Hip Labral Repair Rehabilitation Protocol

This protocol provides a comprehensive guide for physical therapy rehabilitation following hip labral repair surgery. It is a guideline only and should be modified based on individual patient presentation, surgical findings, and surgeon's recommendations. Close communication with the surgeon is essential throughout the rehabilitation process.

Pathophysiology

The hip labrum is a fibrocartilaginous ring that deepens the acetabulum, enhancing hip joint stability and distributing load. Labral tears can occur due to trauma, femoroacetabular impingement (FAI), hip dysplasia, capsular laxity, or repetitive microtrauma. Common symptoms include groin pain, clicking, locking, and a feeling of instability. Surgical repair aims to reattach the torn labrum to the acetabular rim, restoring joint congruity and stability.

Phase I: Protection (Weeks 1-4)

Goals:

• Protect the healing labrum.
• Reduce pain and inflammation.
• Restore pain-free range of motion (ROM) within protected limits.
• Initiate muscle activation and strengthening without stressing the repair.

Precautions:

• Avoid excessive hip flexion (>70-90 degrees), adduction, and internal rotation, particularly in combination.
• Weight-bearing restrictions as prescribed by the surgeon (usually partial weight-bearing with crutches).
• Avoid forceful hip movements.

Interventions:

• Patient Education: Review precautions, weight-bearing status, and home exercise program.
• Pain and Edema Management: Ice, elevation, gentle compression. Medications as prescribed by the surgeon.
• Protected ROM Exercises:
  • Ankle pumps and circles.
  • Gentle knee flexion and extension.
  • Pendulum exercises for hip flexion/extension, abduction/adduction (within protected range).
  • Heel slides.
• Muscle Activation:
  • Isometric gluteal sets.
  • Isometric quadriceps sets.
  • Isometric hip abduction and adduction (avoiding pain).
  • Abdominal bracing.
• Assistive Device Training: Crutch walking with appropriate weight-bearing.
• Modalities (as needed): Electrical stimulation for muscle activation, ultrasound for pain management.

Phase II: Loading (Weeks 5-12)

Goals:

• Progress weight-bearing to full weight-bearing (FWB) as tolerated.
• Increase hip ROM.
• Improve strength and endurance of hip and core musculature.
• Restore normal gait mechanics.

Precautions:

• Avoid activities that provoke pain or clicking.
• Monitor for signs of inflammation or re-injury.
• Progress exercises gradually.

Interventions:

• Weight-Bearing Progression: Gradual progression to FWB as tolerated and prescribed by the surgeon. Wean off crutches when able to ambulate with a normal gait pattern.
• ROM Exercises:
  • Continue with Phase I ROM exercises, gradually increasing the range.
  • Hip capsule stretches (posterior, anterior, inferior glides) as indicated by examination findings.
  • Standing hip flexion, extension, abduction, and adduction exercises.
• Strengthening Exercises:
  • Closed-chain exercises: partial squats, mini lunges, step-ups (progress height gradually).
  • Open-chain exercises: hip abduction, adduction, flexion, extension exercises using resistance bands or cable machine.
  • Bridging exercises (single and double leg).
  • Core strengthening exercises: planks, side planks, bird dog exercise.
  • Hamstring curls.
  • Calf raises.
• Balance and Proprioception Exercises:
  • Single-leg stance.
  • Balance board or wobble board exercises.
  • Agility exercises (e.g., cone drills).
• Gait Training: Focus on restoring a normal gait pattern, including stride length, cadence, and pelvic rotation.
• Cardiovascular Exercise: Stationary bike, elliptical (low resistance, focusing on proper form).

Phase III: Return to Function (Weeks 13+)

Goals:

• Achieve full, pain-free ROM.
• Restore optimal strength, power, and endurance.
• Return to pre-injury activity level.

Precautions:

• Gradual return to activity.
• Monitor for any signs of re-injury.
• Proper warm-up and cool-down procedures.

Interventions:

• Advanced Strengthening Exercises:
  • Progress to full squats, lunges, and step-ups.
  • Plyometric exercises: jump squats, box jumps (progress height gradually), lateral bounds.
  • Sport-specific training (e.g., running, agility drills).
• Agility and Coordination Exercises:
  • Agility ladder drills.
  • Shuttle runs.
  • Figure-of-eight running.
• Endurance Training:
  • Running progression (start with short intervals and gradually increase distance and intensity).
  • Cycling, swimming.
• Sport-Specific Training: Implement sport-specific drills and exercises to prepare for return to play.
• Functional Testing: Isokinetic testing, single-leg hop test, triple hop test, crossover hop test to assess functional strength and stability.

Common Special Tests

These tests can be used to assess hip pathology and monitor progress during rehabilitation:

• FADDIR Test (Flexion, Adduction, Internal Rotation): Assesses for FAI and labral pathology.
• FABER Test (Flexion, Abduction, External Rotation): Assesses for hip joint pathology, including SI joint dysfunction.
• Log Roll Test: Assesses for intra-articular hip pathology.
• Scour Test: Assesses for osteoarthritis and labral tears.
• Trendelenburg Test: Assesses for gluteus medius weakness.

Discharge Criteria:

• Full, pain-free ROM.
• Symmetrical strength and power compared to the unaffected limb (assessed through functional testing).
• Ability to perform sport-specific activities without pain or limitations.
• Demonstration of proper form and technique during all activities.

This protocol is a guide and should be individualized based on the patient's specific needs and progress. Regular communication with the surgeon is crucial for optimal outcomes.