I'll introduce myself again. My name's Amanda Gentile, and I'm a physical therapist at the American Hip Institute. I've been specializing in hips for the past five years. So for this presentation, I'm gonna talk to you about how physical therapy works post hip arthroscopy. So I hope you enjoy. I wanted to start this presentation off talking about teamwork and how important the team based approach is to treating patients post operatively. Without one or the other, you're not gonna get the results that we're looking for. So it's just really exciting how we're kind of bringing all of this together, the doctor side of things, the PT side of things, and hopefully providing some clarity on how to kind of best practices for treating our patients post hip scope. So as my kids always say, teamwork makes the dream work. So I hope you find some of this informative. So when it comes to physical therapy and treating a complicated surgical procedure like hip arthroscopy, it's very beneficial for a doctor to make a protocol. It helps the physical therapist really understand what your goals are for movement patterns based off of your knowledge of healing, what you kind of did inside that hip, and gives us a guidance of kind of the do's and don'ts from a general movement pattern or kind of a general movement plan, if you will. And then we kind of fill in the gaps from there. So at AHI, we use a five phase rehab protocol. We have the immediate rehab, day after surgery, end of week two, transitional week three to end of week six, intermediate week seven to the end of week nine, advanced week 10 to the end of week 12, and then sports specific, the greater than 12 weeks. And kind of after that, really, sky's the limit, again, for PT, because it really becomes about, okay, now what does the body say it needs? Listening to the body, whereas the first five phases are about understanding the healing processes of the tissues that were worked on in surgery and making sure we're giving them time to heal. Once we kind of know that's behind us, then we can just start listening to really more the muscles and working through what the muscles need. So we're going to kind of go into the different phases of rehab and what to expect out of each one when I'm working with my patients. So when we're first starting PT, for my patients, they are starting physical therapy 24 to 48 hours after surgery. When I'm doing my preoperative education and we talk about this, patients can seem a little surprised, but it's always about talking about starting off on the right foot, okay? It's not an expectation that, oh my gosh, we're going to start working out, things are going to go crazy. It's really about a nice little check-in for the patient. Are you using the crutches appropriately? How's that brace going if you have one? How's your pain management going? Let's get you started off on the right foot and making sure that you get what you need, not just kind of, again, that general expectation of things you should start to do. So seeing patients 24 to 48 hours. For our patients, they are presenting with a hip brace. We brace for two or six weeks, depending on if the patient has a repair or reconstruction. This is the brace that we use. And there is a range of motion limitation, as well as the fact that I feel, this is kind of a personal thought, that just having something on somebody's body, whether they feel like it's restricting them or not, will kind of limit their motion and helps reduce patients from necessarily overdoing it. If you recall in my prehab presentation, I talked about kind of the bruise analogy, right? If you get a bruise, you don't touch it, it heals, no interruptions. If you accidentally bump the bruise once or twice, it doesn't feel very good, but it's still going to probably heal without any issues. If you're constantly hitting that bruise throughout each day, every day, the time it might take to heal plus how it heals could be disrupted. And that's what I kind of educate my patients on when I'm talking about the brace, when we're talking about, because we also restrict some weight bearing, is that if we're kind of hitting that bruise less, the hope is that we're healing better, you know, as fast as possibly can, and just kind of setting our hip joint up in a good environment that we can recover as quickly as possible. So we also do this kind of 20 pounds of weight bearing. So our foot is on the ground for a little bit more balance and support, but really just kind of the weight of the leg is resting through the ground, not too much compression through the joint. Again, just trying to reduce any extra activity that could cause more inflammation and irritation into that joint while it's healing. So that's how patients present to me 24 to 48 hours right after surgery. And then we'll get right into that protocol. So for immediate rehab or phase one, our main goals really are to protect and promote healing of the repaired tissues and manage symptoms, right? We are in the brace, we have modified weight bearing for at least two weeks, so we're not going crazy. We're just really trying to help the body recover, heal, and doing anything that we can to kind of help that. We try to reduce muscle tightness. When patients are in pain, they tend to tighten up. So that can