Hip Injection Protocol

Post-injection Protocols and Progression Criteria

Phase 1 (Acute Rehabilitation): Weeks 0-2

Goals and General Comments

• Closely monitor signs of irritation and/or overload
• Progressively increase pain-free hip ROM in all planes
• Improve lower limb proprioception, muscular control and activation
• Normalize heel-toe pattern during full WB gait (1 crutch for painful cases)

Plinth Exercises

• Psoas (supine/kneeling/standing) and quadriceps stretching
• Supine hip external rotation with theraband
• Supine bridging (± theraband resistance for isometric hip abduction)
• Ball bridging
• Progress bridging exercises (i.e. single limb and ball bridge variations)
• Prone isometric heel (and gluteal) squeeze
• Prone hip extension (with extended and flexed knee)
• Clam exercises
• Side lying hip abduction

WB Exercises

• Single leg balance and proprioceptive exercises (as pain permits)
• Standing 'weight shift' activities (using slide boards)
• Wall/ball and free standing squats (0-75°) with theraband resistance as tolerated

Cardiovascular

• Stationary 'high-seat' cycling if ROM permits (no-low load), 2 x daily (10-20 mins)

Criteria to Progress

• Well managed pain and inflammatory control
• Good tolerance to load during 'weight shift' activities
• Proficiency in all non-WB and WB exercises prescribed
• Normalized heel-toe gait pattern
• Adequate single limb balance and proprioceptive control (-ve trendelenburg)

Phase 2 (Early Rehabilitation): Weeks 3-4

Goals and General Comments

• Continue Phase 1 activities
• Progress toward full and pain-free hip ROM
• Progressively increase lower limb strength
• Further enhance proprioception, balance and neuromuscular control
• Improve confidence in walking gait, exercises and daily activities

Plinth Exercises

• Side lying knee extension with theraband (in positions of hip abduction)
• 4pt hip extension with theraband
• Supine hip thrust (single leg)

WB Exercises

• Standing hip extension and abduction using therabands
• Full range wall/ball and free standing squats (theraband resistance as tolerated)
• Bosu (unstable surface) squats
• Lunges (theraband resistance as tolerated)
• Step Exercises (step ups and downs, front step downs, lateral drops)
• Progress proprioceptive exercises (i.e. ball throws etc.)

Cardiovascular

• Stationary cycling (duration/load as tolerated), including interval training

Criteria to Progress

• Pain-free hip ROM in all planes ≥90% of contralateral limb
• Proficiency in all non-WB and WB exercises prescribed

Phase 3 (Late Rehabilitation): Weeks 5-6

Goals and General Comments

• Continue variation in Phase 1-2 exercises
• Progressive increase in trunk, core and lower limb endurance and strength
• Progressive increase in lower limb muscular strength and power

Plinth Exercises

• Side and prone bridging

WB Exercises

• Arabesque
• Pelvic drops
• Walking lunges (straight line)
• Lateral (crab) and frontal (sumo) theraband walks
• Single leg squats (ball/wall, free stand, with hip abduction on ball)
• Functional and proprioceptive single limb exercises (e.g. star excursion)

Cardiovascular

• Elliptical and crosstrainers introduced, including interval training
• Jogging - flat surface, straight lines

Criteria to Progress

• Peak isometric hip strength (all planes) using a HHD ≥90% of contralateral limb
• Proficiency in undertaking ≥15 consecutive single leg squats (75-90° knee flexion)
• Performance on the modified star excursion balance test ≥90% contralateral limb

Phase 4 (Advanced Rehabilitation): Weeks 6-12

Goals and General Comments

• Continue variation in Phase 1-3 exercises
• Progressive increase in lower limb muscular strength and power
• Restoration of sound jump, hop and land mechanics

Jump, Hop and/or Plyometric Exercises

• Bilateral jumping exercises (horizontal and vertical)
• Bilateral jumping exercises (with plyometric focus)
• Bilateral jumping exercises (with single limb land ± plyometric focus)
• Side-to-side jumps over box (± additional weight as required)
• Cross directional jumping exercises (clock jumps ± theraband)
• Single limb hop (horizontal and vertical)
• Single limb hop variations (side, 6m timed, triple and triple crossover)
• Varied hop exercises (clock hop, square hop etc.)
• Bench drops (controlled single limb lands)
• Bench drops (with bilateral plyometric jump)
• Bench drops (with plyometric jump and land on single limb)
• Bench drops (with plyometric jump and land on single limb on bosu)
• Bench drops (with plyometric jump and land on single limb with ball)

Cardiovascular and/or Agility

• Running - flat surface, straight lines, backwards, lateral shuffle
• Introduce agility exercises (i.e. T-test, Illinois, Figure-8 runs etc.)

Criteria to Progress

• Sound jump/land mechanics during all jump/hop/plyometric exercises introduced
• Competency and well tolerated return to running activities
• Single limb hop performance ≥85% of contralateral limb

Phase 5 (Agility and Return to Activity-Specific Training): Weeks 12-16

Goals and General Comments

• Continue variation in Phase 3-4 exercises
• Restore lower limb strength and functional symmetry

Cardiovascular and/or Agility

• Advance agility exercises
• Running - unrestricted, cross directional, cutting manoeuvres

Sport Activities

• Sport-specific drills
• Return to training (non-competitive and competitive)

Criteria to Progress

• Competency and well tolerated return to progressive agility drills
• Competent and confident return to non-competitive, sport-specific training drills
• Single limb hop performance ≥90% of contralateral limb
• Peak isokinetic quadriceps and hamstrings strength ≥85% of contralateral limb

Phase 6 (Return to Sport): Week 16 onwards

Goals and General Comments

• Continue to build general fitness, as well as lower limb strength and power
• Successful return to sport

Sport Activities

• Return to sport
• Provision (and competency) of relevant injury prevention program

Criteria to Progress

• Competent and confident return to competitive, sport-specific training drills

Prior to RTS

• Sound patient-perceived pain/function (consider ≥96/100 on the HOS-ADL Score)
• Sound patient-perceived sport capacity (consider ≥80/100 on the HOS-Sport Score)
• Hip ROM in all planes ≥90% of contralateral limb
• Hop symmetry (single, triple and triple crossover) ≥90% contralateral limb
• 16-hop timed agility test symmetry ≥90% contralateral limb
• Modified Agility T-test symmetry ≥90% contralateral limb
• Peak isokinetic quadriceps and hamstrings strength ≥90% contralateral limb
• Sound hop and land lower limb and trunk mechanics
• Successful completion of competitive, sport-specific training drills

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