Gluteus Medius Tendon Repair: SMOG protocol

Week 0-4
• Touch-down weight-bearing (TDWB) with crutches (or walker).
• Rest
• Ice
• Pain management
• Bike for10-20 min/day when comfortable/as tolerated
– Start with 10 minutes, add 1-2 minutes/day
• Hip Brace to be worn when ambulatory x 3-4 weeks
• Hip Passive Range of Motion (PROM)
– Hip flexion to 90 degrees, abduction as tolerated
– NO ACTIVE ABDUCTION and INTERNAL ROTATION!
– No passive external rotation or adduction for 6 weeks!
• Quadruped rocking for hip flexion
• Hip isometrics
– Extension, adduction, external rotation at 2 weeks
• Hamstring isometrics
• Pelvic tilts
• Neuromuscular Stim to quads with SAQ

Week 4-6
• Continue with previous therapy exercises
• Gait training, wean from crutches
• Progress with passive hip flexion greater than 90 degrees
• Supine bridges
• Isotonic adduction
• Progress with core strengthening (avoid hip flexor tendonitis)
• Progress with hip strengthening
– Start isometric sub max pain free hip flexion
• Quadriceps strengthening
• Aqua therapy in shallow end of water and/or ALTER G machine

Week 6-8
• Continue with previous therapy exercises
• Gait training
– Work on normalizing gait
– Increase WB to 100% by 8 wks with crutches
• Progress with ROM
– Passive hip external rotation (ER) /internal rotation (IR)
• Supine log rolling stool rotation Standing on BAPS
– Hip Joint mobs with mobilization belt (if needed)
• Lateral and inferior with rotation
– Prone posterior – anterior glides with rotation
• Progress with core strengthening (avoid hip flexor tendonitis)

Week 8-10
• Continue previous therapy exercises
• Wean off crutches (2 1 0)
• Progressive hip ROM
• Progress strengthening LE
• Hip isometrics for abduction and progress to isotonics
• Leg press (bilateral LE)
• Isokinetics: knee flexion/extension
• Progress core strengthening
• Begin proprioception/balance
• Balance board and single leg stance
• Bilateral cable column rotations
• Elliptical

Week 10-12
• Continue with previous therapy exercises
• Progressive hip ROM
• Progressive LE and core strengthening
• Hip PREs and hip machine
• Unilateral Leg press
• Unilateral cable column rotations
• Hip Hiking
• Step downs
• Hip flexor, glute/piriformis, and It-band Stretching – manual and self
• Progress balance and proprioception
– BilateralUnilateral Foam Dynadisc
– Treadmill side stepping from level surface holding on, progressing to inclines
– Side stepping with theraband
• Hip hiking on stairmaster (week 12)

Week >12
• Progressive hip ROM and stretching
• Progressive LE and core strengthening
• Endurance activities around the hip
• Dynamic balance activities
• Treadmill running program
• Sport specific agility drills and plyometrics