REHABILITATION PROTOCOL

PHASE I: PROTECTION PHASE (POST-OP - WEEK 1)

The patient is usually kept in the hospital for 3 to 10 days, depending on how well the

patient heals after surgery (Hip Injuries and Disorders). In which case the patient is then given

instructions to the use of crutches or a walker. Rehabilitation exercises should be started almost

immediately, so that there is no further atrophy to the muscles of the lower extremity. The goals

for the patient is to reduce swelling, reduce pain, learn proper ambulation techniques, and restore

a slight amount of range of motion (ROM) .

A. Reduce swelling and control pain.

- Ice/Muscle Stimulation: interferential stimulation and ice complimented with

rest, compression, and elevation.

B. Learn proper ambulation technique

C. Restore a slight amount of ROM

1. Ankle pumps: 3 sets of 10 reps

2. Ankle rotations: clockwise and counter clockwise 20 times each direction

3. Knee flexion with towel: 2-3 minutes 5 times/day

For the patient to move to the Phase II, he must have decreased swelling, decreased pain,

be able to use crutches or walker with out any complications, and have restored slight ROM. To

measure these goals, a pain scale needs to be established and reported each day to be sure the
pain is going down, girth measurements need to be measured and compared to previous

treatments to be sure that swelling is being decreased, and ROM needs to be measured with a

goniometer compared to pre-operative ROM. By the end of this phase, the patient should not

need the use of crutches/walker at all times of the day. Another aspect to look into during this

phase is the motivation and confidence level the athlete is portraying. Be sure to evaluate these

conditions daily, so that the athlete does not become depressed because of the injury. After

passing each of the goals, the patient should be able to move on to Phase II of the rehabilitation

program.

PHASE II: MOTION PHASE (WEEK 2 - WEEK 5)

This is the longest phase in the rehabilitation protocol, and it is probably the most

important. It is also probably the most important because it includes strengthening and

conditioning of the entire lower kinetic chain. In this phase, the patient must have slight, if any,

edema, light to mild pain, regain all ROM/flexibility for each joint in the lower extremity, regain

75 to 80 percent of muscular strength/endurance, and regain nearly all proprioceptive ability

compared to the contralateral side. While completing the above goals, the patient should develop

an acceptable level of overall physical fitness.

A. ROM/Flexibility

1. ABC’s: 3 reps/ 3 x day

2. Ankle pumps: 2 x 25

3. Ankle rotations: clockwise/counter clockwise 2 x 25

 4. BAPS board

a. sitting: clockwise/counter clockwise 50x each direction

b. standing: clockwise/counter clockwise 50x each direction

5. Lying towel slides: 5 minutes/ repeated throughout the day

6. Active knee/hip flexion: 5 minutes/ repeated throughout the day

7. Lying abduction: 5 minutes/ repeated throughout the day

8. Standing abduction/adduction/flexion/extension: 5-10 minutes/ repeated

throughout the day

9. Prone hangs: without weight 5-10 minutes daily; progress to using

weighted prone hang if necessary

10. Exercycling (ROM using bike): backward motion 10-15 minutes progress to

forward/backward motion 20-30 minutes

B. Proprioception

1. Weight shifts: 5 minutes/ repeat throughout the day

2. Balance on injured leg

a. eyes open: 3x30 sec

b. eyes closed: 3x30 sec

 c. proprioception tossing ball: 3x30 sec

d. trampoline eyes open: 3x30 sec

e. trampoline eyes closed: 3x30 sec

f. trampoline tossing ball: as long as tolerated

g. changing directions: going from straight ahead jumping to right/left

side: repeated several times

C. Strengthening/Endurance

1. Isometric exercises for the ankle using a wall or clinician: 3x10/daily

2. Theraband exercises for the ankle (plantar flexion, dorsiflexion, inversion,

eversion): 3x10 in all directions.

3. Heel raises (standing/sitting): 2-3 sets of 25; progress to using free weight or

weight machine

4. Quad sets: 2 sets of 50 reps

5. Gluteal sets: 2 sets of 25 reps

6. Straight leg raises (flexion, extension, adduction, abduction): 2 sets of 25 reps

in each direction

7. Terminal knee extension: start in lying position, progress to standing using

theraband: 2-3 sets of 25 reps

 8. Squats: start with half squats then progress to full squats: 3 sets of 10 reps

9. Leg press: start with half then progress to full: PRE program

10. Hamstring curls using a machine: start off with using theraband or ankle

weights(3x10) then progress to machine using a PRE program

11. Standing hip ranges of motion (flexion, extension, abduction, adduction): start

off without weight then progress to ankle weight: 3 x 10 then, using a PRE

program, progress to using a machine that will allow these motions

12. Hip bridges: 3x10: start off with athlete being on the floor, then progress to

using a Swiss Ball

13. Attach the athlete to a weight machine, add weight accordingly, have athlete

walk as far as the machine allows. The athlete should be able to control the

weight both going out and coming back. 5 min/day

14. Have the athlete either ride a stationary bike, or walk on a treadmill for about

20 - 30 minutes/day

15. After completing the exercises for this phase, the athlete must also be

involved in stretching program. At the end of every session, the athlete must

work on stretching: the gastroc/soleus group, quads, hamstrings, hip flexors, and

hip internal/external rotators.

