Return to Sports following Hip Arthroscopy for FAI

The return to sports after hip arthroscopy for FAI can be challenging for professional and recreational athletes. Regardless of the athlete, all rehabilitation begins with a well-structured physical therapy program. Here at Midwest Orthopaedics, we use a 5-phase rehabilitation protocol. Each phase is carefully structured and designed by Dr. Chahla and his team of physical therapists to advance patients based on milestones. This allows patients to advance when they are functionally ready rather than at non-specific set time points. The major goal of this initial phase of therapy is to restore daily function and pain free living.

When a patient has completed this initial phase of rehabilitation, they are ready to begin sport specific training with the end goal of returning to sports. While Dr. Chahla works with athletes of all sports, runners, cyclers, and swimmers are among the most common patients he treats with hip arthroscopy.

Running

The high levels of force experienced at the hip joint during running can make recovery more challenging. Despite this, the most recent research would suggest that nearly 80% of all athletes are able to return to running. A typical return to running program begins with pain free walking at an aggressive pace (>3.5 miles/hour) on a treadmill. Throughout the program, patients should work on strength maintenance exercises including the single leg squat reach, supine bridge, and band walks. As patients demonstrate pain-free functional ability, they can progress to a supervised plyometric training regimen. Critical drills include ladder drills and dot hops. As patients progress, they can utilize higher level plyometric exercises like grapevines and boxer shuffles. The next phase of running-specific training is a return to distance running. Patients will work with their therapy team to establish a baseline or distance they can run pain free and run again at 48 hours later. Patients should gradually increase their frequency until they can run this distance daily. At this point, they have graduated the program and are ready to increase speed, distance, or add hill work.

Cycling

Like running, cycling athletes frequently have pain related to femoroacetabular impingement. After graduating from the typical 5-phase protocol, cycling athletes are ready to begin sport specific training and start the process of returning to cycling. Because cycling places a significantly reduced weight on patients hips relative to running, these athletes tend to do better after hip arthroscopy. Studies have shown a return to cycling as high as 97% with 59% of patients achieving a higher level of performance after surgery. Like the protocol outlined above, strengthening exercises like band walks are an important component of rehabilitation and should consistently be performed.

A typical cycling specific program begins with a stationary bike. Patients are asked to cycle for 30 minutes straight without pain. If they can demonstrate this, then they are ready to begin road cycling. During this period, patients are asked to gradually increase distance and intensity. It is critical that athletes push themselves only when they are pain free in their hip. By working closely with their therapy team, athletes are able to progress at the fastest and safest possible pace.

At approximately 10 weeks, athletes can begin working with their physical therapy team for a structured resistance program using sit/stand drills. By 12 weeks, patients typically graduate to the next phase of cycling specific training. Athletes are now ready to begin positioning with aerobars or drops before working on single leg peddle drills and/or upper body freeze drills. As the athlete continues to progress with their therapy team, they will likely be cycling at the same or higher level by 4-5 months after surgery.

Swimming

Compared to running and cycling, swimming athletes tend to have the highest level of recovery after hip arthroscopy. The most recent research suggests nearly 100% of swimming athletes return to the activity and 54% perform at a higher level after surgery. Like all patients, the return to swimming begins with a standardized 5-phase protocol. After which, sport specific training begins. Throughout sport specific rehabilitation, foundational strengthening exercises like the single leg squat reach are critical. There is an initial emphasis on stroke technique. As athletes work closely with their therapy team in the pool, they will gradually work on progressive yardage advancement. There is a focus on conditioning and endurance over speed. As patients push themselves, their therapy team will work to prevent any technique maladaptation. The return to swimming is highly dependent on the patient’s goals, and therapy teams will generate unique programs based on a given patient’s swimming specialty. This will lead to specialty specific interval training, kicks, and drills.

Psychology of Recovery

Psychological readiness is the most critical component to a successful return to sports. Research has indicated that readiness is the factor that is most directly related to a return to pre-injury activity and performance. While a patient’s internal drive is crucial, a supportive therapy team is just as important. A strong relationship between the therapy team, the physician, and the patient is critical for optimal progress. Dr. Chahla and his team of therapists work to provide a supportive social environment and a well-structured recovery plan with clear expectations. This allows patients to flourish and reach their maximal athletic potential.