Hip Arthroscopy Rehabilitation Protocol
Phase I: 0 – 4 weeks
Goals:
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Protect healing tissue
Restore ROM within pain restrictions
Reduce pain and inflammation
Enhance proper muscle activation/neuromuscular re-education
Dynamic Warm-up
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Gluteus activation and circumduction
Progress to upright bike without resistance when able to perform without pain
Upright stationary bike to be used 1-2 x/day once cleared by therapist or physician.
No resistance added until 6 weeks
Aquatic Therapy
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Start 7 – 10 days post-op
Use an occlusive cover for sutures
Make arrangements with aquatic facility
To be performed 2 – 4 times weekly, independent from physical therapy
See attached handout for aquatic therapy guidelines
Manual Therapy
Soft tissue techniques should target:
Iliopsoas
ITB and TFL
Adductors
Gluteus medius
Avoid increasing inflammation, pain.
Mobility
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PROM
o Flexion, IR, ABD in pain-free ranges and without complaint of “pinching”
o Can include external rotation and hip extension with caution
o Do not move into or through soft tissue restriction until 2½ weeks post-op
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Hip circumduction
o 10 minutes @ 30o of flexion (5 min CW and 5 min CCW)
o 10 minutes @ 70o of flexion (5 min CW and 5 min CCW)
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FABER slide progression
Begin at 4 weeks with PT-assisted FABER slides
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Cat/camel in quadruped
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Hook-lying butterflies and reverse butterflies
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Quadruped posterior rocks
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Prone lying, “belly time”
Progress to propped on elbows, at least 20
minutes twice/day
Stability
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Gluteus activation progression (continue until activation is symmetrical)
Begin with involved side activation in supine/prone and progressing to kneel, half kneel,
standing
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Transverse abdominus (TrA) – combine
pelvic tilt with TrA
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Stability
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Isometrics: abductors/adductors (supine)
IR/ER (prone)
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Double leg bridges within pain-free ROM
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Begin weight shifts 2 weeks post-op,
progressing to single leg balance
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Clamshells after 3 weeks if pain-free
Gait
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Weaning off crutches depends on patient’s tolerance to gradual increase in weightbearing. Patient should be progressed slowly from bilateral axial crutches to use of one
crutch on nonoperative side. Patient may be progressed to full weight-bearing once painfree and able demonstrate ability to ambulate without antalgic pattern and with proper
activation of gluteal musculature.
Encourage contraction of gluteus muscles with push off and initiation of swing phase to
reduce hip flexor overuse or a “pulling” swing phase may also cue patient to push off with
calf muscles to reduce hip flexor overuse.
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Consider:
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Focus on mobility of the hip in Phase I
Focus on gluteus/TA activation
Upper body conditioning can include suspension-type conditioning
Lower extremities should be positioned as to avoid pinching in hip or pain with weightbearing
Avoid positions that reproduce pain/pinch
Criteria to Progress to Phase II
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Greater than 100o flexion without complaints of pinching
Ambulate without compensatory pattern or pain
Ability to complete all Phase I exercise without increase in pain
Improved activation/isolation of glutes, quads and abdominal musculature without cueing
No effusion, muscular irritation or pain. Do not continue to progress patient until
symptoms subside
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Hip Arthroscopy Rehabilitation Protocol
Phase II: 4 – 8 Weeks
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All repetitions should be controlled and slow, NOT explosive. Correct any compensatory
movement patterns (anterior weight shift, pelvic drop, valgus collapse)
Progress single leg stance balance/proprioception to unstable surfaces (Air-ex, BOSU,
Dynadisc)
Mobility/Flexibility Exercises
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Continue stretches from Phase I
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Progress to Thomas position for
stretching (hip flexor, quads)
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Standing IT band stretch
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Continue with FABER mobility
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Progress to independent FABER slides
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Half-kneeling hip flexor stretch
Add rotation at week 6
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Scar mobilization as needed
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Continue with FABER mobility
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Manual joint mobilizations
GENTLE – avoid aggressive traction
Strengthening/Stability
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Prone hip extension
Lie on stomach. Tighten glutes and
lift leg while keeping knee straight.
