Building upon baseline strength through a variety of resistive devices helps return the muscles to more normal power. Muscles also need to be trained in the range of movement where they will be used. Resistive weight training can include using machines such as the rotary hip, leg press, and calf raise. Leg pulleys or resistive band exercises are more high level, as there is less stability inherent in the position. With unilateral leg pulley or resistive band exercise, performing an isotonic contraction on one side requires a strong stabilizing contraction of the contralateral weightbearing limb. (Figure 17.17.) These hip exercises should include straight plane extension, adduction, and flexion, as well as combined movement or diagonal patterns. Single-leg stance exercises can be made more challenging and functional with activities such as lateral step-ups, step-downs, and retro-steps. (Figure 17.18.). These should be performed slowly and with good eccentric control. Forward or backward lunging often presents a challenge to the post-hip arthroscopy patient with articular wear in the anterior superior acetabular surface. However, control and full excursion of this movement are essential for higherlevel functional and sport activities. (Figure 17.19.) Other closed kinetic-chain-type exercises with the slide board or Fitter prepare the patient for return to sport, as they mimic skating and skiing, respectively.
Proximal control and trunk stability are essential to any sport or physical activity. More advanced physioball exercises, such as hip extension with the legs supported on the ball, facilitate much muscle overflow to the trunk. Push-ups, sit-ups, and double leg lifts also target the trunk musculature in a stabilizing contraction. Holding a medicine ball while performing multijoint movements such as squatting further challenges the trunk musculature while promoting balance reactions.
Plyometrics are exercises that enable a muscle to generate explosive power by utilizing the stretch-shortening cycle of muscle contraction. They begin with a rapid stretch or eccentric contraction that increases muscle tension and facilitates the subsequent concentric contraction of the targeted muscle group. This type of training begins with simple activities such as walking or running, and then progresses to hopping and jumping bilaterally, then unilaterally. Due to the high physi ological demand of plyometric training, this should be performed only one to three sessions per week with low repetition and low intensity initially.33 These activities are not recommended if the patient was diagnosed through arthroscopy with significant degenerative joint disease of the hip.
Proprioceptive training has been included in all the phases of rehabilitation. In this phase of training, more difficult activities should be introduced. Standing-on such devices as balance boards, wobble boards, and mini trampolines while performing squats or upper extremity exercise further challenges the patient's neuromuscular system. Dynamic joint stabilization exercises, such as diagonal lunging or reaching, create self-perturbations of balance. Agility training programs such as backwards running, lateral stepping, cutting, and pivoting and stopping movements will further train the patient to return to their sport or functional activity.34
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