

wing
y
This is to prevent the front of your hip becoming tight.

scop
14. ICE – Use an ice gel pack wrapped in a damp tea
bilita
towel (to protect your skin). 20 minutes every 3 hours.
Do not use on numb skin and keep checking the area
follo
and moving the ice pack to different parts of the leg/
hip/pelvis to avoid ice burns.
rthro
15. RELAXATION – Plenty of sleep and rest is needed
Re h a

in recovery. Take things slow, be realistic, do not try and
rush recovery. Keep positive and keep stress to a
cises

minimum. ‘Self Care – the seed of recovery. It is nearly
hip a

impossible to use your body well and treat it wisely
when you feel hostile, fearful or harshly demanding
toward some part of yourself’ (ref 23).
exer

Note to therapists – Acupuncture (Ref 24,25,26) and
gentle massage techniques for pain relief, muscle
spasm and swelling are helpful at this stage. Some
consultants advise hydrotherapy at this early stage.
Health and safety criteria must be met. See
‘Hydrotherapy exercises following hip arthroscopy
guide’, by Louise Grant (HIP-PHYSIOCURE).

WEEK 1 -Exercise record sheet
Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7
1
2
3
4
5
6
7
8
9
10
11
12
13
52
14
15

LEVEL ONE

hip
Week 2 exercises
Aim – Gentle transversus abdominis/hip/pelvic control

tion 16. Supported heel sides in supine. Lie on your back,

wing
y
knees and hips bent to approx 45 degrees, ideally on a

scop
‘slidey’ surface that your heel can glide along. Use a
strong strap or belt to secure around your operated leg
bilita

foot, hold with both hands – as shown in the photo.
follo
With relaxed breathing, a neutral pelvis and lumbar
rthro
spine and T.Abs engaged….and using the strap to
assist the movement of the operated leg, gently slide
Re h a

the leg out straight, keeping the heel in contact with the
cises

floor. Then assist the leg to bend. You are aiming to go
from 0-70 degrees hip flexion, keeping the heel in
hip a

contact (no lifting) with the floor and the leg supported
at all times, to avoid activation of the hip flexor (ref 27).
Repeat 5-10 times, 2 times a day..SLOWLY
exer


LEVEL ONE
hip
Week 2 exercises
Aim – hip flexion mobility with lumbo-pelvic control and

tion
early dissociation.

wing
y
17. Four point kneeling hip rocks. Set yourself up as in

scop
the first picture. Hands directly under shoulders, knees
bilita
under hips. Perform some pelvic tilts initially in the
position to mobilise the lumbar spine and eventually
follo
find neutral. Gently draw your navel towards your spine,
rthro
activating the T.Abs but keeping the lumbar spine in
neutral. Now, gently ‘rock’ your bottom backwards
Re h a

towards your heels, but do not bend in the back, keep
cises

the spine neutral and T.Abs engaged. Do not rotate the
pelvis and aim for symmetry of movement. Hold for 5
hip a

seconds, then ‘rock’ forward as in the last photo .
Hold 5 seconds. Repeat 10 times, 2 times a day.
(ref 22)
exer


hip LEVEL ONE
Week 2 exercises

tion
Aim – early hip abduction/adduction mobility with

wing
y
lumbo-pelvic control and early dissociation.

scop
18. Four point kneeling hip glides. Set yourself up as
bilita
in the first picture. Hands directly under shoulders,
knees under hips. Perform some pelvic tilts initially in
follo
the position to mobilise the lumbar spine and eventually
rthro
find neutral. Gently draw your navel towards your spine,
activating the T.Abs but keeping the lumbar spine in
Re h a

neutral. Now, gently and slowly, ‘glide’ your hips to the
cises

side. Do not rotate the pelvis. Aim for symmetry of
movement. Avoid painful ranges. Hold for 5 seconds,
hip a

then ‘glide’ to the other side.
Repeat 10 times, 2 times a day. (ref 22)
exer


LEVEL ONE
hip
Week 2 exercises
Aim – Gentle hip mobility

tion
wing
19. Hip internal rotation. Lie on your front, neutral

y
lumbo-pelvic spine, T.Abs engaged. Bend your knees

scop
up to 90 degrees bend, keeping them together. Slowly
bilita
and gently make a ‘V’ shape, separating your feet but
follo
keep your knees together.
Hold 5 seconds, repeat 5-10 times, 2 times a day.
rthro
Re h a
cises
hip a
exer


