protocols for shoulder, ankle & elbow rehabilitation physiotherapy

8/4/2019 Protocols for Shoulder, Ankle & Elbow Rehabilitation Physiotherapy

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ARTIiROSCOPIC SLAP REPAIR

REHABILITATION PROTOCOL

RANGE OF IMMOBILIZER

MOll0N*

P H A S E I Active/Ac.tive-Assistive: Worn at all times except

0-4 weeks streth to 40 Sf fO(hygi ene and the rapeu ti c

ext erna l r ot at ion , and exercse

1 20 0 o f fe xw ard fle xio n -

in te rn al r ot atio n to

stomach

Abd llc tio n to 4 5 d eg re es

o c ro ss -body adduct ion

PHASE II I nc re as e fO ( tard f lelCion to on e

4 -8 weeks 14G'60 ER at side! 60

a bdUc tio n/lR b eh in dbade to

waist

THERAPEUllC

EXERCISE

E lbow .ris ha nd RClY 1, grip

s tr er glh en in g, is an etr ic in s lin g,

ex te rna li ln temal ro ta t ion exerc ises

lith e lb o '/ a t s id e

No resisted forward flexion a biceps

until 6 w eeks post-op

A dvan ce isom etrics in phase I to use

o f a th era ba nd , c on tin ue "lith e lb o/1

v.Tis li hand ROM and g ri p s tr engthenin

b eg in p ro ne e xte ns io ns , a nd s ca pu la r

s ta biliz in g e xe re se s, g enUe p nt m ob s

Moda litie s a s n ee de d

PHASE III

8 -12 weeksP ro gr es s to fu ll a ctiv e

mo ti on v li thou t o is comfo rt

GenUe pas s ive s tr et hi ng

a t e nd ra ng es

on e A dv an ce th era ba nd e xe rc is es to

use of w eights , con tinue lith an d

p ro gre ss e xe re se s in p ha se II

In du de RTC , d elto id , a nd s ca pu la r

stabilizers

P H A S E I V

12 weeks-6 months-

Ful l A th ou t d is comfo rt on e A dv an ce e xe re se s in p ha se III, b eg in

funct i onal p rogr es si on to: 'lQ(kiSpor \

re turn to prel Jious ac ti .. ;1y leve l"

beg in upper body ergometer. p ropr iocenlutvrl.a.frir"'C"



ARTHROSCOPIC ROTATOR CUFF REPAIR



MOllON

P H A S E I Passive range only - to Sling 'lith supporiing

0-4 weeks tolerance - maintain elbo '/ abduction pillo '/ to be 'lOrn

at or anterior to mid-axillary at all times except or

line '.nile supine - limit hYJiene and therapeutic

internal rotation at 90 Yo exercise

40° and behind back to n 2

PHASE II 4-6 weeks: Gentle passive one

4 - 8 weeks stretch to 160 °0 for 'lard

fleJ<ion, 60 °eldernal rotation

at side, and abduction to 60-

80 ° - ircrease intemal

rotation gently at 90 1% 60 °

and behind back to T7-T8

6-8 weeks: increase Ravt

to tolerance

PHASE III Progress to fullmotion one

8 -12 weeks . lithout oiscom ort

THERAPEUTIC

E X E R C I S E " * * *

Codman's , elbo 'I IlfistJhand ROM, grip

strengthening isometric scapular

stabilization

4-6 weeks: begin gentle active assistivel

active exercises, begin gentle joint

mobilizations (grades I and II), continue

'lith phase I exercises

6-8 weeks: begin active exercises

begin deltoid and biceps'

strel'l;lthening

Coninue '.itl scapular strengthening,

progress exercises in phase II, begin

internal/extemal rotation isometrics,

stretch posterior capsule ',nen arm is

'/armed-up

P H A S E I V

12 weeks-5 months

Full without discomfort one Advance exero ses in phase III,

begin sport specac achities, maintain

flexibility, increase velocity of motion,

return to sports activities"



ARTHROSCOPIC ANlERIOR SHOULDER STABILIZATION



MOllON·

P H A S E I Acti ve/ktive- Assistive: Worn at all times except

0-4 weeks sire t::h to 20 Sf for h~ene and therapeutic

external rotation, and exerdse

90 °of forward flexion -

internal rotat ion to

stomach

AbdUction to 45 degrees

o cross-body addUction

PHASE II Increase forward fieldon to one

4 -8 weeks 140/40 ER at sidel 60abdllction/lR behind bad< to

taist

THERAPEUllC

EXERCISE

Elbo I ' l' is lihand RClvI, grip

streng1hening, isanetric in sing,

external/Internal rotation exercises

vlith elbo I at s ide

Advance i somelrics in phase I to use

of a theraband, continue with elbowl

wTislihand ROM and grip strengthening,

begin prone extensions, and scapular

st abilizing exerdses, gentle Pint mobs

Modalities as needed

PHASE III

8 -12 weeksProgress to ful l active

motion l ithout discomfort

Gentle passive stret::hing

at end ranges

one Advance theraband exercises to

use of weights, CXJntinuev.;th and

progress exerdses in phase II

Indude RTe, deltoid, and scapular

stabi lizers

P H A S E I V

12 weeks-

6 months.....

