Gluteus Medius Repair — Open Gluteus Medius Repair

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

Toe-touch WB with AD Phase I; TTWB advancing to 20 lbs through wk 6 Phase II; WBAT with crutches after wk 8 Phase III

Key Restrictions

No active abduction/IR, no hip flexion beyond 90 deg, no passive ER or adduction x6 wks; avoid hip flexor inflammation Phases III-IV

Timeline & Phases

Phase I (surgery-4 wks): protect repaired hip tissue, restore ROM within restrictions, reduce pain/inflammation, prevent muscular inhibition, toe-touch WB with AD, no active abduction/IR, no hip flexion beyond 90 deg, no passive ER/adduction x6 wks, scar massage, quadruped rocking for hip flexion, hip isometrics (hamstring isotonics, pelvic tilts, NMES to quads with SAQ), extension/adduction/ER isometrics added after wk 2, stationary bike no resistance 20 min/day (up to 2x/day), progress to Phase II if minimal pain with Phase I exercises; Phase II (usually 4-6 wks): protect hip integrity, restore full ROM, initiate limited gait, progressively increase strength, TTWB advancing to 20 lbs through wk 6, PROM hip flexion progresses past 90 deg, supine bridges, isotonic adduction, core strengthening (avoiding hip flexor tendinitis), sub-max pain-free hip flexion strengthening, quad strengthening, stationary bike with low resistance, aqua therapy in low end of water, progress to Phase III with FROM; Phase III (usually 6-8 wks): restore muscular strength/endurance and cardiovascular endurance, optimize neuromuscular control/balance/proprioception, WBAT with crutches allowed after wk 8, avoid hip flexor inflammation, progress ROM, passive ER/IR allowed, supine log rolling, stool rotation, standing on BAPS board, hip joint mobs with mobilization belt (lateral/inferior with rotation, prone posterior-anterior glides with rotation), progress core strengthening; Phase IV (usually 8-12 wks): wean from crutches, restore muscular strength/endurance, optimize neuromuscular control/balance/proprioception, progressive LE strengthening, hip isometrics for abduction progressing to isotonics, leg presses, knee flexion/extension isokinetics, core strengthening, proprioception/balance (balance board, single leg stance, bilateral cable column rotations), after wk 10 initiate hip PREs/hip machine/unilateral leg presses/unilateral cable column rotations/step downs/hip hiking/hip flexor and glute/piriformis/IT band stretches, stationary bike with resistance, elliptical, treadmill side-stepping progressing to inclines, hip hiking with Stairmaster, aqua therapy, after wk 12 progress to treadmill running/sport-specific agility/plyometrics; return to sport MD-directed generally 12-16 wks with pain-free ROM and hip strength >85% of uninvolved side

Notes

OSMS Rehabilitation Guidelines; open (non-arthroscopic) gluteus medius repair — distinct from OSMS's Arthroscopic Gluteus Medius Repair protocol, with a more conservative toe-touch/TTWB weight-bearing progression through wk 8 versus the arthroscopic version's earlier FFWB/PWB timeline