The Use of Manual Therapy Post Hip Arthroscopy When an Exercise Based Therapy Approach Has Failed

Despite a growing body of literature on surgical intervention as well as post-surgical rehabilitation of acetabular labral repairs and femoroacetabular impingement (FAI), there is a paucity of information on how to manage patients with lack of progress post-surgery. A 30 year old female underwent surgical labral repair with FAI osteochondroplasty. Post-surgery, she was initially treated with an exercise-based approach, but experienced an increase in hip pain and further decline in function. Her primary functional deficits were difficulty standing and pain (6/10) with ambulation. A combination of soft tissue mobilization and trigger point dry needling were administered to address perceived muscle dysfunction and non-thrust manipulation to address perceived hip joint hypomobility. After 12 therapy sessions over 120 days, the patient returned to her demanding occupation with very few residual symptoms. By the end of the period of care, the Harris Hip Score had improved from 56 to 96 and the lower extremity functional scale from 26 to 70.

This case describes a multimodal manual therapy approach administered to improve outcomes of a patient post labral repair with FAI decompression who did not respond to an initial exercise-based post-surgical rehabilitation approach.