Progress to hip extension off end of
plinth or over exercise ball.
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Side lying hip abduction
Lie on uninvolved side. Position
upper leg in slight extension and lift
up then slowly lower to starting
position. Keep toes facing forward
and hip extended.
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Hip hikes
Stand sideways on a step with
uninvolved leg on a 4-inch step with
involved lower extremity free of the
step. Keep both hips facing forward
with shoulders and pelvis shoulders
level. While keeping your uninvolved
leg straight, raise your hip straight up
then lower slowly.
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Leg press/unilateral leg press
Sit or lie back in the seat with lower back and hips against the pads. Feet should be placed
hip-width apart with feet above hips. Feet should be in a slightly toed-out position. Push on
plate to straighten knees. Slowly bend knees and hips. Start bending knees only 45o,
progress depth based on tolerance. Do not progress depth if patient complains of pinching or
reproduction of symptoms. Progress to single leg.
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Sport cord rotations – begin at 6 weeks
Start with double leg rotations with band around waist, progress to single leg stance
rotations. Patient should focus on good glute and core activation while maintaining a level
pelvis and preventing any valgus collapse throughout lower extremity. Avoid pinching.
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Posterior squats
Position feet parallel to each other.
Emphasize proper form with knees
remaining above ankles without collapsing
in or out. Start with partial knee bends and
increase depth per tolerance without
complaints of pinching. Progress to squats
on unstable surfaces. Can use wall to
facilitate posterior weight shift and proper
squat mechanics.
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Split squats/lunges
Step forward with involved lower extremity. Lower hips toward floor then push through front
foot to return to starting position. Depth is dependent on patient tolerance and no complaints
of pinching.
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Bridging progression
Lie on back and position both feet on ball.
Keep knees straight and raise hips off floor to
form straight line from feet to shoulders.
Return to starting position slowly.
May progress to marching bridges and then single leg bridges after ~6 weeks, once able to
perform double leg bridges on ball without anterior hip pain.
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Step and holds
Position in front of mirror. Step forward onto a slightly bent knee and balance for a few
seconds. Maintain control of knee and do not let it move in or out. Knee should remain
positioned directly above foot.
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Romanian dead lift
Start with feet parallel to each other. Lift
uninvolved leg back and off the floor. Bend
forward at the hips while maintaining a
straight lower back position. Only bend
forward as far as you can without rounding
your lower back.
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Sidesteps
Start with knees and hips slightly flexed with
resistance band positioned around ankles.
Keep feet and knees pointed forward as you
step sideways with leading leg then take a
small step in same direction with back leg
while maintaining tension in band.
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Posterior reaches
Start with knees and hips slightly flexed with
resistance band around ankles. Step back
with one leg at a 45o angle then return to
starting position.
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Planks
Lie on your stomach with your elbows and forearms underneath your chest. Prop yourself up
to form a plank using your knees/toes and forearms for support. Maintain a flat back. Do not
allow your hips to sag towards the ground.
Kneeling planks at Week 6 – trial full planks beginning at Week 8.
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Side Planks
Lie on your side with your elbow on the ground below your shoulder. Lift yourself up to form
a plank. Hold this position until you can no longer maintain a straight line from your shoulders
to your knee/toes.
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Step-ups/step-downs
Place foot on small (2- or 4-inch) step. Step
up onto step then lower uninvolved foot back
to the floor. Repeat. Increase step height per
tolerance without pain or symptoms.
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Stand with involved leg on a small step.
Lower opposite foot to the ground by slowly
bending your knee while keeping hips/pelvis
level. When foot touches ground, straighten
knee and return to starting position. Control
knee, do not allow knee collapse. Keep knee
behind toes.
