1. Postoperative Management of hip fractures  Severe, persistent groin, thigh  knee pain that increases with limb movement or weight bearing  progressive limb length inequality  Persistent external rotation of the operated limb  A positive Trendelenburg sign during weight bearing Signs and Symptoms of Possible Failure of the Internal Fixation Mechanism

2. Postoperative Management Exercise: Maximum Protection Phase  Prevent vascular and pulmonary complications.  Improve strength in the upper and sound lower extremities.  Prevent postoperative reflex inhibition of hip and knee musculature  Restore active mobility and dynamic control of the involved hip and adjacent joints

3. Postoperative Management Exercise: Moderate and Minimum Protection Phases  Increase flexibility of any chronically shortened  improve strength and muscular endurance in the lower extremities for functional activities.  Improve postural stability and standing balance.  increase aerobic capacity/cardiopulmonary endurance

4. PAINFUL HIP SYNDROMES/ OVERUSE SYNDROMES: NONOPERATIVE MANAGEMENT Related Pathologies and Etiology of Symptoms Tendinitis or Muscle Pull Trochanteric Bursitis Psoas Bursitis Ischiogluteal Bursitis (Tailor’s or Weaver’s Bottom)

5. Common Impairments and Functional Limitations/Disabilities Pain Gait deviations. Imbalance in muscle flexibility and strength. Decreased muscular endurance.

6. Management: Protection Phase Control Inflammation and Promote Healing Develop Support in Related Areas

7. Management: Controlled Motion Phase Develop a Strong Mobile Scar and Regain Flexibility. Develop a Balance in Length an Strength of the Hip Muscles. Develop Stability and Closed-Chain Function. Develop Muscle and Cardiopulmonary Endurance. Patient Education

8. Management: Return to Function Phase Progress Strength and Functional Control Return to Function

9. Exercises to Increase Mobility Accessory movements

10. Anterior Glide to Increase Hip Extension and External Rotation

11. Posterior Glide to Increase Hip Flexion & Internal Rotation

12. Mobilization with movement An inferolateral glide To increase pain-free internal rotation

13. Mobilization with movement An inferolateral glide To increase pain-free flexion

14. Mobilization with movement An inferolateral glide To increase pain-free extension

15. Mobilization with movement An inferolateral glide To increase extension during weight bearing.

16. Techniques to Flexibility Physiological Movements

17. Techniques to Stretch Range-Limiting Hip Structures To Increase Hip Extension Modified Fencer Thomas Test Stretch Stretch

18. Techniques to Stretch Range-Limiting Hip Structures Self-stretching of the adductor muscles with the hips at 90

19. Techniques to Stretch Range-Limiting Two-Joint Muscles Gluteus maximus self-stretch

20. Techniques to Stretch Range-Limiting Hip Structures Self-stretch of the rectus femoris while standin

21. Techniques to Stretch Range-Limiting Hip Structures Self-stretching the tensor fasciae latae occurs as the trunk bends away from and the pelvis shifts toward the tight side.

22. Techniques to Stretch Range-Limiting Hip Structures Tensor fasciae latae self-stretching: side-lying position

23. Strength Training

24. Resisted flexion of the hip with the knee flexed.

25. Strength Training Resisted end-range hip extension with stabilization of the pelvis.

26. Strength Training Resisted external rotation of the hip with the patient lying supine.

27. Strength Training Resisted internal rotation of the hip with the patient lying prone.

28. Strength Training Resisted hip abduction.

29. EXERCISESTO DEVELOPAND IMPROVE MUSCLE PERFORMANCE AND FUNCTIONAL CONTROL Isolated training and strengthening of the gluteus maximus.

30. EXERCISESTO DEVELOPAND IMPROVE MUSCLE PERFORMANCE AND FUNCTIONAL CONTROL Training and strengthening the hip adductors.

31. Closed-Chain Weight-Bearing Exercises Training the hip abductor and hiker muscles for frontal plane strenthening and stability.

32. Closed-Chain Weight-Bearing Exercises Closed-chain exercise with elastic resistance around the opposite leg

33. Closed-Chain Weight-Bearing Exercises Training and strengthening the hip extensor muscles using bridging exercises.

34. Closed-Chain Weight-Bearing Exercises Lunge with cane assistance to develop balance and control for lowering body weight.

35. Closed-Chain Weight-Bearing Exercises Wall slides/partial squats to develop eccentric control of body weight.

36. Closed-Chain Weight-Bearing Exercises Resisted walking using a large elastic resistance band secured around the pelvis.