Physical therapy protocol for arthroscopic rotator cuff repair
Phase I protective phase
Goals
- Minimize pain and inflammatory response
- Achieve ROM goals
- Establish stable scapula
Weeks 0 to 6
- Elbow, wrist and hand AROM (EWH)
- Codman’s pendulum exercises as tolerated
- Supine passive forward elevation in plane of scapula (PFE) to tolerance
- 10 reps, 2 x day
- Supine passive external rotation (PER) to tolerance with T-stick in
- 0-20 degrees flexion and 20 degrees abduction
- 10 reps, 2 x day
- C-spine AROM
- Ice
- Positioning full time in sling with abduction pillow
- Shoulder shrugs and retractions (no weight)
- ***Pain control modalities PRN
- ***Aquatics PROM after sutures are out
- Slowly progress PROM to full in all planes
- Complications/Cautions
- If pain level is not dissipating, decrease intensity and volume of exercises.
- Assure normal neurovascular status
- No AAROM or AROM until 6 weeks
- No Pulley until 6 weeks
Weeks 6 to 12
- Heat/ice PRN to help obtain motion
- D/C sling as comfortable at 6 weeks
- Achieve PROM goals in FE (full)
- Achieve PROM goals in ER at 20 deg and 90 deg abduction (full)
- Initiate posterior capsule stretching
- Isometrics, keeping elbow flexed to 90 degrees
- Sub maximal, pain free
- Theraband scapula retractions
- ***Aquatics
- ***Mobilizations PRN
- ***Trunk stabilization/strengthening
- Start AAFE and progress to AFE
- Start periscapular strengthening
- Very low weight and high repetitions
- Cautions
- Do not initiate rotator cuff strengthening until 12 weeks
Phase II progressive strengthening
Goals
- Achieve staged ROM goals
- Eliminate shoulder pain
- Improve strength, endurance and power
- Increase functional activities
Months 3 to 4
- Continue as above
- ROM should be full in all planes
- Progress isometrics
- Advance scapula strengthening
- ***Mobilizations PRN
- ***Aquatics for strengthening
- ***CKC activities for dynamic stability of scapula, deltoid and cuff
- ***Trunk stabilization/strengthening
- ***Light PNF D1, D2 and manual resistance for cuff/deltoid/scapula
- Rhythmic stabilization or slow reversal hold
- Initiate theraband ER and IR strengthening
- Progressive serratus anterior strengthening
- Isolated pain free, elbow by side
- Progress to isotonic dumbbell exercises for deltoid, supraspinatus
- Up to 3 lbs max
- Cautions
- Do not initiate AAFE or theraband rotator cuff strengthening until overall pain level is low
- Assure normal scapulohumeral rhythm with AAFE and AFE
- Strengthening program should progress only without signs of increasing inflammation
- Strengthening program should emphasize high repetitions, low weight and should be performed a maximum of 2x/day
Phase III return to activity/advanced conditioning
Goals
- Normalize strength, endurance and power
- Return to full ADL’s and recreational activities
Month 4 to 6
- Stretching PRN
- Continue deltoid/cuff/and scapula strengthening as above
- 5lbs max for isotonic strengthening
- Follow the below progression:
- Prone isotonic strengthening PRN
- Decreasing amounts of external stabilization provided to shoulder girdle
- Integrate functional patterns
- Increase speed of movements
- Integrate kinesthetic awareness drills into strengthening activities
- Decrease in rest time to improve endurance
- May begin tennis ground stroke/batting/return to golf after completing strengthening progression
- ***Progressive CKC dynamic stability activities
- ***Impulse
- ***Initiate isokinetic strengthening
- ***Mobilizations PRN
- ***Trunk stabilization/strengthening
Month 6 to 8
- Stretching PRN
- Continue deltoid/cuff/scapula strengthening program
- Initiate plyometric program (if needed)
- Do not begin until 5/5 MMT for rotator cuff and scapula
- QD at most
- Begin with beach ball/tennis ball progressing to weighted balls
- 2-handed tosses at
- Waist level
- Overhead
- Diagonal
- 1-handed stability drills
- 1-handed tosses
- vary amount of abduction, UE support, amount of protected ER
- May begin Interval Throwing Program after 3-6 weeks of plyometrics
- Initiate progressive replication of demanding ADL/work activities
Discharge/return to sport criteria
- PROM WNL for ADL’s/work/sports
