Hip Arthroscopy Rehab

Hip arthroscopy is a minimally invasive surgery, and that can create the impression that recovery is quick. The incisions are small; the work inside the joint is not. A repaired labrum needs weeks of protection while it heals to bone, reshaped bone needs time before it is loaded hard, and the muscles around the hip, especially the deep rotators and glutes, shut down after surgery and have to be deliberately rebuilt.

The other thing that makes this rehab distinct is how much it depends on the specific procedure. A labral repair, a cam resection, a capsular closure, and a microfracture each carry different restrictions. Your surgeon's protocol is the starting point for everything I do, and I coordinate with their office so you are never getting two different sets of rules.

Phase one, roughly the first two to four weeks depending on the procedure: protect the repair. Partial weight-bearing on crutches as prescribed, range of motion within the limits set by your surgeon (deep flexion and external rotation are typically restricted early after a labral repair), stationary biking without resistance to keep the joint moving, and muscle activation work for the glutes and trunk. Managing swelling and preventing the hip flexors from locking down are the daily priorities.

Phase two, roughly weeks four to eight: restore normal walking and build the base. Crutches come off when you can walk without a limp. Range progresses toward full. Strength work starts in earnest: bridges, hip abduction and rotation, leg press in a protected range, and trunk work. You move on when gait is normal, range is close to full, and pain is settled.

Phase three, roughly months two to four: strength and control. Squats and lunges progress in depth and load, single-leg work builds, and we address the movement patterns that loaded the hip before surgery. Phase four, roughly months four to six or beyond: running, cutting, jumping, and sport-specific work, each introduced on criteria. Return to sport is typically somewhere in the four-to-six-month range and later for microfracture or more complex procedures, but I clear it on strength, control, and symptom-free sport drills, not on the calendar.

Hip flexor irritation is the most common early setback. After arthroscopy the iliopsoas often gets irritable, and pushing straight-leg raises or aggressive flexion work too early makes it worse. I program around it deliberately.

The second is losing range because of guarding. A hip that is protected too cautiously for too long gets stiff, and stiffness after arthroscopy is hard to win back. The balance between protecting the repair and keeping the joint moving is the art of the early phase.

The third is skipping the strength phase. Most people feel good by month two and want to run. Running on a hip that has not rebuilt its rotators and glutes is how people end up with the same pinch they had before surgery.

Ideally I see you within the first week or two after surgery, or before it if you want a head start. We go through your operative report and your surgeon's protocol together, then take a baseline: range within your restrictions, muscle activation, swelling, and how you are moving on crutches. You leave with a clear list of what you can do this week, what you cannot yet, and the exact exercises to start.

If you are further out from surgery and feel stuck, the first session is a full assessment of where your hip actually is compared to where it should be at that stage, and a plan to close the gap.

A full hour, one-on-one, every visit. Early sessions are a mix of hands-on care for swelling and guarding, guided range of motion, and activation work, with a short home program that changes as you progress. As you move through the phases, sessions shift toward loaded strength, single-leg control, and eventually running and sport drills, with retesting at each transition.

Between sessions you have direct messaging access, which matters most in the early weeks when small questions come up daily. And because I work with your surgeon's timeline, you never have to reconcile conflicting advice.

Not just a hip that healed. A hip that is stronger, better controlled, and more resilient than the one that needed surgery, with the movement patterns that loaded it in the first place addressed so you are not back in a few years. That is what a well-run rehab delivers, and it is worth doing properly.