Transcript Hip Resurfacing - Elite Physical Medicine

Hip Resurfacing and Arthroscopy
Rehabilitation
Role of the Physiotherapist
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Pre-operative guidance and information
Guide rehabilitation
Motivation
Support
Facilitate Discharge
Stages of Rehabilitation
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Stage 1
Day 1 – Day 5/7 Post op
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Initial contact and explanation of rehabilitation
Safe transfers from bed-chair-walking
Increasing mobility and exercise tolerance
Stairs
Gait re-education (walking aids)
Teaching of home exercise programme
Home Exercises
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Circulation exercises
Range of motion exercises in supine and
standing
Extension – Gluteus Maximus
Flexion – Iliopsoas
Hip Abduction – Gluteus Medius
Teach basic core stability HEP – TA and
Psoas
Stages of Rehabilitation
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Stage 2
2 weeks– 4 weeks
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Re-evaluation of ROM exercises
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Improve ROM
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Muscle strength testing
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Improve muscle strength and control and
personalise the exercise programme to the patient
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Gait Education/Walking Aids
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Exercise tolerance
Stages of Rehabilitation
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Stage 3
4 weeks – 6 weeks
 Fine tune dynamic
stability – specific
muscle improvement.
 Proprioception
 Core Stability
 Exercise Tolerance
Aims of the Rehabilitation
Programme
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Restore normal range of active and passive
movement
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Restore dynamic stability of the muscles in the
lumbar/pelvic/hip region
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Restore balance and proprioception
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To regain normal functional ability for the individual
patient
1. Restore Normal ROM
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Mobilising exercises
Manual Mobilisations
Muscle lengthening techniques (sustained
stretch)
Muscle energy techniques
2. Restore Dynamic Stability
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Facilitate muscles that act as local stabilisers and
those that act as global stabilisers of the pelvis on
the weight bearing leg
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Failure causes gait abnormalities
-Antalgic
-Trendellenburg (glut medius)
-Glut maximus gait
3. Balance and Proprioception
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Impulses originating from joints, muscles,
tendons and deep tissue
Processed by the CNS to provide
information about joint position, motion,
vibration and pressure
This is the process by which the body can
vary muscle contraction in immediate
response to incoming information regarding
external forces.
3.Balance and Proprioception
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Wobble-boards
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PNF stretches and
exercises
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Swiss Balls – Core
stability
Strength and ROM Exercises
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Hip Abduction
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Aim to increase
strength and dynamic
stability of the hip
through increased
strength of Gluteus
Medius.
Proximal stability and
control
Pelvis control
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Strength and ROM Exercises
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Hip Abduction
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Aim to increase
strength and dynamic
stability of the hip
through increased
strength of Gluteus
Medius.
Proximal stability and
control
Pelvis control
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Strength and ROM Exercises
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Hip Abduction
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Aim to increase
strength and dynamic
stability of the hip
through increased
strength of Gluteus
Medius.
Proximal stability and
control
Pelvis control
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Strength and ROM Exercises
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Hip Flexion
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Improve functional
range of motion and
strengthen Ilio Psoas
Control of Trunk on
Pelvis movement
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Strength and ROM Exercises
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Hip Flexion
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Improve functional
range of motion and
strengthen Ilio Psoas
Control of Trunk on
Pelvis movement
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Strength and ROM Exercises
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Hip Extension
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Strengthen the gluteus
maximus muscles and
improve gait
Dynamic stability
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Strength and ROM Exercises
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Hip Extension
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Strengthen the gluteus
maximus muscles and
improve gait
Dynamic stability
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Strength and ROM Exercises
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Hip Extension
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Strengthen the gluteus
maximus muscles and
improve gait
Dynamic stability
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Strength and ROM Exercises
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Hip Extension
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Strengthen the gluteus
maximus muscles and
improve gait
Dynamic stability
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Discharge Criteria
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Full weight-bearing gait without walking aids
Good hip stability/control – absence of Gait
disturbances.
Good proximal stability and muscle strength
Full/Functional Pain free ROM
Advise patient to continue with exercise programme
for up to 6 months.
