Dominic S. Carreira, M.D.
300 SE 17th St First Floor, Fort Lauderdale, FL 33316 (954) 764-2192
POST OPERATIVE HIP PROTOCOL
Phase I: Initial Hip Exercises
A. Ankle Pumps - 20 repetitions, 2 times/day
B. Isometrics - 20 repetitions, 2 times/day
1. Gluteal sets - Tighten buttock muscles - hold 5 seconds.
2. Quad Sets - Tighten thigh muscles - hold 5 seconds.
3. Transverse abdominal Isometrics - Draw belly button in towards spine without moving
pelvis or spine - hold while taking 5 breaths. This exercise is to be completed along with
core stabilization exercises.
4. Hip adduction and abduction - No resistance should be added until week 5 or 6.
C. Passive ROM (performed by therapist and caretaker) - 2 times/day for 6 weeks
1. Circumduction:
A. In Flexion: Lying on your back and with hip in 70° flexion, move knee in a circular
motion (pendulum rotation). Knee not rotating beyond the shoulder. 3 sets for 5
minutes.
B. In Neutral: Lying on your back with hip und knees straight, move the leg in a circular
motion (bring hip into abduction and slight flexion). May be uncomfortable for first
few days. 30 reps in each direction.
2. Passive Supine Hip Roll (IR): Lying on your back with legs straight, have partner rotate
thigh inward. 20 repetitions.
3. Flexion: Lying on your back have partner bend knee toward chest (90° limit for 10 days).
Increase range as tolerated after 10 days. 20 repetitions.
4. Abduction: Lying on back with leg straight, have partner bring leg away from your
midline (35° limit for 3 weeks). Increase range as tolerated after 3 weeks. 20 repetitions.
5. Prone Internal Rotation: Lying on stomach with knee bent to 90°, have partner bring
ankle away from your body. No external rotation in prone for 3 weeks. 20 repetitions.
Start 6 and 7 at Week 4:
6. Extension: Lying on your stomach have partner grasp knee and lift leg up from the table
20 repetitions.
7. FABER for ER: Lying on back bring involved leg into figure four position with ankle
resting on top of opposite knee. Gently lower bent knee towards the table. You may need
to start with ankle resting on shin or inside of leg. It is normal to feel lateral hip
discomfort. Do not push on knee.
D. Passive Stretching - 5 repetitions, hold 20 seconds, 2 times/day
1. Piriformis Stretch: Lying on uninvolved side, bottom leg straight/pelvis stacked) bend
involved hip to 50°- 70° flexion, hook your top foot behind uninvolved knee. Stabilizing
pelvis, lower the involved knee towards table. Stretch should be felt in buttock. Avoid
pinch in groin.
POST OPERATIVE HIP PROTOCOL
Dominic S. Carreira, M.D.
(954) 764-2192
2. Quadriceps Stretch: Lying on stomach, have partner bring ankle toward buttock, feeling a
stretch in front of thigh.
3. Kneeling hip flexor stretch (Start Week 4) In a half kneeling position with the involved
knee on the floor tighten stomach muscles. Shift weight forward while keeping trunk
upright, feeling stretch in front of hip/thigh. (PT can start using Thomas stretch in
therapy)
4. General Hip, Knee, Calf Stretching (Start 3rd 4th week): Stretching in all directions is
acceptable from this point forward
5. Heel Slide to a March; perform heel slide then lift your heel off table so hip is bent to 90°
keeping core stable, return leg to starting position. Alternate legs. (PT can advance to
even more difficult exercises as long as you avoid hip flexor pain including alternating
heel lifts and toe touch: both heels up tapping one heel down at a time)
6. At this point, progression dependent on patient / therapist discretion. Examples include
dead bug exercises; planks; etc.
E. Gluteal Progression - 3 sets, 10 repetitions, once a day
1. Glute Medius Firing: Attempt to initiate glute medius with assisted side lifts in muscle
test position. Work on eccentrics (negatives) until patient can perform lift without pelvic
compensation.
2. Side leg raises (glute medius focus): Start only when can properly perform without
compensating. Focus on form. Lying on uninvolved side, raise top leg up and slightly
back without moving your trunk (side leg raise)
3. Stomach leg raises (Glute Maximus focus): Lying on your stomach flex knee 90° degrees
or further. Lift your knee off the table keeping the knee flexed. Raise your leg up 6 8
inches.
4. Rose Wall Slides (week 4): Lying on uninvolved side with shoulders, hips, and heels
flush up against a wall. Slowly slide top involved heel along wall maintaining firm
abdominal muscles.
