Hip Arthroscopy Protocol
Precautions (follow MD protocol if provided):2
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Labral Repair
o PWB (up to 20 lbs) for 10-28 days
o Avoid excessive early flexion and abduction; full PROM at week 2
o Common precautions include: flexion to 90; abduction to 25; and extension to
10; caution with ER/IR
Osteoplasty/Microfracture
o PWB (up to 20 lbs) for 4-6 weeks
o Avoid excessive early flexion and abduction; full PROM at week 2
Capsule Repair (Plication/Capsulorraphy)
o Assumed anterior repair
o PWB (up to 20 lbs) for 10-14 days
o No extension and external rotation past 10 for 3-4 weeks; progress extension
and external rotation after 3 weeks, full PROM allowed at week 4
Avoid active straight leg raises early in treatment
o For partial psoas release: No straight leg raises for at least 4 weeks
Post-operative braces worn during ambulation for approximately 10 days limiting flexion
(80-90)
**For combined procedures use most conservative approach
PHASE I (0-4 weeks):
Goals:
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Protect healing tissue
Restore ROM
Diminish pain and inflammation
Enhance proper muscle activation/neuromuscular re-education
Normalize gait
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Interventions:
 Manual Therapy:
o Soft tissue techniques to iliopsoas, ITB/TFL, adductors, gluteus medius
o Gentle joint mobilizations
o Scar massage
 Mobility:
o PROM within restrictions/pain-free range
o Do not move through soft tissue restriction until 2.5 weeks post-op
o Examples:
 Stationary bike: no resistance until week 6
 Aquatic therapy starting 7-10 days post-op
 Hip circumduction @ 30 of flexion and 70 of flexion
 FABER Slides w/ PT assist: begin at 4 weeks
 Cat/Camel in Quadruped
 Hook-lying Butterflies and Reverse Butterflies
 Quadruped Posterior Rocks (for hip flexion)
 SKTC (iliopsoas stretch); full range on uninvolved side
 Stool Rotations (IR/ER)
 Strength:
 Quad sets
 Gluteal sets: supine, prone, tall kneeling, ½ kneeling
 Isometrics: abd/add (supine); IR/ER (prone); no flexion
 Prone TKE->standing TKE, SAQ, hamstring curls; heel slides
 Prop up position (belly time) for at least 20 minutes/day
 TA activation; TA marching; posterior pelvic tilt
 Bridges (within pain-free ROM)
 Weight-Shifts @ 2 weeks post-op
 Clamshells @ 3 weeks post-op if pain-free; progress to reverse clamshells
 Forward Step up
 Isotonic hip abduction/adduction/extension (end of phase 1/beginning of
phase 2)
 Balance:
 SLS
Criteria to progress to Phase II:
 ROM greater than or equal to 75% of uninvolved side
 Performance of phase II interventions with minimal pain
 Full weight bearing
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PHASE II (4-8 weeks):
Goals:
 Progress ROM
 Transition focus to strengthening
 No ballistic movements or forceful stretching
Interventions:
 Manual therapy:
o Progress joint mobilizations (avoid aggressive traction)
 Mobility:
 Stationary bike: with resistance at week 6; consider elliptical
 Thomas test stretch, ½ kneeling hip flexor stretch (progress @ week 6 by
turning upper body away from surgical leg), standing ITB stretch, standing
hamstring stretch
 Independent FABER slides
 Strength:
o Increased focus on gluteal and core strengthening
 Bridge progression
 Legs on physioball
 Marching (@ 6 weeks)
 Single leg (@ 6 weeks)
 Steamboats (stance leg=surgical leg)
 Ball wall squats (progress to posterior squats)
 Resisted seated internal and external rotation; Resisted Stool IR/ER with
TB
 Leg press/unilateral leg press
 Start at 45 and progress as tolerated
 Step and holds
 Romanian deadlifts
 Side steps and posterior reaches with TB
 Split squats/lunges
 Kneeling front planks @ week 6; Full planks @ week 8
 Side planks; progress to S/L plank with hip ABD
 SLS with TB cross-body pull
 Balance:
 SLS on unstable surfaces (Foam/BOSU)
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Criteria to progress to Phase III:
 Full ROM
 Normal and pain-free gait pattern (without trendelenberg)
 Hip flexion strength greater than 60% of uninvolved side
 All other strength measurements (ab/add/ext/IR/ER) greater than 70% of uninvolved
side
PHASE III (8-12 weeks):
Goals:
 Restore endurance/strength/balance
 Incorporate multi-planar movements
 Progress hip strengthening in functional positions
Interventions:
 Manual Therapy:
o Continue joint mobilizations as needed (may add long axis distraction and AP
mobilizations)
 Mobility:
o Continue phase I and II stretches as needed
 Strength:
 Standing resisted hip external rotation
 Three position squats
 Band hip flexor protocol
 Walking lunges
 Reverse lunge with X chop
 Side steps with X chop
 SL squats with chair taps
 Sport cord walking
 Plyometrics @ 10-12 weeks
 Shuttle DL and SL hops
 DL mini hips in place
 Agility drills (single plane)
 May add crunches and sit ups if no hip pinching
Criteria to progress to Phase IV:
 Hip flexion strength 70% of uninvolved side
 All other strength measurements greater than 80% of uninvolved side
 Performance of initial agility drills with proper mechanics
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PHASE IV Exercises: (12-16 weeks):
Goals:
 Return to full level of function and/or sport
Interventions:4
 Mobility:
 Seated FABER stretches
 Inch worms
 Hurdle steps
 Walking spiderman stretch
 Dynamic strengthening/stability:
 Hop ups/downs
 DL and SL line jumps
 3-way hop drill
 3-way jog matrix
 Agility ladder drills
 Initiate walking/jogging program after 12 weeks
Criteria to return to sport:
 No signs of FAI
 Full and pain free ROM
 Ability to perform sport-specific drills at full speed without pain
 Greater than or equal to 90% on HOS or 90% on global rating scale
 <10% side to side difference with:
o Single leg hop/single leg triple hop tests
References:
1. ATI: Rehabilitation Guidelines for Hip Labral Injuries
2. Enseki KR, Martin RL, Draovitch P, et al. The Hip Joint: Arthroscopic Procedures and
Postoperative Rehabilitation. J Orthop Sports Phys Ther. 2006; 36(7): 516-525.
3. Garrison JC, Osler MT, Singleton SB. Rehabilitation after arthroscopy of an acetabular
labral tear. North American Journal of Sports Physical Therapy. 2007; 2(4): 241-250.
4. Ohio State Hip Arthroscopy Rehabilitation Protocol
5. Stalzer S, Wahoff M, Scanlan M. Rehabilitation Following Hip Arthroscopy. Clin Sports
Med. 2006; 337-357.
6. UPMC Hip Arthroscopy Rehabilitation Protocol
7. Voight ML, Robinson K, Gill L, Griffin K. Postoperative Rehabilitation Guidelines for Hip
Arthroscopy in an Active Population. Sports Health. 2010; 2(3): 222-230.
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