- MMT 5/5shoulder girdle and/or satisfactory isokinetic test
- Complete plyometric program, if applicable
- Complete interval return to sport program, if applicable
Physical therapy protocol for arthroscopic slap repair
Phase I immediate post-operative phase (restrictive motion)
Goals
- Protect the anatomic repair
- Prevent negative effects of immobilization
- Promote dynamic stability
- Decrease pain and inflammation
Weeks 0 to 4
- Sling for 4 weeks
- Sleep in immobilizer for 4 weeks
- Elbow, wrist and hand ROM exercises
- Hand gripping exercises
- ***No active elbow flexion
- Cryotherapy, modalities as indicated
- No AROM, ER, extension or abduction
Week 4
- Discontinue sling at 4 weeks
- May use immobilizer for sleep
- ROM exercises (PROM and AAROM)
- Flexion to 90-110
- Abduction to 75-85
- ER in scapular plane to 15-20
- IR in scapular plane to 55-60
- Progress ROM and initiate AROM after 4 weeks
- Continue modalities and cryotherapy
Weeks 4 to 6
- Gradually improve ROM
- Flexion: 140
- ER at 45 degrees abduction: 25-30
- IR at 45 degrees abduction: 55-60
- PNF manual resistance
- May initiate gentle stretching
- Posterior Capsular Stretching
- No biceps strengthening
Phase II intermediate phase (moderate protection)
Goals
- Gradually restore full ROM
- Preserve the integrity of the surgical repair
- Restore muscular strength and balance
Weeks 6 to 10
- Gradually progress ROM
- Full flexion
- ER at 90 abduction: 45-70
- IR at 90 abduction: 60-70
- Initiate exercise tubing ER and IR (arm at side)
- Initiate isotonic dumbbell exercises for deltoid, supraspinatus
- up to 3 lbs. max (once full AFE is achieved)
- PNF strengthening
Weeks 10 to 14
- Slightly more aggressive strengthening
- Continue all stretching exercises
- ***Progress ROM to functional demands
Phase III minimal protection phase
Goals
- Establish and maintain full ROM
- Improve muscular strength, power and endurance
- Gradually initiate functional activities
Criteria to enter phase III
- Full pain-free ROM
- Satisfactory stability
- Strength improving
- No pain or tenderness
Weeks 14 to 18
- Continue all stretching exercises
- Continue strengthening exercises
- Fundamental throwing exercises
- PNF manual resistance
- Endurance training
- Initiate light plyometrics
- Light swimming
- Initiate plyometric program (if needed)
- Do not begin until 5/5 MMT for rotator cuff and scapula.
- QD at most
- Begin with beach ball/tennis ball progressing to weighted balls
- 2-handed tosses
- overhand
- Underhand
- Diagonal
- 1-handed stability drills
- 1-handed tosses (vary amount of abduction, UE support, amount of protected ER)
- 2-handed tosses
Weeks 18 to 20
- Continue all above exercises
- Initiate ITP
Phase IV advanced strengthening phase
Goals
- Enhance strength, power and endurance
- Progress functional activities
- Maintain shoulder mobility
Criteria to enter phase IV
- Full pain-free ROM
- Satisfactory static stability
- Strength 75-80% of contralateral side
- No pain or tenderness
Weeks 20 to 24
- Continue flexibility exercises
- Continue isotonic strengthening program
- PNF manual resistance patterns
- Plyometric strengthening
- Progress ITP
Phase V return to activity phase (6 to 9 months after surgery)
- Gradually progress sport activities to unrestricted
- Discharge/Return to sport criteria
- PROM WNL for ADL’s/work/sports
- MMT 5/5 shoulder girdle and/or satisfactory isokinetic test
- Complete plyometric program, if applicable
- Complete interval return to sport program, if applicable
Physical therapy protocol for arthroscopic subacromial decompression with or without excision of distal clavicle
POD 1
- Elbow, wrist and hand AROM (EWH)
- Supine passive forward elevation in plane of scapula (PFE) to tolerance
- 10-20 reps, 2 x day
- Supine passive external rotation (PER) to tolerance
- T-stick in 0-20 degrees flexion and 20 degrees abduction
- 10-20 reps, 2 x day
- C-spine AROM
- Ice
- Positioning full time in sling until block has worn off
- Shoulder shrugs and retractions (no weight)
- ***Pain control modalities PRN
- D/C sling as tolerated
- Slowly achieve full PROM in all planes
- Complications/cautions
- If pain level is not dissipating, decrease intensity and volume of exercises.
