Recovery

Rehabilitation after hip surgery involves distinct phases of recovery. The goal is to allow the best environment for tissue healing while maximizing long-term function. The guidance of a physical therapist, in consultation with your physician, is essential to an effective recovery.

View our Rehabilitation Guidelines (PDF).

Typical Recovery Process

This is an example of a typical recovery process, and should not be used to direct your rehabilitation after surgery. Each procedure and patient presents a unique set of circumstances, and progressions should be based on your individual responses, exam findings, and progress.

Immediate Post-Operative Phase (0-2 Weeks)

Goals of Phase

• Decrease post-operative swelling/inflammation
• Decrease pain
• Prevent post-operative stiffness and adhesions
• Restore basic muscle activation patterns
• Normalize gait pattern with assistive device

Passive Range of Motion (Within Pain‑Free Range)

• Precautions x 4 weeks
  • Avoid aggressive “Stretching”
  • Flexion 0-90º
  • Extension limited to 0º x 4 weeks for routine capsular closure, x 6 weeks if plication performed
  • No external rotation > 20º in prone
• Circumduction at 30º initially, including circumduction at greater degrees of flexion when able
• Upright stationary bike (elevated seat, low/no resistance)

Flexibility

• Opposite knee to chest stretch (early hip flexor stretch)
• Prone knee flexion/quadricep stretch
• Prone positioning progressing toward prone prop position

Edema Control and Muscle Activation

• Glute set progression (supine then prone)
• Quadriceps setting
• Ankle pumps
• SAQ
• Transverse abdominis activation

Gait Training

• Emphasize foot flat WBAT pattern with use of bilat crutches
• Avoid all treadmill ambulation including use of anti-gravity treadmill
• Review stair negotiation technique (up w/ good, down w/ bad)

Criteria to Advance

• Minimal to no pain at rest
• <3/10 pain on VAS with initial therapeutic exercise
• Normalized gluteal, quadricep, and transverse abdominis activation
• No increase in pain with prone positioning

Early Post-Operative Phase

Goals of Phase

• Decrease post-operative pain and inflammation
• Improve muscular strength & endurance for ambulation and ADLs
• Normalize gait pattern without use of assistive device
• Restore range of motion necessary for ADLs and ambulation
  • Ensure adequate hip extension once appropriate
  • No extension > 0º x 4 weeks for routine closure, x 6 weeks if capsular plication performed

Range of Motion

• Continue circumduction
• Initiate and progress upright stationary bike with elevated seat height per tolerance
• Supine bent knee fall outs/ins within protected, pain free range of motion
• Quadruped heel sits within pain free range of motion at 4 weeks

Flexibility

• Begin scar and soft tissue mobilization as necessary once incisions well healed
• Progress prone positioning time and progress toward prone prop position
• Prone quadriceps stretch
• Lunge position hip flexor stretch when appropriate (@ 4 or 6 weeks)

Strengthening

• Submaximal abduction and adduction isometrics
• Prone internal and external rotation isometrics in prone
• Bridges to 0º extension
• Quadruped hip extension to 0º
• Long-arc knee extension
• Standing hip abduction with IR
• Standing TKE with gluteal muscle activation
• Bilateral Leg press with < 90º of hip flexion (progress toward SL)
• Mini squats/sit to stands
• Partially-loaded active external rotation within pain free ROM

Gait Training

• Avoid use of all treadmill devices for gait retraining
• Wean from assistive device after 4 weeks once pattern normalized

Criteria to Advance

• No reactive pain with exercise or complaints of pain at rest
• Able to demonstrate > 30 seconds of single leg balance without loss of pelvic stability
• Patient reports ability to sit > 30 minutes without exacerbation of pain
• Patient reports pain free community ambulation without assistive device
• > 10 repetitions of prone hip extension without compensations or altered activation pattern

Intermediate Phase

Goals of Phase

• Restore full ROM and flexibility
• Regain adequate muscular strength & endurance for progression of IADLs
• Progress activity level without exacerbation of intra- or extra-articular irritation/pain
• Normalize dynamic lower extremity and lumbopelvic control during functional activities