5. Prone heel squeeze (week 5): Lie on your stomach. Slightly separate, then bend your
knees about 45 degrees, place your heels together (froggie style). Draw abdominals in
and squeeze heel together for 5 seconds. Increase difficulty by lifting your thighs off the
mat with heel squeeze maintaining a stable pelvis. Do not arch your back.
F. Water Progression - 20 30 minutes, 3 times/week.
Start Week 4
1. Water Walking Walk forward, backward and lateral in chest deep water. Emphasize full
weight shift to involved side.
2. Water Jogging In deep water using an aqua jogger, jog in place.
Start Week 5
3. Swimming started at 5 wks. We prefer frog kick as in the breast stroke.
G. Quadruped Racking - 3 sets, 20 repetitions, Once a day
On your hands and knees, shift your body weight forward on your arms then back onto your legs.
You may also shift side to side and in diagonal directions.
H. Standing Hip IR - 3 sets, 20 repetitions, Once a day
Place knee of involved leg on a stool. Rotate hip without moving trunk, so that the stool turns
(moving foot outward from your body). Progress to using a resisted band when tolerated.
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POST OPERATIVE HIP PROTOCOL
Dominic S. Carreira, M.D.
(954) 764-2192
I.
Active Prone IR/ER - 20 repetitions, Once a day
Lying on your stomach with knee bent to 90°, allow foot to drop out so that the hip is in full IR.
Actively rotate hip back to neutral only. Partner gradually adds resistance to this motion in both
direction. May go beyond neutral after 3 weeks.
J.
Lower Abdominal/Short Lever Hip Flexor Progression - 20 repetitions, Once a day
For each stage, progress when no pulling is felt in hip flexor
1. Heel Slides with Strap: Lying on your back place strap around foot and use arms to pull
heel towards your buttocks keeping heels on mat and core stable.
2. Heel Slides without strap: Gradually reduce the use of your arms and strap and increase
the use of hip muscles to slide heel until you do not need the strap (monitor for hip flexor
pain).
K. Bridging Series - 3 sets, 20 repetitions, 1 - 2 times/day
1. Double leg bridge: Lying on your back place rubber tubing around knees with hip and
knees bent. Raise buttocks while keeping core stable slowly lower.
0
Progress to single leg bridging
2. Bridge on Swiss Ball: Lying on your back place feet up on swiss ball. Keep knees
straight and core stable as you raise your buttocks, hold 5 seconds then lower.
0
0
Progress to laying with shoulders on ball and feet on floor then lowering and raising
your buttocks.
Add arm rotations in this position or perform with single leg bridge
L. Leg press (limited weight) - 3 sets, 30 repetitions, Once a day
Using light weight (20-30 lbs), perform leg press. Increase weight in Phase II.
M. Gait Progression: "Crutch weaning" - USE TWO CRUTCHES as you increase weight bearing.
1. Weight shifting exercises: Focus on avoiding Trendelenburg/compensated Trendelenburg
2. Increase weight-bearing tolerance.
3. Gradually add 25% weight on surgical leg every 1-3 days until 100%, continuing to use
both crutches during this period, Return to crutches avoiding early fatigue. Avoid limping
and focus on correct walking, weight shift, and mechanics. Make sure patient is getting
full hip extension.
Phase II: Intermediate Exercises “Close Chain, Single Plane”
For specific questions about running, dance, skating and golf, please review Phase III progressions for
potential start times.
A. Balance Progression - 3 sets, hold 30 seconds, Once a day
1. Single Leg Stance
2. Dyna disc: Start with poles for support. Progress by touching the opposite foot to the
ground @ 9, 10.5, 12, 1.5 and 3 o'clock positions. Add Dynamic Balance activities as
tolerated.
B. Stationary biking with resistance - 30-45 minutes
Increase resistance slowly while maintaining 60 80 RPM. Reduce time on bike when initiating
resistance.
For Cyclists: Due to the correct pedaling motion and the great amount of hip flexor use:
1st three weeks: use flats on trainer
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POST OPERATIVE HIP PROTOCOL
Dominic S. Carreira, M.D.
(954) 764-2192
3rd to 4th weeks: clip-less with no resistance.
C. Double 1/3 knee bends - 3 sets, 20 repetitions, Once a day
Start standing with feet shoulder width apart, bend at the knees to 60°. Do not allow knees to go
past toes. Progress by using a sport cord for resistance.
D. Advanced Core Progression - 3 sets, 20 repetitions, Once a day
1. Planks: Lie on either side with your knees bent resting on your elbow. Lift your hips up
to a straight line, and then slowly lower. Progress by performing with legs straight.
Progress to performing on back and stomach positions
2. Pilates: With an instructor:
Footwork series, Skater series, hip extensions
E. Manual mobilization: (Therapist as needed).
Address posterior or medial capsule tightness. Refer to photos for the preferred mobilizations.
