A hip prehab plan built, but not yet tested

Femoroacetabular impingement syndrome causes hip pain in active young adults and is often managed with arthroscopic surgery, but people frequently spend months on a waiting list before the operation. Whether structured exercise during that window — pre-operative rehabilitation, or 'prehabilitation' — improves readiness for surgery in this group is unknown. Exercise is also tricky here, because certain hip positions can provoke the very symptoms patients are trying to avoid. Before anyone can test whether prehabilitation works, someone has to define exactly what the programme should contain, at what intensity, and how it should be delivered.

The team used the Medical Research Council framework for developing complex interventions, combining several methods rather than a single study. Patient and Public Involvement work explored patients' experiences of hip pain, their barriers to engaging with exercise, and their preferences for how an intervention should be delivered. A systematic review and meta-analysis of prehabilitation in orthopaedic surgery was used to set dosage and delivery characteristics. An international expert consensus identified the core domains the programme should target, and a focused literature review of electromyographic data, expressed as percentage of maximum voluntary isometric contraction (MVIC%), was used to select and grade individual exercises by muscle activation and risk of provoking symptoms.

The output is the PREHAB FAI programme: 8 weeks long, in two phases, covering progressive strengthening, range of motion, balance and proprioception, cardiovascular conditioning and education. Phase 1, weeks 1 to 4, uses low-to-moderate intensity work at 16-40% MVIC aimed at the hip abductors, extensors, adductors and trunk muscles. Phase 2, weeks 5 to 8, progresses to higher-intensity strengthening above 40% MVIC. Exercises that put the hip into an impingement position or were judged likely to aggravate symptoms were deliberately excluded. Delivery mixes supervised and home-based sessions with digital monitoring to support adherence. No patient outcomes are reported in this paper.

This sits at the development end of the evidence pipeline rather than the effectiveness end. It formalises something clinicians already do informally, and its main contribution is transparency: the dosage came from pooled orthopaedic prehabilitation data, the content from expert consensus and patient priorities, and the exercise selection from muscle-activation evidence. It does not settle whether prehabilitation shortens recovery, reduces pain or improves function after hip arthroscopy, because no comparison was made. The authors state the programme will next be examined for feasibility, suitability, acceptability and safety in patients with FAIS undergoing arthroscopic surgery.

If you are on a waiting list for hip surgery, this is a reason to think structured pre-operative exercise is being taken seriously and designed with symptom provocation in mind, rather than assumed to be harmless. It also shows why exercise selection for an irritable hip is not arbitrary: intensity was graded, and positions likely to pinch the joint were removed on purpose. What it cannot tell you is whether following such a programme leads to a better result after surgery — that question is still open. Anyone in this situation would be looking at individualised guidance from their own clinical team rather than a published template.