“DR. TREVOR” STEFANSKI, M.D.
Minimally Invasive Specialist
Hip Bursectomy
Physical Therapy Protocol
Trochanteric Bursectomy Rehabilitation Protocol

Rehabilitation Protocol Following Trochanteric Bursectomy

Goals

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

Day 1–5

  • Weight-bearing: WBAT with crutches to normalize gait and control post-op pain.
  • Exercises:
    • Ankle pumps, gluteal sets, and quad sets.
    • Hip isometrics (adduction, flexion).
    • Heel slides, pelvic tilts, and seated knee extensions.
    • Assisted ROM (AAROM) and passive ROM (PROM) for hip and knee to tolerance.
    • Single-leg knee-to-chest stretch.
    • Mini-squats (0–45 degrees) by Day 3.

Day 5–7

  • Continue exercises above and add:
    • Hip isometrics (include abduction).
    • Weight shifts, standing hip extension, and supine knee-bent trunk rotations.
    • Stationary biking (if pain-free) with a high seat.
    • Double-leg bridges and supine hamstring stretches.

Week 2

  • Progress AAROM and PROM exercises.
  • Add light hip flexor, adductor, and IT band stretches.
  • Pain-free standing hip abduction and seated hip ER/IR.
  • Gradually strengthen muscles using low resistance.

Week 3

  • Emphasize improved ROM with AAROM, PROM, and stretching.
  • Introduce:
    • Hip mobilizations (Grades III/IV) for stiffness.
    • Straight leg raises (all directions).
    • Light leg press, single-leg bridging, and planks.
    • Sidelying clams, lunges onto a box, and lateral step-ups.
    • Tilt board squats, wall squats, hamstring curls, and physioball-assisted squats.
  • Begin pool exercises once incisions are closed (e.g., retrowalking, ROM drills).

Phase II: Intermediate Phase (Moderate Protection Phase) – Weeks 4–6

Goals

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

Week 4–5

  • Continue and progress isotonic strengthening exercises.
  • Maintain flexibility with stretches and ROM exercises.
  • Gradually increase duration and resistance on a stationary bike.
  • Introduce:
    • Elliptical, proprioception drills, and perturbation training.
    • Bosu squats, Biodex squats, tilt board work, and foam training.
    • Emphasize glute medius strengthening with single-leg balance exercises.
    • Step-downs, step-ups, and functional hamstring curls.

Week 5–6

  • Progress functional drills:
    • Lateral, forward, and diagonal lunges.
    • Walking for exercise (gradually increasing duration).
    • 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 Phase III

  • Full, non-painful ROM.
  • Satisfactory hip stability.
  • Adequate muscular strength (minimum "good" grade).
  • No pain with functional drills.

Weeks 7–8

  • Continue stretching, ROM exercises, and mobilizations for stiffness.
  • Progress:
    • Leg press (0–90 degrees) and vertical squats (0–60 degrees).
    • Sidelying clams, step-downs, and lateral lunges with resistance.
    • Core strengthening (bridging and physioball sit-ups).
  • Increase aerobic activity: biking, walking, and elliptical.
  • Begin stair stepping and functional core/hip 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 Phase IV

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

Weeks 8–12

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