Range of Motion and Flexibility

• FABER slides progressing toward FABER/figure 4 position
• Thomas position hip flexor stretch if necessary
• Include IT band stretches only if necessary and no recreation of groin pain

Flexibility

• Continue stretching/flexibility from previous phases
• Half-kneeling hip flexor stretch with rotation opposite
• Progress to Thomas position anterior hip stretch
• Walking spider man stretch
• Inch worms

Strengthening

• Side-lying hip abduction
• Step ups
• Side and prone planks
• Side stepping with band resistance
• Single leg balance with perturbations
• Upper extremity assisted single leg mini squats
• Lateral step downs
• Single leg romanian dead lifts
• Standing stork turns/band resisted external rotation

Endurance and Cardiovascular Training

• Progress stationary bike duration and resistance per tolerance
• Elliptical trainer (initially no incline and low resistance)
• Avoid all treadmill or anti-gravity treadmill walking

Low-Intensity Plyometric Training

• Avoid all plyometrics until 10 weeks post-op
• Begin with low intensity < bodyweight bilat hopping on shuttle
• Ladder drills
  • Forward 2 feet in each box
  • Lateral 2 feet in each box
  • Forward 1 foot in each box
  • In-in/out (shuffle)
• 2-foot line jumps/hops front/back
• 2-foot dot hops
• Alternating traveling single-leg hop and holds
• Short step height bilateral box jumps

Criteria to Advance

• Full ROM without pain or signs/symptoms of impingement
• Symmetrical FABER position
• 5/5 strength in all planes without reproduction of symptoms
• Patient is able to ambulate > 15 minutes at quick pace without pain
• Hip Outcome Score: ADL subscale score > 85%
• No errors on lateral step-down test
• No pain/symptom provocation and good control with completion of plyometric program

Late Phase (Running and Return to Sport Phase > 12 Weeks Post-Op)

Goals of Phase

• Return to running without asymmetries
• Regain adequate cardiovascular endurance for desired recreational activities and/or sport
• Restore and maximize lower extremity power

Strengthening

• Continue to progress intensity and volume of progressive resistance exercises
• Gradually return to previous gym-based resistance training exercises if appropriate
  • Avoid seated abductor/adductor strengthening machines
  • Avoid squats and lunges below 90˚
  • Avoid “maxing out” or resistance preventing completion of < 6 repetitions

Cardiovascular Training

• Progress stationary bike to spin/road bike if desired
• Progress elliptical intensity and duration
• Initiate Structured walk/jog program

Example Program

• Run no more than every other day
• Jogging should be initiated outdoors if possible
• No hills or incline and no speed work should be included until completion of program
• Progress distance and initiate speed training only after completion of walk/jog program

Plyometric Training

• Progress intensity and volume of bilateral lower extremity plyometrics
• Example exercises
  • Forward/backward skips
  • Single foot line hops
  • Single foot dot hops
  • Single foot step/box jumps

Agility and Sports Specific Training

• Anterior-posterior shuttle drills
• Lateral shuffle/shuttle drills
• Carioca
• Progress ladder footwork drills
• Box drills
• Planned cutting drills progressing toward reactive change in direction drills
• Begin sport specific skill work (> 4 months post op)

Criteria for Return to Sport Clearance

• Physician clearance
• No sign/symptoms of impingement with clinical testing
• HOS ADL subscale score > 95%
• HOS Sport subscale >90%
• No reactive pain or symptoms with agility and sport specific skills
• >90% limb symmetry on single-leg hop tests
  • SL forward hop for distance
  • SL medial hop for distance
  • SL lateral hop for distance
  • SL triple hop for distance
  • SL triple crossover hop for distance
• < 10% difference on 10 RM unilateral leg-press
If criteria are not achieved return to full sport participation should be delayed and patient should continue with rehabilitation to address remaining functional limitations