Recovery Protocols
This section covers recovery protocols for: Hip Arthroscopy, Labaral and Capsular Repairs, Bankart Repairs, Rotator Cuff Repairs and ACL Repairs.
HIP ARTHROSCOPY PHYSICAL THERAPY PROTOCOL
First two weeks: partial weight bearing, manual distraction, immobilization techniques, gentle range of motion.
Weeks 2-4: closed chain exercises, isometrics, partial to full weight bearing.
4-6 Weeks: open chair, isokinetics, no significant impact for 3-6 months.
PROTOCOL FOR LABRAL AND CAPSULAR REPAIRS
Phase I Protective Phase (week 0-6)
GOALS
Control inflammation
Increase ROM
Decrease pain
Week 0-3
Patient remains in sling
Passive Shoulder ROM - protect repaired capsule (no ADB. with ER). Limit ER, with anterior repair. If posterior superior repair, watch IR, arm distraction and aggressive flexion
Modalities for comfort
Cervical, wrist and elbow ROM
Week 3-6
Initiate AAROM for flexion and ER to 30
if stable and strong, start AROM week 4
If using a swathe, DC end of week 3
Discharge sling weeks 4-5
Continue to protect capsule
Allow non pounding general conditioning
Phase II Intermediate Phase (week 6 - 12)
GOALS
Restore full PROM/AROM
Increase strength
Back to usual daily tasks except heavy lifting and sports
Week 6-8
AROM against gravity
Restore full ext. rotation by end of week 8
Initiate strengthening except bicep curls or ADB. combined with ER
Allow return to running for conditioning
Rehabilitation Considerations for Bankart Repair
0 - 3 weeks
Protect repair, passive ROM only - limit exterrial rotation to 40 degrees in adducted position. Modalities as needed.
3 - 4 weeks
Start active assistive ROM, avoid stress to anterior capsule.
Mobilization to the posterior capsule, (posterior capsule restrictions increase potential for humeral head to shift anterior/superior).
4 - 6 weeks
Start AROM - still protecting anterior capsule, start dynamic scapular stabilization program. Discontinue sling.
6 - 8 weeks
Strengthen rotator cuff and scapula rotators. No resisted internal rotation until 8 weeks.
8 - 12 weeks
Start light bicep curls.
12 weeks+
Progress general arm strength. No bench press, no push-ups, no military press, no shoulder shrugs.
Rotator Cuff Repair Protocol
1. Period of Maximal Protection (weeks 0-3)
a. The patient is to remain in a sling for the first 3 weeks as directed by both the MD and the physical therapist. PROM will begin as soon as the MD directs.
b. If the repair is secure and the patient is either tight currently or had pre-operative ROM problems AAROM may be begun after 2 weeks post-op and a Home Exercise Program prescribed to facilitate the ROM.
c. Icing is encouraged for 20 minutes of every 4-6 hours to reduce inflammation.
d. The patient will be seen in physical therapy 2-3 times per week depending on early ROM and favorable response to treatments, indicated by week.y progression in ROM.
2. Period of Moderate Protection (weeks 3-6)
a. The patient will be tapered out of a sling and encouraged to do light ADL's including personal hygiene activities. The patient still should be avoiding aggressive reaching or lifting.
b. PROM will continue as needed to improve ROM weekly.
c. The patient will begin both AAROM and AROM and a Home Exercise Program will be prescribed to facilitate full ROM.
d. After week 4 post-op, the emphasis is on scapular stabilizing exercises, IR/ER active exercise progressing toward light resistance and antigravity active elevation with scapular control.
e. Patient will be seen in physical therapy 2-3 times per week as we are working on functional control and strengthening.
f. Neuromuscular re-education is also emphasized.
3. Period of Minimal Protection (weeks 6-9)
a. During this phase both PROM and AROM should be normalized and within 5 degrees of the uninvolved extremity.
b. Light, tolerable, strengthening will be progressed, generally using weights from 1-5#. In order to carefully select appropriate methods and planes of strengthening, skilled physical therapy will be needed 2-3 times per week.
c. Patients should be doing all normal ADL's independently.
d. The patient will have a HEP for strength developed that they can independently progress.
4. Sport Specific or Functional Strengthening Phase (weeks 9-12)
a. Advanced strengthening exercises will be continued including sport specific drills or plyometrics of low load.
b. General conditioning for sport and the development of a sport specific in-season and off-season strengthening programs will be emphasized.
Return to competitive play or unsupervised advanced gym routines can be initiated between 4-6 months post injury if patient had full ROM and is strong and non-painful.
General Guidelines for ACL Rehab
The time frames outlined below are general in nature and subject to change dependent upon the progress of the particular patient, the surgery performed, and the pre-surgical condition of the patient.
Post-op Week 1:
Emphasis is on obtaining FULL passive extension and eliciting an effective quad set. Gait is WBAT and ROM goal is 0-90 by day 7 post-op. Brace is locked in 0 degrees extension unless the patient demonstrates excellent terminal quad control.
- Quad Sets (use ESTIM as needed)
- SLR's all hip planes with weight as tolerated.
- Patellar mobilizations and ankle theraband exercises.
- AAROM for knee flexion (wall slides, ball slides and prone hamstring curls with weight as tolerated).
- Passive extension positioning either in long seated, prone, or supine.
- Hamstring and calf stretching.
- Modalities, tubigrip or ted hose to control swelling.
Post-op Week 2:
Progress RIM to 0-105. when control of terminal extension is obtained, open brace to 0-90 degress or flexion as tolerated. Concentrate rehabilitation on control of closed chain terminal knee extension.
- Continue strengthening as above.
- Add closed chain exercises of mini-squat (total gym, shuttle, leg press, etc.)
- Add resistive tubing closed chain extension.
- Gait Refinement (retro treadmill, unilateral stance drills).
- Continued modalities to control swelling.
Post-op Week 3:
Continue progressing ROM toward normal ROM. D/C brace when SLR without lag and brace inhibiting normal gait.
- Add Stationary Cycling.
- Add additional closed chain exercises: multidirectional squats, partial lunes, multihip, reebok step.
- Increase resistive training as tolerated.
- Add isotonic quadriceps training 90-30.
- Add proprioceptive and balance drills.
Post-op Week 4-8:
Patient should be full ROM and walking without a limp.
- Progress strength with continued weight training.
- Begin functional activities.
- Continued neuromuscular training.
Post-op Week 8-12:
- Continued independent strengthening.
- Progression of endurance activities and cardiovascular conditioning.
- Agility Training.
Post-op Week 12-16:
Return to jogging and non-competitive sport/leisure.
Post-op Week 16-20
Return to all sports if normal strength, no swelling, full ROM, and excellent neuromuscular control.