Hip Arthroscopy / Labral Repair — Iliopsoas Release

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

50% WB with bilateral axillary crutches (foot flat) for 2 wks, then WBAT; DonJoy brace worn until FWB

Key Restrictions

Avoid active SLR and sit-ups x4 wks; no ballistic/forced stretching throughout; first 2 wks limit flexion to 90 deg, ER/IR to 0 deg; DonJoy brace locked to 90 deg hip flexion when upright x4 wks; no treadmill use through Phase II; no contact activities until 12+ wks

Timeline & Phases

Phase I (surgery-4 wks): protect remaining hip tissue integrity, restore ROM within restrictions, reduce pain/inflammation, prevent muscular inhibition, gentle PROM all planes within pain limits (first 2 wks limit flexion to 90/ER-IR to 0, emphasize IR and prone lying), CPM 0-45 deg x8 wks (4 hr/day wks 1-2 tapering to 2 hr/day by wk 4), DonJoy brace locked 90 deg flexion when upright x4 wks (worn until FWB), gait training with bilateral axillary crutches (50% WB x2 wks then WBAT), grade 1-2 hip mobilizations, long axis distraction, pool therapy after incision healing, ankle pumps, quad/glute/hamstring isometrics, leg raises in abduction/adduction/extension, DL bridging, SLR, light leg press, SL clamshells, light hamstring curls, stationary bike low resistance, progress to Phase II with minimal pain, full PROM, proper muscle firing, and FWB allowed; Phase II (usually 4-9 wks): protect hip integrity, restore full ROM, restore normal gait without AD, SL stance >15 sec, pain-free functional movements, progress PROM to full, supine SLR with gradual resistance, grade 3-4 hip mobilizations, manual A/P mobs, gait training (control hip IR/valgus), strength/endurance progression (weight shifts, seated resisted IR/ER, weighted SLRs), core progression, mini-squats, wall sits with abductor bands, light hamstring curls, advanced/single leg bridging, clamshell, 4-way hip machine, SL/DL balance static-to-dynamic, step progression, hip stretch progression, water walking, stationary bike with resistance, elliptical/Nordic Track, stair climber as tolerated, progress to Phase III with FROM, pain-free gait, hip flexion strength >90% of uninvolved side; Phase III (usually 9+ wks): restore muscular strength/endurance, cardiovascular endurance, optimize neuromuscular control/balance/proprioception, restore full AROM/PROM all planes, aggressive stretching/mobilizations, progress core stability with swiss ball, standing resisted hip ER, lunges with trunk rotation, deeper squats, resisted sidestepping, monster walking, 4-way hip machine, after wk 10 initiate single-plane agility (step drills, SL landing, sport cord, return-to-running progression, cariocas, z-cuts/w-cuts); return to sport MD-directed generally 12-16 wks with hip flexion strength >85% of uninvolved side

Notes

OSMS Rehabilitation Guidelines; addresses iliopsoas tendinitis via arthroscopic or open debridement/release; distinct from OSMS's Iliopsoas Lengthening after THA protocol (this one is a standalone/primary procedure, not a THA revision)