Dillon E. Hyland, MS, LAT, ATC; Zachary K. Winkelmann, MS, LAT, ATC; Kenneth E. Games, PhD, LAT, ATC
Athletic Training and Sports Health Care. 2019;11(3):103-104https://doi.org/10.3928/19425864-20181002-03
Abstract
Voight ML, Robinson K, Gill L, Griffin K. Postoperative rehabilitation guidelines for hip arthroscopy in an active population. Sports Health. 2010;2:222–230.
Clinical Question: How successful are general and specific rehabilitative protocols in improving strength, endurance, range of motion, and flexibility following hip arthroscopy?
Study Selection: A literature review was conducted of articles in PubMed, EMBASE, and PEDro published between 1992 to 2009 focusing on the hip, rehabilitation, and physical therapy.
Main Results: This review identified four distinct phases of post-surgical hip rehabilitation: (1) mobility and initial exercise, (2) intermediate exercise and stabilization, (3) advanced exercise and neuromuscular control, and (4) return to activity. Each phase of rehabilitation and progressive training corresponds to a phase of healing.
Conclusions: Clinicians should be proactive in the use of hip progressive phasic rehabilitative guidelines (PPRG) in conjunction with their own clinical judgment and patient values to ensure positive therapeutic outcomes.
Summary: Hip arthroscopy has become an increasingly common procedure, with prevalence increasing by 25 times its original rate between 2006 and 2013.1,2 Sports health care professionals are recommending arthroscopic procedures most often due to the less invasive nature of arthroscopy and the decreased time in return to activity for sporting populations.3 Despite these positive findings for arthroscopy, 47% of patients report pain resulting from athletic activity following hip athroscopy.2Patients report varying locations of this pain, primarily in the groin, anterior hip, and lateral hip. Pain was also reported but less frequent in the posterior hip and with a C-sign distribution.2
Voight et al.1 support the hip PPRG rather than specific exercise prescription. PPRG allow clinicians to use their own clinical judgment in prescribing specific exercises to reach a specific treatment goal in conjunction with physician restrictions. PPRG offer a larger rehabilitative view, providing context through generalized exercise types and insight focused on assessing imbalances and substitutions.1Hip PPRG provide a contextual frame-work with which a clinician can operate, whereas specific surgical rehabilitation protocols suffer from a lack of uniformity and validation.1
Phase 1: Mobility and Initial Exercise. Phase 1 is based on the initial healing, return to a pain-free range of motion, and joint extensibility. This can be accomplished through multiplanar motion, joint mobilizations, gait training through muscle reeducation, and correction of altered muscle contraction and movement patterns caused by a reflex inhibition, with an emphasis on appropriate post-surgical precautions including weight bearing and level of pain.1,2 Immediately after surgery, isometric exercises prove useful to increase tone and basic strength while healing occurs.1,2 Appropriate examples of dynamic stability exercises include double leg bridging, reverse clam shell, mini-squats, and short arc leg press.1 Aquatic therapy can also be a viable treatment option.
Phase 2: Intermediate Exercise and Stabilization. This phase typically begins 4 to 6 weeks after arthroscopy depending on the local trauma sustained during the surgical procedure.1 The goals of phase 2 are characterized by full pain-free range of motion, progressive strength and stabilization, the addition of weight bearing and progressive resistance training, and the elimination of muscular imbalance and substitution patterns.1,4 The recognition of muscular imbalance and substitutions can be identified through tests such as the pelvic rotation, pelvic tilt, torso rotation, and bridge with leg extension tests.1 These tests can detect imbalances and facilitate the subsequent correction of lower abdominal, erector spinae, hip flexors, and gluteal musculature.1
Phase 3: Advanced Exercise and Neuromuscular Control. The role of neuromuscular control is essential in the therapeutic rehabilitation process because fatigue can negatively influence kinesthetic and proprioceptive awareness. As such, activities focused on functional movement patterns and dynamic stabilization may be effective transitional exercises.1,2
Although these goals are similar to those of phase 2,…