20. Exercise bike (as per description in ex. 10)

LEVEL ONE
hip
Week 2 exercises
Aim – maintain calf muscle strength

tion 21. Ankle plantar flexion with resistance band. Secure

wing
y
a resistance band like a stirrup around the ball of the foot.

scop
Hold with both hands. Firstly pull the foot back towards
you, pull the band tight so it under tension, then flex your
bilita
foot at the ankle pushing against the resistance of the
follo
band. Hold 5 seconds, repeat 10 times, 2 times a day.
rthro
Re h a
cises
hip a
exer

SAFETY WARNING – ALWAYS CHECK YOUR ELASTIC
EXERCISE BAND BEFORE USE, THERE IS A DANGER
THAT IT COULD SNAP. EYE GOGGLES ARE ADVISED
TO BE WORN WITH THESE PRODUCTS.

LEVEL ONE
Week 2 exercises
hip
Aim – maintain quadriceps and hamstring strength
and flexibility

tion
wing
22. Prone lying hamstring curls/Quads stretch.

y
Position yourself as in exercise 7 but with a small ankle

scop
weight around your ankle. Perform the exercise as in
bilita
exercise 7, slowly.
Hold 10 seconds, 10 repetitions, 2 times a day.
follo
This exercise aims to gently work your hamstrings and
at the same time stretch your quadriceps muscles. (ref
rthro
27)
Re h a

23. Seated knee quads extension/Hams stretch. Sit up
cises

straight on a firm chair. Feet should be on the floor and
hips/knees at 90 degrees, or hips at more of an open
hip a

angle if required. Gently draw in your lower stomach
muscles (T.Abs), lumbar spine in neutral. Straighten one
knee, tensing up the muscle on the front of the thigh…
exer

try to keep your back straight.
Hold 10 seconds, 10 repetitions, 2 times a day.

Top tip- place one hand in the area between your
incisions and try and ‘tense’ contract that area as
you do exercise 23. This area may be inhibited with
muscular activity after surgery.

hip LEVEL ONE
Week 2 exercises

tion
Aim – maintain hip abductor and adductor length

wing
and strength

y
scop
24. Isometric hip abduction (as per exercise 5).
bilita
25. Hip Abductor/ITB stretch (as per exercise 8).
follo
26. Hip Adductor stretch (as per exercise 9).
rthro
27. Isometric hip adduction. Gentle squeeze with a soft
Re h a

football or pilates ‘magic-circle’. Try in sitting/lying/
standing, which ever is comfortable. Do not do if it
cises

increase any adductor soreness.
hip a

Squeeze for 5-10 seconds, 5-10 times, 2 times a day.
exer

sitting standing
lying

LEVEL ONE
Week 2 exercises
hip
Aim – maintain gluteal strength and length
28. Isometric hip gluteals (as per exercise 6).

