Rehabilitation programme following hip arthoscopy

Exercises for 4–8 weeks after hip arthroscopy

The first 6 weeks are crucial for healing. After 3 weeks, you may start moving your hip more freely as Phase 1 restrictions are lifted.

Goals of Rehabilitation in Phase 2

The aims of rehabilitation 4–8 weeks after your operation are to:

Restore normal movement in your operated hip.
Control and reduce pain and swelling around the hip.
Regain a normal walking pattern

Although you may now fully weight-bear on your operated hip, we recommend you continue to use crutches until you can walk normal gait without the crutches and you do not have pain in normal gait.

You are now allowed to fully weight-bear on your operated hip. However, we recommend that you continue to use crutches until you can walk with a normal gait, without crutches, and without compensation or pain. Crutches help protect your hip from overloading. Still, ensure that you place as much weight as possible on your operated leg without causing pain.

Start with short walks and gradually increase the distance. Avoid irritating your hip by walking or standing too much, or by resting too little. If you have pain several hours after activity, this may indicate overloading (too much activity for now).
If you are pain-free, you may use stairs normally 4–6 weeks after surgery

Managing and avoided pain and swelling

To reduce pain and swelling, rest your hip when needed and avoid sitting for prolonged periods.

Exercise Guidance

Continue to exercise with consideration for pain. Mild to some pain and some discomfort during exercise can be normal and is acceptable, but pain should settle within 24 hours. Persistent pain may indicate overloading, and you then have to do more rest in between your execises.

Static Bike / exercise bike

We recommend cycling on a stationary bike with no resistance, or with minimal resistance, for 20–30 minutes, twice a day. After 4 weeks, you may begin to gradually increase the resistance over time, aiming for a light to moderate level as your hip becomes stronger. Once you are comfortable cycling with increased resistance, you may also introduce interval training: after a 10-minute warm-up, cycle for 3–5 minute intervals with higher resistance.

Outdoor cycling should not begin before 6 weeks post-operation.

Hydrotherapy – Exercise in Water

You may start water-based exercise once your stitches have been removed and the wound has fully healed. For the first 4–6 weeks, use a pull buoy between your thighs when swimming. After this period (6 weeks), you may swim normally, including front crawl and breaststroke.

Exercises

Perform the exercises 1–2 times daily. Complete 3 sets of 10 repetitions for exercises 1–9.

Exercise 1 – Quadruped Hip Flexion

Start on your hands and knees with a straight back.
Shift your weight backwards towards your heels by bending at the hips. Avoid rounding your back.
Stop when you feel tension in the hip or groin.
Return to the starting position.

Exercise 2 – Supine Hip External Rotation

Lie on your back with your knees bent.
Tighten your lower abdominal muscles by tilting your pelvis so that the front of your pelvis moves towards your torso and head. Then return to the neutral position, engage the muscles you used for the tilt, and maintain this tension and position throughout the exercise.
Rotate your hip outward by moving your knee to the side.
Stop when you feel tension in your hip.
Return to the starting position.

Exercise 3 – Prone Internal Rotation (Knee Bent 90°)

Lie on your stomach with your operated knee bent to 90 degrees.
Rotate your hip inwards by moving your foot out to the side.
Stop when you feel tension in your hip.
Return to the starting position.

Exercise 4 – Bridge (+/- ball or band)

Lie on your back with your knees bent.
Tighten your lower abdominals (as in exercise 2), squeeze your glutes, and lift your pelvis so that your hips are extended.
Hold for 3–5 seconds.
Lower slowly back down.
You may add a ball between your knees or a resistance band for variation.

Exercise 5 – Supine Adductor Activation

Lie on your back with your knees bent and a ball between your knees.
Gently squeeze the ball and hold for 3–5 seconds.
Slowly relax.

Exercise 6 – Supine Hip Flexor Activation

Lie on your back with your legs resting on a chair, so that your hips and knees are both bent at 90 degrees.
Place your hands on your knees.
With your operated leg, push your knee upwards against your hand. At the same time, use your arm to provide resistance, keeping your arm straight.
Hold this position for about 5 seconds.

Exercise 7 – Diagonal Lift (+/- arms)

Start in a hands and knees position with your back in a neutral position.
Tighten your lower abdominals to stabilise your lower back.
Extend one arm and the opposite leg in line with your body.
Hold for 3–5 seconds.
Return to the starting position.
You may perform this exercise using only your legs.

Exercise 8 – Standing Hip Extension

Stand upright on your non-operated leg with a cloth under your operated foot.
Move your operated leg straight back until your hip is extended.
Return to the starting position.
Progression: add a resistance band.

Exercise 9 – Standing Diagonal Hip Extension

Stand with your weight on your non-operated leg.
Place your operated leg, with your foot on a cloth.
Move your operated leg diagonally backwards until your hip is extended.
Return to the starting position.
Progression: add a resistance band.

Exercise 10 – Supine Hip Flexor Stretch

Lie on your back with both knees bent.
Bring your non-operated knee towards your chest.
Extend your operated leg fully so you feel a stretch at the front of your operated hip.
Hold for about 30 seconds.
Rest briefly and repeat the stretch 3 times.

Rehabilitation programme following hip arthoscopy - phase 2