Center for Hip Preservation

Rehabilitation

A team approach focuses on a patient's goals.

Nonsurgical treatment should always be considered first when treating hip pain. With some conditions, it is possible to resolve the pain with rest, modifying one’s behavior, and a physical therapy and/or anti-inflammatory regimen. Such conservative treatments have been successful in reducing pain and swelling.

Physical Therapy

Physical therapy is an integral component to the multi-faceted team approach of examining and treating hip pain. The importance of physical therapy at the Center for Hip Preservation is to assist in gaining an understanding of the underlying causes of hip pain and then to collaborate with a team of physicians in order to design a comprehensive treatment approach. Rehabilitation is useful in many ways. It may be used as a non-invasive approach to treatment, whereby surgery for the patient is not or no longer indicated.

The hip joint is a very deep joint surrounded by almost 30 muscles. Physical therapy aims to strengthen these muscles, increase flexibility, maintain range of motion of the joint, and decrease the associated inflammation. In the case of a labral tear, physical therapy will not heal the tear. With the appropriate muscular training and activity modification, however, the condition may become asymptomatic and therefore require no surgery.

If operative treatment is inevitable, a pre-operative physical therapy program will provide the ability to address nearly all underlying joint problems or muscle imbalance, which ultimately leads to a better outcome. Additionally, in the event of surgery, post-operative therapy is essential in educating the patient regarding daily activities and in providing an appropriate recovery course. Physical therapy is an integral component in the management of hip pain.

Modify Recreational and Daily Activity:

  • Avoid exercises involving repetitive hip flexion, the motion involving bringing your hip or leg up toward your chest.
  • If doing squats, keep them shallow and hold off on lunges entirely, until you receive a diagnosis from your doctor.
  • Do not work through pain.
  • When walking or running, pay attention to pain. If the discomfort accompanies running, then stop. If it occurs with walking, lessen your stride length by taking smaller steps.
  • To minimize pain while sitting, open the seat angle so that your knees are below your hips while maintaining good upright posture.

Core Strength Exercise for Hip Pain:

Because of the complex nature of a hip injury, a proper diagnosis is required before proper strengthening exercises can be recommended. In fact, with some hip injuries, routine strengthening and stretching might complicate the problem. However, a core strength exercise won't harm and can actually help to “re-educate” the lower abdominals so that they provide the best support.

  • Lie with knee bent up.
  • Maintain a neutral/comfortable spine position.
  • Gently tighten your lower abdominals initiating from the pelvic floor. If you are familiar with a Kegal exercise, perform a Kegal.
  • Tighten up the lower abdominals by gently pulling “up and in” without moving your trunk.
  • Hold 5 seconds without changing your breathing pattern.
  • Complete 3 sets of 10 repetitions, 5 times a week.

Research Highlights in Rehabilitation:

Physical Therapy Can Help Patients Respond Better to Hip Surgery

A treatment plan designed by a physical therapist after she connected a patient’s hip pain to a back injury suffered in high school, helped the patient avoid the need for hip surgery. The unusual case study describing the patient’s diagnosis and treatment experience was published in the February 2009 issue of the HSS Journal, the musculoskeletal journal of Hospital for Special Surgery in New York. Read More


Tips for Recovering Patients Following Arthroscopic Hip Surgery


How to Walk with Crutches Following Arthroscopic Hip Surgery

Keeping your feet flat and gripping the crutches firmly with your hands, place pressure on your hands, not on your armpits. Move crutches forward and then follow with the operated leg, touching down only for balance. When moving the un-operated leg forward, go only as far as the operated leg, not past. This protects the operated leg from extending behind and safeguards you from the soreness such a move will generate.

Walking Up Stairs with Crutches Following Arthroscopic Hip Surgery

With both crutches under one arm and firmly planted for support, lift un-operated leg and place it on the step. Leaning forward on crutches, lift up body, using crutches and un-operated leg to support weight. Lift operated leg up onto the step. Use a handrail for additional balance; it may help to have assistance the first few times trying stairs until movement is mastered.

Walking Down Stairs with Crutches Following Arthroscopic Hip Surgery

Place both crutches and operated leg on the lower step. Using the crutches for balance, lower oneself carefully down onto the step making sure to shift the crutches as the operated leg is moved. Use a handrail for additional balance and consider obtaining assistance the first few times until the movement is mastered.

Getting In and Out of Bed Following Arthroscopic Hip Surgery

Rest the operated leg on top of the un-operated leg when moving from bed to floor. This will help to reduce use of the muscles around the hip.

Things to Avoid Following Arthroscopic Hip Surgery

  • Sitting on low, soft surfaces
  • Pivoting over the operated leg
  • Crossing the legs so that the ankle is on the knee
  • Lifting leg straight up


Home Exercises for Recovering Patients


Quadriceps Strengthening

Lie on your back and keep the knee of the operated leg straight. Place a small rolled towel underneath the knee of the operated leg. Slowly tighten the muscle on top of the thigh (quadricep) and push the back of the knee down into the rolled towel. Hold contraction for 5 seconds and then slowly release, resting 5 seconds between each contraction. Perform 3 sets of 10 repetitions, 3 times daily.


Abdominal Strengthening

This exercise develops the body’s ability to contract and control its abdominal muscles. Lie on your back keeping the spine and pelvis in neutral and bend your knees. Tighten your abdominal muscles by pulling in your belly button towards the spine without rotating the pelvis or holding your breath. Breathe evenly while maintaining the abdominal contraction, holding for 10 seconds. Perform 10 repetitions, 2-3 times daily.

Knee Extension

This exercise strengthens and helps the quadriceps to have a full range of motion and can also help stretch the hamstrings. While sitting on a bench or bed, lean back on your hands. Make sure that hands remain behind the trunk of the body to keep hips from flexing. Try to keep pivoting at the hips and pelvis to a minimum. Straighten the knee while keeping your thigh on the table/bed. Perform 3 sets of 10 repetitions, 2-3 times daily.

Rectus Stretch and Abdominal Control Strengthening

This exercise helps to lengthen the quadriceps as well as strengthen the abdominal muscles, gluteals and hamstrings. Lying on your stomach, tighten the stomach so your back does not arch. With the knee of the non-operated leg straight, bend the knee on the operated leg until a stretch on the front of the thigh is felt (Sole of shoe should be facing the ceiling). Hold 10 seconds, 5 repetitions, 2-3 times daily.

Note: Be sure not to roll the operated leg out when bending the knee. Try to keep it in line with the body.

Gluteus Strengthening

This exercise aids in your core stability, your trunk control and strengthening of the hip musculature. Lie on your stomach with hips over a pillow and squeeze your buttocks together, holding each contraction for 5 seconds. Perform 15 repetitions, 2-3 times daily.

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