Deep hip rotators activation facedown
The aquatic program usually commences 3 weeks after surgery. This will initially consist of walking in the pool and using a stationary bike and cross-trainer. The use of hydrotherapy in gait retraining and weight bearing is very effective once the incisions have healed. Lastly, proprioceptive exercises in bilateral stance are started as soon as weight-bearing restrictions are lifted.
After 2 weeks, the patient can begin working daily without resistance on a stationary bike. Soft tissue mobilization and massage focus on the adductor muscle group, which tends to quickly develop tone (Fig. 19.2). Clinically, it appears that while other pelvic and hip stabilizers are inhibited on account of pain or neuromuscular dysfunction, the adductors are often the first muscle group that compensate. Following hip arthroscopy, the psoas muscle is often inhibited. Clinically, the tensor fascia lata and the rectus femoris tend to compensate for the lack of the function of the psoas and become overused and irritated during the postoperative course. These muscles, along with the gluteus, benefit from massage to reduce tone throughout the rehabilitation process .
Soft tissue mobilization and massage
Criteria transition to Phase II: walking with full loads; absent or minimal pain with exercises of Phase I; proper muscle activation during the activity; no inflammation at the hip flexor.
19.4.2 Phase II
With a duration of 4–6 weeks for uncomplicated forms and 6–12 weeks for complicated forms, the goal of the second phase is for the patients to achieve independence in daily activities with little or no discomfort. The focus of this phase is to continue progressing ROM (pain-free) and soft tissue flexibility while beginning to transition the emphasis to strengthening. We continue with hip circumduction and deep massage and mobilization. It’s very important to reeducate and address the psoas muscle imbalance. Edelstein suggests it is most effective to reeducate the psoas from the trunk down versus the leg up. The results have thus far been successful, in that the patients regain full hip flexion strength without developing tendonitis of the psoas or the secondary hip flexors. Progressive eccentric exercises for the psoas should be introduced. Another important point is the gluteal function, and this may be accomplished by having the patient lie prone and reeducate transversus firing, then gluteal firing, followed by a small hip extension motion being careful to not permit the activity to nullify the core stabilizers as shown by lumbar extension or pelvic rocking. Anterior (Fig. 19.3) and posterior capsular stretching (Fig. 19.4) and kneeling hip flexor stretch as tolerated. Phase II is the time to progress from closed chain bilateral dynamic stability exercises to unilateral exercises. Examples include forward step downs, three point stepping with elastic band, windmill, and lawnmower (Fig. 19.5).
Anterior capsular stretching
Posterior capsular stretching
Elastic band in three point
Other exercises are core and hip and pelvis strengthening, adding resistance to the stationary bike, for athletes progressive cardiovascular fitness and upper extremity.
Criteria transition to Phase III: Ambulation with full load in the absence of pain; complete recovery of ROM; recovery of hip flexion strength >60% compared to the contralateral limb; abduction, adduction, external rotation, internal rotation >70% compared to the contralateral limb. Precautions: No ballistic stretching; no running on the treadmill.