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Rehabilitation following Open surgery for Hip Impingement
Physiotherapy Protocol after Open Hip Debridement

First 6-8 weeks (until radiological verification of healed trochanter) - Healing phase.
Touch weight bearing on operated leg, 10Kg of weight, with crutches.
Patient can stand with weight distributed evenly but not take a step without crutches.
Patient should get out of bed towards non-operated side and return to bed from the opposite side, (non-operated side lifted onto the bed first).
Patient should slide backwards onto the bed so that the operated thigh is supported before moving the operated leg onto the bed.
A raised toilet seat and chair should be used for the first 6-8 weeks, until the hip is allowed to flex more than 70 deg.

Hip movements allowed.
Hip flex passively to 70 deg.
Hip abduction to 30 deg
Hip extension to neutral (ie. Lying supine or prone)

Hip movements to be avoided
Hip Adduction beyond neutral.
Any active hip flexion or abduction.
Avoid powering up hip abductors.

Recommended Exercises.
Active foot and ankle movements.
Static quads and gluts.
Passive hip flexion to 70 and abduction to 30 - should be done 5 times daily.
(This is to maintain motion between the hip capsule and the repaired labrum to avoid adhesions forming between these two structures).
Prone lying for 30 mins daily - (pillow between knees to turn).
Knee flexion in prone lying.
Knee flexion /extension in sitting.
ITB stretch in standing position.
Pilates exercises for un-operated leg.

After check X-ray and confirmed trochanteric healing (6-8weeks)
Gluteal strengthening and range of movement phase.
Gradually increase weight bearing as pain and weakness allow.
Encourage even gait with aids, rather than limping without aids.
Pool for walking, stretching and active hip movements
All active hip movements as pain allows. Not SLR
Prone lying 30 mins each day, with active hip extension.
Strengthening exercises for core muscles and hip abductors, Shoulder bridge, Clam, Hundreds, side leg lift
ITB stretch
4-point kneeling hip extension.
Static bike, but not recumbent bike
Cross trainer
Stepper/wave machine(stepper with abduction) - stop if any anterior knee pain develops.
Walking distance 1mile - focus on form and increase slope rather than speed.
1/2 squats on both legs - light resistance.

3 months
Return to work - phased return for manual jobs.
Proprioceptive exercises, lunges, cliniband balance board
Progress strengthening exercises to longer lever and add weights
Single leg half squats and increase to full squats with light weight.
Progress core exercises to the “Plank”, gym ball exercises.
Walking distance 2 miles

4 months +
Return to sport and gradually increase all physical activity back to normal.
Weekly full squats - 3 sets 8 of full squats aiming to return to lift 25% of body weight.
Return to running when comfortable - if uncomfortable - aqua jogging.