Post-operative Hip Arthroscopy – Physiotherapy & Rehabilitation Protocol

Physiotherapy & Rehabilitation Protocol for Post-operative Hip Arthroscopy

Rehabilitation Phases:

  • Phase 1: Early Protection & Mobility (Post-op Weeks 0-2)
  • Phase 2: Progressive Loading & Gait Normalization (Weeks 2-6)
  • Phase 3: Strength, Endurance & Dynamic Control (Weeks 6-12)
  • Phase 4: Advanced Strength & Impact Preparation (Weeks 12-16)
  • Phase 5: Return to Sport / Discharge (16+ Weeks)

Disclaimer: This list is produced for information purposes only. Effort is made to ensure accuracy, but as this information changes frequently, The Ottawa Hospital and its staff do not offer any guarantees regarding accuracy or completeness, nor do they endorse any specific service or facility.

Important Information

This protocol serves as a guideline and should be individualized based on surgical findings, associated procedures, and patient-specific goals.

Physiotherapy & Rehabilitation Protocol

Procedures Covered

  • Labral repair ± FAI correction
  • Labral debridement / chondroplasty (modify as indicated)

General Principles

  • Rehabilitation is criteria-based and symptom-limited, not purely time-based.
  • Emphasize early restoration of movement quality and neuromuscular control.
  • Avoid prolonged symptom flares (pain, catching, synovitis).
  • Protect healing labrum and articular cartilage while avoiding stiffness.
  • No routine CPM required; cycling and active-assisted motion are preferred.

Key Precautions

  • Avoid aggressive hip hyperextension for first 4 weeks.
  • Avoid long-lever resisted hip flexion early to reduce risk of hip flexor tendinopathy.
  • External rotation: no strict restriction — progress as tolerated with pelvis controlled.
  • Monitor for:
    • Hip flexor
    • tendinopathy,
    • Trochanteric bursitis,
    • Synovitis,
    • Scar adhesions around portals.

Rehabilitation Phases

1 Phase 1: Early Protection & Mobility (Weeks 0-2)
  • Goals: Pain and inflammation control, protect repair, initiate controlled motion, normalize gait.
  • Weight Bearing: Protected weight bearing as tolerated with crutches immediately post-op. Emphasize symmetrical step length.
  • Focus & Exercises: Gentle PROM and AAROM within comfort, stationary cycling (20-30 min, low resistance), log rolling, pelvic tilts, gentle bridging.
  • Avoid: Active straight-leg raise, open-chain resisted hip flexion, hyperextension.
2 Phase 2: Progressive Loading (Weeks 2-6)
  • Goals: Discontinue assistive device with normalized gait, restore functional ROM, improve hip and core strength.
  • Weight Bearing: Progress to full weight bearing as tolerated. Wean crutches once gait is non-antalgic.
  • Focus & Exercises: Bent-knee fallouts, prone hip rotations, step-downs, isotonic clamshells, hip hiking, balance training, elliptical or cycling, aquatic therapy (if available).
3 Phase 3: Strength & Endurance (Weeks 6-12)
  • Goals: Full functional ROM, improved lower extremity strength and endurance, enhanced neuromuscular control.
  • Focus & Exercises: Leg press, multi-hip machine, FABER stretching as tolerated, planks, lateral band walking, treadmill sidestepping. Manual therapy joint mobilizations only if necessary.
4 Phase 4: Advanced Strength (Weeks 12-16)
  • Goals: Symmetrical strength and control, prepare for impact and sport-specific tasks.
  • Focus & Exercises: Plyometric progression, dynamic trunk and pelvic control, agility and change-of-direction drills, light plyometrics, running progression, sport-specific drills.
5 Phase 5: Return to Sport (16+ Weeks)
  • Goals: Independent conditioning program, safe return to sport.
  • Return-to-Activity Criteria: Pain-free or minimal symptoms, strength within 10–15% of contralateral limb, good dynamic pelvic control during single-limb tasks, functional hop testing without compensation.
Notes for Patients
  • Some soreness and occasional clicking may be expected; sharp pain, catching, or swelling is not.
  • Progression speed varies depending on procedure and symptoms.
  • Always follow surgeon-specific restrictions if provided.
  • This protocol serves as a guideline and should be individualized based on surgical findings and patient goals.