Full . ;thout discomfort one Advance exerd ses in phase III, begin

funct ional progression to 'lOrkfspor\

return to prelJious actill1ty level"

begin upper body ergometer, proprioception



ARTHROSCOPIC ANlERIOR SHOULDER STABILIZATION


RANGE O F IMMOBILIZER

MOllON*

PHA SE I Acti velActive- Assistive: Worn at all times except

0-4 weeks stret:h to 20 8 or hygi ene and therapeutic

external rotat ion. and exercise

90 °of forward flexion-

intemal rot at ion to

stomach

Abduct ion to 4S degrees

o cross-body ad.duction

PHASE II Increase or 'tard f ieldon to one

4 - 8 weeks 140/40 ER at side/60abd'uction/lR behind bad< to

valst

THERAPEUllC

EXERCISE

Elbo' , ' ri stJhand R<lV1, gr ip

stren;;!thening, isan etric in sling,

extemannlemal rotation exercises

.lith elbo "at side

Advance isometrics in phase I to use

o a theraband. continue "ith elbo " I

' lTistJhand ROM and grip strengthening,

begin prone extensions , and scapular

stabilizing exereses, genUe pint mobs


PHASE III

8 -12 weeksProgress to full act ive

mot ion 'lithout discom ort

GenUe passive stret:hingat end ranges

one Advance theraband exercises to

use 0 ';eights, eontnue ' li th and

progress exereses in phase IIIndude RTe, deltoid, and scapular

stabilizers

PHA SE I V

12 weeks-6 months"

Full 'lithout diSCXJmort one Advance exero ses in phase III, begin

functi onal progressi on to I/ork/spor\

rerum to previous act i'J ity level"



LATERAL EPICONDYLITIS POST-OPERAllVE


RANGE OFMOTION

IMMOBILIZER lHERAPEUTICEXERCISE*

PHASE I0-6 weeks

Passive ROM as tolerated Worn for Ii rst 5 days

post-operative

Countenorce brace fO(

actil,ities

GenUe han lrist /elbo t !shoulder

stretdling, isometric han Ifis elbowl

shoulder s treng1hening - avoid lr is t

extension exereses fO( f irst 2 weeks

PHASE"

