Iliopsoas Release Protocol Surgery Date:_____________________________________ • Other o Standard stationary bike without This protocol should be used as a guideline for progression resistance at 3 days post-op (10 min if and should be tailored to the needs of the individual patient. tolerated) o Upper body ergometer, upper body Weight bearing as tolerated – use crutches to normalize strengthening gait. Week 2 Date: ____________________________ • May be needed for 2-4 weeks • Abduction isometrics Gentle emphasis on passive extension exercises. • Superman Aggressive hip flexion strengthening delayed 6 weeks. • ¼ mini squat • Thera band resistance on affected side – Functional progression as tolerated. abduction, adduction, and extension (start very low resistance). Flexion ONLY IF TOLERATED Resumption of full activities as tolerated after 3 months. • Standing heel raises • Other: Always use pharmacologic prophylaxis against o Wall mini-squats heterotopic ossification (unless contraindicated) o Physio-ball mini-squats with co- • Quiz patient contraction Pool exercises (water walking, range of • Must initiate and maintain immediately postop. o motion, march steps, lateral steps, Phase 1: Initial Exercises (Week 1-3) backward walking, mini-squats, heel raises, hamstring and hip flexor Goals of Phase 1 stretches) à Restore range of motion Week 3 Dates: ___________________________ à Diminish pain and inflammation à Prevent muscular inhibition • Manual hamstring stretch à Normalize gait • Stiffness dominant hip mobilization – grades III, IV • Double leg bridges to single leg bridges Week 1 Date: ____________________________ • Prone leg raise – extension • Sidelying Clamshells (pain-free range) • Seated knee extensions • Shuttle leg press 90 degree hip flexion with co- • Seated weight shifts contraction of adductors • Ankle pumps • Sidelying leg raise – abduction • Hamstring sets • Dead bug • Glut sets • Quadriped 4 point support, progress 3 point • Adductor isometrics support, progress 2 point support • Quad sets • Seated physio-ball progression – Hip Flexion • Heel slides, active-assisted range of motion • Forward walking over cups and hurdles (pause on • Log IR rolling affected limb), add ball toss while walking • Double leg bridges • Lateral walking over cups and hurdles (pause on • Posterior pelvis tilt affected limb), add ball toss while walking • Prone on elbows • Other: • Lower trunk rotation (supine) o Stationary bike with minimal resistance • Prone knee extension (5 min increase daily) • Standing abduction, adduction, flexion, extension o Active range of motion with gradual end without resistance range stretch with tolerance • Pain dominant hip mobilization – grades I, II o Sidelying leg raise – adduction o Single leg sports cord leg press (long • Thera band walking patterns – forward, sitting) limiting hip flexion sidestepping, carioca, monster walks, backward, ½ circles forward/backward – 25 yards. Start band Criteria for progressing to Phase 2 at knee height and progress to ankle height. • Side steps over cups/hurdles (with ball toss and à Minimal pain with phase 1 exercises external sports cord resistance, increase speed à Minimal range of motion limitations • Single leg body weight squats, increase external à Normalized gait without crutches resistance, stand on soft surface Phase 2: Intermediate Exercises (Weeks 4-6) • Other: o Full squats Goals of Phase 2 o Single stability ball bridges à Restore pain-free range of motion Criteria for Progression to Phase 4 à Initiate proprioception exercises à Single leg mini-squat with level pelvis à Progressively increase muscle strength and endurance à Cardiovascular fitness equal to preinjury level Weeks 4-5 Dates: _______________________ à Demonstration of initial agility drills with proper body mechanics • Crunches • Bosu squats Phase 4: Sports specific training rehab clinic based • Standing thera band/pulley weight – Abduction, progression (Weeks 9-11) Adduction, Flexion, Extension Weeks 9-11 Dates: ________________________ • Single-leg balance – firm to soft surface • Sidelying Clamshells with thera band • Single leg pickups, add soft surface • Sidestepping with resistance (pause on affected • Other: limb), sports cord walking forward and backward o All phase 3 exercise (pause on affected limb) o Pool running (progress from chest deep • Other: to waist deep), treadmill jogging o Gradually increase resistance with o Step drills, quick feet step ups (4-6 inch stationary bike box) forward, lateral, carioca o Initiate elliptical machine o Plyomtertrics, double leg and single leg o Pool water exercise – flutter kick shuttle jumps swimming, 4 way hip with water weights, o Thera band walking patterns 1 rep of six step-ups exercises x50 yds., progress to band at knee height and ankle height Week 6 Date: ____________________________ Phase 4: Sports specific training on field or court • Leg press (gradually increasing weight) (Weeks 12 and beyond) • Physio-ball hamstring exercises – hip lift, bent knee hip lift, curls, balance Week 12 Date: ___________________________ • Superman on physio-ball – 2 point on physio-ball • Other: • Running Progression o Single leg balance – firm to soft, surface • Sports specific drills with external perturbation (ball catch, • Traditional weight training sports specific/simulated ex) o Knee extensions, hamstring curls Criteria for full return to competition Criteria for progression to Phase 3 à Full range of motion à Hip strength equal to uninvolved side, single leg pick up à Minimum pain with phase 2 exercise with level pelvis à Single leg stance with level pelvis à Ability to perform sport-specific drills at full speed without pain Phase 3: Advanced Exercises (Weeks 7-8) à Completion of functional sports test Goals for Phase 3 à Restoration of muscular endurance/strength à Restoration of cardiovascular endurance à Optimize neuromuscular control/balance/proprioception Weeks 7-8 Dates: _________________________ • Step-ups with eccentric lowering • Lunges progress from single plane to tri-planar, add medicine balls for resistance and rotation .