Initial Assessment

When setting treatment goals it is important to have a clear understanding of the nature of the hip pathology. Knowing if the hip pathology was related more to an inflammatory process than to mechanical forces such as load, friction, or blunt trauma is useful information in planning treatment interventions to restore mobility and strength.4 Learning of the presence and extent of articular cartilage involvement is essential for exercise progression and for setting realistic functional outcomes. Patients with a resection of a labral tear, or removal of loose bodies without evidence of articular cartilage involvement, may progress more quickly to closed kinetic chain weightbearing exercise and return more quickly to sports or to physically demanding jobs. For those with concomitant articular pathology, nonweightbearing exercises such as supine or aquatic exercise are more indicated, and a return to prior activity level may take longer. Existence of comorbidities such as lumbopelvic dysfunction, associated joint involvement, collagen disorders such as Ehler-Danlos syndrome and disease processes such as arthritis and congenital hip dyspla-sia can guide the therapist in setting realistic treatment parameters. For example, joint mobilization to restore capsular extensibility in the middle phase of treatment would be con-traindicated in a postoperative patient who had hyperlaxity resulting from Ehler-Danlos syndrome.

Other such variables as individual differences in healing time or quality, patient compliance, and motivation can impact the recovery from hip arthroscopy. For these reasons, rehabilitation phases cannot be time specific but need to be based on the presence of impairments. Achieving maximal functional outcome for the patient requires effective treatment planning based on his impairments coupled with realistic goal-setting. Good communication among the surgeon, physical therapist, trainer, and patient is essential for successful rehabilitation and will result in a higher level of patient satisfaction.

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