10/25 - Rehab and Return to Sport Following Hip Arthoscopy Flashcards
what does the research say on post-op protocols
subjective in nature
- research isn’t great
what are the 4 concepts of post-op rehab
- provide environment to optimize healing
- initiate early/controlled ROM as an early approach to restore mobility
- restore neuromuscular control
- restore LE and lumbopelvic strength
what ab surgical procedures is a predictor of future fx
the more aggressively shaved down bone (like in CAM lesion) can inc risk of future fx
what should be avoided in femoroplasties
avoid spontaneous femoral neck fx
what should be limited with labral repairs
limited wt bearing x4wks
what is the main protocol w microfx
longer protection to encourage fibrocartilage healing response
expected timeline after a hip arthroscopy
phase 1: immediate rehab
- protection of healing structures & mobility
phase 2: intermediate rehab
- normalize gait
- initiate CKC activity
phase 3: advanced rehab
- strengthening
phase 4: sport specific training
- functional training
what are 5 goals of rehab in the immediate post-op phase
- minimize pain & inflammation
- protect surgical site
- compliance w HEP & precautions
- normal gait w AD and appropriate WB
- patient ed
what are 5 precautions in the immediate post-op phase
- no pivoting/rotating hip when amb
- avoid sx provocation during ADLs and ther-ex
- no active SLR / no hyper-ext
- protective WBing (typically 20% for 3-6wks)
- limit ER to 30deg w capsular shift
what are ROM interventions in the immediate postop phase (6)
- circumduction (reduce incidence of post-op intra-articular adhesions)
- flexion (0-90deg immediately)
- stationary bike (high seat <90deg hip flex, low resistance, upright posture)
- incision site scar mobility
- quadruped hip flex - moving back into child’s pose (partially loaded, pt controlled)
- stool rotations (active hip rotation, joint loading)
what strengthening treatment interventions are done in immediate post-op phase of rehab
transversus abdominus
isometrics
- quad set
- ABD/ADD
- glut squeeze
- prone heel squeezes
why are isometrics used to strengthen in the immediate post op phase of rehab
NO HIP FLEX
avoid challenging ant capsule
- hip flex, ext, ER, SLR
what is 5 milestones to progress to intermediate post-op phase of rehab
- 90deg hip flex w/o inc pain
- 10deg hip ext
- min pain at rest
- tolerates 10-15min of stationary bike
- normal gait w AD
what are 6 goals of intermediate post-op phase of rehab
- normal gait w/o AD
- restore full ROM
- no pain w ADLs
- protect hip flex
- NM control
- good lumbopelvic stability
what are 3 precautions in intermediate post-op phase of rehab
- AD until non-antalgic gait
- avoid sx provocation during ADLs and ther-ex
- avoid hip flex if sx
what are 3 interventions in the intermediate post-op phase of rehab
- joint mobs prn (6-8wks)
- CKC strengthening
- hip hike, sumo walk, windmills
- glut activation (ie bridging), min hip flex & TFL - double limb -> SLS balance
what are 3 milestones to progress from intermediate to advanced post-op phase
- full ROM
- normal gait w/o AD
- good pelvic control during SLS
what are 5 goals of the advanced post-op phase of rehab
- (I) w HEP & gym program
- full ROM (symmetrical)
- pain-free ADLs
- return to non-labor occupational duties
- good dynamic balance
what are 2 precautions in the advanced post-op phase of rehab
- sx provocation
- quality of movements and avoiding compensation is key w all activity
what are 2 interventions introduced in the advanced post-op phase of rehab
- progress lumbopelvic/core exercises
- initiate plyometrices
- jumping on leg press -» then move to hopping
what are 5 milestones to progress from advanced to sport specific training phase
- hip/pelvic strength >80% of opposite limb
- ROM appropriate for work/sport demands
- lumbopelvic control w single leg activities
- good dynamic balance (30’’ SLS x3)
- cont amb >10min
what are 2 goals of sport specific training
(I) w HEP and gym program
min post-exercise reactivity
what are 2 precautions w sport specific training
- sx provocation
- maintain adequate strength for work / sport activity
what are 5 interventions implemented in sport specific training
- maintain strength and flexibility
- advanced plyometrics
- initiate running program
- dynamic balance activities
- agility drills
- challenging positions & also for endurance
what are 4 return to sport criteria
- cleared by MD
- full ROM, strength (pain-free)
- complete functional testing
- sport-specific drills at full speed (pain-free)
what role does psychological readiness play in return to sport
likelihood of reinjury significantly higher in less psychologically ready
- if don’t feel ready, lot of apprehension
what are 7 qualities to consider when determining return to sport capability
- impairment info
- subjective/self report
- hop testing
- balance
- agility
- power
- psychological readiness
what are outcome measures that can be used for return to sport
- LE functional scale
- hip outcome score
- U of Wis Running Injury and Recovery Index
what are balance assessments that can be used (2)
- star excursion balance test (SEBT)
- Y balance test
star excursion balance test vs Y balance test assessments
star:
- strength
- flexibility
- proprioception
Y
- ant, post-med, post lat
what are 2 types of strength tests for return to sport
drop jump
hop testing
what are functional tests (4)
single leg squats
lateral agility
forward running
backward running
in single leg squats, what are we looking for to consider it a pass (5)
30-60deg knee flex
no knee valgus
no locking knee
no knee past toes
upright trunk
in lateral agility of hopping side to side, what are we looking for to consider it a pass (5)
knee flex >30deg
no knee valgus
in landing boundaries
<1’’ landing phase
upright trunk
what is a key quality that functional testing assesses
endurance
in forward and backward running running, what are we looking for to consider it a pass (6)
30-60deg knee flex
in landing boundaries
no knee valgus
no locking knee
<1’’ landing phase
upright trunk
what does a trendelenburg compensation indicate in functional testing
poor endurance
what are 2 agility and speed tests
T-test
illinois
what do agility and speed tests require and what do we look for
rapid changes of direction
look for if they are able to plant and change direction
- or do they shift to stronger side to change direction
what is important in considering what clinical/functional tests are most beneficial in which patients
correlate individual demands of sport for each pt to a sound test
what should be considered when determining the interventions (5)
quality of tissue
phase of healing
baseline strength
what ms should be activated
what ms activation should be minimized
