Phase Iimmediate Rehabilitation


• Protect integrity of repaired tissue

• Restore ROM within restrictions

• Diminish pain and inflammation

• Prevent muscular inhibition


• Do not push through hip flexor pain

• Specific ROM restrictions (surgery dependent)

• Weight-bearing restrictions

Criteria for Progression to Phase II

• Minimal pain with all phase I exercise

• Proper muscle firing patterns for initial exercises

• Do not progress to phase II until full weight bearing is allowed


The initial phase of rehabilitation is started immediately following surgery. The goals during this phase are to protect the integrity of repaired tissue, diminish pain, and inflammation, restore ROM within restrictions, and prevent muscular inhibition. During the initial phase, a brace is used to maintain motion restrictions and protect the joint for 10 days. Swelling and pain are controlled through the use of ice and nonaspirin nonsteroidal anti-inflammatory drugs.

Early ROM is initiated to restore joint motion and decrease tissue scarring in the joint. ROM is started the day of surgery using a continuous passive motion (CPM) machine, passive ROM exercises, and stationary bicycling. The CPM is typically used 8 6 to12 hours per day for 4 to 6 weeks. With early PROM, emphasis is placed on internal rotation and flexion of the hip to prevent formation of adhesions between the joint capsule and the labrum. Progressive stretching of the piriformis and iliopsoas muscles is beneficial in preventing muscle contractures. Early stretching of the posterior hip capsule is achieved through quadruped rocking (Fig. 1). Stationary bicycling with minimal resistance is done for 20 minutes daily, starting the day of surgery.

The prevention of muscular inhibition is achieved through early strength exercises that limit joint stress while providing the appropriate load through the hip and lower extremity muscles. Aquatic walking with the use of a waterproof dressing in chest deep water can be initiated postoperative day 1. Early ambula-tion in the pool allows patients to work on gait symmetry and low load strengthening in an unweighted environment. Isometric strengthening is initiated as early as day 1 for the gluteals, quadriceps, hamstrings, and transverse abdominals. Hip adduction and abduction isometrics, prone internal and exter-

Fig. 1. Quadruped rocking.
Fig. 2. Prone internal and external rotation isometrics.
Fig. 3. Double leg bridges.

nal rotation isometrics (Fig. 2), and three-way leg raises (abduction, adduction, and hip extension) are started as early as week 2. Patients also start double leg bridges (Fig. 3), leg press with limited weight, and short lever hip flexion (Fig. 4) during the initial exercise phase. Once the goals for phase I have been met and full weight bearing is allowed, patients are progressed to the intermediate phase of rehabilitation.

Fig. 4. Short lever hip flexion.

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