Abductor Repair (Gluteus Medius/Minimus Repair) Protocol • Pain dominant hip mobilization – grades I, II (used only when hip joint has been affected) Surgery Date:____________________________ • Other: o Upper body ergometer, upper body This protocol should be used as a guidelines for progression strengthening and should be tailored to the needs of the individual patient. o Passive ROM: hip abduction Strict protective weight bearing status for 8 weeks Week 2 Date: ____________________________ • Allow to place weight of leg on ground (neutralizes • Supine marching, modified dead bug joint reaction forces) • Thera band resistance on affected side – Flexion and Extension (start very low resistance) Emphasis on range of motion • Seated hip flexion, IR/ER in pain-free range • Superman • Active assisted (hip flexion)/passive motion (hip • Other: abduction) Standard stationary bike without • Avoid stress to repair site by avoiding passive o resistance (10 min tolerated) adduction, ER/IR for 4 weeks o Pool water exercises – water walking, No active abduction for 2 months to allow healing range of motion (no active abduction or adduction), march steps, backward Pool program to initiate functional exercises in reduced walking, mini-squats, heel raises, weight environment hamstring and hip flexor stretches Soft tissue mobilizations as needed Phase 2: Intermediate Exercises (Weeks 4-6) Emphasis on cycling range of motion without resistance Goals for Phase 2 (as long as this is tolerated by the patient) o Protect ntergrity of healing tissue At 2 months, transition to full weight bearing (transition o Restore pain-free range of motion variable) o Progressively increase muscle strength and endurance Minimum 3 months before progression of functional o Continue to respect weight bearing precautions activities as tolerated The rehab progression may be advanced or slowed by 1-2 weeks based on the quality of the repair and the Weeks 4-6 Dates: _________________________ security of the fixation • Pool water exercises – flutter kick swimming, 4- Phase 1: Initial Exercises (Weeks 1-3) way hip with water weights, step-ups • Add PROM IR/ER and adduction Week 1 Date: ____________________________ Criteria for progression to Phase 3 • Seated knee extension • Ankle pumps ü Minimum pain with phase 2 exercises • Glut sets • Quad sets Phase 3: Advanced Exercises (Weeks 7-10) • Hamstring sets Goals for Phase 3 • Adductor isometrics • Heel slides, acitive-assisted range of motion o Restoration of muscular endurance/strength • Posterior pelvis tilt o Restoration of cardiovascular endurance • Prone on elbows o Optimize neuromuscular • Prone knee flexion control/balance/proprioception • Standing flexion and extension without resistance o Restore 60-70% gluteus medius strength Weeks 7 Date: ___________________________ ½ circles forward/backward – 25 yds. Start band at knee height and progress to ankle height • Standing thera band/pulley flexion and extension • Side steps over cups/hurdles (with ball toss and with multi-hip external sports cord resistance), increase speed • Pool water exercises – flutter kick, swimming, 4- • Lunges progress from single plane to tri-planar way hip with water weights, step-ups lunges, add medicine balls for resistance and rotation Week 8 Date: ____________________________ • Sidestepping with resistance (pause on affected limb), sports cord walking forward and backward • Log IR rolling (pause on affected limb) • Superman (quadruped position) • Single leg body weight squats, increase external • Standing heel raises resistance, stand on soft surface • Abduction Isometrics • Other: • Other: o All phase 3 exercises o Gradually weaning off crutches o Wall mini-squats Final Phase: Sports specific training on field or court o Physio-ball mini-squats with co- (Weeks 16 and beyond) contraction o Leg Press (minimal resistance, • Running Progression gradually increasing resistance to • Sports specific drills patient tolerance) • Traditional weigh training o Initiate AROM abduction (supine) • Pool running (progress from chest deep to waist o Hip mobilizations as needed deep), treadmill jogging • Step drills, quick feet step-ups (4-6 inch box) Week 9 Date: ____________________________ forward, lateral, carioca • Single leg bridges/stabilization/alternate kick outs • Plyometrics, double leg and single leg shuttle • Standing hip abduction without resistance jumps • ¼ mini-squats Criteria for full return to competition • Sidelying clamshells • Other: ü Full range of motion o Knee extensions, hamstring curls ü Hip strength equal to uninvolved side, single leg o Single stability ball bridges pick-up with level pelvis o Initiate elliptical machine ü Ability to perform sport-specific drills at full speed o Add seated IR/ER AROM in pain free without pain range ü Completion to functional sports test ü Restore full gluteus medius strength before higher Week 10 Date: ___________________________ level activities are added • Thera band resistance on affected side – Abduction (start very low resistance) • Sidelying leg raise – Abduction • Bosu squats • Single leg balance – firm to soft surface with external perturbation (ball catch, sports specific/simulated ex.) • Physio-ball hamstring exercises – hip lift, bent knee hip lift, curls, balance • Sidelying Clamshells with resistive tubing/band Phase 4: Sports specific training rehab clinic based progression (Weeks 11-15) Goals for Phase 4 o Single leg mini squats with level pelvis o Cardiovascular fitness equal to preinjury level o Demonstration of initial agility drills with proper body mechanics Weeks 11-15 Dates: _______________________ • Single leg pick-ups, add soft surface • Lateral step-ups with eccentric lowering • Thera band walking patterns – forward, sidestepping, carioca, monster walks, backward, .