Hip FAI Arthroscopy

Case Study: Hip FAI Arthroscopy

Tamara Johann Moreno, MS, DPT, COMT, ATC

Introduction

19-year-old female college field athlete with a 1-2 year history of bilateral hip pain, not resolved with conservative treatment. Left hip FAI arthroscopy approximately 6 weeks after right hip FAI arthroscopy, each with labral repair.

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Goals

  • Progressive strengthening of lower extremity musculature, especially hip joints
  • Normal, pain-free hip range of motion
  • Strengthen core and pelvic stabilizers
  • Improve tolerance for loading to prepare for jogging on ground
  • Develop cardiovascular endurance to prepare for return to sport progression

History / Progression

  • History of osteitis pubis and bilateral hip flexor  tendinitis
  • Unable to play sport at desired level with conservative care
  • Diagnosed with bilateral hip FAI, including bilateral labral tear, and scheduled consecutive arthroscopies with goal of return to sport in 1 year
  • Rehabilitation after right hip arthroscopy focused on leg strength, core strength, and normalizing gait to prepare for left hip arthroscopy
  • Rehabilitation after left hip arthroscopy focused on range of motion, strengthening both legs, normalizing gait pattern, and strengthening core
  • Patient had complaints of hip flexor tendon pain during progression, resolved with rest and core strengthening
  • Post-op protocol to allow for ground running around 4 months and AlterG running at 50% body weight at 4 weeks.
  • Patient returned to pre-season sport competition at 9 months post left hip arthroscopy

Considerations

  • Pain and latent soreness were considered when progressing running on the AlterG. Monitor and avoid hip flexor and piriformis tendinitis
  • Body weight and duration were the primary variables manipulated at each workout, while speed and incline were maintained at a constant level
 

Results

The patient was seen in physical therapy 3x/week except forholidays or during final examinations. She had some anterior hippain with the initial stages of rehabilitation due to hip flexortendon weakness and irritation. This was resolved with resting thehip flexor and then resuming a gradual strengthening program.

Initial rehabilitation focused on range of motion (especiallyextension and FABER) and gait training, while later stages focusedon higher level strengthening and single leg stance stability.TheAlterG was introduced early in rehabilitation (week 4) as a way tosupplement cardiovascular training and to prepare the athlete foroverground running and sport-specific exercise. Body weight andduration were the primary variables manipulated throughout theprogression. A slight incline of 3-4% was used while at lowerbody weights in order to reduce the sensation of running "on yourtoes.” The running progression was slowed around weeks 7-8due to a mild flare up of "groin pain,” which was resolved withNSAID’s and relative rest.

The AlterG physical therapy equipment was better tolerated by thispatient than biking or elliptical training due to occasional hipflexor pain with the latter activities. When she progressed toground running and was cleared for cutting activities, aprogression of agility skills was created and followed.

The patientwas able to return to sport competition the following season. Shecontinued to use to AlterG physical therapy exercises as an alternative to conditioning inorder to decrease total stress to the hip joint.

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