Physical therapy following femoroacetabular impingement arthroscopy
DOI:
https://doi.org/10.15448/1983-652X.2015.3.20026Keywords:
physical therapy, femoroacetabular impingement, hip arthroscopy, rehabilitation.Abstract
Introduction: Different methods for the gain in hip range of motion, loading of the operated limb and return to sports practice are based on the experience of a few research groups on femoroacetabular impingement. However, the ideal rehabilitation protocol for the femoroacetabular impingement arthroscopy has not been established in the literature.
Objective: To present a rehabilitation protocol based on the authors’ experience of several years in the rehabilitation of the femoroacetabular impingement arthroscopy and also based on biomechanical knowledge.
Description of experience: The proposed rehabilitation protocol is divided in four phases: (1) immediate rehabilitation, comprising the hospital period and the first two weeks of rehabilitation; (2) phase of returning to the daily life activities, which encompasses the first month after surgery; (3) phase of muscle strengthening and proprioceptive training; and (4) final phase for the preparation of the patient for the return to sports practice. The authors try to present the scientific bases for the proposed rehabilitation program in each of the four proposed phases.
Conclusion: Knowledge of the pathology, of the hip joint biomechanics and of the physiological bases of the physical therapy techniques are fundamental in order to propose an adequate protocol in the absence of sufficient scientific evidences supporting the best or the most adequate protocol.
References
Martin RL, Enseki KR, Draovitch P, Trapuzzano T, Philippo MJ. Acetabular labral tears of the hip: examination and diagnostic challenges. J Orthop Sports Phys Ther. 2006; 36(7): 503-515.
Crestani MV, Telöken MA, Gusmão PDF. Impacto femoroacetabular: uma das condições precursoras da osteoartrose do quadril. Rev Bras Ortop. 2006; 41(8): 285-93.
Martin RL, Irrgang JJ, Sekiya JK. The diagnostic accuracy of a clinical examination in determining intra-articular hip pain potential hip arthroscopy candidates. Arthroscopy; 24(9): 1013-1018.
Banarjee P, McLean CR. Femoroacetabular impingement: a review of diagnosis and management. Curr Rev Musculoskelet Med. 2011; 4(1): 23-32.
Ng VY, Arora N, Best TM, Pan X, Ellis TJ. Efficacy of surgery for femoroacetabular impingement: a systematic review. Am J Sports Med. 2010; 38(11): 2337-45.
Wahoff M, Ryan M. Rehabilitation after femoroacetabular impingement arthroscopy. Clin Sports Med. 2011; 30: 463-482.
Enseki KR, Draovitch P. Rehabilitation for hip arthroscopy. Oper Tech Orthop 2010; 20: 278-281.
Spencer-Gardner L, Eischen JJ, Levy BA, Sierra RJ, Engasser WM, Krych AJ. A comprehensive five-phase rehabilitation programme after hip arthroscopy for femoroacetabular impingement. Knee Surg Sports Traumatol Arthrosc. 2014;22(4):848-59.
Stalzer S, Wahoff M, Scanlan M, Draovitch P. Rehabilitation after hip arthroscopy. Oper Tech Orthop. 2005; 15: 280-289.
Stalzer S, Wahoff M, Scanlan. Rehabilitation following hip arthroscopy. Clin Sports Med. 2006; 25: 337-357.
Enseki KR, Martin RL, Draovitch P, Kelly BT, Philippon MJ, Schenker ML. The hip joint: arthroscopic procedures and postoperative rehabilitation. J Orhopaed Sports Phys Ther. 2006; 36(7): 516-525.
Enseki KR, Martin R, Kelly BT. Rehabilitation after arthroscopic decompression for femoroacetabular impingement.Clin Sports Med. 2010; 29:247-255.
Bennell KL, O'Donnell JM, Takla A, Spiers LN, Hunter DJ, Staples M, Hinman RS. Efficacy of a physiotherapy rehabilitation program for individuals undergoing arthroscopic management of femoroacetabular impingement - the FAIR trial: a randomised controlled trial protocol. Journal BMC Musculoskelet Disord. 2014; 26:15-58.
Edelstein J, Ranawat A, Enseki KR, Yun RJ, Draovitch P. Post-operative guidelines following hip arthroscopy. Curr Rev Musculoskelet Med. 2012;5(1):15-23.