just kind of cause this negative downward spiral. And we can do manual therapy, we can do some passive range of motion to help move that fluid, to help with that blood flow, to help people feel a little bit better. So again, treatment plan is really a passive range of motion within any protocol limitations, soft tissue work, symptom management. And then we usually do start with some just gentle isometric. What I tell people is kind of like that waking up of the muscles, just keeping that brain to muscle communication going. And again, this timeline is that 24 hours post-op day one through the end of week two. So we kind of maintain that first phase 21 days after surgery. So going in depth a little bit more into what that phase one treatment looks like. Like I said, it's a lot of symptom management, it's passive range of motion from the therapist it's manual therapy. We do some kind of quad and gluteal isometrics, mainly glute max, transverse abdominus activation, which there can be a handful of exercises you can use for there. And you can also do some heel slides. I am cautious with heel slides at times. I find that if a muscle is going to get irritated at this beginning phase, it's going to be the hip flexor. It tends to guard, we tend to be sitting a lot. So just, I do heel slides with a grain of salt. So if patients are doing fine, they do the heel slides, no issues, great, they're great. If I start having a patient do heel slides, they seem to be compensating, it's causing more pain, I just hold the exercise. We can do that later when the patient's not kind of in this limbo phase of not being able to put weight, not moving the right way, still recovering from healing. And then we also use a bike or a CPM or another kind of range of motion, passive range of motion machine. That patients can use at home. So they can kind of be filling in the gaps between PT sessions to just try to get that range of motion and not so much even range of motion, more as like that synovial fluid movement, right? If we don't want them really, we don't want weight bearing, we don't want to move in their hip around too much. We want to keep things calm. So it's kind of a passive way at home that they can get that synovial fluid, the nutrients into the joint. And again, just kind of promote that good healing. There's a little caveat between phase two, phase one and phase two for us is it just depends on when you can start weight bearing. So like I'd said, if you are, the patient gets a labral repair, we will discharge the brace and start weight bearing as tolerated at the start of two weeks. So in this first phase, if you had a labral repair, you could be starting some gait training, weight bearing exercises, again, kind of just more working, working your body to get used to more of that good gait pattern and start weaning off the crutches as tolerated. We go discharge brace, cold turkey, and then we wean off a crutch. So just kind of depending there, you could be starting some gait training in this phase. And if you did already watch my preoperative PT slides, then you're going to know how I feel about manual therapy. And I think it's important to note, and even in our protocol, we make kind of specific notations on the manual therapy about where to go, kind of about some general timelines, because this can be a missed opportunity for some therapists and for patients, that as you're recovering, you've just had a major surgery. The muscles get freaked out from that. Now you're recovering, but we're also kind of modifying what you can and can't do, and the muscles just want to do what they're made to do, which is activate. The joint wants to weight bear. So you can start getting some muscle compensation, some tightness, some guarding, that just some basic and simple manual therapy can go such a long way. So it's really important to start that manual therapy. Day one also helps with pain management. So just kind of put my list of go-tos here. If you remember from the preoperative stuff, I do hold dry needling until about phase three. It isn't invasive, right? It's a needle going into the skin, just had surgery, want to reduce any type of risk of possible introduction of infection, as well as dry needling can be a fairly aggressive treatment and the way your muscles respond that, in my personal opinion, kind of let the dust settle from the surgery, let your muscles wake back up, and then we'll kind of see what we're working with. So you'll see dry needling jump back into manual therapy options for phase three, but for right now, phase one kind of looks at getting that soft tissue, mobilization, trigger point release manually is completely appropriate, cupping is still good, easy on that when the tissues are sensitive, obviously avoiding any scars right away, let them heal. You can consider passive range of motion into this manual because when I put my hands on you, I'm moving, I'm assessing the movement feel, do I feel like your hip flexor is guarding, do I feel like I'm not getting that good, you know, the head of the femur and the way that it rolls and glides in the socket, is that feeling normal, you kind of get a feel for that, are we getting some pinching, again, kind of working through very limited pain range of motion, right, shouldn't be causing a