初級 股関節神経損傷リハビリテーション

Pain at rest < 3/10 on VAS scale, Able to perform passive hip flexion to 70 degrees without increased neuropathic symptoms,No aggravation of sensory disturbances in femoral, obturator, or sciatic nerve distributions,Hip abduction strength grade 2/5 or greater,Able to ambulate with assistive device (cane) for 5 minutes without increased hip or groin pain,Trochanteric bursa tolerance to gentle palpation without radiating symptoms

→ 次の段階へ： Early Passive Mobilization

Pain at rest < 2/10 and with activity < 4/10,Passive hip flexion improved to 90 degrees with neutral rotation,No increase in paresthesia or dysesthesia along lateral femoral cutaneous or pudendal nerve pathways,Hip extension to 0 degrees achieved without pain provocation,Able to perform gentle supine hip rolls without nerve irritation,Isometric gluteus medius contraction held for 5 seconds without fatigue or pain

→ 次の段階へ： Active Range of Motion

Active hip flexion to 90 degrees with controlled movement,Hip external rotation to 30 degrees and internal rotation to 20 degrees achieved,No reproduction of nerve pain with hip rotation movements,Can perform active hip abduction in side-lying to 20 degrees,Hip flexor stretch tolerated for 30 seconds without increased neurological symptoms,Single leg stance on unaffected limb for 20 seconds maintained

→ 次の段階へ： Early Strengthening

Hip flexion strength 3/5 or greater,Hip abduction strength 3/5 or greater,Active hip range of motion: flexion 100 degrees, abduction 25 degrees, external rotation 35 degrees,No night pain or rest pain greater than 2/10,Can perform bridging exercise with hip neutral without increased sciatic nerve tension,Tolerates 10 minute continuous ambulation without assistive device

→ 次の段階へ： Progressive Strengthening

Hip flexion strength improved to 4/5,Hip abduction strength improved to 4/5,Active hip flexion to 110 degrees with good motor control,Hip adduction strength 3/5 or greater,Can perform clamshell exercise to 45 degrees hip abduction without hip labrum pain,Single leg stance on affected limb for 10 seconds achieved

→ 次の段階へ： Intermediate Strengthening

Hip extension strength 4/5,Hip external rotation strength 3/5,Active hip range of motion within 80% of contralateral side,Can perform single leg squat to 45 degrees knee flexion with good hip kinematics,No provocation of iliopsoas tendon pain with resisted hip flexion,Tolerates 15 minute stationary cycling at low resistance

→ 次の段階へ： Advanced Strengthening

Hip abduction strength 5/5,Hip external rotation strength 4/5,Single leg stance on affected limb for 30 seconds with minimal trunk lean,Can perform lateral step-down from 4-inch step with controlled descent,Hip flexion strength 5/5,No reproduction of acetabular labral symptoms with hip flexion and rotation

→ 次の段階へ： Functional Training

Can walk 20 minutes continuously at moderate pace without increased symptoms,Hip range of motion within 95% of contralateral side in all planes,Single leg squat to 60 degrees knee flexion with proper hip strategy,Tolerates progressive resistance cycling for 20 minutes,No pain with resisted hip external rotation in functional positions,Can ascend and descend stairs with alternating pattern

→ 次の段階へ： Plyometric Preparation

Hip abduction endurance: side-lying hip abduction 15 repetitions with good form,Can perform drop landing from 4-inch step with bilateral landing,No increase in hip joint effusion or bursal inflammation,Single leg hop in place 10 times without hip pain,Hip flexor tendon tolerance to repetitive loading,Can perform forward walk with exaggerated stride

→ 次の段階へ： Plyometric Progression

Single leg hop forward 6 meters in < 4 seconds,Can perform box jumps to 12-inch height with proper landing mechanics,Hip abduction power: lateral hop test > 90% of contralateral side,No recurrence of nerve symptoms with high-impact activities,Can perform bounding in straight line without compensation,Tolerates agility ladder drills at 75% speed

→ 次の段階へ： Sport-Specific Training

Can perform running progression: 50 meters at 50% speed,No hip labral symptoms with cutting maneuvers in controlled setting,Hip internal rotation strength 4/5,Can perform figure-8 running at moderate speed,Tolerates sport-specific drills for 15 minutes total,No increase in trochanteric bursa pain with impact activities

→ 次の段階へ： Return to Activity Preparation

Running progression: 200 meters at 75% speed completed without symptoms,Single leg hop test > 85% limb symmetry index,Can perform sports-specific cutting and pivoting without hip pain,Hip range of motion and strength within normal limits compared to contralateral side,No provocation of nerve-related symptoms with high-velocity movements,Patient-reported outcome measures showing meaningful improvement

→ 次の段階へ： Return to Sport Progression

Full-speed running for 5 minutes without symptoms,Can perform unanticipated direction changes at full speed,Hip endurance: single leg stance on affected limb > 45 seconds,No pain with hip flexion against resistance in functional positions,Tolerates full practice session duration with modified drills,No post-activity increase in hip symptoms or nerve-related complaints

→ 次の段階へ： Advanced Sport Training

Can participate in full practice with non-contact drills,Single leg hop for distance > 85% contralateral side,Hip power metrics within 90% of contralateral limb,No recurrence of labral, cartilage, tendon, or bursal symptoms,Performs sport-specific movements at full intensity without compensation,Patient cleared for progressive return to full training

→ 次の段階へ： Return to Competition

Completes full training session with contact drills,No increase in symptoms following high-intensity activity,Hip function score > 85% of pre-injury level,Can perform repeated sprinting without hip symptoms,No post-competition soreness exceeding baseline,Subjective readiness for competitive return reported by patient

→ 次の段階へ： Final Progression

Full return to sport or activity without restrictions,Hip outcome scores at or above pre-injury baseline,No ongoing nerve-related symptoms (paresthesia, dysesthesia, weakness),Maintenance of hip strength and range of motion at discharge level,Patient education completed for self-management and prevention,Discharge criteria met for safe transition to independent maintenance program

→ 次の段階へ： Discharge