tion
wing
29. Gluteal/piriformis stretch. Lie in the position

y
shown with your operated leg on top. Place a pillow
under the knee of your operated leg for comfort (if

scop
required). You should feel a stretch in your bottom
bilita
muscles. If uncomfortable, try having your top foot
tucked behind the underneath foot, rather than behind
follo
the knee. To increase the stretch, rotate upper body
backwards, or lie near the edge of a bed so you can drop
rthro
the knee of the top leg over. BE AWARE THAT THIS
EXERCISE CAN CAUSE NIPPING IN THE GROIN…if you
Re h a

feel this, please do not do. Hold the stretch 5-10
seconds, as comfort allows, repeat 5-10 times, 2
cises

times a day.
hip a

exer

30. Upper body stretches (as per exercises 11 and 12).

LEVEL ONE
hip
Week 2 exercises

tion
wing
Continue with as in week 1 –

y
scop
Prone lying, rest, relaxation and ice (exercises 13-15)
bilita
follo
Note to therapists – Early passive gentle hip
circumduction is recommended (Wahoff & Ryan, ref
rthro
20). Done passively with hip in 70 degrees flexion.
Re h a

Gentle passive ‘log rolling’ of the leg in neutral is
also useful.
cises

Appropriate joint mobilisations and soft tissue
hip a

techniques, such as myofascial release (Ref
28,29,30,31,32,33,34) , positional release and active
release techniques can be beneficial. Emphasis is
exer

placed on the iliopsoas, iliotibial band, adductors,
gluteus medius, quadratus lumborum and
quadriceps(Ref 20). Acupuncture and electro-
acupuncture can be helpful throughout
rehabilitation (Ref 24,25,26).


WEEK 2 - Exercise record sheet
16
17
18
19
20
21
22
23
24
25
26
27
28
62
29
30

LEVEL ONE
Aim – improve hip/lumbo-pelvic control

tion
wing
31.Heel slides in supine. Progress exercise 16, to be

y
done without a strap, if adequate control is displayed

scop
and it is pain free. Still keep heel in contact with the
bilita
floor at all times.
Repeat slide 5-10 times slowly, 1-2 times a day.
follo
Aim – activation of gluteus medius with low iliopsoas
rthro
activation (exercise 32) (ref 27)
Re h a

32. Double leg bridges. Lie on your back with your feet
flat on floor, knees and hips bent. Lumbo-pelvic neutral,
cises

T.Abs engaged. Squeezing your bottom gently lift up
hip a

your pelvis to bring your hips up into a neutral position.
Hold 5-10 seconds, 5-10 repetitions, 1-2 times a day.
exer


LEVEL ONE
hip
Week 3 exercises
Aim – weight transference to prepare for independent

tion
walking

wing
y
33.Weight transference exercises.If your consultant

scop
has given you consent to wean off crutches at the end
of two weeks, then you will need to do exercises so
bilita

you are balanced and do not have a limp.
follo
DO NOT DO THIS EXERCISE IF YOU STILL HAVE
WEIGHT BEARING RESTRICTIONS
rthro
Stand near an appropriate support that you can
Re h a

comfortably hold onto. Try and make sure your weight
cises

is distributed equally between your feet. Imagine
each foot to be a tripod of weight bearing, (heel, the
hip a

base of the big toe and the little toe) and try to evenly
distribute your weight through these three points.
Now, position your body alignment imagining a line
exer

dissecting through your side ankle bone up to the
boney prominence of your lateral hip (greater
trochanter), the middle of the lateral aspect of your
shoulder, and finally your ear. Next, put your hands on
top of your pelvis and imagine this to be rim of a
bucket, tilt your pelvis anterior/posterior so the ‘rim’
is level. Engage your T.Abs and now you are ready to
do weight transference!...see next page….

LEVEL ONE
Week 3 exercises
hip
Continued …. In the position detailed in exercise 33.
slowly and gently sway your body weight forwards over
your feet and then back into your heels. Keep your Trans
tion
wing
Abs engaged (Ref 35) and you should feel your gluteals

y
‘switch on’ at certain points. Do this 20 times. Then try

scop
side sways 20 times, get your physiotherapist to check
bilita
your technique with these. Progress standing posture
work with the ‘tight rope’ stance. One foot in front of the
follo
other and gaining hip joint neutral (Ref 36)and lumbo-
rthro
pelvic neutral.
Re h a

34. Hydrotherapy. (see separate hip arthroscopy
hydrotherapy guide).
cises

Aim – as a medium to practice walking, weight
hip a

transference, early hip mobility , early lumbo-pelvic
stability challenges and a ‘whole body’ approach.
(ref 37,38) Health and safety criteria must be met before
exer

commencing hydrotherapy – see
separate hydro guide.