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Consider:
• No crunches, no sit-ups (no hip flexor dominant/lower abdominal leg lowering)
• Resistance training: Caution loading equipment and machines. Limit carrying weights or
twisting and pivoting on hip during exercise setup/preparation. Utilize preloaded upper
body circuit machines early in phase
• Cardio: Elliptical/bike/swimming with pull buoy. Add resistance to upright bike at 6 weeks.
Begin easy skating at week 8
o Discuss duration/volume with physical therapist or physician
• Avoid walking on treadmill
Criteria to Progress to Phase III
• Ability to complete all Phase II exercises without increase in pain, joint effusion, muscle
irritation
• Demonstrate full pain-free PROM with minimal hip flexion AROM “pinching” at 115 o
• Full weight-bearing as tolerated – able to ambulate 15 minutes without fatigue or pain
and without compensatory pattern or pain, no use of assistive devices
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Hip Arthroscopy Rehabilitation Protocol
Phase III: 8 – 12 Weeks
Avoid knee valgus positioning with all exercises. (Knee valgus is when your
knees fall inwards towards the middle of your body as compared to the ankle
position.) Keep knees BEHIND toes with all exercises.
Mobility / Flexibility Exercises:
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Continue stretches from Phase I and Phase II
as needed
Continue to Thomas position for stretching (hip
flexor, quads)
Standing IT band stretch
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Walking spiderman stretch
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Manual AP joint mobilizations,
manual long axis distraction
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Continue supine active
FABER stretches
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Prone quad stretch
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Continue scar tissue
mobilizations – by PT and
patient
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Strengthening/Stability
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Three position squats
Position feet parallel to each other, shoulder-width apart.
Now stagger your stance so your surgery foot is in front of the non-surgery foot and feet
are shoulder width apart (the farther the stagger distance, the increased difficulty of
exercise). Shift more bodyweight to posterior leg. Repeat with legs switched.
Band Hip Flexor Progression
Start in supine position with feet supported by ball and band around foot. Pull back on band, bringing
knee toward hip. Stop once knee is above hip. Avoid excessive flexion or any pinching in hip.
Progress to feet unsupported then to bridge position on ball.
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Walking lunges
Step forward with one leg in front, feet
shoulder-width apart, and bend both
knees to lower pelvis toward the floor.
Straighten knees and step forward to
advance other leg in front. You should be
making forward progress. Repeat across
the length of room. Be sure not to lower
past any “pinch” pain.
Progress to walking lunges with rotation –
can add weight as able without increased
pain or pinch symptoms.
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Reverse lunge with X chop
Posterior leg elevated on surface ~1-2
feet high (low plinth, couch seat). Hold a
1-2 pound weight (medicine ball) in
hands. With both knees slightly bent and
arms starting at one shoulder, chop down
moving weight to opposite hip. Increase
knee bending as you chop down. Repeat
10 times.
Then, keeping legs in same position, switch starting position of arms to begin at opposite shoulder
and repeat 10 times. You’ve made an “X” with arm chops. Switch legs and make an “X” with the arm
chop again.
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Sidesteps with X chop
Progression of lateral ambulation: When
going to the right, start with medicine ball
at right shoulder and chop to left hip.
Repeat downward chop with each left leg
sidestep. Return ball to right shoulder with
each sideways right step. Repeat with the
opposite chop on your return to the start
position. Avoid sideways trunk lean.
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Single leg squats with chair taps
Single leg squat tapping your buttock to a
chair. Do not put any weight on the seat of
the chair – it’s just a tap.
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Sport cord walking
Walk against resistance in all four directions – forward, sideways and backward. Maintain end
resistance for a period of time, starting with 15 seconds and increasing by 5 seconds as able.
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Single leg balance (advanced)
Plyometrics (10 – 12 Weeks)
All landings should be
performed quietly and
controlled, with knees behind
toes and no knee valgus.
Discontinue and return to
strengthening exercises if pain
increases with any plyometric
activity.
Shuttle
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Double leg (DL) hops
Begin with minimal resistance, as this is one of
your first plyometric exercises. Push off footplate
and land with equal weight on both legs. Land with
feet shoulder-width apart, knees behind toes and
no valgus knee positioning. Repeat (slowly and
with control) for 15 seconds before stopping.