- Assure normal neurovascular status
Weeks 1 to 4
- Heat/ice PRN to help obtain motion
- D/C sling as comfortable
- Achieve PROM goals to full in FE
- Achieve PROM goals in ER at 20 deg and 90 deg abduction to full
- Initiate posterior capsule stretching
- Isometrics, keeping elbow flexed to 90 degrees
- Sub maximal, pain free
- Theraband scapula retractions
- ***Aquatics
- ***Mobilizations PRN
- ***Trunk stabilization/strengthening
- Start AAFE and progress to AFE
- Start periscapular strengthening
- Very low weight and high repetitions
- Cautions
- Do not initiate rotator cuff strengthening until 3-4 weeks and until night pain has subsided and overall pain level is low
Weeks 4 to 8
- Continue as above
- ROM should be full in all planes
- Progress isometrics
- Advance scapula strengthening
- ***Mobilizations PRN
- ***Aquatics for strengthening
- ***CKC activities for dynamic stability of scapula, deltoid and cuff
- ***Trunk stabilization/strengthening
- ***Light PNF D1, D2 and manual resistance for cuff/deltoid/scapula
- Rhythmic stabilization or slow reversal hold
- Initiate theraband ER and IR strengthening
- Progressive serratus anterior strengthening
- Isolated pain free, elbow by side
- Progress to isotonic dumbbell exercises for deltoid and supraspinatus
- Cautions
- Assure normal scapulohumeral rhythm with AAFE and AFE
- Strengthening program should progress only without signs of increasing inflammation
- Strengthening program should emphasize high repetitions, low weight and should be performed a maximum of 2 x day
Phase III return to activity/advanced conditioning
Goals
- Normalize strength, endurance and power
- Return to full ADL’s and recreational activities
Month 2 to 6
- Stretching PRN
- Continue deltoid/cuff/scapula strengthening as above with the following progressions:
- Prone isotonic strengthening PRN
- Decreasing amounts of external stabilization provided to shoulder girdle
- Integrate functional patterns
- Increase speed of movements
- Integrate kinesthetic awareness drills into strengthening activities
- Decrease in rest time to improve endurance
- May begin tennis ground stroke/batting/return to golf after completing strengthening progression
- ***Progressive CKC dynamic stability activities
- ***Impulse
- ***Initiate isokinetic strengthening
- ***Mobilizations PRN
- ***Trunk stabilization/strengthening
Physical therapy protocol for knee arthroscopy
POW 1-2
- Patellar Mobilizations
- Cryotherapy
- Quad sets
- SLR’s: supine
- May use e-stim to promote quad recruitment
- Progress ROM to full actively and passively
- Teach gait training
- Emphasize heel-toe, good quad isolation, normal knee flexion and push-off
- Start the following open chain exercises
- Side lying hip abduction and adduction
- Sitting hip flexion
- Ankle theraband
- Standing hamstring curls to tolerance
- Begin closed chain knee exercises
?ENCOURAGE PROPER TECHNIQUE AT ALL TIMES- Single leg stance: level to unlevel surfaces
- Therakicks: progress resistance, speed, arc of motion
- Walking forward, retro, and sidestepping
- Standing calf raises, wobble board
- Wall slides
- Leg press
- Stationary bike
- Encourage upper extremity strengthening for overall conditioning
- Continue modalities
POW 2-4
- Continue as above
- Progress exercises for building strength and endurance
- 4-6 sets of 15-20 reps
- Progress from double to single leg and concentric to eccentric
- Emphasis on closed chain activities only
- Leg press
- Squats
- Lunges (front/side/back)
- Step-ups
- Leg curls
- Hip strengthening
- Resisted walking
- Exercises for balance and proprioception
- Progress from local to whole body
- Mini-tramp
- Sport cord
- Slide board
- Swiss ball
- Progress from local to whole body
- Exercises for endurance
- Bike
- Stairmaster
- Elliptical trainer
- Treadmill walking
- Aquatic exercise
POW 4-6
- Continue as above but slowly progress weight and decrease reps (8-10)
- Increase load
- Decrease time and increase power
- Progress walking to a fast walk then walk/jog on treadmill
- High knee march
- Figure of “8”
- Begin jumping rope.