LEVEL ONE
Week 3 exercises
hip
Aim – to develop calf muscle strength to aid gait re-
education

tion 35. Bilateral calf raises. Stand, facing an appropriate

wing
y
support that you can hold onto. Modify weight bearing

scop
on operated side as per surgeon’s instructions. Ensure
bilita
a good posture as you raise your heels so you are
standing on the balls of your feet. Keep your ankles
follo
strong, do not let them rotate or twist. Repeat 10-20
times, 2 times a day.
rthro
Note – Progression to alternate calf raising and
Re h a

single leg calf raises will all depend on how much
cises

weight limit you have been instructed by your
surgeon to put through your leg. You must comply
hip a

with this advice.
exer


hip LEVEL ONE
Week 3 exercises

tion Aim – to improve lower limb flexibility

wing
y
36. Hamstring stretch. Lie on your back with head

scop
supported. Place an elastic resistance band (note
bilita
health & safety warning ex.21) like a stirrup around
your foot. Start position, knee and hip bent to 90
follo
degrees. Shoulders relaxed, lumbo-pelvic neutral,
rthro
T.Abs engaged, band under tension. Use band to assist
straightening of the knee so a stretch in the back of
Re h a

your thigh is felt. Hold 10-30 seconds, 5-10 times, 2
cises

times a day.
hip a
exer


hip LEVEL ONE
Week 3 exercises

tion Aim – to improve lower limb flexibility

wing
y
37. Calf stretch. Stand as in the picture. If still

scop
partial weight bearing, use an appropriate
bilita
support to hold onto so you can take some weight
through your arms. Put one leg behind you, one in
follo
front, feet pointing forwards. Slowly bend the knee
rthro
of the front leg, keep the heel of the back leg on
the floor and the knee straight. A stretch should be
Re h a

felt in the back of the rear calf muscle. Hold 10-30
cises

seconds, 5-10 times, 2 times a day.
hip a
exer

Try and maintain a
good posture, do not twist
in the pelvis;… use T.Abs
to control.

hip

LEVEL ONE

tion Week 3 exercises

wing
y
Aim – to improve lower limb flexibility

scop
bilita
38. Iliotibial band stretch. Sit on the floor, one
leg straight and the other crossed over it, as
follo
shown in the photo. Pull your bent knee towards
your opposite shoulder and turn your body
rthro
slightly away so you feel a stretch in your lateral
Re h a

thigh/buttock. Hold 10-30 seconds, 5-10 times, 2
times a day.
cises
hip a
exer

Please check this
exercise does not pinch
in the groin.
Try exercise 8 if that
Copyright-PHYSIOCURE is more comfortable.

LEVEL ONE
hip
Week 3 exercises

tion
Aim – to improve flexibility

wing
y
39. Faber stretch. Lie on your back. Cross one leg, so

scop
the foot is on the top of the opposite ankle, top leg is
bilita
turned slightly out (figure 4 position). You can place
some pillows under the knee of the top leg for support.
follo
For an increased stretch, slide the top foot up the shin
towards the knee and let the top knee lower towards the
rthro
floor. Do not push on the knee or force the stretch.
Re h a

An alternate position is to lie on your front in the
cises

position shown below.
hip a

Hold 10-30 seconds, 5-10 times, 2 times a day.
exer

Check the limit
of external
rotation in surgeon’s
protocol. Some will
prefer this movement
Copyright-PHYSIOCURE to be done later on.