Cheatham SW, Kolber MJ. Rehabilitation after hip arthroscopy and labral repair in a high school football athlete. Int J Sports Phys Ther. 2012;7(2):173-84.
Beck M, Kalhor M, Leunig M, Ganz R.Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005;87(7):1012-8.
Loudon JK, Reiman MP. Conservative management of femoroacetabular impingement (FAI) in the long distance runner. Phys Ther Sport. 2014;15(2):82-90.
Matheney T, Sandell L, Foucher K, Lamontagne M, Grodzinsky AJ, Peters CL. Motion analysis, cartilage mechanics, and biology in femoroacetabular impingement: current understanding and areas of future research. J Am Acad Orthop Surg. 2013;21 Suppl 1:S27-32.
Sankar WN, Matheney TH, Zaltz I. Femoroacetabular impingement: current concepts and controversies. Orthop Clin North Am. 2013;44(4):575-89.
Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003; 417:112-20.
Bardakos NV, Villar RN. Predictors of progression of osteoarthritis in femoroacetabular impingement: a radiological study with a minimum of ten years follow-up. J Bone Joint Surg Br. 2009; 91:162-169.
Houcke J Van, Pattyn C, Bossche L Vanden, Redant C, JW Maes, EA Audenaert. The pelvifemoral rhythm in cam-type femoroacetabular impingement. Clin Biomech. 2014; 29(1):63-7.
Samora JB, Ng VY, Ellis TJ. Femoroacetabular impingement: a common cause of hip pain in young adults. Clin J Sport Med. 2011; 21(1): 51-56.
Reid GD, Reid CG, Widmer N, Munk PL. Femoroacetabular impingement syndrome: an underrecognized cause of hip pain and premature osteoarthritis? J Rheumatol. 2010; 37(7):1395-404.
Clohisy C. John, Knaus R. Evan, Hunt M. Devyani, Lesher M. John, Harris-Hayes Marcie, Prather Heidi. Clinical presentation of patients with symptomatic anterior hip impingement. Clin Orth and Rel Res. 2009; 467(3):638-644.
Brisson N, Lamontagne M, Kennedy M, et al. The effects of CAM femoroacetabular impingement corrective surgery on lower extremity gait biomechanics. Gait Posture. 2013; 37(2):258-63.
Casartelli N, Maffiuletti N, Item-Glatthorn JF. Hip muscle weakness in patients with symptomatic femoroacetabular impingement. Osteoarthr Cartil. 2011;19(7):816-21.
Rylander J, Shu B, Andriacchi T, et al. Preoperative and postoperative sagittal plane hip kinematics in patients with femoroacetabular impingement during level walking. Am J Sports Med. 2011; 39:36S-42S.
Kennedy MJ, Lamontagne M, Beaulé PE. The effect of CAM femoroacetabular impingement on hip maximal dynamic range of motion. J Orthop, 2009; 1(1):41-50.
Kennedy MJ, Lamontagne M, Beaulé PE. Femoroacetabular impingement alters hip and pelvic biomechanics during gait: walking biomechanics of FAI. Gait Posture. 2009; 30(1):41-4.
Kennedy MJ, Lamontagne M, , Beaulé PE. The effect of CAM FAI on hip and pelvic motion during maximum squat. Clin Orthop Relat Res. 2009; 467(3):645-50.
Philippon M, Schenker M, Briggs K, et al. Femoroacetabular impingement in 45 professional athletes: associated pathologies and return to sport following arthroscopic decompression. Knee Surg Sports Traumatol Arthrosc 2007; 15(7):908-914.
Stulberg SD, Cordell LD, Harris WH, Ramsey PL, MacEwan GD. Unrecognized childhood hip disease: a major cause of idiopathic osteoarthritis of the hip. In: The Hip. Proceedings of the Third Open Scientific Meeting of The Hip Society, 1975. St. Louis, MO: C.V. Mosby; 1975;212-28.
Bedi A, Chen N, Robertson W, Kelly BT. The management of labral tears and femoroacetabular impingement of the hip in the young, active patient. Arthroscopy. 2008; 24(10):1135-45.
Chow RT, Johnson MI, Lopes-Martins RAB, Bjordal JM. Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active treatment controlled trials. Lancet. 2009; 374:1897-908.