6 -8~eks

Increase range 01motion to full,

begin active v.ristextension

one AdVanre stengihening exercises in

phase I b resistive, maintain flelCibililyl

ROVI, begin genUe act ive wnst extension

exercises

PHASE '" Full and pain-free

8 -10weeksone AdVance phase II acti\lities, gradUal

progression to lardret .Jm

to full acti\lily

"NO act ive Vlfis t extension fO(2 leeks post-operat ive



P H A S E I

2 -4 weeks

PHASE II4 -6 weeks

PHASE III

6 -12 weeks

I:LHUW M(;L HI:(;UN:SIHU(; IIUNREHABILITATION PROTOCOL

RANGE OF

MOTION

IMMOBILIZER

Passive ROM to tolerance Brace locked at 0 -~O ~d to

be 10m at a ll t imes

Begin AAROM to full flexion" Brace locked at 0 -<!lO <9ld to

be '10m at a ll t imes

Progress to ful l mot ion

'Iithout oisCXlmfort

one

P H A S E I V

3 - 5 m on th s Full and pain-free one

THERAPEUTlC

EXERCISE

Scapular stabilizing exercises, gentle

rotator cu strengthening, gentle han

"ristlshoulder Ravl

.Advance exereses in phase I

Continue \ 'I;t h scapular and rotator cuff

strengthening, begin forearm resistance

exereses -f irst in flexion and then

advance to extensi01

Coninue 'lith shoulci:r strengthening,

begin aggressi~ rotational exereses,

light tossing, and sport-specific a.ctivities



UI~ I AL DIl"I:.t"'~ II:.NUUN MI:.t'"AIM


RANGE OF

MOllON

IMMOBILIZER THERAPEUTIC

EXERCISE

P H A S E I

0-2 weeks

one Splint for first ' reek

Elba ',lROM at first post-op

IAsit

GenUe 'I rist and shoulder ROvl

PHASE II

2 - 6 weeks

Active extension to 30 0

in brace, passive f lexion

as tolerated

Brace ' IO r nat a ll t imes ( induoing

exerdse) - removed or hygiene

Continue 'I it h 'ITist and shoulder ROM,

begin active extension to 30 , <No

active flelCion, genUe joint mobilizations

PHASE III

6 - 9 weeks

Active exension to 0 iR

brace

Worn at all t imes ( inducing

exerdse) - removed for hygiene

Coninue b maintain 'lTist and shoulder

flexibility. begin rotator cuff eltoid

isometrics, progress active extension

in brace, begin genUe flelCion strength

P H A S E I V

9 -12 weeks

GenUy advance ROvl to

tolerance

one Begin active flexion and extension

against gra~ity. advance strengthening

in phase III to resistive, maintain flexibility/

ROM

PHASE V Gradual retum to full and one Begin genUe flelCion strengthening,

12 weeks- pain-free adVance achities in phase IV6 months

PHASE VI Full and pain-free one Retum to ful l actilAtyt: . rn"nthr '1I:nr4



PHASE I0-8 weeks

PHASE II

8 -12weeks

PHASE III

12 weeks-5 months

ACHILLES TENDON REPAIR


WEIGHT

BEARING

0-4 weeks: on

leight bearing

4-8 weeks: as

tolerai:d lith

cru td1es and cam-

talker

As tolerated vlith

crutd1es - discontinue

crutd1 use vAlen

gait is norrnalaed

Full lith a norrnarzed

gait pattern

BRACE

0-2 weeks: splint

lorn at al l t imes

2-4 weeks: Iod<ed

in 20 0 of plantar-

fl e lCion - IOf'n at all

t imes except fOf 'ex-

erdse and hygiene"

4-8 weeks: ,\Yn

ciUring leight

bearing activities

one

one

ROM

0-2 weeks: NO

physical therapy Of '

motion

2-6 weeks: limit act il te

dorsiflelCion to 90 0

THERAPEUllC

EXERCISE

0-2 weeks: NO physical therapy Of'

motion

2-8 weeks: lnversioo ltersion ROvl,

stationary bike lit h brace on, knee/hip

strengthening, Pint mobilizat ions - NO

,ith knee flexed at 90 0 passive heel cord stretd1ing

6-8 weeks: ROM to

tolerance

Gain full and pain-free

Full and pain-free

Begin light resistve dorsilplantarflexion

exerdses li th knee f lexed, inltersionl

eversion isometrics, continue lith

bicycle and knee-hip strengthening

Progress phase II achities, begin

inversi O1teltersion isotonics, aggressi ve

doI'sitpiantar1elCion resistive exercises

l ith emphasis on plantar eccentr ics



TOTAL SHOULDER REPLACEMENT


RANGE OFMOTION

IMMOBILIZER lHERAPEUTIC

EXERCISE*

PHASE I0-6 weeks

Passive to act ive range

as toleratecf

ROM Goals :

Week 1: 90 '?Ofward

fleldon, 20 ~xternal

rotat ion at side, 75 ~ax

abdUction vlithout rotation

Week 2:120 ClfOf'laI'd

fleldon, 40 ~xternal rotation

atside, 75 ~axabouction

\',ithout rotation

Sling lit h abduct ion pillow

fOf comfort

Grip strengthening, pulleys/canes,

elbowlvAist Jhand active RavI - NO

resisted internal rotation or extension

to protect subscaplJaris

PHASE II Increase range of motion

6 - 12 weeks as tolerated, begin act ive

assisjvelactive intemal

rotation and extension as

toleraed

one Begin light resisted external

rotation, farvlal 'd flexion, and

abduction - concentr ic motions

any, NO resisted internal rotation,

extension, Of scapular retraction

PHASE III Progress to ful l motion one Begin resis ted internal rotat ion and

extension exereses, advance

strength t ra i ning as tal erated,

begin eccentric motions and

dosed d1ain activities

12 weeks-12 months

vlithout discomfOft



::;UtsAl;HUMIAL UI=l;UMt'HI=::;::;IUNIUI::; I AL l;LAVIl;LI= I=Xl;I::;IUN><


PHASE I

0-4 weeks

PHASE II

4 - 8 weeks

PHASE III

8 -12 weeks

RANGE OF

MOllON

Passive to active rang. e as

tolera ed

ROM Goals:

