Table 2.

Four phase rehabilitation program.

Phases of Rehabilitation
Phase T: Initial	Focus: protect the repaired tissue, restore ROM, control pain & inflammation, and restore neuromuscular control.17–20, 22
	Criteria for Phase IT: full weight bearing, minimal pain with phase T activity. ROM > 75% of the uninvolved side, and proper muscle firing patterns.17–19
	Precautions: avoid hip flexor pain and follow ROM & weight bearing restriction.19
	Range of Motion: upright bike riding, ankle pumps, towel slides, prone lying, quadruped rocking, and standing IR/ER with chair.
	Strengthening: isometrics for the hip and leg (e.g. Quad sets, hamstring sets), resisted prone TR/ER, three way leg raises (abduction, adduction, and hip extension), sidelying clams, double leg bridges, and leg press.
	Stretching: gluteals. hamstrings, and piriformis, hip flexor & adductor stretching began at 4 weeks.
	Manual Therapy: passive range of motion and joint mobilization began at 5 weeks
	Home Program: daily prone lying and passive range of motion.
Phase II: Intermediate	Focus: protect the repaired tissue, restore ROM, restore a normal gait pattern, and progressively increase muscle strength.17–19,22
	Criteria for Phase III: pain-free gait, full ROM, hip flexion strength >60% of the uninvolved side, all other hip motion (abd, add, ext, IR, ER) strength >70%.17–19
	Precautions: avoid forceful or ballistic stretching, no treadmill, and prevent hip flexor and joint irritation.19
	Range of Motion: phase I activity
	Strengthening: phase I activity with the addition of closed kinetic chain (CKC) exercises which included: bilateral squats, side stepping, and ¼ lunges (sagittal & frontal plane).
	Abdominal Core: basic core strengthening (e.g. planks) exercises.
	Stretching: phase 1 stretching continued with the addition of self-myofascial release with the foam roll
	Cardiovascular: elliptical & stationary bicycle
	Manual Therapy: passive range of motion and joint mobilization
	Home Program: phases I & II activity and the addition of cardiovascular conditioning with the elliptical and stationary bike.
	Phases of Rehabilitation
Phase III: Advanced	Focus: further restore muscular endurance & strength, improve cardiovascular endurance, and optimize neuromuscular control, balance, and proprioception.17–19,22
	Criteria for Phase IV: hip flexion strength >70% of the uninvolved side, all other hip motion fabd, add, ext, IR, ER) strength >80% of the uninvolved side, cardiovascular fitness equal to pre-injury level, and ability to participate in controlled initial agility drills.17–19
	Precautions: avoid forceful or ballistic stretching, no treadmill, prevent hit) flexor and joint irritation, and avoid contact sports.19
	Range of Motion: phases I & II activity
	Strengthening: phase 11 activity with the addition of multidirectional closed kinetic chain (CKC) exercises and basic movements on the TRX© suspension training system were introduced including (e.g. single leg squats, side lunges).
	Abdominal Core: progressive core exercises using the TRX© suspension training system (e.g. suspended planks, gluteal bridges).
	Stretching: basic stretching and self-myofascial release techniques were continued with emphasis on the rectus femoris, hip flexors, tensor fascia lata, and adductors.
	Cardiovascular: elliptical & stationary bike
	Manual Therapy: passive range of motion and joint mobilization
	Home Program: phases I to III activity, continue cardiovascular conditioning with the elliptical and stationary bike.
Phase IV: Sports Specific	Focus: for the patient to work towards returning to competition.17–19,22
	Criteria for Phase IV: hip flexion strength >85% of the uninvolved side, full pain-free ROM. ability to perform sports specific drills at full speed, and successful completion of any sports related testing.17–19
	Precautions: pain free activity
	Range of Motion: phases I to III activity as needed.
	Strengthening: phases 1 to 111 activity as needed. Begin sports specific activity including low level plyometrics, multi-directional agility drills, and circuit training.
	Abdominal Core: advanced core strengthening exercises on the TRX© (e.g. mountain climbers).
	Stretching: phases I to III activity as needed with the addition of a dynamic warm-up.
	Cardiovascular: elliptical, stationary bike, & progressive jogging (12 weeks)
	Manual Therapy: passive range of motion and joint mobilization as needed.
	Home Program: phases I to III activity and the introduction of jogging for cardiovascular conditioning.