Rehabilitation Following Arthroscopic Surgery for FAI Hip Pain
Post-operative rehabilitation protocols for FAI Hip pain must factor in advancements in surgical techniques when considering time lines for goals and progressions. Rehabilitation following arthroscopic debridement of bony abnormalities for FAI differs to traditional post-operative hip rehabilitation, as there is no hip dislocation with arthroscopic surgery, therefore greater ROM is allowed earlier on in rehabilitation. In any case, progression of rehabilitation should always be based on each individual’s presenting signs and symptoms rather than on a time line or recipe approach.
Initial phase of rehabilitation should focus decreasing inflammation, restoring normal ROM, gentle stretching, re-establishing correct muscle recruitment and isometric strengthening for the muscles around the hip. Optimising position of the femoral head in the acetabulum by strengthening the deep external rotators of the hip, especially quadratus femoris, is crucial as well as restoring gluteus minimus function. Once these things have been achieved, progression can be made to the intermediate and then advanced stages of rehabilitation.
Intermediate and Advanced Phases
The intermediate to advanced stage of rehabilitation should focus on restoring muscular strength and endurance; achieve optimal neuromuscular control, balance and proprioception as well as increasing core and pelvic stability. Normal function of the hip musculature must be restored during this phase of rehabilitation, with a progression from isometric exercises to more functional type movements. Increasing strength of gluteus medius muscle as well as further strengthening deep external rotators of the hip is also particularly important during this phase, due to the client’s weakness in these muscles. This will also assist in the progression to single leg exercises. The close relationship between the hip and the pelvis means that strengthening exercises need to incorporate lumbo-pelvic and trunk stabilisation exercises for return to full function.
References for Further Reading
- Enseki, KR, Martin, R & Kelly, BT 2010, ‘Rehabilitation after arthroscopic decompression for femoroacetabular impingement’, Clin Sports Med, vol. 29, no. 2, pp. 247-55, viii.
- Philippon, MJ, Stubbs, AJ, Schenker, ML, Maxwell, RB, Ganz, R & Leunig, M 2007, ‘Arthroscopic management of femoroacetabular impingement: osteoplasty technique and literature review’, Am J Sports Med, vol. 35, no. 9, pp. 1571-80.
- Stalzer, S, Wahoff, M & Scanlan, M 2006, ‘Rehabilitation following hip arthroscopy’, Clin Sports Med, vol. 25, no. 2, pp. 337-57, x.
- Wahoff, M & Ryan, M 2011, ‘Rehabilitation after hip femoroacetabular impingement arthroscopy’, Clin Sports Med, vol. 30, no. 2, pp. 463-82.
Written By Jack Hickey
Exercise Physiologist at MD Health Pilates