Aquatic Therapy Protocol For Total Hip Replacement: THR Aquatic Therapy Protocol

Subarna Debbarma (BPT, DNHE)

Total Hip Replacement: Aquatic Therapy Protocol

A female total hip replacement  patient on aquatic Therapy

The following is to be used as a guideline in progressing patient’s status post total hip reconstruction( Total hip replacement). Each patient’s specific needs, response to treatment, and comorbidities should be assessed determining the specific course of treatment.Refer to Total Hip Protocol for specific precautions.

Initial visit through the end of the first week:

● Appropriate bio-occlusive dressing is applied.

● Primary focus in first week of treatment is to control swelling, decrease pain, and introduce motion.

● Initiate gentle lower extremity range of motion (ROM). Patient is encouraged not to force motion, but rather to gently move through a comfortable ROM. Reinforce Total Hip Precautions through our treatment.

○ Seated knee flexion and ankle pumps

○ Heel/toe lifts

○ Gentle mini squats, not past 70 degrees of hip flexion

○ Gentle and slow hip abduction, ensure that patient does not return to full adduction

○ Gentle hip circles

● Begin gentle ambulation (suggest .5 mph x 5 min).

Second through end of third week:

● Continue with above exercises.

● D/C bio-occlusive dressing when all steri-strips have fallen off or have been taken off and wound is well healed.

● Focus on gentle strengthening and ROM exercises:

○ Standing hip flexion and extension

○ Marching in place

○ Hamstring stretch

○ Calf stretch

○ Step ups/downs side/side from platform to deeper water

● Increase ambulation speed and time by approximately 2 mph and by 2 min per day, add jets for resistance as patient tolerates.

Fourth through sixth weeks:

● Continue with above exercises.

● Add swim fins, aqua socks, or balance rings for resistance.

● Alternating lunges not past 70 degrees of hip flexion.

● Upper extremity resistance for challenges to balance and core stabilization.

● Hip hikes from step to strength hip stabilizers.

● Patient to begin walking step over, step up, and down pool stairs.

● Massage jets to decrease swelling, decrease muscle spasms, and scar massage.


Wilk KE, Joyner DM. The Use of Aquatics in Orthopedic And Sports Medicine Rehabilitation and Physical Conditioning (pp 145-146).

© 2014 SLACK Incorporated.

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