- Shuttle
POW 6 return to sport
- Progress jump roping to line jumps, then box jumps, and then distance jumps
- Begin sport specific drills
- Progress speed and intensity of above activities
Return to athletics criteria
- Satisfactory clinical exam
- <10% isokinetic strength deficit (Leg Press)
- Completion of sport replication activity
- Single leg hop test
Physical therapy protocol for large rotator cuff repair
ROM Goals
- POW2
- PFE: 60°-90°
- PER@20: 0°-20°
- PER@90: N/A
- AFE: N/A
- POW6
- PFE: 90°-120°
- PER@20: 20°-30°
- PER@90: N/A
- AFE: to 90°
- POW9
- PFE: 130°-155°
- PER@20: 30°-45°
- PER@90: 45°-60°
- AFE: 90°-120°
- POW12
- PFE: 140°-WNL
- PER@20: 30°-WNL
- PER@90: 75°-WNL
- AFE: 120°-WNL
Phase I protective phase) – NO PROM UNTIL POW 2
Goals
- Minimize pain and inflammatory response
- Achieve ROM goals
- Establish stable scapula
Weeks 0 to 6
- Elbow, wrist and hand AROM (EWH)
- Supine passive external rotation (PER)
- T-stick in 0-20 deg flexion and 20 deg abduction
- 10 reps, 2 x day
- Supine passive forward elevation in plane of scapula
- 90 after the first 2 weeks
- 10-20 reps, 2 x day
- Do not begin passive forward elevation until 2 weeks post op
- C-spine AROM
- Ice
- Positioning full time in sling with abduction pillow
- Shoulder shrugs and retractions (no weight)
- ***Pain control modalities PRN
- Complications/Cautions
- If pain level is not dissipating, decrease intensity and volume of exercises.
- Assure normal neurovascular status
- No AAROM or AROM until 6 weeks
- No pulley until 6 weeks
Weeks 6 to 12
- Heat/ice PRN to help obtain motion
- D/C sling as comfortable
- Progress PROM goals
- Achieve PROM goals in ER at 20 degrees and 90 degrees abduction
- Start AAFE and progress to AFE
- Initiate posterior capsule stretching
- Isometrics, keeping elbow flexed to 90 degrees (Sub maximal, pain free)
- Theraband scapula retractions
- ***Aquatics
- ***Mobilizations PRN
- ***Trunk stabilization/strengthening
- Start periscapular strengthening with very low weight and high repetitions
- Cautions
- Do not initiate rotator cuff strengthening until 12 weeks and until night pain has subsided and overall pain level is low
Phase II progressive strengthening
Goals
- Achieve staged ROM goals
- Eliminate shoulder pain
- Improve strength, endurance and power
- Increase functional activities
Months 3 to 4
- Continue as above
- ROM should be full in all planes
- Progress isometrics
- Advance scapula strengthening
- ***Mobilizations PRN
- ***Aquatics for strengthening
- ***CKC activities for dynamic stability of scapula deltoid and cuff
- ***Trunk stabilization/strengthening
- ***Light PNF D1, D2 and manual resistance for cuff/deltoid/scapula (rhythmic stabilization or slow reversal hold)
- Initiate theraband ER and IR strengthening
- Progressive serratus anterior strengthening (isolated pain free, elbow by side)
- Progress to isotonic dumbbell exercises for deltoid, supraspinatus, up to 3 lbs max
- Cautions
- Do not initiate AAFE or theraband rotator cuff strengthening until overall pain level is low
- Assure normal scapulohumeral rhythm with AAFE and AFE
- Strengthening program should progress only without signs of increasing inflammation
- Strengthening program should emphasize high repetitions, low weight and should be performed a maximum of 2 x day
Phase III return to activity/advanced conditioning
Goals
- Normalize strength, endurance and power
- Return to full ADL’s and recreational activities
Month 4 to 6
- Stretching PRN
- Continue deltoid/cuff/scapula strengthening as above (5lbs max for isotonic strengthening) with the following progressions:
- Prone isotonic strengthening PRN
- Decreasing amounts of external stabilization provided to shoulder girdle
- Integrate functional patterns
- Increase speed of movements
- Integrate kinesthetic awareness drills into strengthening activities
- Decrease in rest time to improve endurance
- May begin tennis ground stroke/batting/return to golf after completing strengthening progression
- ***Progressive CKC dynamic stability activities
- ***Impulse
- ***Initiate isokinetic strengthening
- ***Mobilizations PRN
- ***Trunk stabilization/strengthening
Month 6 to 8
- Stretching PRN
- Continue deltoid/cuff/scapula strengthening program
- Initiate plyometric program (if needed)
- Do not begin until 5/5 MMT for rotator cuff and scapula
- QD at most
- Begin with beach ball/tennis ball progressing to weighted balls
- 2-handed tosses
- waist level
- Overhead
- Diagonal
- 1-handed stability drills
- 1-handed tosses (vary amount of abduction, UE support, amount of protected ER)
- May begin Interval Throwing Program after 3-6 weeks of plyometrics
- Initiate progressive replication of demanding ADL/work activities
Discharge/return to sport criteria
- PROM WNL for ADL’s/work/sports
- MMT 5/5shoulder girdle and/or satisfactory isokinetic test
- Complete plyometric program, if applicable
- Complete interval return to sport program, if applicable
Physical therapy protocol for massive rotator cuff repair
Phase I protective phase)
Goals
- Minimize pain and inflammatory response
- Achieve ROM goals
- Establish stable scapula
Weeks 0 to 8
- Elbow, wrist and hand AROM (EWH)
- Passive forward elevation in plane of scapula (PFE) (supine ) to 90 after the first 6 weeks; 10-20 reps, 2 x day. Do not begin PROM until 6 weeks post op.
