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Patients without Micro Fractures

Time frame: Weeks 0-3


-Protect repair

-Avoid hip flexor irritation (no sitting 90 deg hip flexion, avoid actively

-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 3 week

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 3-6


-Protect repair

-Wean from crutches

-Normalize gait pattern

-Initiate closed chain and weight shift exercises

-Continue with phase 1 exercises as appropriate


Week 4 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 5 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 6 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:
-Discontinued use of crutches and no gait deviations

-Minimal pain following activities

-Physician clearance

Time frame: Weeks 7-12


-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

Phase IV:

Time frame: Months 3-6


-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