6 weeks of physiotherapy prior to discharge,
may require more if returning to a specific sport
Resurfacing
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Ease of movement - ROM
Confidence in the prosthesis
Less pain
Mobility progress
No precautions
Dynamic Stability
Return to activity quicker
vs
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THR
Limited ROM – slower
progress
Initially apprehensive
More painful
Mobility takes longer
Combined movement
limitations
Less Stability
Slow return
Hip Arthroscopy
Rehabilitation
Aims of Physiotherapy
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Address pattern of recruitment of muscles
involved in hip movement
Restore normal range of movement and gait
pattern
Increase core stability and proprioception
(balance reactions)
Return patient to previous lifestyle/sport
Stage 1 (immediate Rehabilitation)
This should be followed whilst the patient is
using walking aids, and may last 2 days -> 6
weeks dependent on the level of surgical
intervention.
Exercises during Stage 1 aim to:
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Restore range of movement
Maintain muscle function
Allow tissue healing and pain to settle
Exercises (Stage 1)
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Range of movement (flex, ext abd)
Begin core stability HEP:
TA setting
Pelvis tilting with TA control
Gentle stretches ( quads, hams, piriformis)
Bent knee fallout with theraband
Static Quads, Hams, Gluts etc.
Precautions
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Do not push through hip flexor pain
May need to keep to specific range of
movement restrictions
May need to keep to specific weight bearing
restrictions
Criteria for progression to stage 2
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Minimal pain with stage 1 exercises
ROM (85% of uninvolved side)
Correct muscle recruitment patterns for initial
exercises
Do not progress until patient is fully weight
bearing
Stage 2 (Intermediate Rehabilitation)
Exercises taught at this stage are aimed at:
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restoring and maintaining movement
promoting normal walking patterns
strengthening muscles
improving balance reactions
There is a strong focus on core stability work at this
stage.
Exercises (stage 2)
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Cycling (stationary bike) low resistance
Swimming (no breast stroke)
-front crawl
-kicking with float
Progression of core stability HEP
-Bridging
-Heel slides
Proprioception Work
Exercises (Stage 2)
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Strengthening with theraband
-Flex, ext, abd, add, int/ext rot, PNF patterns
Side stepping
Stretches (Piriformis, ITB, Quads, Hams etc)
Passive Stretches/ Joint mobilisations
Gait Reeducation
Precautions
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No forced stretching
No treadmill use
Avoid inflammation of anterior structures of
hip
Criteria for progression to stage 3
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Full ROM
Pain free / normal gait pattern
Hip strength 70% of uninvolved side
Stage 3 (Advanced Exercises)
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The goals at this stage are the restoration of
muscular and cardiovascular endurance, and
the improvement of balance reactions.
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Return to social sport should be possible at
this stage.
Exercises (stage 3)
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Gradually build up gym routine to pre-injury
level
-Cross trainer
-Stepper
-Cycling
Introduce gentle jog and gradually build up
time and intensity
Exercises (Stage 3)
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Introduce Ball work, Starting with a light ball
and gradually introduce full size ball with
drills
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Lunges
Criteria for progression to stage 4
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Cardiovascular fitness equal to pre-injury
level
Demonstrates no faulty muscle recruitment
patterns during stage 3 exercises
Hip strength 80% of uninvolved side
Stage 4 (sport specific training)
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Not all patients require rehabilitation to this level.
Those who take part in competetive sport will
certainly benefit from further strengthening and more
sport specific exercises.
Training regimens should be developed in
conjunction with sports club physio /personal trainer.
Stage 4 (Sports specific Training)
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Speed
Endurance
Plyometrics
Advanced proprioception exercises
Multidirectional
Full sport specific training can begin
Criteria for return to full competition
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Full, painfree range of movement
Hip strength >90% of the uninvolved side
Ability to perform sport specific drills at full
speed without pain
Conclusion
Physiotherapy is an integral part of the process of
recovery for patients undergoing any hip surgery in
order to restore:
-Movement
-Strength
-Core stability
-Proprioception
-Function