lot of pain, and honestly, most of the time, the hip range of motion comes along nicely, that if you crank, in my opinion, you have a greater chance of making things more irritated and limiting your range of motion than just kind of taking it nice and easy and working through what we have, and then again, some of that instrument assisted kind of scraping that patients usually talk about, I usually would go light if I felt like I needed to do this, honestly, during this phase, I probably keep more to just that STM, that soft tissue manipulation or mobilization, and I just use my hands. So we're going into that transitional rehab phase, which is that phase two, and transitional is the name for a reason, because some of us are shifting from non-weight, or our limited weight bearing to weight bearing is tolerated, some people are actually still in the brace and have weight bearing limitations because they had that labral reconstruction, and we keep those restrictions going for the first six weeks, so at this phase, a lot of patients can be at a different level as they go, and again, this goes through the end of week six, so before you transition into that third phase, during this phase, everybody should start weight bearing at whatever timeline that is. So you're going to find patients at different levels during this. Our goals for transitional rehab is to restore that normal gait pattern, if able, or at least start that, if they're six weekers, before we start going into that third phase, continue to protect healing tissues, work on regaining that full hip active range, or passive and or active range of motion, if allowed, so again, if you're still in the brace, we still have those restrictions, starting to work into those more isotonic exercises, and what I tell my patients is kind of, we're trying to wake these muscles up, we're not working into hypertrophy at this phase, we're doing that neural re-ed, we're waking these muscles up, we're reinforcing good muscle patterns and trying to get rid of those compensatory patterns that most likely were developing before surgery. So again, we're focusing on that neural re-ed, any kind of hip active range of motion, active assisted range of motion exercises, gait training as appropriate, and continuing with that soft management, okay? You're going to see that throughout all of this, that some form of soft tissue management is appropriate and should be done throughout everything. Timeline is that start of week three, and going through the end of week six. You're going to start to see a pattern as I go through my slides, but again, kind of what does phase two exercise look like? We're talking about some of that neural imbalance, you know, we start with stable surfaces, double leg balance and stability, and working on progressing to a little bit of unstable or single leg, kind of as tolerated, again, you have to do what the patient is successful at doing, all right? You know, good old bird dog for core, for stability, a little bit of kind of a quadruped rock back for some range of motion, working into that hip flexion. You know, we see bridges, those more isolated, waking each individual muscle up, right? Each individual muscle needs to know what it can do and what it's capable of doing again before you take it to the functional level. So this is really for me, it's kind of the sweet spot in PT, all right? This is where we can get our most bang for our buck, especially with our patients that are two weeks in the brace and they can really start progressing in this phase. If we don't take the time here and help the body reset, if we let compensatory activation patterns go, if we don't help manage soft tissue restrictions or things that could be inhibiting functional movement patterns, or manage the pain appropriately, then when we try to go squat and lunge and run and jump and get functional again, it's not going to work, all right? We might be able to tolerate it for a little bit, but they're going to have a setback. I've seen it, I've treated patients that have seen somebody else and I've had to kind of reset expectations and it's just a lot easier to do it right from the start. So don't ignore this phase of things, even though it seems simple, it's super impactful. Work in things like hurdles for that gait retraining, talk about where the muscle activation should be, where that weight shift should start and finish. So again, another little passionate area that I have kind of seen and developed over the last five years of really working with as many HIPS as I have, that this can be very influential for the end game that the patients are looking at. So it should not be a phase that's just kind of skipped over because we're just waiting to start strengthening. So yeah, that's my little soapbox. Nothing too new here, same kind of manual treatment options as phase one and two. What I'll say here is probably my most addressed muscles that I'll see in these first two phases that need attention is iliopsoas, iliacus especially, rectus femoris, because if you think about where that rectus femoris tendon is attaching at the pelvis and where it crosses over that hip joint, it's very easy for that to guard, TFL and adductors. Those are probably the four big muscles that will guard, will restrict, it's