Hip Resurfacing and Arthroscopy Rehabilitation
Role of the Physiotherapist
Pre-operative guidance and information Guide rehabilitation Motivation Support Facilitate Discharge
Stages of Rehabilitation
Stage 1
Day 1 – Day 5/7 Post op Initial contact and explanation of rehabilitation Safe transfers from bed-chair-walking Increasing mobility and exercise tolerance Stairs Gait re-education (walking aids) Teaching of home exercise programme
Home Exercises
Circulation exercises Range of motion exercises in supine and
standing Extension – Gluteus Maximus Flexion – Iliopsoas Hip Abduction – Gluteus Medius Teach basic core stability HEP – TA and
Psoas
Stages of Rehabilitation
Stage 2
2 weeks– 4 weeks Re-evaluation of ROM exercises Improve ROM Muscle strength testing Improve muscle strength and control and
personalise the exercise programme to the patient Gait Education/Walking Aids Exercise tolerance
Stages of Rehabilitation
Stage 3
4 weeks – 6 weeks Fine tune dynamic
stability – specific muscle improvement.
Proprioception Core Stability Exercise Tolerance
Aims of the Rehabilitation Programme
1. Restore normal range of active and passive movement
2. Restore dynamic stability of the muscles in the lumbar/pelvic/hip region
3. Restore balance and proprioception
4. To regain normal functional ability for the individual patient
1. Restore Normal ROM
Mobilising exercises Manual Mobilisations Muscle lengthening techniques (sustained
stretch) Muscle energy techniques
2. Restore Dynamic Stability
Facilitate muscles that act as local stabilisers and those that act as global stabilisers of the pelvis on the weight bearing leg
Failure causes gait abnormalities-Antalgic-Trendellenburg (glut medius)-Glut maximus gait
3. Balance and Proprioception
Impulses originating from joints, muscles, tendons and deep tissue
Processed by the CNS to provide information about joint position, motion, vibration and pressure
This is the process by which the body can vary muscle contraction in immediate response to incoming information regarding external forces.
3.Balance and Proprioception
Wobble-boards
PNF stretches and exercises
Swiss Balls – Core stability
Strength and ROM Exercises
Hip Abduction
Aim to increase strength and dynamic stability of the hip through increased strength of Gluteus Medius.
Proximal stability and control
Pelvis control
Strength and ROM Exercises
Hip Abduction
Aim to increase strength and dynamic stability of the hip through increased strength of Gluteus Medius.
Proximal stability and control
Pelvis control
Strength and ROM Exercises
Hip Abduction
Aim to increase strength and dynamic stability of the hip through increased strength of Gluteus Medius.
Proximal stability and control
Pelvis control
Strength and ROM Exercises
Hip Flexion
Improve functional range of motion and strengthen Ilio Psoas
Control of Trunk on Pelvis movement
Strength and ROM Exercises
Hip Flexion
Improve functional range of motion and strengthen Ilio Psoas
Control of Trunk on Pelvis movement
Strength and ROM Exercises
Hip Extension
Strengthen the gluteus maximus muscles and improve gait
Dynamic stability
Strength and ROM Exercises
Hip Extension
Strengthen the gluteus maximus muscles and improve gait
Dynamic stability
Strength and ROM Exercises
Hip Extension
Strengthen the gluteus maximus muscles and improve gait
Dynamic stability
Strength and ROM Exercises
Hip Extension
Strengthen the gluteus maximus muscles and improve gait
Dynamic stability
Discharge Criteria
Full weight-bearing gait without walking aids Good hip stability/control – absence of Gait
disturbances. Good proximal stability and muscle strength Full/Functional Pain free ROM Advise patient to continue with exercise programme
for up to 6 months. 6 weeks of physiotherapy prior to discharge,
may require more if returning to a specific sport
Resurfacing vs THR
Ease of movement - ROM Confidence in the prosthesis Less pain Mobility progress No precautions Dynamic Stability Return to activity quicker
Limited ROM – slower progress
Initially apprehensive More painful Mobility takes longer Combined movement
limitations Less Stability Slow return
Hip Arthroscopy Rehabilitation
Aims of Physiotherapy
Address pattern of recruitment of muscles involved in hip movement
Restore normal range of movement and gait pattern
Increase core stability and proprioception (balance reactions)
Return patient to previous lifestyle/sport
Stage 1 (immediate Rehabilitation)
This should be followed whilst the patient is using walking aids, and may last 2 days -> 6 weeks dependent on the level of surgical intervention.
Exercises during Stage 1 aim to:
Restore range of movement Maintain muscle function Allow tissue healing and pain to settle
Exercises (Stage 1)
Range of movement (flex, ext abd) Begin core stability HEP:
1. TA setting
2. Pelvis tilting with TA control Gentle stretches ( quads, hams, piriformis) Bent knee fallout with theraband Static Quads, Hams, Gluts etc.
Precautions
Do not push through hip flexor pain May need to keep to specific range of
movement restrictions May need to keep to specific weight bearing
restrictions
Criteria for progression to stage 2
Minimal pain with stage 1 exercises ROM (85% of uninvolved side) Correct muscle recruitment patterns for initial
exercises Do not progress until patient is fully weight
bearing
Stage 2 (Intermediate Rehabilitation)
Exercises taught at this stage are aimed at:
restoring and maintaining movement promoting normal walking patterns strengthening muscles improving balance reactions There is a strong focus on core stability work at this
stage.
Exercises (stage 2)
Cycling (stationary bike) low resistance Swimming (no breast stroke)
-front crawl
-kicking with float Progression of core stability HEP
-Bridging
-Heel slides Proprioception Work
Exercises (Stage 2)
Strengthening with theraband
-Flex, ext, abd, add, int/ext rot, PNF patterns Side stepping Stretches (Piriformis, ITB, Quads, Hams etc) Passive Stretches/ Joint mobilisations Gait Reeducation
Precautions
No forced stretching No treadmill use Avoid inflammation of anterior structures of
hip
Criteria for progression to stage 3
Full ROM Pain free / normal gait pattern Hip strength 70% of uninvolved side
Stage 3 (Advanced Exercises)
The goals at this stage are the restoration of muscular and cardiovascular endurance, and the improvement of balance reactions.
Return to social sport should be possible at
this stage.
Exercises (stage 3)
Gradually build up gym routine to pre-injury level
-Cross trainer-Stepper-Cycling
Introduce gentle jog and gradually build up time and intensity
Exercises (Stage 3)
Introduce Ball work, Starting with a light ball and gradually introduce full size ball with drills
Lunges
Criteria for progression to stage 4
Cardiovascular fitness equal to pre-injury level
Demonstrates no faulty muscle recruitment patterns during stage 3 exercises
Hip strength 80% of uninvolved side
Stage 4 (sport specific training)
Not all patients require rehabilitation to this level. Those who take part in competetive sport will
certainly benefit from further strengthening and more sport specific exercises.
Training regimens should be developed in conjunction with sports club physio /personal trainer.
Stage 4 (Sports specific Training)
Speed Endurance Plyometrics Advanced proprioception exercises Multidirectional Full sport specific training can begin
Criteria for return to full competition
Full, painfree range of movement Hip strength >90% of the uninvolved side Ability to perform sport specific drills at full
speed without pain
Conclusion
Physiotherapy is an integral part of the process of recovery for patients undergoing any hip surgery in order to restore:-Movement-Strength-Core stability -Proprioception-Function