Patients with Micro Fractures

Time frame: Weeks 0-6

Goals:

-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

Exercises:

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

Goals:

-Protect repair
-Wean from crutches
-Normalize gait pattern
-Initiate closed chain and weight shift exercises
-Continue with Phase 1 exercises as appropriate

Exercises:

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

Goals:

-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

Exercises:

-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

Goals:

-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

Exercises:

-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