kind of protecting that hip. And when we start to do a little bit more, if we start to get more functional, if those are still stuck and won't release, it's really going to limit you, especially if we go back to that prehab kind of presentation and talking about that posterior chain in the glutes, we see the same thing post-operatively here. Those glutes don't want to fire, that posterior chain, the hamstrings, they don't want to fire as well. And if we're trying to wake them up, but we have these tight anterior muscles, I promise you right now, the tightness will win over the activation, so we have to release the front. So at the beginning, a lot of my work is done more anteriorly, and then as we get more active and waking up muscles, I'll start to kind of hit everything. But not too much different from options for phase one, but honestly, I'll probably, phase one compared to phase two, I'm doing more manual in phase two, because we're starting to get more functional, we're starting to get more active, and I need to help those muscles know where they're supposed to be. You're supposed to be relaxed, you're supposed to be waking up, all that kind of stuff. So again, still very important to do this manual, and when and where can make or break a patient. So on to the intermediate rehab, which is considered phase three. So this is where conversations with the patient need to be had as far as the protocol and expectations, because we're going to start to see a split in patients that had the repair versus the reconstruction. If you've had the repair, you've been in phase two for the last four weeks, and you've been activating muscles, and you've been walking, and you've been strengthening, and you've been doing some balance. So most likely, you've hit the goals that are required to go to the intermediate phase once you meet that week seven timeline. If you were six weeks with the reconstruction, you've only had a week of weight bearing, a little bit of gait training, and just starting exercises. So most likely, when week seven hits, you may have hit the timeline restriction, but your muscles are most likely not ready to transition. So it's really important for the patients to understand that it's not an either or, it's an and, right? You need to hit six or seven weeks post-surgery, and then you also need to hit your muscle and range of motion goals. I do a lot of education on patients about what a protocol truly is, because a lot of patients will look at a protocol and say, I'm seven weeks post-op, why haven't I started squatting? I couldn't squat even if I tried to. So it's not about that if you're not at that timeline, or if you're not at that functional level at that time that you're behind. It's a guide for how much time the labrum, the tissue within the hip needs to heal before you can start putting a squat stress on that labrum. And then if your muscles are ready to do it, then it's appropriate. But if you've got the timeline, excuse me, if you've got the timeline, but you don't have the muscular strength or the proper muscle patterns, then guess what? We're still in phase two, and that's okay, because it's what is appropriate for your body. So just making sure that patients understand that from a protocol standpoint, it's not a bad thing. It's not trying to make you feel like you're behind. It's about just making sure we're managing the progression appropriately and bringing the two worlds together, going back to that teamwork kind of idea that it's the docs know what they did inside the hip and kind of the expectations for healing. And then we work on the muscles and bring the two together. So if you're ready to transition into the intermediate phase or phase three, we're starting to focus a little bit more on strength progression, actually looking into hypertrophying more of the muscles versus the activation patterns, initiating some squat progressions, continuing to manage that soft tissue and those symptom irritations. Very common to see kind of muscles and tissues talk back, if you will, when we start changing into different phases, because it's just something new. So we don't want to forget about our soft tissue management, the things that we can do with our hands to help manage those symptoms and continue to help those muscles and tissues recover as we continue to stress and strain them with exercises. So this is what our phase three exercise options look like. I mean, again, there's just a plethora of exercises, but we're starting that squat progression. We're working into like a step up progression. So activating those glutes, activating that posterior chain, starting in maybe some resistance training with some machines. Again, I'd love to start on the glutes first. We'll even start into like more of like an elliptical or a stepper to get a little bit more for the cardio where we've been on the bike for the last two phases. And it also promotes a little bit more of that extension, that glute firing. So getting a little bit more exciting with the exercises that we can do. Patients usually feel like they've done a little bit more, even though they've done so much work in the first two phases, this starts to become more of a normal workout. And most patients get really excited during this phase that they feel, they start to