F. Side Stepping - 3 sets, 20 repetitions, Once a day
Place rubber tubing around ankles. Bend at the knee and sidestep in each direction while
maintaining the bent knee position and chest upright.
G. Elliptical trainer/stair climber - 15-20 minutes, 3 times/week
Begin with minimal resistance and progress in intensity over time as tolerated. TREADMILL
USE IS PROHIBITED
H. Single 1/3 Knee Bends - 3 sets, 20 repetitions, Once a day
Same starting position as double knee bends but with only surgical leg. Bend knee to 60° flexion
while maintaining a level pelvis and not letting the knee “fall in” (corkscrew). Progress by adding
cord for resistance (sport test exercise)
Other single-leg closed kinetic chain exercises:
1. Lateral Step Downs
2. Balance Squats: With one leg behind you on a chair, squat with your opposite leg to 70
degrees. Perform with opposite leg on chair.
3. Lunges
4. Reverse Lunges
Following hip surgery by Dominic Carreira, the patient can NEVER use the treadmill. Concern is with
the secondary force of the moving tread being dissipated through the hip!
Phase III: Advanced exercises “multi directional & plyometric”
A. Plyometrics: water to dry land progression - 10 sets, 1 - 2 minutes, 3-5 times/week
Begin with water: in chest deep water, perform forward bounding. Focus on absorption when
landing, Progress to dry land plyos.
B. Side to side lateral agility with cord - 3 sets, 50 reps, 3 times/week
Attach the sport cord from the side with the surgical leg facing the cord. Step sideways to create
tension on the cord. From a single knee bend position on the surgical side, explode off laterally,
touching momentarily with the opposite leg before the tension pulls you back. Emphasize the
absorption back onto the surgical leg.
C. Forward/ Backward running with cord - 3 sets, 1-2 minute intervals, 1 time/day
Shift from one leg to the other while running in place without exaggerating the absorption and
push off motion. Face the cord for backwards running.
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POST OPERATIVE HIP PROTOCOL
Dominic S. Carreira, M.D.
(954) 764-2192
D. Running/ Skating/Golf progression. NEVER USE TREADMILL
RUNNING: Expect to have mild limping/discomfort/awkwardness – this should go away
gradually. Common sense dictates that if limp worsens or there is pain, running should stop.
Progress to the next phase each week.
No Treadmill Use
Walk/Run Ratio
Sets/Total Time
Frequency
R1
4 minutes/ 1 minute
4 sets
20 min
4-5 times/week
R2
3 minutes/ 2 minutes
4 sets
20 min
4-5 times/week
R3
2 minutes/3 minutes
4 sets
20 min
4-5 times/week
R4
1 minute/ 4 minutes
4 sets
20 min
4-5 times/week
R5
15 minute Jog
2 sets
10 min
4-5 times/week
From 10 min jogging, increase as tolerated.
SKATING: Goalie: hold back pads an extra week. Progress to the next phase each week
SKATING PROGRESSION
Time
Frequency
S1
Skate no pads forward and back
with crossover
20-30 min
4-5 times/week
S2
Skate Use of Pads with change
of direction, stop/start
20-30 min
4-5 times/week
S3
Sport-Specific Drills
S4
Sports Test (to be cleared)
Week 10 + of
protocol
S5
Full Contact – Practice with
Team
After passing
sports test
2-4 times/week
GOLF: Begin after 3 weeks of walking. Don't carry bag and do not pull cart.
GOLF PROGRESSION
Volume
Frequency
G1
Put, chip, ½ swing only
1 bucket
For 1-2 weeks
G2
8-9 Irons, ¾ swing only
1 bucket
For 2 weeks
G3
All Irons, Use cart, full swing
9 holes
For 2 weeks
G4
Full play, walking 18 holes
18 holes
E. Initial agility drills - Straight Plane Agility, Chop Downs/Back Pedaling jog forward, stutter step
to a stop, absorb and push off smoothly into a back pedal.
Side Shuffles Start with feet shoulder width apart, maintain an athletic stance and shuffle to the
right, then back to the left.
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POST OPERATIVE HIP PROTOCOL
Dominic S. Carreira, M.D.
(954) 764-2192
Phase IV: High Level Activities
Functional Sport Test
Passing the Sport Test = you are cleared
A. Multi Plane Agility
1. Z Cuts
2. W Cuts
3. Cariocas
4. Ghiardelli's
Start by crossing the right leg over iliac crest, swing the left leg out from behind the right
absorbing and touching the ground with your left hand in one fluid motion. Repeat to the
right side.
B. Sport Specific Training
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