Post-Op Physical Therapy Timeline

//Post-Op Physical Therapy Timeline

As you go to PT following your arthroscopic procedure, the following general guidelines should be followed. This information should be shared with your home PT and NSM therapist should be notified if the expectations are not being met. Note, patients all progress differently so it is very likely that this may be variable by 1-2 weeks, especially with regard to the progression of advanced exercise.

Weeks 1-2:

  • Basic week one exercises reviewed and performed (should be done at home 2x/day)
  • Week two exercises added as tolerated
    • resistance added to knee exercises as tolerated
  • Traction with circumduction (as we taught you on day one) should be performed at each visit (as well as HEP)
  • Stationary bike (without resistance) may be added at the end of week one if tolerated
  • Game Ready use where applicable (some clinics may not have one)

Weeks 2-4:

  • Exercise progression should continue as outlined in protocol and as tolerated
    • Remember, exercises should not create pain
  • Soft Tissue Mobilization should be initiated to any/all needed regions by week 3
    • This can and should be started earlier when incisions are fully healed
  • Log rolling internal rotation mobilization should be started by end of week 2
  • Inferior glides should be added around week 3; distraction/circumduction may continue as well but should not be used to replace inferior glides
  • For those with a capsular closure; hip extension and gentle stretching of the anterior hip may begin after 3 weeks (start of week 4)
    • Patient should be taught home exercise to stretch hip flexors and begin to restore normal mobility
    • Stretch to discomfort, NOT PAIN
    • Side lying PA with hip extension may be initiated in this time frame as well

Weeks 4-8:

  • At 4 weeks patients who have not had a micro fracture may begin to wean off of their axillary crutches with the guidance of the PT. Initially, most patients will be moved to one crutch until gait is normalized and can move to no assistive device once gait is normal and pain free. Patients are encouraged to have crutches available for longer distances until they have had 1-2 consecutive weeks of pain free ambulation.
  • All manual therapy should continue as needed.
    • External rotation log rolling mobilization may be added
    • PROM ER assessed and gradually progressed
    • Flexion may be progressed as tolerated beyond 90 degrees
  • Weight bearing exercises are added as outlined in protocol
  • Use of elliptical may be added with or as an alternate to the use of stationary bike
  • Continued progression/adjustment of HEP

Weeks 8-12:

  • ROM should be full/normal passively in this phase
    • Continued manual therapy is needed to reach this goal
  • As exercises and demands on the hip progress, patients form and proper activation of hip musculature should be monitored by the therapist
    • Do not progress just for the sake of keeping up with the protocol
    • Exercises should not be painful
    • Soft tissue mobilization and self-myofascial release may be necessary to alleviate muscular pain and/or restrictions
  • Running, jumping, and loaded rotation are still restricted at this time.
    • Underwater treadmill or AlterG are permitted if available, but not required
  • At 12 weeks loaded rotational activities and exercises are permitted as tolerated
  • If full ROM, normal, strength and pain free, a walk/jog or jog/run program may be initiated (prefer outdoor or track vs treadmill)
    • Use of a lateral single leg step down test to determine readiness to run
      • Complete 1 min of repetitions without valgus collapse/trunk lean

Weeks 12-16 (and beyond):

  • Initiate agility drills and increasingly high demands in multi-planar activities
  • Initiate sport specific activity
    • Guided by PT, trainer, coach as a team