sweat a little bit. So this is a fun time for the patient and for the therapist that we can really start showing the patient that like, we're gonna get you back to the life that you wanna do. And this is really kind of that, can be that turning moment for the patient. So this is always a fun phase to start. Well, Groundhog's Day on the soft tissue treatment, except for you're gonna see that dry needling is introduced back at this phase. Again, usually now I'm starting to kind of, we're starting to push the glutes, we're starting to strengthen those muscles a little bit more so I might start addressing glute men, glute max, piriformis, external rotators, hamstring, QLs, you kind of name it to help with that recovery. Since the workout is putting a stress and strain through a muscle that may not have been firing as well as it should, before surgery we wanna make sure we're giving it some love to make sure it knows how to recover and that it just doesn't get irritated because it's doing something new. So again, sky's the limit here. Just don't forget about this soft tissue management. It's important throughout, please. So for the advanced rehab, which we consider phase four, we're continuing to progress that resistance training. Machines have a nice, it's nice because it's a more controlled environment. So a patient can kind of get that weight going but without worry about stability and body mechanics so much. So in this phase, now I'm starting to add a little bit, maybe more weight to that body weight squad, if appropriate, to start kind of building that functional stability and control as well. We're initiating some lunging sequences, we're really getting the patient back to just a good workout, right? A good resistance, a hypertrophy, a muscle activation, just what you would kind of normally think if you went to the gym and you got on the machines, that's what we're working towards, right? We're doing some cardio on the machines, we're doing resistance on the machines, doing some body weight stuff like lunges and squatting, but just kind of really setting up our muscles for the next phase, going into phase five, when we're getting a little bit more functional and dynamic going, but we wanna make sure our muscles know how to activate and they're strong enough to do those higher level things, and that's what this phase is about, okay? So we're restoring that muscle strength and endurance, progressing that cardiovascular strengthening and continuing to manage soft tissue as needed. Now, there is definitely a chance that at this phase, patients probably don't need much soft tissue, but I do think there's an importance of putting your hand on every patient, okay? Putting your hands on every patient. That could be soft tissue, it could just be kind of a nice recovery massage, it could be stretching, it could be putting your hands on them for body mechanics, but just letting them know that you are watching and continuing to assess how they're moving and their movement patterns, right? You're not just sending them off with the tech, you're not just sending them off with a list of exercises to do that they could do at the gym. It's really important at physical therapists that patients understand why they're continuing to come, because it's still really important for them at this phase to still have that guidance and that focus on how they're moving, because it's really easy for their bodies to kind of go back into those old ways because it's easier, right? We're making them do harder stuff, things their muscles haven't done in a while, and if they don't buy into why they're with you, they're just gonna wanna be discharged. And that can really do a detriment to their overall outcome. They might be fine right now, but when they start progressing to higher level stuff, if they don't have you watching, if they don't have your hands to help you recover or your eyes, they could start having issues that when they come back and see the doc four months, six months out, they're having inflammation in their glute med tendon, inflammation in their hip flexors, and I say this because I've seen it. I don't see it very much with me because I force my patients to stay with me at least four to six months, but I've seen it in other patients. And if we just make sure they buy into it, and this is where we kind of have to put in the effort and that buy-in, because it's easy to just let them go through the exercises, because that's really what they need now. Now they need to get stronger. They need to get those movement patterns, but there are still things that we can critique by tactile cueing, by verbal cueing, by demonstration that they know that there's still a reason that they need PT. So again, the little soapbox for me, but I just think it's really important for that to be reiterated during these phases as a PT. And again, we're looking at week 10 through the end of week 12 for this phase. Like I said, it gets fun in this phase. Couple different options. There's so many different ways to do these things. Start progressing higher level planks, functional stability, single leg exercises, forward lunges, lateral lunges, adding that weight to the squats. Just start to work every muscle in that hip in kind of every direction that we possibly can when it comes