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8/4/2019 Protocols for Shoulder, Ankle & Elbow Rehabilitation Physiotherapy
http://slidepdf.com/reader/full/protocols-for-shoulder-ankle-elbow-rehabilitation-physiotherapy 1/12
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"
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ARTHROSCOPIC ROTATOR CUFF REPAIR
REHABILITATION PROTOCOL
RANGE OF IMMOBILIZER
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"
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ARTHROSCOPIC ANlERIOR SHOULDER STABILIZATION
REHABILITATION PROTOCOL
RANGE OF IMMOBILIZER
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
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ARTHROSCOPIC ANlERIOR SHOULDER STABILIZATION
REHABILITATION PROTOCOL
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
Modalities as needed
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"
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LATERAL EPICONDYLITIS POST-OPERAllVE
REHABILITATION PROTOCOL
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
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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
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UI~ I AL DIl"I:.t"'~ II:.NUUN MI:.t'"AIM
REHABILITATION PROTOCOL
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
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PHASE I0-8 weeks
PHASE II
8 -12weeks
PHASE III
12 weeks-5 months
ACHILLES TENDON REPAIR
REHABILITATION PROTOCOL
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
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TOTAL SHOULDER REPLACEMENT
REHABILITATION PROTOCOL
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
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::;UtsAl;HUMIAL UI=l;UMt'HI=::;::;IUNIUI::; I AL l;LAVIl;LI= I=Xl;I::;IUN><
REHABILITATION PROTOCOL
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
Modalities as needed
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.
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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
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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