Martin SS, Spindler KP, Tarter JW, Detwiler KB, Petersen HA. Cryotherapy: An effective modality for decreasing intraarticular temperature after knee arthroscopy. Am J Sports Med. 2001; 29(3):288-291.
Aimbire F, Albertini R, Pacheco MT, Castro-Faria-Neto HC, Leonardo PS, Iversen VV, Lopes-Martins RA, Bjordal JM. Low-level laser therapy induces dose-dependent reduction of TNFalpha levels in acute inflammation. Photomed Laser Surg. 2006; 24(1):33-7.
Bjordal JM, Couppé C, Chow RT,Tunér J and Ljunggren AE. A systematic review of low level laser therapy with location-specific doses for pain from joint disorders. Austral J Physiother. 2003; 49:107-116
Konrath GA, Lock T, Goitz HT, Scheidler J. The use of cold therapy after anterior cruciate ligament reconstruction. A prospective, randomized study and literature review. Am J Sports Med. 1996; 24(5):629-33.
Raynor MC, Pietrobon R, Guller U, Higgins LD. Cryotherapy after ACL reconstruction: a meta-analysis. J Knee Surg. 2005;18(2):123-9.
Ni SH, Jiang WT, Guo L, Jin YH, Jiang TL, Zhao Y, Zhao J. Cryotherapy on postoperative rehabilitation of joint arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2014. [Epub ahead of print].
Nadler SF, Weingand K, Kruse RJ. The physiologic basis and clinical applications of cryotherapy and thermotherapy for the pain practitioner. Pain Physician. 2004; 7:395-399.
Knobloch K, Grasemann R, Spies M, Vogt PM. Midportion Achilles tendon microcirculation after intermittent combined cryotherapy and compression compared with cryotherapy alone: a randomized trial. Am J Sports Med. 2008; 36(11):2128-2138.
Yanagisawa O, Homma T, Okuwaki T, Shimao D, Takahashi H. Effects of cooling on human skin and skeletal muscle. Eur J Appl Physiol. 2007;100(6):737-745.
Karunakara RG, Lephart SM, Pincivero DM. Changes in forearm blood flow during single and intermittent cold application. J Orthop Sports Phys Ther. 1999; 29(3):177-80.
Banerjee S, Kapadia BH, Issa K, McElroy MJ, Khanuja HS, Harwin SF, Mont MA. Postoperative blood loss prevention in total knee arthroplasty. J Knee Surg. 2013; 26(6):395-400.
Schaser KD, Disch AC, Stover JF, Lauffer A, Bail HJ, Mittlmeier T. Prolonged superficial local cryotherapy attenuates microcirculatory impairment, regional inflammation, and muscle necrosis after closed soft tissue injury in rats. Am J Sports Med. 2007;35(1):93-102.
Glenn RE, Spindler KP, Warren TA, McCarty EC, Secic M. Cryotherapy decreases intraarticular temperature after ACL reconstruction. Clin Orthop Rel Res. 2004; 421(9): 268-272.
Brosseau L, Milne S, Wells G, Tugwell P, Robinson V, Casimiro L, Pelland L, Noel MJ, Davis J, Drouin H. Efficacy of continuous passive motion following total knee arthroplasty: a metaanalysis. J Rheumatol. 2004; 31(11):2251-64.
O’Driscoll SW, Giori NJ. Continuous passive motion (CPM): theory and principles of clinical application. J Rehabil Res Dev. 2000;37:179-188.
Salter RB. The physiologicic basis of continuous passive motion for articular cartilage healing and regeneration. Hand Clin. 1994; 10(2): 211-219.
Wilk M, Frańczuk B.Evaluating changes in the range of movement in the hip joint in patients with degenerative changes, before and after total hip replacement. Orthop Traumatol Rehabil. 2004; 30;6(3):342-9.
Dy CJ, Thompson MT, Crawford MJ, Alexander JW, McCarthy JC, Noble PC. Tensile strain in the anterior part of the acetabular labrum during provocative maneuvering of the normal hip. J Bone Joint Surg Am. 2008; 90: 1464-1472.
Safran MR, Giordano G, Lindsey DP, Gold GE, Rosenberg J, Zaffagnini S, Giori NJ. Strains across the acetabular labrum during hip motion: a cadaveric model. Am J Sports Med. 2011; 39 Suppl:92S-102S.
