Physical Therapy Continuing Education: Protocol Post FAI Hip Surgery

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Published: 06th December 2010
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Physical Therapy Continuing Education recently interviewed a leading Hip Rehabilitation Expert about his protocol for rehabbing patients post FAI Hip Surgery.



Here are some of his comments:



Interviewer: If we talk a little bit more specifically about the protocol, for the therapists who may get one of your patients could you just talk us through the early phase? Maybe zero to six weeks, just talk a little bit about what are some of the key elements, what are the things they should be doing and shouldn’t be doing?



Hip Rehabilitation Expert: Sure. It amazes every physician that comes out here to observe what’s going on in surgery as well as the clinic because we’ll have patients get on a stationary bicycle the day of surgery. If it’s a late surgery they would obviously get on the next morning but every patient for the most part is getting on the stationary bicycle the day of or the day right after surgery. So, early mobility is really something that we are a big proponent of.



Our goals, much like almost any arthroscopy clinic is obviously to protect the integrity of what is repaired, diminish pain and inflammation, we want to restore the range of motion, and then we want to prevent muscle inhibition.



That being said, a patient will come down, and they have this hinge brace that they’ll wear whenever they’re weight bearing. Their weight bearing status, if they’re a non-microfracture patient – which is a surgical procedure, the microfracture – a non-microfracture patient will be on those crutches, put flat weight bearing which is about 20 pounds, which is very minimal. We don’t do non-weight bearing because of the joint reaction forces that are placed through the hip. We do want the foot on the ground and they’ll use the crutches like that for three weeks.



They are in a CPM machine for 4 to 6 hours the first couple days and then reduce that to one to two hours. They’re on the bike. They’ll do passive range of motion with that circumduction motion I spoke about earlier, and then their limits for the range of motion is we limit external rotation and extension.



Our hip surgeon is really a huge proponent of the hip needing stability and when you tear your labrum or you have FAI or if you have a capsule that has laxity in it, those three things cause that hip to be non-congruent and he repairs all those. He makes the bony geometry congruent with the surgery, he repairs the labrum, and he repairs the capsule. So, he wants that capsule to heal and so we’re gonna limit external rotation for somewhere in the range of 17 to 21 days and extension for about 21 days.



And that’s really what the key elements are that first six weeks. They’ll be on the crutches for the three weeks, wean off at week three to four, and then spend the next two weeks, weeks five and six, just really normalizing their gate.

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