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Patients with Micro Fractures

Time frame: Weeks 0-6


-Protect repair

-Avoid hip flexor irritation (no sitting, 90 deg hip flexion, avoid active lifting leg, not properly activating deep core muscles, etc.)

-Control and decrease pain, inflammation, swelling, or effusion

-Avoid adhesion formation with passive motion and soft tissue mobilization

-Hip brace x 2 weeks

-20# Weight bearing with foot flat gait pattern x 6 weeks

-ROM restrictions x 3 weeks (abduction to 45 deg, no extension >0, no ER)

-A theraband circle around the feet can reduce ER past neutral at rest


Initial exercises:

-Stationary bike (no resistance, seat high, no recumbent bike)

-Log rolls

-Hip circumductions

-Soft tissue mobilizations

-Seated or long sitting hamstring stretch

-Isometrics (focus on TA/obliques/multifidi prior to all. Also special focus on gluteals and abductors)

-Prone lying 2-3 hours a day

Week 2 exercises:
Continue all week 1 exercises
-Quadruped cat and camel

-Standing abduction with IR

-Quadruped rockback (with slight posterior pelvic tilt)|

-Quadruped hip extensions (within motion limitations, being careful when approaching full ext in the presence of core weakness)

-Quadruped bird dogs (if demonstrating appropriate muscle firing patterns)

Week 3 exercises:
-Continue all week 1 and 2 exercises
-Double leg bridges

-Stool rotations (within ROM restrictions)

-Physioball rollouts

-Criteria to progress:

-Well-controlled postoperative pain

-No frontal/sagittal plane deviations of hip and pelvis when ambulating

-Physician clearance

Time frame: Weeks 7-9


-Protect repair

-Wean from crutches

-Normalize gait pattern

-Initiate closed chain and weight shift exercises

-Continue with Phase 1 exercises as appropriate


Week 7 exercises:
-Wean from crutches

-Stationary bike (no resistance, seat high, NO RECUMBENT BIKE)

-Double leg bridges with abduction

-½ kneeling weight shifts

-½ kneeling single arm row/single arm extension (with sport cord or Theraband)

-Standing hip abduction isometrics (against wall or foam roller)

-Hip Hikes (off edge of step)

Week 8 exercises:

-Sidelying clam shells (pain free ROM, add/progress TB resistance according to firing pattern)

-Standing lateral and forward/backward weight shifts

-Single leg stance and balance progression

-Quadruped Fire hydrant

-½ kneeling upper body lifts/chops with sport cord (NO torso or hip rotation)

-Double leg ¼ squats

-Forward Step-ups

Week 9 exercises:

-Forward shift to Romanian Dead Lift

-Modified prone plank (knees to elbows)

-Therapy ball hamstring curls

-Side Step-ups

-Split Lunge

-Y Balance Reaching

Criteria to progress:
-ROM equal to contralateral side

-Discontinued use of crutches and no gait deviations

-Minimal pain following activities

-Physician Clearance

Time frame: Weeks 10-15


-Prevent compensation due to fatigue

-Begin resisted biking

-Progress strengthening exercises from double to single leg

-Focus on return to prior activities without pain or irritation

-Progress lower extremity strength and endurance


-Continue all appropriate exercises from Phase II (PT will instruct)

-Bridge with alternating knee extensions (progress to SL Bridge when appropriate)

-Half Prone Plank/Pillar bridge (progress to full/bosu when appropriate)

-Side Stepping in squat/athletic position (progress to TB)

-Double leg body weight squats

-Single leg ¼ squat

-Forward/Lateral/Reverse Lunges

-Side Plank

-Resisted stool rotations (begin WEEK 8)

Cardiovascular Exercises:

-Elliptical Trainer (start with 5 minutes, increase 5 minutes each week)

-Resisted Biking

Criteria to progress:

-No pain with ADLS

-Normal Gait Pattern

Patients returning to sport activities must pass “Sport Test” before progressing to Phase IV

-Physician clearance

Phase IV

Time frame: Months 4-6


-No complaints of pain or weakness

-Running Progression

-Safe return to sport or patient’s functional activities

-Maintenance of strength, endurance, and proprioception

-Patient education with regards to any possible limitations


-Balance Squats with rotations

-Retro Walking with resistance band

-Lunge with trunk rotations (with sport cord or Physioball)

-Begin running progression and single plane agilities

  • Quick Feet
  • Backpedaling
  • Side Shuffles

Double leg Plyos (i.e., broad jumps, 4-square hops, A and D skips)

-Sport Specific Exercises

-Begin advanced/multi directional agilities (not before WEEK 16)

  • Z and W cuts
  • Cariocas
  • Transition to single leg plyos

-Maintenance program for strength, endurance, and proprioception