初級 股関節神経損傷リハビリテーション

安静時疼痛 VAS 3/10未満,歩行補助具を使用し、耐容可能な範囲での荷重が可能, No aggravating symptoms with gentle passive hip range of motion to 45 degrees flexion, Soft tissue mobility: no exacerbation of trochanteric or iliopsoas bursa tenderness, Neural mobility: able to tolerate prone hip flexion with knee extension (prone knee bend) without increased neuropathic symptoms, Gait pattern: able to achieve short stride length with front-wheeled walker without antalgic gait pattern

→ 次の段階へ： 早期モビライゼーション

活動時の痛み < 4/10, Passive hip flexion increased to 70 degrees without provocation of labral symptoms, Active assisted hip flexion to 60 degrees with neutral rotation, Able to perform glut activation in side-lying without exacerbation of trochanteric bursa pain, Tolerates neuromuscular electrical stimulation to gluteus medius without discomfort, Prone lying tolerance increased to 10 minutes without increased nerve symptoms

→ 次の段階へ： 自動可動域（自動ROM）

自動的な股関節屈曲75度、最小限の不快感のみ, Active hip extension to neutral (0 degrees) without compensation, Hip abduction in side-lying to 25 degrees against gravity without tendon provocation, Internal rotation at 90 degrees flexion to 20 degrees without labral clicking or catching, Hip adduction active range to 10 degrees from neutral, Single leg stance time > 10 seconds on affected side without loss of balance

→ 次の段階へ： 早期筋力強化

重力に抗する股関節屈曲：2 lbの抵抗で反復10回、屈筋腱の疼痛増悪なし, Hip abduction strength 4/5 on manual muscle testing, Hip extension in prone: able to hold 10 second hold against gravity without posterior hip pain, Adductor strength 4/5 on manual muscle testing, Gluteus medius contraction in side-lying: palpable contraction without tensor fascia lata dominance, No reproduction of neuropathic pain with slump sit test

→ 次の段階へ： 漸進的筋力強化

股関節屈曲：3 lbの抵抗で3セット×12回、腸腰筋腱刺激増悪なし, Hip abduction: able to perform clamshells with resistance band without lateral hip pain, Hip extension: 3 sets of 10 with 5 lb against gravity in prone, Hip external rotation: 3 sets of 12 with Theraband at neutral hip angle, Hip internal rotation: 3 sets of 12 with Theraband at neutral hip angle, Single leg squat to 45 degrees knee flexion without compensatory hip adduction or internal rotation

→ 次の段階へ： 中間期筋力強化

股関節屈曲持久力：5 lbで3セット×15回、屈筋疲労や腱痛なし, Single leg stance > 30 seconds with eyes closed without significant sway, Hip hike on step: 3 sets of 10 each side without lateral pelvic drop, Bridge with single leg progression: 3 sets of 10 each side without posterior hip or ischial tendon provocation, Functional movement screen hip mobility score improved from initial eval, Tolerates 20 minutes continuous ambulation without assistive device

→ 次の段階へ： 上級筋力強化

MMTによる股関節外転筋力4+/5, Hip flexion strength 4+/5 on MMT, Lateral step-down onto affected leg: 3 sets of 8 without valgus collapse, Single leg deadlift: 3 sets of 8 without lumbar compensation, Pigeon pose or equivalent hip internal rotation stretch: able to hold 2 minutes without labral symptoms, Balance board standing: 2 minutes with minimal perturbation

→ 次の段階へ： 動きパターントレーニング

パラレルまでのスクワットパターン：適切なHip hingeと膝のトラックを伴う3セット×12回, Lunge forward on affected leg: 3 sets of 10 without anterior hip impingement sensation, Hip rotation control: able to control internal rotation during descent phase of squat, Gait analysis: normalized stride length and cadence without compensation, Single leg hop in place: 10 repetitions without labral discomfort, Stair ascent/descent alternating step without handrail support

→ 次の段階へ： パワー開発

片脚ホップ距離で評価された股関節パワー、非患側の75%以上, Vertical jump: able to perform with proper hip and knee mechanics, Reactive strength index: able to demonstrate controlled landing from jump, Running progression: interval walking 5 min jog/5 min walk without increased symptoms, Agility: lateral shuffles and Carioca without cutting pain, Sports specific movement introduction based on patient goals

→ 次の段階へ： スポーツ特異的トレーニング

中等度ペースで20分間の連続走行、防御的パターンなし, Figure-8 running pattern without pain or compensation, Cutting maneuvers at 50% speed without hip symptoms, Agility ladder: full court with good hip mechanics, Repeated sprint ability: 6x30 meter sprints with adequate recovery, Subjective hip outcome score improvement > 15 points from baseline

→ 次の段階へ： 活動復帰準備

全ての平面での制限のない全可動域, Hip strength > 90% of uninvolved side on isokinetic testing, Functional movement screen score > 15, Return to sport testing: modified hop test > 90% limb symmetry, Hip stability assessment: no positive anterior apprehension sign, No reproduction of nerve symptoms with maximal neural tension

→ 次の段階へ： スポーツ復帰フェーズ1

制限なしの完全な練習参加, Contact drills: able to withstand expected physical demands, Plyometric volume: 150+ foot contacts per session without increased symptoms, Power output > 85% of pre-injury baseline, Patient subjective readiness score > 8/10, No increase in symptoms 24 hours post training

→ 次の段階へ： スポーツ復帰フェーズ2

試合形式的練習への完全参加, Game speed execution of all movements without hesitation, Endurance: able to complete full practice or competition duration, Power maintenance through mid-range of training week, No regression in outcome measures from previous phase, Sleep quality and recovery metrics normalized

→ 次の段階へ： スポーツ復帰フェーズ3

試合復帰：フルゲーム参加のクリア, Performance metrics at 90%+ of pre-injury levels, No compensatory movement patterns under fatigue, Player confidence self-assessment at pre-injury levels, Coach clearance for full sport participation, Maintenance program established

→ 次の段階へ： 維持と退院

最終アウトカム測定、退院基準達成,在宅運動プログラムの実施遵守を確認,医療フォローアップが必要な警告兆候の理解度,退院後3ヶ月および6ヶ月のフォローアップ予定,患者満足度の記録,具体的なガイダンスを伴う活動復帰許可

→ 次の段階へ： 完了