Hip Bursectomy
Physical Therapy 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).
- 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.
- 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.
- 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.
- 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.
- Lateral, forward, and diagonal lunges.
- Walking for exercise (gradually increasing duration).
- Pool drills for functional strength and motion.
- 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).
- Backward running, side slides, fast feet, and cone step-overs.
- Plyometric exercises for select patients (e.g., box jumps).