16. Gait pattern should also be observed and corrected, as seen fit, on a daily

basis
 For the athlete to be able to move on to Phase III, he must have reduced local symptoms,

and displayed adequate wound healing to be able to participate in at least part of the athlete’s

regular practice or conditioning. A sufficient amount of ROM, flexibility, muscular

strength/endurance, and proprioception should have returned, so that the athlete can participate in

at least part of regular practice or conditioning sessions. Another aspect to look into during this

phase is the motivation and confidence level the athlete is portraying. Be sure to evaluate these

conditions daily, so that the athlete does not become depressed because of the injury. To be sure

the athlete is progressing, a measurement of each criteria should be done a couple of times a

week. Measure ROM/flexibility using a goniometer then compare to contralateral side, measure

proprioception by comparing to contralateral side or by timing the athlete, and measure strength

by performing manual muscle tests and compare to contralateral side. Endurance can be

observed daily while the athlete is performing the exercises, and also while he is on the

stationary bike or treadmill.

PHASE III: STRENGTHENING PHASE (WEEK 6 - WEEK 8)

This phase of the rehabilitation program will test what has been done up until now.

During this phase the athlete will continue with completing exercises in the clinic, as well as

participating in a portion of practice or condition sessions. In this phase, the athlete must regain

100 percent, or more, ROM/flexibility, proprioception, muscular strength/endurance, and overall

confidence/motivation compared to where he/she was before the injury. The athlete should also

restore optimal overall physical fitness. This phase should give the athlete an opportunity to do

more sport specific activities. Also, normal gait pattern, during both walking and running,

should be re-established during this phase.

A. ROM/Flexibility

1. If the athlete is still lacking ROM, he/she needs to complete this with the

assistance of the BAPS board in the standing and seated position. 25-50 reps in

each direction

2. After completing the exercises for this phase, the athlete must also be

involved in stretching program. At the end of every session, the athlete must

work on stretching: the gastroc/soleus group, quads, hamstrings, hip flexors,

and hip internal/external rotators.

3. Gait pattern should also be observed and corrected, as seen fit, on a daily basis

B. Proprioception

1. If the athlete is still lacking proprioception, he/she should completely regain

using the exercises from the previous phase

2. New proprioception exercises should be incorporated in this phase. The

exercises should portray sport specific activities the athlete may need while

playing the sport.

C. Strength

1. Leg press: PRE program

2. Squats: PRE program; start off with light weight then adjust accordingly

3. Heel raises: PRE program (standing/seated position)

 4. Hip extension, flexion, adduction, abduction with a weight machine: PRE

program

5. Walking with weight attached to waist: PRE program

6. Lunges: work up to doing 100 yards

D. Endurance

1. Stationary bike: 20-30 minutes/day

2. Treadmill: 20-30 minutes/day

3. Stairmaster: 15-20 minutes/day

- Rotate these exercises it may not be necessary to do all these each day

4. Slide board

a. side-to-side: 2 sets 15-20 sec

b. X-Country: 2 sets 15-20 sec

c. Bridge position: X-country or W pattern: 2-3 sets 15-20 sec each

5. Jogging: start off slow then progress as the athlete’s endurance gets better

6. Dot drills: 2 sets 30 sec change pattern

7. A plyometric program can be designed during this phase. Be sure not to

include it more that 2-3 days a week, and do not incorporate after a leg
 workout routine. Progress accordingly, do not start off with something the

athlete can not do.

For the athlete to be able to move on to phase IV, the athlete must have regained all ROM

and proprioception the athlete had prior to the injury. Muscular strength and endurance should

be close (90-100 percent) to where the athlete was at prior to injury. The athlete’s overall

physical fitness should allow him/her to participate in a majority of the practice or conditioning

activities. Measure ROM/flexibility using a goniometer then compare to contralateral side,

measure proprioception by comparing to contralateral side or by timing the athlete, and measure

strength by performing manual muscle tests and compare to contralateral side. Endurance can be

observed daily while the athlete is performing the exercises, and also while he/she is performing

any of the endurance exercises listed above. Another important factor is that the athlete MUST

have a release from his/her physician stating that the athlete has fulfilled the goals, and is

physically able to participate. Be sure that the athlete is mentally able to return to play.

PHASE IV: RETURN TO PLAY

During this phase the athlete should have completed a vast majority of the rehab

protocol. Exercises may still need to be done to maintain overall physical fitness. The athlete

should be at 100 percent, or better, compared to previous level of fitness. The hip should be

protected in any way seen fit, so that there is no chance for re-injury. This phase may last until

the athlete has resigned from playing sports.