1 40 0 Olward flexion,

60 0 external rotat ion at s ide,

intemal rotation behind back 'lit h

gentle posterior capsule stretching

Increase range 0 motion

as tolerated

ROM Goals:

160 0 orward flexion,

80° external rotation at side,

intemal rotat ion ' li th gent le

posterior capsule s tretching be-

hind back and at 90 8 abduction

Progress to full motion

'Iithout ciisromlort

IMMOBILI ZER

0-2 weeks: sing to be

vern or romfort only

2-4 weeks: discontinue

useo sing

one

one

lHERAPEUllC

EXERCISE

Qip strengthening, pulleys/canes,

e lbo ' / ' '' ;s tJhand ROM, Cocrnan 's ,

NO resis ted motions

Begin light isomet rics 'Iit h arm at side,

rotator cuff and deltoid - advance to

therabands as tolerated, passive

stretching at end ranges to maintain

1eJCibility


AdVance strengthening as tolerated,

begin eccentrical ly res isted motions and

dosed chain acti-.ities

"'If a distal clavicle excision is performed, horizontal adduction is restricted for 8 weeks post-op*14h i,..."nr tnnnrlnrir ir ,...~,...l"'U"'ftit.,.ntl", nnrf nrr nnrf ~In il'l"V'\r rtrn nnth 'V1o. ,n until t : . . ,ul'V"\l"rnn.r-t_n.n.



P H A S E I

0-6 weeks

PHASE II

6 -12weeks

PHASE III

POSTERIOR STABILIZATION

REHABILITAllON PROTOCOL

RANGE OF

MOTION

0-3 VleekS: one

3·6 VleekS: begn passive

ROM - limit flexion to 90 ,0

internal rotation to 45 , &1d

abouction to 90 0

IMMOBILIZER THERAPEUllC

EXERCISE

Immobilized at all times (except 0-3 VleekS: eloov ~rist ROM, grip

tor exerdse) in flexion, abduction, strengthening

and 0 °of rotation 3-6 VleekS: begin passive ROM

actilJities- Godman's, anterior capsule

mobilizations

Begin acivelactive-assistive Sling 'tom for combrt only

ROM - passive ROM to

tolerance - ROM Goals:

full external rotation, 135 0

of flexion, 120 S abduction

12 - 1 6 weeks ROM

Gradual return to full active

P H A S E I V

4 - 6 mon th s " "

PHASE V

Full and pain-free

Full and pain-free

Goninue ,,;thexereses in phase I,

begin active-assislive exereses, deltoi

rotator cuff isometrics -

atB 'leeks: begin resistive exereses'

for scapular stabilizers, biceps, triceps,

and rotator cuff

one Advance activities in phase II,

emphasize external rotation and

latissimus eccentrics and glenohumeral

stabilization, begin musde endurance

actilJities(upper body ergometer)

one ,Il.ggressivescapular stabilization and

eccentric strengthening, begin

plyometric and thro ,;nghacquet program,

continue ',ith endurance actilJities,

maintiin ROM exibility

one Progress phase IV activities, return to



MUl TlDIRECTIONAllNSTABlllTY POST-STABiliZATION

REHABlllTAllON PROTOCOL

RANGE OF

MOTION

IMMOBILIZER THERAPEUl1C

EXERCISE

PHASE I0-6 weeks

0-6 weeks: one Immobil ized at al l t imes (except 0-6 weeks: elba !,rist ROVI, gnp

for exercse) in flexion, abdUction, strergthening

and 0 °of rotation

PHASE II

6 -12 weeksBegin act ve/active-assistive

ROM - passive ROVI to

tolerance - ROVI GoeJs:

40 external rotation, 1 40 0

of flexion, 45 6l abdUction

Sling tOm for c:ombrt only

and at night

Contnue \llith exereses in phase I,

begin act ive-ass ist ive exereses, deltoi

rotator cuff isometrics -

at 8 weeks: begin resistive exereses'

for scapular stabilizers, biceps, triceps,

and rotator cuff

o stretching or manipulation

PHASE III Gracil.Jal retum to full active one AdVance activities in phase II,

emphasize extemal rotat ion and

latissimus eccentrics and glenohumeral

stabilization, begin muscle encil.Jrance

acti-.ities (upper body ergometer)

Sport specific rehab at 4 1 12 months

Retum to throv. ;ng at 6 months

o collision sport s for 12 months

3 - 6 months ROV I

"Utilize exercise arcs that prot ect the posterior capsule f rom str ess cil.Jring resist ive exereses, and keep

all strengthening exercises belC7J/the horizontal plane in this phase

protocols for shoulder, ankle & elbow rehabilitation physiotherapy

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