Only progress to jogging and hops with rotation if
no pain with DL hops.
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DL hops with rotation
Same as DL hops but rotate hips and pelvis so both feet point about 45o to the side with landing.
Rotate hips to the right for first landing, 45o to the left for the second landing. Repeat (slowly and
with control) for 15 seconds before stopping.
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Single leg (SL) hops and jogging
SL hops: Begin with minimal resistance. Repeat
(slowly and with control) for 15 seconds before
stopping.
Only trial jogging and hops with rotation if there is
no pain.
Jogging: With same minimal resistance, alternate
SL landings on foot plate. Repeat (slowly and with
control) for 15 seconds before stopping.
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DL mini hops in place
Land with feet shoulder-width apart.
Repeat for 15 seconds before stopping.
Consider:
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May add crunches and sit-ups now if there is NO pinch feeling in the hips and no pain
Resistance Training: Caution adding weight to exercises. Hand weights may be used if
no pain or “pinch” is felt with exercises using body weight. Slow gradual return to back
squat with barbell – caution with racking and unracking weights
Increase the depth of squats and lunges as able but avoid any “pinch” feeling in the hip
Cardio: Continue elliptical/bike/swimming now without pull buoy
o Discuss duration/volume with physical therapist or Dr. Thomas Ellis
Criteria to Progress to Phase IV
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Ability to complete all Phase III exercises without increase in pain, join effusion, muscular
irritation
Demonstrate full pain-free AROM without hip “pinching”
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Hip Arthroscopy Rehabilitation Protocol
Phase IV: 12-16 weeks
Continue emphasis on proper landing mechanics as before. Do not continue if plyometrics
exercises cause increased pain – return to strengthening program.
Mobility/Flexibility Exercises
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Seated FABER stretches
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Inch worms
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Hurdle steps
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Walking spiderman
stretch
Dynamic Strengthening and Stability
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Hop ups
DL hop up to 2-inch box – soft, quiet
landing with good knee position. Progress
to 4-inch box. Trial SL if not painful and
with proper mechanics.
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Hop downs
DL hop down from 2-inch box to floor.
Remember important landing mechanics.
Progress to 4-inch box. Trial SL if not
painful and with proper mechanics.
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DL line jumps
Jump forward across the room for distance – but note that
control and proper landing mechanics are more important
than distance itself. Be sure each landing is quiet and
controlled before beginning next jump.
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SL line jumps
Jump forward across the room for distance – but note that
control and proper landing mechanics are more important
than distance itself. Be sure each landing is quiet and
controlled before beginning next jump.
First alternate legs – jump from R to L to R to L.
Then continue on same leg – jump from R to R to R.
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3-way hop drill (DL first and trial SL)
o Perform small DL hops forward and backward over line for 15 seconds
Remember soft and quiet landings!
o Perform small DL hops sideways back and forth over line for 15 seconds
o If no pain with above, perform small DL rotational hops (no line needed) for 15
seconds
o Keep feet shoulder-width apart and maintain proper landing mechanics before trial
of SL hops
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3-way jog matrix
o Slowly jog forward and then backpedal to return
o Repeat down and back with side shuffling
o Repeat with carioca
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Agility ladder drills
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Begin walk/jog program after 12 weeks if able to complete above exercises without
pain/pinch
Criteria to progress to walk/jog program:
o 20 heel touches
o Ambulation with symmetrical gait
o No weight shifts with squatting
o No pain with SL hopping
Consider:
• Cardio: Continue elliptical/bike/swimming now without pull buoy
Discuss duration/volume with physical therapist or physician
Return to Sport Criteria:
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No signs of FAI with clinical testing
90% on Hip Outcome Score (ADL 68/76; Sport 32/36) or 90% on Global Rating Scale
<10% side to side difference with:
Single leg hop
Single leg triple hop
No compensation with functional movements (e.g. pelvic drop, knee valgus, excessive
anterior weight shift)
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