to strengthening, so that it can be prepared for that next phase. Again, nothing new here, but just want to kind of drive that home that all of this stuff can continue to be important. So just keep it in the back of your mind and use it as needed. Phase five is our sports-specific training. Now we're really at the point that, and this is what I tell patients, that we've kind of recovered from the surgery, right? Like there should be enough time that everything that they've done in the surgery, as long as we continue to support the hip, we make smart choices on our movement patterns, we're really kind of done with surgery, if you will, and now it's about restoring that function that they lost before surgery. So what is that? What do you want to get back to? Do you want to get back to pickleball? Do you want to just get back to weight training? Do you want to get back to hiking? Do you just want to be able to get up and down off the floor with your kids, with your grandkids? What do you want out of this hip? And this is the conversation that I start having with patients at this phase, right? We had to do all the other stuff, no matter what you really wanted to do. Maybe we didn't put weight into those squats or lunges, but you kind of do a lunge. If you got to get down onto the ground, go onto one knee, you got to be able to get down and up. That looks like a lunge, right? So all of those movement patterns that we have done, they're all beneficial to anybody and to whatever they want to get to. But now we start to really get specialized into that. And after this phase, the amount of time that they are with PT really just kind of depends on what the patient's goals are and how their body wants to respond. So I keep most of my patients and give them a heads up that unless there's an insurance limitation or just something unique, I expect to hang out with my patients for at least four months, right? I want to get the first four phases out of the way. And I want to get at least a couple of weeks of getting specified workouts into what they want to do, okay? So what that can mean, really sky's the limit. Obviously you can probably figure out, I like that term, that verbiage, I use it a lot, but I mean, that's really what it is. What do you want to get out of this hip? Now there might be times that we have to have some tough discussions about activity modification and let's be honest with what your hip can take, but those are conversations that can be had now and there's some of that trial and error that we are progressing appropriately. And that's why you still need to come to physical therapy because you need to do A before you do B before you do C kind of thing. So that's really where we're going here. We're continuing to progress strengthening, working agility, maybe some high impact exercises, cardiovascular activities, starting a little bit of maybe return to run if that's a goal for them. What movement goals do they have? And let's figure out a plan to do it. Little star there. You know, I love my soft tissue management. Don't forget about it. You still might need it. Or now is a great time to really start getting into, as a patient, how does the patient do their own soft tissue management? Because if they're doing well, that's great. They can probably finish off endurance stuff. They can finish off really hypertrophying those muscles if they're doing everything right on their own, but they still might come, still might have a day where they did a little too much. They get a little fatigued. So what kind of soft tissue, what kind of symptom management options will they have independently? So this is a great time to start having those conversations and maybe trialing. Okay, we're not doing any soft tissue stuff today because I want to see how your body responds because when you're out on your own, you don't have me to do it. That's completely appropriate, but it's a conversation that you have so they understand why they're not getting it or they understand why they're doing it on their own with stretching or a foam roller or whatever they may have. Again, letting the patient know that you were part of the process throughout the whole thing and there's a reason for it. So the sport-specific training can be anywhere from three months to six plus months. Just kind of depends and it's up to the PT, the patient, and as long as you as the doc feel like it's still appropriate and there's no insurance limitations or anything, we want to make sure that the patient gets what they need and they've put in so much work already, let's finish it out, okay? Again, just for fun to kind of see, get creative, right? Get people back into the gym, get people back doing classes they want to do, get that life back to them, whatever it may mean. This slide can probably speak for itself now. So just a reminder, don't forget about it. Okay, so we've gone over the phases of the rehab. Again, very kind of general. There's a whole lot more that goes into it from a PT aspect, but just so you kind of get a little bit of knowledge at how I look at each phases and how we break things down a little bit to just kind of help get that nice controlled progression for the patient. The last couple of things I want to talk about are not so much PT related, but I think