Programming: Bilateral Hip Labral Surgery

Case

On July 29th, my client underwent labral repair surgery on both of their hips. The surgeon repaired the damage in the labrums, repaired a cyst on one side, and shaved some bone on both sides. That’s the skinny version, anyway.

Some more background on this client. One labrum was damaged and never tended to other than “light physical therapy” over 15 years ago. The other hip was caused while landing funny snowboarding and tearing the other side.

This person has been a client of mine for over five years and is fantastic at doing his training work in the clinic and on their own.

Findings in the Clinic

Given the circumstances and our joint assessment using the Functional Range Assessment, we can be very specific in our treatment and training.

The assessment revealed a significant issue: little to no internal rotation of the hip due to neurological tightness. This is a great finding and will help constrain our treatment plan moving forward.

Our findings on external rotation, however, revealed a decent amount of passive range of motion, and we were able to get a good stretch into the tissue of the posterior hip joint. This finding indicates that we are able to provide training inputs into the architecture.

His active control of external rotation was well below our standard of being within 20 degrees of the passive range of motion, which was to be expected.

Ecologies and Specificity

We have our joint, the hip joint.

We have the tissue, the posterior hip joint capsule, and connective tissue architecture.

The zone in which we are going to train this tissue is external rotation.

We can also use the available capsular workspace by performing zone-specific capsule articulations at a retraining or even detraining intensity level.

Conjugate Strategy

Our goal is to train these ecologies weekly, if not daily, to recover from surgery.

Accumulating a lot of training volume to build new architecture before introducing more and different types of load into the architecture.

Similarly, with the available joint and capsular workspace, we are having them do a handful of reps several times a day to maintain the joint’s range of motion, particularly in rotation, and keep a spotlight on those areas for the nervous system.

Coincidentally, this strategy has indirectly affected the neurological tightness in internal rotation on both hips, giving us a handful of degrees of internal rotation to play with. For now, we aren’t loading here; we are just keeping our rotational inputs at a low intensity.

Training

Here is the training provided to my client based on our clinical assessment and treatment:

1. I gave the client a choice of which external rotation position to use on their own. - 4 sets of 30-second stretching bouts to accumulate a total of two minutes a day. This was a very modest approach but a good launchpad and starting point. (We have quickly progressed since).

2. For joint workspace, I gave them the option to perform open-chain or closed-chain capsule articulations. Doing one or two sets per day of 5 repetitions each time. Again, a simple and safe place to start.

3. The surgeon also suggests they walk daily, which is definitely in the daily mix, and has since built up his mileage capacity quite quickly.

Final Thoughts

The overall loading strategy behind this case is to apply a training volume geared toward stimulating connective tissue architecture and keeping the nervous system active by performing low-intensity articulations.

As I write this, we are completing our fourth week of treatment post-surgery and are up to ten minutes of total connective tissue volume. Based on the client's feedback, we are also introducing low-intensity holds or HIMA isometrics to elicit biological effects.

If you have any questions on this case, please leave a comment.