(NOTE: ALL OF THESE ARE JUST GUIDELINES FOR A SUCCESSFUL RECOVERY AND ARE ASSUMING A TYPICAL LABRAL REPAIR PROCEDURE. IF YOU'RE SURGEON HAS SPECIFIC INSTRUCTIONS THAT HE/SHE WANTS YOU TO FOLLOW, THEN ABSOLUTELY FOLLOW THEIR PROTOCOL. THIS IS MEANT TO BE EDUCATIONAL AND IN NO WAY SHOULD REPLACE YOUR MD'S PROTOCOL.)
Okay, now that we have that disclaimer out of the way, let's dive into some anatomy first.
What is a "labrum?"
You have two pairs of labrums in your body: one in each shoulder and one in each hip. We will look at the shoulder labrum in a future blog entry, but today's is all about the hip.
The labrum has a very important job: it helps to deepen the socket of the hip (acetabulum) to provide greater stability and reduce the risk of dislocation. It also helps to protect the bony structures in the hip.
Why would I need surgery on my labrum?
Labrums can tear. They are a soft tissue structure that with enough force, often times rotational, can get a small tear or tears.
If you have a tear in your labrum, some common symptoms including a "catching" or even "locking" sensation in your hip with certain movements. You may also head/feel clicking that seems to be deep in your hip. Many people that I've worked with have complained of groin pain, as well. Pain seems to be fairly constant, but definitely experience good and bad days depending on what you've been doing. Special testing can be done by your PT, ATC, MD, or other licensed professionals to determine if an MRI is necessary.
Surgery isn't always necessary, but since this post is about the post-operative rehab protocol, we're going to assume you're going under the knife.
Post-Op Week 1:
Typically we want to limit your weight bearing following this procedure. You'll be on crutches with instructions on partial weight bearing for about six weeks depending on your surgeon and their guidelines. During this time, it is recommended that we avoid external rotation of the hip (rotating your toes/foot outward) as well as flexion of the hip beyond 90 degrees (bringing your knee toward your chest). This can place an increased amount of stress on the posterior (or back side) of the labrum that was just repaired.
The main goal here is to reduce your pain levels. We want you to understand the difference between discomfort and pain. Pain means something is wrong, whereas discomfort is more tolerable and should be expected.
Basic, low level muscle activation exercises are initiated. These will often include ankle pumps (mostly the blood flow), quad sets, glute sets, pelvic tilts, and even bridges (all meant to engage supportive musculature), and ROM exercises such as heel slides to help improve tolerance to hip flexion while maintaining knee range of motion.
I also like to include low grade joint mobilizations (grades I and II) to help control your pain with some gentle massage to the muscle around the hip. Again, pain control is important early on in the rehab process.
Week 2:
Here, we can progress the ankle pumps to more of a seated heel raise. This targets the soleus muscle in the lower leg, but also helps progress you towards weight acceptance when allowed to being more weight bearing positions. We need to minimize the amount of muscle lost due to surgery and being partially weight bearing for these first 6 weeks.
Another big thing here is the stationary bike. This is great for blood flow, but also lower extremity (leg) endurance. Seat positioning can be important, as we don't want your knee getting too close to your chest just yet.
Week 3:
We're basically continuing on with our previous exercise load, but can add 4-way SLR now. This is simply leg raises but in different directions. We can do them laying on either side as well as on your back and stomach. The purpose of these is to help strengthen all of the muscle groups around the hip, which include your quads, gluteals, and adductors (muscles along the inside of your thigh).
Week 6:
(Weeks 4 and 5 are kind of blah. Nothing really changes, other than we want you to be able to move within your available ROM fairly pain free; you can do some light pool exercises at this time, though, should your MD allow aquatic-based exercise).
We can start weaning from the crutches at this point assuming weeks 4 and 5 showed good pain tolerance.