very, very important in the physical therapy process. And if they are missed, you could give the patients the best exercises possible. But if you're missing some of this compassion and connection type characters, characteristics, excuse me, took me a second to think of those words, characteristics in the treatment plan, I think you'd be missing a piece of the puzzle when it comes to really giving the patient just the best possible care they can. I know it seems silly, but make sure we're listening to the patient, all right? They feel things. It may be different. We may think we give the best exercises, but if it's not getting the results to the patient, then it's not the best exercises for the patient. So just making sure that you're asking them, not just like, how are you feeling? Good, great, let's keep going. Or I don't feel good. Okay, well, let's not do too many exercises. Where do you feel that pain? How do you feel that pain? Really getting in depth to what they're feeling, because it can be very different in the world of PT because pain and soreness is not always a bad thing. Sometimes it's necessary. Just reiterating what I've already talked about. I think the manual therapy, what we do with our hands is so, so important and can be a big missing piece to how the patients feel their therapy goes. Treating the patient's whole body, right? And I don't mean like whole body, like you gotta work their shoulders and everything, but treating the, when you're really getting functional, you're using all of your knees, your hips, your ankles, your quads, both sides. So making sure that we're talking about recovery kind of for the whole body, especially as we get more functional. So don't forget that this person is a person. It's not just a hip and that if there's issues elsewhere, are we addressing them? Do they need to be referred out? If you had pain and if you had multiple surgeries, most likely just your hips not affected. And some of those other areas may need to be addressed as well in one way or the other. And this seems maybe silly to most, but if you can show your patients in one way or another that you truly care about them, not just their hip, not just if they feel better or not and move along, like really show that you care. Those patients, especially that maybe are not going in the way that we would want them or their progression's a little bit more complicated. When you tell them we're still going in the right direction, even for them, it may not seem like it. They might seem behind. They still might have pain. They will believe you and they will trust you. And getting the trust from a patient as a physical therapist is probably the biggest reward that you can have because there's a lot of trust involved because you are in, they are in pain. They are not moving how they want to. And you are continuing to tell them, it's okay. We're gonna get you better. If they don't trust you, if they don't feel like you're on their side, they're not gonna get better because either they're gonna leave. They're not gonna do the things that you say. Or they're just gonna get so down and out that it's not gonna give us the outcomes that we can. So I know it seems like, well, duh, why wouldn't we do all of these things? I've unfortunately seen that this doesn't happen with everybody and it's a bummer because I've gotten patients better. And I'm not trying to toot my own horn, but I've gotten patients better that missed some of this and we got them better. But they unfortunately had to go through months of not feeling good, feeling like they were going to need another surgery when some of these things were missing. And when we included them, we got them back going. So just, it goes beyond just the exercise choices that we pick as physical therapists. And I just think this is a huge thing that continues to need to be promoted in the world of physical therapy and just recovering and healing altogether. Okay, so I apologize for the intensity on that last slide, but it's just, it's a passion that I have. I love being a PT. I love helping people. And these are things that I did not learn in school and I've learned on the job. And I'm just hoping maybe some of the new therapists, therapists that I know were kind of on the hip arthroscopy, but the hip arthroscopy is complicated. And some of these extra things can make a huge difference in a more complicated surgery. So if we do all of that and the patient's body is willing to cooperate with us, we're gonna achieve those goals that the patients have, that the doctors have, that myself as a PT have, which is just getting patients back to the life that they wanna do. Why would we do a surgery if we didn't wanna get back to those activities? So I appreciate all of your guys' time. I hope this was informative and beneficial to everybody. I am definitely open for any questions that anybody would have at any point in time. So just let me know, but I love being a physical therapist. I love helping patients in general, but I have thoroughly enjoyed working with the hips that I do at American Hip Institute and getting patients their lives back. So thank you for your time.

hip arthroscopy

team-based approach

rehabilitation protocol

patient-specific care

manual therapy

patient education

emotional support