T Nation

Rehab of Hip Impingement Surgery


#1

Hi guys. Got this thing

I had a hip surgery cause of a impingment, and i am starting now to rehab this cause i cant even walk without sticks.

So my goal is first to MOVE again, then i like to train again. My main goals is to do the main moves again sqauts, deads etc. Plus i need alot of hypertrophy on my whole body cause of muscle loss, especially on my post-surgery left leg. My quad just seems to disapear.

How should i start this rehab, do you have any tips on how to correct those imbalances?

Right now i am just re-learning to walk.

My goal is to start a 5/3/1 routine again without any more problems.
Maybe the coaches here have some good advices.

Thx


#2

How long ago did you have the surgery? If it's less than 2 weeks, you whouldn't even be bearing weight on that leg.


#3

I had my surgery on dezember 8th, now i have my transission from walking with stick to walking to my own


#4

Be patient. It will take time. Strength will come back relatively quickly, focus on doing your physical therapy and regaining motion. After that, then worry about addressing your goal of doing 5/3/1.

I had a hip impingement surgery 2 years ago and I can't, and don't ever expect to, perform deadlifts or squats again as they cause me pain. That is my unique situation though, and my doctor is surprised I cannot do them pain free despite many hours a day doing my physical therapy.

For imbalances, do some single leg work when you get back to training. One legged leg press, lunges, extensions, leg curls, everything. And do 2 leg stuff also, but the 1 leg stuff will help you assess your strength levels. Start light, don't worry about getting back to your old maxes. It will come in time, if your lifting some days and your hip/leg feels "off" don't try and push through and go for a PR just because "you want to be strong again".


#5

Hey mate,

First off what physio are you doing? Your main goals at the moment are to increase active (unassisted) ROM and to re-establish joint position and neuromuscular control whilst managing pain and inflammation. You also want to be performing some form of proprioception. Hopefully you are doing all of this already.
Once you have progressed with your rehab you need to focus on stabilising the hip joint and improving your ROM at the hip. You'll need to do lots of soft tissue work and lots of glute max, glute med and trunk stability work. I'd also recommend doing some VMO and hamstring stuff to help maintain the position of the femur. You should be doing your rehab stuff 3 times per day, every day, no matter what stage you're in. If you do everything right you should be able to recover and squat and deadlift again easily. Elite athletes have FAI surgery regularly and return to competition no dramas, you just have to apply yourself to doing the right rehab.
In regards to training I recommend you start with a higher rep accumulation phase before operating with the higher intensities as present in 5/3/1. This will help you re-establish your neural and movement patterns and also promote hypertrophy. You could start with regressions of squats and deadlifts or exercises you can perform pain free and confidently that benefit these movements. You can address your imbalances through uni-lateral exercises but your main focus should be to improve the integrity and stability of your hip joint and re-establishing neuromuscular control, this will massively benefit both your structural balance and progress.

All the best


#6

staystrong, this makes me both worried and relieved. I'm just over 8months post-op with more external rotation, and hip flexion then I have had since I first started feeling symptoms (about 4 years ago). I still have pain in the deepest and most extreme ranges of motion (like deep squats) and this does present an issue because my chosen endeavor is Olympic Weightlifting. For awhile I was afraid I had messed up my physical therapy, or re-injured my labrum, even went so far as to get a follow up MRI with contrast. If it is not unheard of to still have pain despite everything looking fairly normal, then I am at least marginally happy with my results, even if I may never be able to catch a snatch like one of the Asian lifters.


#7

My doctor, before the surgery, made me optimistic I would be squatting, deadlifting, and power cleaning like normal about a year after the surgery. He also figured (and logically I did too) that I would gain SOME internal rotation since my IR was about 0 prior to the surgery. I gained none of it back. I don't expect to squat or deadlift ever, though maybe trap bar deadlift. I've found whether a exercise is "good" or not for my hip almost always boils down to hip hinge angle, meaning squats and deadlifts where your back is flat/arched and hips hinge always cause pain. I can do leg presses on certain leg press machines but not others, so most of my work is 1 leg because it seems like less stress is placed on my hip. Not 100% sure why, maybe just lighter weights?

I've met another person that was post-op and similar results as mine. Hip hurts randomly some days for the first 1-1.5 years, can't do full range of motion exercises like squats without pain. My theory is either scar tissue or more likely missing cartilage, since some cartilage was removed in my case. My physical therapist mentioned the recovery for the surgery is easily over a year, not the 6 months a doctor says. He had a classmate with the surgery done and said it took almost 2 years to be normal. I'm still occasionally trying to figure out how to "loosen" up my hip and get back some internal rotation, but I'm fairly sure it's a capsule issue and I haven't had much luck there.

I too thought I re-injured my labrum, I had a scary lifting accident about 4-6 weeks post-op (tried benching, got stuck, stood up with the weight from a full squat) that caused some discomfort in my hip for a week. And maybe I did re-injure it, I have no idea and there's not a great way to tell since they removed some cartilage during the surgery. But from reading online, there is a signficant number of people who have the same issue for many years after the surgery. There is also some that report great results, but I don't know which is the majority to be honest.

If you're like me, you'll have some days your hip is sore from working out. Or maybe it just hurts some when you go to lift. Either case, be smart about it. Taking a day off from what you planned to do and doing something else won't ruin your progress and it'll make your hip much happier.


#8

Yeah, that's about what I've figured. It you ever get a chance to get ahold of some monster bands, get some and try some hip distraction. That always makes my hip feel better if it's aching or feels like it's grinding.

I definitely have more range of motion than prior to the surgery, its just that not all of it is pain free.


#9

I'll look into the monster bands. A question though, where do you attach the bands around your house so that you can do the dislocates? Looking around my place I'm not sure there's spots that can handle that kind of force regularly without damaging it.

Right now I'm in another phase of tying to see if I can do front squats again somehow. Not having much success, but I do miss squatting a lot. I'm wondering if the distractions could help so I figure id look into it.


#10

Luckily, the gym i work and train at has a salmon ladder rig bolted into the ground and wall that we all use for mobility/rehab stuff. I am looking to start doing it sometimes at home, and I have a railing I can try to attach to. Or the base of my toilet.