LEVEL ONE
hip
Week 3 exercises
40. Exercise Bike. As per exercise 10.
tion
wing
y
41. Hip rocks and glides. As per exercises 17
and 18.

scop
bilita
42. Hip internal rotation. As per exercise 19.
follo
43. Isometric hip adduction with ball. As per
exercise 27.
rthro
44. Resisted hamstring curls. As per exercise
Re h a

22.
cises

45.Standing hip abduction of operated side.
hip a

Stand near an appropriate support to hold on to.
Assume correct stand posture as in exercise 33.
Take your weight on to your un-operated side,
exer

engaging T.Abs and gluteals. Slowly glide your
operated leg out sideways, a short distance so the
foot is clear of the floor, squeezing your bottom
gently. Hold 5-10 seconds, repeat 5-10 times, 2
times a day.


LEVEL ONE
hip Week 3 exercises (additional suggestions)
Aim – lumbo-pelvic control and mobility

tion Swiss Ball exercises. Sit on the swiss ball feet flat on

wing
y
the floor, seated so your hips are NOT lower than your

scop
knees, pic 1. Ensure you have equal weight through the
bilita
‘sit bones’ (ischial tuberosities) by putting your hands
under your bottom. Adopt a good posture, engage your
follo
T.Abs gently and engage pelvic floor, ref 39 (ask your
physio how to do this). Now tuck your ‘tailbone’ under,
rthro
pic 2 (posterior pelvic tilt), your ‘sit bones’ should feel
Re h a

more flat, then roll back the other way, sticking your
bottom out so your lumbar spine has a hollow, pic 3,
cises

(anterior pelvic tilt)…your ‘sit bones’ will feel more
hip a

pointed. Repeat 10-20 times, 2 times a day.
exer

1 2 3


hip
LEVEL ONE

tion
Week 3 exercises (additional suggestions)

wing
y

scop
Swiss Ball exercises. ..continued. Assume the
bilita

position as before. Lumbo-pelvic neutral, T.Abs
follo
engaged, good overall posture. Glide your hips
laterally to the side, and then to the other side. Place
rthro
your hands under your ‘sit bones’ to monitor weight
Re h a

bearing and weight transference being equal as you
go to one side and then another.
cises

Repeat 10-20 times, 2 times day.
hip a
exer


hip

LEVEL ONE

tion

wing
y

scop
Swiss Ball exercises. ..continued. These are
bilita

optional other exercises that may be useful…
follo
rthro
Re h a

Alternate heel raises
cises
hip a
exer

Progressing to alternate
foot lifts….


hip

LEVEL ONE

tion

wing
y

scop
bilita

follo
rthro
Re h a

Upper body rotations
cises

– early dissociation work of Tx/pelvis
hip a
exer

Upper body side
bends


hip
LEVEL ONE

tion
wing

y
scop
bilita
follo
rthro
Re h a

Seated chest openings
cises

start position
hip a
exer

Seated chest openings
finish position


LEVEL ONE

hip
Week 3 exercises
Note to therapists – Encourage your patient to still
get adequate rest and to use ice on areas that are
tion
wing
sore. Teach patient self-massage AROUND but not

y
on scars.

scop
Some patients may be planning to returning to work
bilita

at this stage. If you have any concerns about this,
follo
you must discuss with the patient/surgeon.
rthro
Pushing rehab/manual therapy to extremes of
movement will not enhance function, and will
Re h a

increase soreness, inflammation and potentially
cises

prolong recovery. Do not provoke hip flexor
tendinitis or bursitis, monitor exercises and modify
hip a

if necessary.
Gentle hip gliding mobilizations and caudad
exer

longitudinal distraction in neutral can be
performed if appropriate with the type of surgery
and type of protocol. Some surgeons do not allow
hip distraction manual techniques until a later
stage – check. (Ref 9 Chapter 25, and ref 6 Chapter
17).


WEEK 3 - Exercise record sheet
31
32
33
34
35
36
37
38
39
40
41
42
43
78
44
45

hip arthroscopy rehabilitation part one

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