Things can really gear up now, as we can get you on the leg press for further strengthening of the leg. We can even initiate more gluteal-based exercises with activities such as the clamshell and single leg bridges. Two of my favorite parts, though, are progressing your available ROM a little further into flexion and external rotation, as well as getting you on your feet with an elliptical.
It seems like progress is a little easier for post-surgical patients to see around week six. This is when big things/progressions begin to take shape, most notably the weaning from the crutches, especially if you're doing well.
The main goal here is to reduce your pain levels. We want you to understand the difference between discomfort and pain. Pain means something is wrong, whereas discomfort is more tolerable and should be expected.
Basic, low level muscle activation exercises are initiated. These will often include ankle pumps (mostly the blood flow), quad sets, glute sets, pelvic tilts, and even bridges (all meant to engage supportive musculature), and ROM exercises such as heel slides to help improve tolerance to hip flexion while maintaining knee range of motion.
I also like to include low grade joint mobilizations (grades I and II) to help control your pain with some gentle massage to the muscle around the hip. Again, pain control is important early on in the rehab process.
Week 2:
Here, we can progress the ankle pumps to more of a seated heel raise. This targets the soleus muscle in the lower leg, but also helps progress you towards weight acceptance when allowed to being more weight bearing positions. We need to minimize the amount of muscle lost due to surgery and being partially weight bearing for these first 6 weeks.
Another big thing here is the stationary bike. This is great for blood flow, but also lower extremity (leg) endurance. Seat positioning can be important, as we don't want your knee getting too close to your chest just yet.
Week 3:
We're basically continuing on with our previous exercise load, but can add 4-way SLR now. This is simply leg raises but in different directions. We can do them laying on either side as well as on your back and stomach. The purpose of these is to help strengthen all of the muscle groups around the hip, which include your quads, gluteals, and adductors (muscles along the inside of your thigh).
Week 6:
(Weeks 4 and 5 are kind of blah. Nothing really changes, other than we want you to be able to move within your available ROM fairly pain free; you can do some light pool exercises at this time, though, should your MD allow aquatic-based exercise).
We can start weaning from the crutches at this point assuming weeks 4 and 5 showed good pain tolerance.
Things can really gear up now, as we can get you on the leg press for further strengthening of the leg. We can even initiate more gluteal-based exercises with activities such as the clamshell and single leg bridges. Two of my favorite parts, though, are progressing your available ROM a little further into flexion and external rotation, as well as getting you on your feet with an elliptical.
It seems like progress is a little easier for post-surgical patients to see around week six. This is when big things/progressions begin to take shape, most notably the weaning from the crutches, especially if you're doing well.
Weeks 7-8:
These two weeks are about challenging your muscles with higher level exercises. We will instruct more single leg activity to help increase the strength on your affected extremity and include more resistance band exercises. This is also a time where I like to get you into weight bearing positions and get out of the sagittal plane a little bit and more into the horizontal and frontal planes of motion. These will be our more dynamic activities and help set the stage for ...
Weeks 9-11:
During this phase of the rehab process (which is significantly more important for athletes, whether you're a high school athlete, weekend warrior, or anything in between) we get to begin more sport-specific activity.
Assuming your progression has gone well, we will now being increasing your endurance/cardio activity as well as incorporate plyometric (jumping) exercises. This phase is set for weeks 9-11 but, in reality, can and does transition into the final phase (weeks 12+) because you will still be working on all of this even after return to sport.
Weeks 12+:
From this point on, you're looking for pain-free activity/exercise before being allowed to return to you sport of choice. We are constantly looking for deficiencies at this point because if we allow you to return to sport too soon, you can be at a greater risk for not only re-injury to the affected hip, but also injury to another joint/ligament/muscle somewhere else on the body (secondary to compensation strategies).
I always like to stress to my athletes that even when you feel like your 100% ready, it's sometimes best to take another couple of weeks to work on higher level strengthening exercises to make sure your body can handle the demands that are about to be placed on it.
Thanks to everyone for reading. If you have questions, please comment below!
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