- Supine passive external rotation (PER) to tolerance with T-stick in 0-20 degrees flexion and 20 degrees abduction; 10-20 reps, 2 x day beginning week 6.
- C-spine AROM
- Ice
- Positioning full time in sling with abduction pillow
- Shoulder shrugs and retractions (no weight)
- ***Pain control modalities PRN
- Complications/Cautions
- If pain level is not dissipating, decrease intensity and volume of exercises.
- Assure normal neurovascular status
- No AAROM or AROM until 12 weeks
Weeks 8 to 12
- Heat/ice PRN to help obtain motion
- D/C sling as comfortable
- Progress PROM goals to full in all planes
- Achieve PROM goals in ER at 20 degrees and 90 degrees abduction (full)
- Start AAFE and progress to AFEat 12 weeks
- Initiate posterior capsule stretching
- Isometrics, keeping elbow flexed to 90 degrees (Sub maximal, pain free)
- Theraband scapula retractions
- ***Aquatics
- ***Mobilizations PRN
- ***Trunk stabilization/strengthening
- Start periscapular strengthening with very low weight and high repetitions
- Cautions
- Do not initiate rotator cuff strengthening until 16 weeks and until night pain has subsided and overallpain level is low
Phase II progressive strengthening)
Goals
- Achieve staged ROM goals
- Eliminate shoulder pain
- Improve strength, endurance and power
- Increase functional activities
Months 3 to 4
- Continue as above
- ROM should be full in all planes
- Progress isometrics
- Advance scapula strengthening
- ***Mobilizations PRN
- ***Aquatics for strengthening
- ***CKC activities for dynamic stability of scapula deltoid and cuff
- ***Trunk stabilization/strengthening
- ***Light PNF D1, D2 and manual resistance for cuff/deltoid/scapula (rhythmic stabilization or slow reversal hold)
- Initiate theraband ER and IR strengthening
- Progressive serratus anterior strengthening (isolatedpain free, elbow by side)
- Progress to isotonic dumbbell exercises for deltoid,supraspinatus, up to 3 lbs max
- Cautions
- Do not initiate AAFE or theraband rotator cuff strengthening until overall pain levelis low
- Assure normal scapulohumeral rhythm with AAFE and AFE
- Strengthening program should progress onlywithout signs of increasing inflammation
- Strengthening program should emphasizehigh repetitions, low weight and should beperformed a maximum of 2 x day
Phase III return to activity/advanced conditioning
Goals
- Normalize strength, endurance and power
- Return to full ADL’s and recreational activities
Month 4 to 6
- Stretching PRN
- Continue deltoid/cuff/and scapula strengthening asabove (5lbs max for isotonic strengthening) with thefollowing progressions
- Prone isotonic strengthening PRN
- Decreasing amounts of external stabilization provided to shoulder girdle
- Integrate functional patterns
- Increase speed of movements
- Integrate kinesthetic awareness drills into strengthening activities
- Decrease in rest time to improve endurance
- May begin tennis ground stroke/batting/return to golf after completing strengthening progression
- ***Progressive CKC dynamic stability activities
- ***Impulse
- ***Initiate isokinetic strengthening
- ***Mobilizations PRN
- ***Trunk stabilization/strengthening
Month 6 to 8
- Stretching PRN
- Continue deltoid/cuff/scapula strengthening program
- Initiate plyometric program (if needed)
- Do not begin until 5/5 MMT for rotator cuff and scapula
- QD at most
- Begin with beach ball/tennis ball progressing to weighted balls
- 2-handed tosses
- waist-level
- overhead
- diagonal
- 1-handed stability drills
- 1-handed tosses (vary amount of abduction, UE support, amount of protectedER)
- May begin Interval Throwing Program after 3-6 weeks of plyometrics
- Initiate progressive replication of demanding ADL/work activities
Discharge/return to sport criteria
- PROM WNL for ADL’s/work/sports
- MMT 5/5shoulder girdle and/or satisfactory isokinetic test
- Complete plyometric program, if applicable
- Complete interval return to sport program, if applicable
Physical therapy protocol for meniscal repair
POD 1
- Ankle pumps: 20-25 per hour
- Active flexion to 90 as tolerated
- Strict NWB. Brace locked in extension at all times unless performing exercises.
