Trochanteric Bursectomy with IT Band Lengthening

Physical Therapy Protocol

Precautions

• Weight-Bearing: WBAT with crutches for 1–2 weeks.
• Activity Restrictions:
  • Avoid aggressive hip abduction strengthening.
  • Postpone aggressive functional activities until cleared by the physician.

Phase I – Immediate Postoperative Phase (Day 1 to Week 3)

Goals:

• Restore non-painful range of motion (ROM) and flexibility
• Reduce pain and inflammation
• Begin muscular strengthening
• Normalize a pain-free gait

Day 1–5:

• WBAT with crutches to normalize gait and control pain

Exercises:

• Ankle pumps, gluteal sets, quad sets
• Hip isometrics (adduction, flexion)
• Heel slides, pelvic tilts, seated knee extensions
• AAROM and PROM for hip and knee to tolerance
• Single-leg knee-to-chest stretch
• Mini-squats (0–45°) by Day 3

Day 5–7:

• Hip isometrics (include abduction)
• Weight shifts, standing hip extension, supine trunk rotations
• Stationary biking (if pain-free) with high seat
• Double-leg bridges, supine hamstring stretches

Week 2:

• Progress AAROM and PROM exercises
• Light hip flexor, adductor, and IT band stretches
• Pain-free standing hip abduction, seated ER/IR
• Gradually strengthen with low resistance

Week 3:

• Continue ROM and stretching
• Introduce:
  • Hip mobilizations (Grade III/IV)
  • Straight leg raises in all directions
  • Light leg press, single-leg bridging, planks
  • Sidelying clams, lunges onto box, lateral step-ups
  • Tilt board and wall squats, hamstring curls, physioball squats
  • Pool exercises once incisions are closed (e.g., retrowalking, ROM drills)

Phase II – Intermediate Phase (Weeks 4–6)

Goals:

• Restore full, pain-free motion
• Normalize strength in lower extremities and core
• Gradually increase functional activities

Week 4–5:

• Continue isotonic strengthening
• Maintain flexibility with ROM and stretching
• Increase duration/resistance on stationary bike
• Introduce:
  • Elliptical, proprioception drills, perturbation training
  • Bosu/Biodex squats, tilt board, foam balance
  • Single-leg balance, glute medius focus
  • Step-downs, step-ups, hamstring curls

Week 5–6:

• Progress functional drills:
  • Lateral, forward, and diagonal lunges
  • Walking for exercise (gradually increase)
  • Pool drills for functional strength and motion

Phase III – Advanced Exercise Phase (Weeks 7–8)

Goals:

• Maintain full ROM
• Improve muscular strength, power, and endurance
• Gradually reintroduce functional activities

Criteria to Begin:

• Full, non-painful ROM
• Satisfactory hip stability
• Muscle strength at least "good"
• No pain with functional drills

Weeks 7–8:

• Continue ROM, stretching, mobilizations
• Progress:
  • Leg press (0–90°), vertical squats (0–60°)
  • Sidelying clams, step-downs, lateral lunges with resistance
  • Core strengthening (bridges, physioball sit-ups)
  • Increase aerobic activity (biking, walking, elliptical)
  • Stair-stepping, core/hip functional drills

Phase IV – Return to Activity Phase (Weeks 8–12)

Goals:

• Enhance muscular strength, power, and endurance
• Progress functional activities
• Maintain hip mobility

Criteria to Begin:

• Full, pain-free ROM
• Satisfactory clinical exam
• Hip strength ≥ 75–80% of contralateral side
• No pain/tenderness during functional drills

Weeks 8–12:

• Pool running and treadmill walk/run intervals
• Functional agility drills:
  • Backward running, side slides, fast feet, cone step-overs
• Plyometrics (e.g., box jumps) for select patients
• Initiate interval sports or golf if pain-free

Final Notes

• Progress based on pain tolerance and clinical milestones
• Follow physician recommendations before advancing phases
• Modify activities based on individual response and recovery