Philippon MJ, Decker MJ, Giphart JE, Torry MR, Wahoff MS, LaPrade RF.
Rehabilitation exercise progression for the gluteus medius muscle with consideration for iliopsoas tendinitis: an in vivo electromyography study. Am J Sports Med. 2011; 39:1777-1785.
Freeman S, Mascia A, McGill S. Arthrogenic neuromusculature inhibition: a foundational investigation of existence in the hip joint. Clin Biomech. 2013; 28(2):171-7.
Palmieri-Smith RM, Kreinbrink J, Ashton-Miller JA, Wojtys EM. Quadriceps inhibition induced by an experimental knee joint effusion affects knee joint mechanics during a single-legged drop landing. Am J Sports Med. 2007; 35(8): 1269-1275.
Selkowitz DM, Beneck GJ, Powers CM. Which exercises target the gluteal muscles while minimizing activation of the tensor fascia lata? Electromyographic assessment using fine-wire electrodes. J Orthop Sports. 2013; 43(2): 54-65.
Richardson C, Hodges P, Hides J. Therapeutic Exercise for Lumbopelvic Stabilization. London: Churchill Livingstone; 2004.
Akuthota V, Nadler SF.Core strengthening. Arch Phys Med Rehabil. 2004; 85(3 Suppl 1):S86-92.
Yazbek PM1, Ovanessian V, Martin RL, Fukuda TY.Nonsurgical treatment of acetabular labrum tears: a case series. J Orthop Sports Phys Ther. 2011; 41(5):346-53.
Pennock AT, Philippon MJ, Briggs KK. Acetabular labral preservation: surgical techniques, indications, and early outcomes. Oper Tech Orthop. 2010; 20: 217-222.
Jayasekera N, Aprato A, Villar RN. Are crutches required after hip arthroscopy? A case-control study. Hip Int. 2013;23(3):269-73.
Behrens BJ, Michlovitz SL. Physical Agents. Theory and Practice. Philadelphia: F.A Davis Company; 2006.
Kelly BT, Bedi A, Robertson CM, Dela Torre K, Giveans MR, Larson CM. Alterations in internal rotation and alpha angles are associated with arthroscopic CAM decompression in the hip. Am J Sports Med. 2012; 40(5):1107-12.
Kubiak-Langer M, Tannast M, Murphy SB, Siebenrock KA, Langlotz F. Range of motion in anterior femoroacetabular impingement. Clin Orthop Relat Res. 2007; 458:117-24.
Ellison JB, Rose S, Sahrmann SA. Patterns of hip rotation range of motion: a comparison between healthy subjects and patients with low back pain. Phys Ther. 1990; 70(9): 537-541.
Levine D, Whittle MW. The effects of pelvic movement on lumbar lordosis in the standing position. J Orthop Sports Phys Ther. 1996; 24(3):130-135.
Watanabe W, Sato K, Itoi E, Yang K, Watanabe H. Posterior pelvic tilt in patients with decreased lumbar lordosis decreases acetabular femoral head covering. Orthopedics. 2002; 25(3):321-4.
Van Dillen LR, Bloom NJ, Gombatto SP, Susco TM. Hip rotation range of motion in people with and without low back pain who participate in rotation-related sports. Phys Ther Sport. 2008; 9(2):72-81.
Almeida GP, de Souza VL, Sano SS, Saccol MF, Cohen M. Comparison of hip rotation range of motion in judo athletes with and without history of low back pain. Man Ther. 2012; 17(3):231-5.
Le Beau RT, Nho SJ.The use of manual therapy post hip arthroscopy when an exercise based therapy approach has failed: a case report. J Orthop Sports Phys Ther. 2014; 6:1-29.
Almeida TF, Roizenblatt S, Benedito-Silva AA, Tufik. The effect of combined therapy (ultrasound and interferential current) on pain and sleep in fibromyalgia. Pain. 2003; 104(3):665-72.
Renan-Ordine R, Alburquerque-Sendín F, de Souza DP, Cleland JA, Fernández-de-Las-Peñas C. Effectiveness of myofascial trigger point manual therapy combined with a self-stretching protocol for the management of plantar heel pain: a randomized controlled trial. J Orthop Sports Phys Ther. 2011; 41(2):43-50.
Kolt GS, Snyder-Mackler L. Fisioterapia no Esporte e no Exercício. São Paulo: Revinter; 2008.
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