- Gait with crutches.
- Patellar mobilizations
- Polar care/ cryotherapy
- Dressing change: remove bulky dressing, leave clear dressing intact
- Quad sets
POW 1-4
- Continue as above
- Start SLR’s: start standing, then sitting, then supine
- May use e-stim to promote quad recruitment
- Continue active flexion and encourage full extension
- Begin active ROM to full at 4 weeks
- Gait training with assistive device
- Continue NWB
- Start the following open chain exercises
- Side lying hip abduction and adduction
- Sitting hip flexion
- Ankle theraband
- Standing hamstring curls to tolerance
- Encourage upper extremity strengthening for overall conditioning
POW 4-12
- Continue as above
- Be sure to advance knee to full ROM
- Begin weight bearing
- Progress from PWB to WBAT with brace locked in extension.
- Unlock brace at 6 weeks
- D/C brace at 8 weeks
- Aquatic therapy may start at 8 weeks for LE strengthening
- Stationary bike with low resistance and seat up high to avoid hyperflexion
- Standing terminal knee extension with theraband.
- May increase resistance on stationary bike at 10 weeks
POW 12-16
- Begin closed chain knee exercises
?ENCOURAGE PROPER TECHNIQUE AT ALL TIMES.- Single leg stance: level to unlevel surfaces
- Therakicks: progress resistance, speed, arc of motion
- Walking forward, retro, and sidestepping
- Standing calf raises, wobble board
- Wall slides
- Leg press with very light weights at 12 weeks
- Stationary bike
- Jog Progression
- Fast walk
- High knee march
- Figure 8
- 4 way reaction drill
- Jog
- Continue modalities
- Encourage upper extremity strengthening for overall conditioning
POW 16-20
- Continue as above
- Progress exercises for building strength and endurance
- 4-6 sets of 15-20 reps
- Progress from double to single leg and concentric to eccentric
- Emphasis on closed chain activities only
- Leg press
- Squats
- Lunges (front/side/back)
- Step-ups
- Leg curls
- Hip strengthening
- Resisted walking
- Exercises for balance and proprioception
- Progress from local to whole body
- Mini-tramp
- Sport cord
- Slide board
- Swiss ball
- Progress from local to whole body
- Exercises for endurance
- Bike
- Stairmaster
- Elliptical trainer
- Treadmill walking
- Aquatic exercise
POW 20 return to sport
- Progress jump roping to line jumps, then box jumps, and then distance jumps
- Begin sport specific drills
- Progress speed and intensity of above activities
Return to athletics criteria
- Satisfactory clinical exam
- <10% isokinetic strength deficit (Leg Press)
- Completion of sport replication activity
- Single leg hop test
Physical therapy protocol for patellar tendon repair
POD 1
- Ankle pumps: 20-25 per hour
- Active/active assisted knee flexion to 30 degrees as tolerated
- Strict NWB. Brace locked in extension at all times unless performing exercises.
- Gait with crutches
- Patellar mobilizations
- Polar care/ cryotherapy
- Dressing change: remove bulky dressing, leave clear dressing intact
- Quad sets
POW 1-6
- Continue as above
- Start SLR’s: start standing, then sitting, then supine
- May use e-stim to promote quad recruitment
- