 
 
Rehabilitation Protocol for Hip Arthroscopy for 
Femoroacetabular Impingement 
 
This protocol is intended to guide clinicians through the post-operative course for Hip Arthroscopy for Femoroacetabular 
Impingement. This protocol is time based (dependent on tissue healing) as well as criterion based. Specific intervention 
should be based on the needs of the individual and should consider exam findings and clinical decision making. The 
timeframes for expected outcomes contained within this guideline may vary based on surgeon’s preference, additional 
procedures performed, and/or complications. If a clinician requires assistance in the progression of a post-operative 
patient, they should consult with the referring surgeon. 
The interventions included within this protocol are not intended to be an inclusive list of exercises. Therapeutic 
interventions should be included and modified based on the progress of the patient and under the discretion of the 
clinician.  
Post-Operative Considerations: 
One surgical technique that merits special consideration in post-operative rehabilitation is capsular closure. Capsular 
closure is performed to restore the normal anatomy and minimize the risk of postoperative issues with instability. With 
the capsular repair closure technique, it is necessary to protect and limit hip external rotation and extension in the early 
healing phase to protect the integrity of the repair. Capsular integrity has been correlated to improved outcomes after 
hip arthroscopy with FAI correction. Additionally, the clinician should consider whether the labrum was repaired or 
reconstructed. If the labral tissue is inadequate the surgeon may reconstruct the labrum using an autograft or allograft. 
This information can be accessed in the operative note and will impact rehabilitation. 
If the patient develops a fever, unresolving numbness/tingling, excessive drainage from the incision, uncontrolled pain 
or any other symptoms you have concerns about, the referring physician should be contacted. 
 
Procedures Performed: 
☐ Acetabuloplasty 
☐ Labral repair 
☐ Labral debridement 
☐ Labral reconstruction 
☐ Chondroplasty 
☐ Microfracture 
 
☐ Fibrin glue repair 
☐ Femoroplasty 
☐ Capsular repair 
☐ Iliopsoas Release 
☐ Endoscopic Trochanteric Bursa Excision 
☐ Endoscopic Abductor Repair 
 
Specific Case Complexity and Limitations: 
☐Primary Procedure 
☐Revision Procedure 
Comments: ___________________________________________________________________ 
 
Pace of Protocol: 
☐ROUTINE 
☐LESS-AGGRESSIVE 
Comments: ___________________________________________________________________ 
 
 
 
PHASE I: IMMEDIATE POST-OP (0-3 WEEKS AFTER SURGERY) 
Rehabilitation Goals 
• Minimize pain and inflammation   
• Protect integrity of repair   
• Avoid post-operative adhesions   
• Improve pain-free AROM/PROM within stated parameters   
• Attain non-antalgic gait with use of device and appropriate weight bearing 
• Address muscle inhibition   
• Patient demonstrates independence with initial home exercise program   
Weight Bearing 
• Partial weightbearing 20 lbs, step-to pattern, foot flat gait with crutches 
Range of Motion 
Limitations 
• Hip Flexion: 0-90 deg 
• Hip Extension: 0 degrees, no motion beyond neutral 
• Hip Abduction: 0-30 degrees 
• Hip External Rotation: 0-30 degrees 
• Hip Internal Rotation: 0-30 degrees 
Precautions/ 
Guidelines 
• No active straight leg raises 
• Avoid ambulation to fatigue or pain   
• No active hip flexion for days 0-21, hip flexion should be self-assisted for functional mobility  
• No Gr III-IV hip joint mobilization for 1st 8 weeks   
• No long axis hip distraction for first 8 weeks for labral repair  
• No long axis hip distraction for first 12 weeks for labral reconstruction   
• Avoid pain and pinching in the hip at all times 
 
Throughout rehabilitation period every effort should be made to avoid:   
• Hip flexor tendinitis 
• Synovitis of operative joint   
• Trochanteric bursitis   
• Lower back pain or sacroiliac pain 
Interventions 
Patient Education 
• Activity modification, bed mobility, positioning: 
- No crossing of legs  
- Avoid sitting for more than 30 minutes for first 2 weeks, vary position frequently 
throughout the day.  Gradually increase sitting time as tolerated after first 2 weeks. 
- Sit with hip angle less than 90 degrees by sitting on a highchair or sit slightly 
reclined  
- Prone lying 15 minutes 2-3 times per day to avoid hip flexor contracture   
- Assist operative leg when getting in/out of bed, in/out of car and for all functional 
mobility 
- Consider obtaining raised toilet seat to avoid hip flexion greater than 90 degrees 
when sitting on toilet   
 
Manual Therapy 
• Soft tissue mobilization as appropriate for quadriceps, hamstrings, TFL, gluteus medius, 
iliacus, psoas, quadratus lumborum, lumbar paraspinals. Avoid suture sites until sutures 
removed and incisions healed. 
• Joint mobilizations to lumbar spine/sacrum to address lumbosacral dysfunction as indicated  
• Gr I-II hip joint mobilizations for pain modulation as appropriate  
• Initiate small range hip circumduction and passive IR as indicated below 
 
Range of motion/Mobility 
• PROM small range hip circumduction at 70° Hip Flexion 
• PROM log rolls to internal rotation/external rotation  
 
Gait Training 
• Gait training with B axillary crutches maintaining indicated weight bearing  
 
 
• Stair training with step to pattern, maintaining indicated weight bearing with rail/assistive 
device   
 
Modalities 
• Cryotherapy as needed   
• Electrical stimulation for pain management as needed   
 
Therapeutic Exercise 
• Supine Ankle Pumps  
• Supine Quad Set  
• Supine Glute Set  
• Transversus Abdominis Activation Hooklying  
• Prone Knee Flexion  
• Passive Supine Hip Flexor Stretch  
 
Cardiovascular Exercise 
• Upright Stationary Bike  
Criteria to Progress 
• Minimal pain with ambulation   
• Non-antalgic gait with use of crutches   
• Minimal pain at rest   
• Patient able to perform exercise program without increase in baseline pain  
• Patient compliant with weight bearing, home exercise program, and activity precautions 
 
PHASE II: INTERMEDIATE POST-OP (4-6 WEEKS AFTER SURGERY) 
Rehabilitation Goals 
• Progress weight bearing as appropriate per timeline   
• Progress ROM as tolerated per protocol   
• Minimize pain and inflammation   
• Protect integrity of repair   
• Avoid post-operative adhesions   
• Improve pain-free AROM/PROM within stated parameters   
• Attain non-antalgic gait with use of device and appropriate weight bearing 
• Address muscle inhibition   
• Patient demonstrates independence with initial home exercise program   
Weight Bearing 
• Gradually increase weight bearing to WBAT pain-free 
Range of Motion 
Limitations 
• Flexion: gradually increase in pain free manner 
• Extension: 0 -10 degrees 
• Abduction: 0-45 degrees 
• External Rotation: 0-45 degrees 
• Internal Rotation: 0-45 degrees 
Precautions/Guidelin
es 
• No active straight leg raises for 8 weeks  
• No Gr III-IV hip joint mobilization for 1st 6 weeks   
• No long axis hip distraction for first 8 weeks for labral repair  
• No long axis hip distraction for first 12 weeks for labral reconstruction   
• Avoid pain and pinching in the hip at all times   
• Avoid functional activities that cause hip pain 
Additional 
Interventions 
*Continue with Phase I 
interventions 
Manual Therapy 
• Soft tissue mobilization as appropriate per earlier phases  
• Joint mobilizations to lumbar spine/sacrum to address lumbosacral dysfunction as indicated   
• Gr I-II hip joint mobilizations as appropriate   
• Scar mobilization to portal scars as appropriate   
• PROM small range hip circumduction at 70 degrees flexion   
• PROM log rolls to internal rotation/external rotation  
• PROM all motions within allowed ROM 
 
 
 
 
Gait Training 
• Increase to weightbearing as tolerated with bilateral axillary crutches and normalize gait 
pattern. Avoid contralateral pelvic drop. 
• As tolerated decrease to single crutch and normalize gait pattern.   
• Wean from crutches by 6-8 weeks as tolerated.   
 
Modalities 
• Cryotherapy as needed  
• Electrical stimulation for pain management as needed   
 
Therapeutic Exercise 
Continuation of Phase 1 Exercises as deemed appropriate by treating physical therapist 
• Quadruped Rocking   
• Hip rotations on stool IR/ER 
• Prone B hip IR 
• Hook-lying Lumbar Rotation (small range) 
• Hip ABD/ADD Isometrics Hook-lying   
• Hook-lying Gluteal Set 
• Standing Knee Flexion   
• Quadruped Hip Extension Knee Slides for Operative Leg w/TrA Activation 
• Quadruped ‘Cat and Camel’ Exercise 
• Supine Modified Thomas Stretch (operative leg straight) 
• Sidelying Piriformis Stretch   
• Bilateral Bridging 
• Standing Hip Abduction 
• Quadruped Hip Extension for Operative Leg 
• Standing Hip Extension to Neutral 
• Counter Plank   
• Single Leg Balance   
• Sidelying Clamshell in Neutral   
• Hip Internal Rotation Prone with Resistance   
 
 
Cardiovascular Exercise 
• Upright bike up to 20 minutes, 2 x per day with seat slightly elevated to minimize excessive 
hip flexion, no resistance 
 
Criteria to Progress 
• ROM within functional limits  
• Ascend/descend 8-inch step with good pelvic control  
• Good pelvic control during single-limb stance  
• Normalized gait without an assistive device  
• No joint inflammation, muscular irritation, or pain  
• Good neuromuscular control and optimal muscle firing patterns 
 
PHASE III: LATE POST-OP (7-12 WEEKS AFTER SURGERY) 
Rehabilitation Goals 
• Performance of exercise program without hip pain   
• Normalize hip ROM through appropriate ROM progression as outlined  
• Good activation of hip musculature without evidence of muscle inhibition   
• Normalized soft tissue of hip and lumbopelvic region   
• Normal gait without evidence of gait deviations   
Weight Bearing 
• 6-8 weeks post-op: Gradually wean from crutches, decrease to single crutch, then without 
device as tolerated 
Range of Motion 
• Continue to increase hip flexion gradually in a pain-free manner 
• Increase hip extension, abduction, external rotation, and internal rotation ROM to full as 
tolerated 
 
 
Precautions/Guidelin
es 
• No extreme combined ROM (e.g. flexion/IR, flexion/ER)  
• No plyometrics  
• No running   
• No squatting below 90 degrees   
• Avoid painful ROM  
• No pivoting on operative leg   
• Avoid extreme combined hip ROM   
• Avoid symptom provocation during ambulation, ADLs, or therapeutic exercise and avoid 
post-activity soreness    
• Avoid pinching in operative hip with range of motion exercises   
 
Additional 
Interventions 
*Continue with Phase I-
II Interventions  
Manual Therapy 
• Soft tissue mobilization per earlier phases  
• Joint mobilizations to lumbar spine/sacrum to address lumbosacral dysfunction as indicated   
• Gr III-IV hip joint mobilization as needed to address joint hypomobility   
• Long axis hip distraction if needed beginning at 8 weeks for labral repair  
• No long axis hip distraction for first 12 weeks for labral reconstruction   
• PROM small range hip circumduction at 70 degrees flexion   
• PROM log rolls to external and internal rotation  
• PROM all motions within allowed ROM 
 
Gait Training 
• Normalize gait without device.   
• If patient has pain with ambulation continue to use 1 crutch and wean as tolerated 
 
Modalities 
• Cryotherapy as needed   
• Electrical stimulation for pain management as needed.   
 
Therapeutic Exercise 
• Sidelying Hip Abduction 
• Bridge with Aternating Leg Extension  
• Side Plank- modified (knees/forearm) 
• Modified Plank (knees/forearms) 
• Quadruped Alternating Leg Extension (progress to opposite arm/leg as tolerated) 
• Partial Range Squats (gradually increase to 90 degree squats) 
• Prone Hip Extension 
• Single Leg Forward Weight Shifts (progressing to Romanian dead lift) 
• Lateral Band Walk 
• Backwards Monster Walk with Band 
• Banded Hip Clamshell 
• Single Leg Balance with Clock Taps 
• Single Leg Balance with Hip ABD and Band Resistance 
• Single Leg Balance with Hip Ext and Band Resistance 
• Paloff Press   
• Standing IT Band Stretch 
 
Cardiovascular Exercise:  
• Upright stationary bicycle: gradually increase time and resistance as tolerated   
• Elliptical training: pedaling forward and backward if pain-free, gradually increase time and 
resistance as tolerated   
• Swimming: initiate flutter kick as tolerated, avoid frog kicking 
 
 
Criteria to Progress 
• ROM within normal limits pain-free  
• Alternate Ascend/Descend 8-inch step with good pelvic control no UE support  
• Good pelvic control during single-limb stance and dynamic balance  
• Normalized gait pain-free without an assistive device  
• No Pain at rest, ADL/IADL nor walking  
• Strength of operative hip 75% of contralateral hip   
• No joint inflammation, muscular irritation, or pain  
• Good neuromuscular control and optimal muscle firing patterns 
 
 
PHASE IV: TRANSITIONAL (12+ WEEKS AFTER SURGERY) 
Rehabilitation Goals 
• Independent home exercise program  
• Optimize ROM  
• >=4/5 LE strength, >=4/5 trunk strength  
• Improved dynamic balance  
• Pain-free ADL  
• Pain-free hip flexion with ADLs and functional mobility   
Range of Motion 
• If full hip ROM still not attained, continue to progress as tolerated 
Precautions/Guidelin
es 
• No extreme combined ROM (e.g. flexion/IR, flexion/ER)  
• No plyometrics  
• No running   
• No squatting below 90 degrees   
• Avoid painful ROM  
• Avoid extreme combined hip ROM   
• No symptom provocation during ambulation, ADLs, or therapeutic exercise   
• Avoid pinching in operative hip with range of motion exercises   
Additional 
Interventions 
*Continue with Phase I-
III interventions 
Manual Therapy 
• Soft tissue mobilization as appropriate per earlier phases 
• Joint mobilizations to lumbar spine/sacrum to address lumbosacral dysfunction as indicated  
• Gr III-IV hip joint mobilization as needed to address joint hypomobility  
• Long axis hip distraction if needed  
 
Modalities 
• Cryotherapy as needed   
• Electrical stimulation for pain management as needed   
 
Therapeutic Exercise 
• Progressive lower extremity and core exercises- progress exercises from prior phases by 
increasing challenge and resistance   
• Advanced balance exercises as appropriate for sport or desired recreation 
• Sport specific plyometrics and agility exercises as appropriate   
• Progress core strengthening as deemed appropriate by therapist   
 
Cardiovascular Exercise 
• Upright stationary bicycle: gradually increase time and resistance as tolerated   
• Elliptical training: pedaling forward and backward if pain-free, gradually increase time and 
resistance as tolerated   
• Swimming: initiate flutter kick as tolerated, avoid frog kicking 
Criteria to Progress 
• Y Balance Test Limb symmetry index 80% of uninvolved side   
• Strength of operative hip 90% of uninvolved side   
• Perform progressed exercise program without pain   
• No joint inflammation, muscular irritation, or pain 
 
PHASE V: EARLY RETURN TO SPORT (4 MONTHS AFTER SURGERY) 
 
 
Rehabilitation Goals 
Please note: Individuals who do not engage in higher level activities may not need to progress to 
advanced and sport specific activities. 
 
