Orthopedics Specialists - Shoulder, Ankle & Elbow Rehabilitation Physical Therapy Protocols.pdf

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Kevin B. Freedman, M.D.
Sports Medicine
27 South Bryn Mawr Ave
Bryn Mawr, PA 19010-3470
Phone: (610) 527-2727
Fax: (610) 527-1588
ARTHROSCOPIC ANTERIOR SHOULDER STABILIZATION
REHABILITATION PROTOCOL
RANGE OF
IMMOBILIZER
THERAPEUTIC
MOTION*
EXERCISE
PHASE I
Active/Active-Assistive:
Worn at all times except
Elbow/wrist/hand ROM, grip
0-4 weeks
stretch to 20
of
for hygiene and therapeutic
strengthening, isometric in sling,
external rotation, and
exercise
external/internal rotation exercises
90
of forward flexion -
with elbow at side
internal rotation to
stomach
Abduction to 45 degrees
No cross-body adduction
PHASE II
Increase forward flexion to
None
Advance isometrics in phase I to use
4 - 8 weeks
140/40 ER at side/ 60
of a theraband, continue with elbow/
abduction/ IR behind back to
wrist/hand ROM and grip strengthening,
waist
begin prone extensions, and scapular
stabilizing exercises, gentle joint mobs
Modalities as needed
PHASE III
Progress to full active
None
Advance theraband exercises to
8 - 12 weeks
motion without discomfort
use of weights, continue with and
Gentle passive stretching
progress exercises in phase II
at end ranges
Include RTC, deltoid, and scapular
stabilizers
PHASE IV
Full without discomfort
None
Advance exercises in phase III, begin
12 weeks -
functional progression to work/sport,
6 months**
return to previous activity level *
begin upper body ergometer, proprioception
plyometrics
* Patient may return to the weight room at 3 months, if appropriate
** Patient may return to competitive sports, including contact sports, by 6 months, if approved
NOTE: For open stabilization, no internal rotation strengthening for first 6 wks
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Kevin B. Freedman, M.D.
Sports Medicine
27 South Bryn Mawr Ave
Bryn Mawr, PA 19010-3470
Phone: (610) 527-2727
Fax: (610) 527-1588
ARTHROSCOPIC ROTATOR CUFF REPAIR
REHABILITATION PROTOCOL
RANGE OF
IMMOBILIZER
THERAPEUTIC
MOTION
EXERCISE***
PHASE I
Passive range only - to
Sling with supporting
Codman's, elbow/wrist/hand ROM, grip
0 - 4 weeks
tolerance - maintain elbow
abduction pillow to be worn
strengthening, isometric scapular
at or anterior to mid-axillary
at all times except for
stabilization
line while supine - limit
hygiene and therapeutic
internal rotation at 90
to
exercise
40
and behind back to T12
PHASE II
4-6 weeks : Gentle passive
4-6 weeks: begin gentle active assistive/
None
4 - 8 weeks
stretch to 160
of forward
active exercises, begin gentle joint
flexion, 60
external rotation
mobilizations (grades I and II), continue
at side, and abduction to 60-
with phase I exercises
6-8 weeks : begin active exercises
80
- increase internal
rotation gently at 90
to 60
begin deltoid and biceps*
and behind back to T7-T8
strengthening
6-8 weeks : increase ROM
to tolerance
PHASE III
Progress to full motion
None
Continue with scapular strengthening,
8 - 12 weeks
without discomfort
progress exercises in phase II, begin
internal/external rotation isometrics,
stretch posterior capsule when arm is
warmed-up
PHASE IV
Full without discomfort
None
Advance exercises in phase III,
12 weeks -
begin sport-specific activities, maintain
5 months
flexibility, increase velocity of motion,
return to sports activities **
* If biceps tenodesis is concomitantly performed, NO biceps strengthening until 6 weeks post-operative
**If approved by physician
*** For larger tears, active exercise will not be allowed for 6 weeks
NOTE: For mini-open repairs, same protocol is followed
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Kevin B. Freedman, M.D.
Sports Medicine
27 South Bryn Mawr Ave
Bryn Mawr, PA 19010-3470
Phone: (610) 527-2727
Fax: (610) 527-1588
ARTHROSCOPIC SLAP REPAIR
REHABILITATION PROTOCOL
RANGE OF
IMMOBILIZER
THERAPEUTIC
MOTION*
EXERCISE
PHASE I
Active/Active-Assistive:
Worn at all times except
Elbow/wrist/hand ROM, grip
0-4 weeks
stretch to 40
of
for hygiene and therapeutic
strengthening, isometric in sling,
external rotation, and
exercise
external/internal rotation exercises
120
of forward flexion -
with elbow at side
internal rotation to
No resisted forward flexion or biceps
stomach
until 6 weeks post-op
Abduction to 45 degrees
No cross-body adduction
PHASE II
Increase forward flexion to
None
Advance isometrics in phase I to use
4 - 8 weeks
140/60 ER at side/ 60
of a theraband, continue with elbow/
abduction/ IR behind back to
wrist/hand ROM and grip strengthening,
waist
begin prone extensions, and scapular
stabilizing exercises, gentle joint mobs
Modalities as needed
PHASE III
Progress to full active
None
Advance theraband exercises to
8 - 12 weeks
motion without discomfort
use of weights, continue with and
Gentle passive stretching
progress exercises in phase II
at end ranges
Include RTC, deltoid, and scapular
stabilizers
PHASE IV
Full without discomfort
None
Advance exercises in phase III, begin
12 weeks -
functional progression to work/sport,
6 months**
return to previous activity level *
begin upper body ergometer, proprioception
plyometrics
Return to throwing at 4 1/2 months
Throw from pitcher's mound at 6 months
* Patient may return to the weight room at 3 months, if appropriate
** Patient may return to competitive sports, including contact sports, by 6 months, if approved
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Kevin B. Freedman, M.D.
Sports Medicine
27 South Bryn Mawr Ave
Bryn Mawr, PA 19010-3470
Phone: (610) 527-2727
Fax: (610) 527-1588
MULTIDIRECTIONAL INSTABILITY POST-STABILIZATION
REHABILITATION PROTOCOL
RANGE OF
IMMOBILIZER
THERAPEUTIC
MOTION
EXERCISE
PHASE I
0-6 weeks : None
0-6 weeks : elbow/wrist ROM, grip
Immobilized at all times (except
0 - 6 weeks
for exercise) in flexion, abduction,
strengthening
and 0
of rotation
PHASE II
Begin active/active-assistive
Sling worn for comfort only
Continue with exercises in phase I,
6 - 12 weeks
ROM - passive ROM to
and at night
begin active-assistive exercises, deltoid/
tolerance - ROM Goals:
rotator cuff isometrics -
at 8 weeks: begin resistive exercises *
40 external rotation, 140
of flexion, 45
of abduction
for scapular stabilizers, biceps, triceps,
and rotator cuff
No stretching or manipulation
PHASE III
Gradual return to full active
None
Advance activities in phase II,
3 - 6 months
ROM
emphasize external rotation and
latissimus eccentrics and glenohumeral
stabilization, begin muscle endurance
activities (upper body ergometer)
Sport specific rehab at 4 1/2 months
Return to throwing at 6 months
No collision sports for 12 months
* Utilize exercise arcs that protect the posterior capsule from stress during resistive exercises, and keep
all strengthening exercises below the horizontal plane in this phase
** Limited return to sports activities
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