• Progress to sport specific training without pain  
• Progress to jogging pain free when cleared by surgeon  
• Independent home exercise program  
• Optimize ROM •5/5 LE strength, >=4/5 trunk strength  
• Normal Muscle Length of B LE   
• Good, dynamic unilateral balance of operative extremity   
• Pain-free with all activities 
Precautions/Guidelin
es 
• Avoid pain in hip joint with functional activities or exercises   
• If post-exercise joint pain or limping occurs, activity level should be decreased   
• Avoid joint inflammation   
• Focus on quality of movement and exercise   
Additional 
Interventions 
*Continue with Phase II-
IV interventions 
Manual Therapy 
• Soft tissue mobilization as appropriate for per earlier phases 
• Joint mobilizations to lumbar spine/sacrum to address lumbosacral dysfunction as indicated  
• Gr III-IV hip joint mobilization as needed to address joint hypomobility  
• Long axis hip distraction as needed for labral repair or reconstruction   
 
Modalities 
• Cryotherapy as needed   
• Electrical stimulation for pain management as needed   
 
Therapeutic Exercise 
• Progress strength, proprioception, dynamic balance, agility, and power to address sport 
specific demands. Sport specific retraining as tolerated.   
 
Cardiovascular Exercise 
• Upright stationary bicycle: gradually increase time and resistance as tolerated   
• Elliptical training: pedaling forward and backward if pain-free, gradually increase time and 
resistance as tolerated   
• Swimming: gradually progress time and swimming strokes at tolerated   
• Jogging: initiate at 16-18 weeks as indicated by referring surgeon and patient status 
Criteria for Discharge  
• Cross over triple hop for distance 90% of uninvolved side   
• Y Balance Test Limb symmetry index 80% of uninvolved side   
• Patient able to jog 30 minutes   
• Patient able to perform sport specific drills without pain   
• Good neuromuscular control and optimal muscle firing patterns 
 
Outcome Measures:   
• Hip Outcome Score (HOS) 
- If unavailable, Lower Extremity Functional Scale (LEFS) may be used 
Revised 10/2021 
 
 
Contact 
Please email MGHSportsPhysicalTherapy@partners.org with questions specific to this protocol 
 
 
References: 
 
1. 
Dippmann, C., Thorborg, K., Kraemer, O., Winge, S., Palm, H., & Hölmich, P. (2014). Hip arthroscopy with labral repair for femoroacetabular 
impingement: short-term outcomes. Knee Surgery, Sports Traumatology, Arthroscopy, 22(4), 744-749. 
 
2. 
Kuhns, B. D., Weber, A. E., Batko, B., Nho, S. J., & Stegemann, C. (2017). A four-phase physical therapy regimen for returning athletes to sport 
following hip arthroscopy for femoroacetabular impingement with routine capsular closure. International journal of sports physical therapy, 12(4), 
683.  
 
 
 
3. 
Heerey, J., Risberg, M. A., Magnus, J., Moksnes, H., Ødegaard, T., Crossley, K., & Kemp, J. L. (2018). Impairment-based rehabilitation following hip 
arthroscopy: postoperative protocol for the HIP ARThroscopy International Randomized Controlled Trial. journal of orthopaedic & sports physical 
therapy, 48(4), 336-342.  
 
4. 
Willimon, S. C., Briggs, K. K., & Philippon, M. J. (2014). Intra-articular adhesions following hip arthroscopy: a risk factor analysis. Knee Surgery, 
Sports Traumatology, Arthroscopy, 22(4), 822-825.  
 
5. 
Enseki, K. R., & Kohlrieser, D. (2014). Rehabilitation following hip arthroscopy: an evolving process. International journal of sports physical therapy, 
9(6), 765.  
 
6. 
Enseki, K. R., Martin, R., & Kelly, B. T. (2010). Rehabilitation after arthroscopic decompression for femoroacetabular impingement. Clinics in sports 
medicine, 29(2), 247-255. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
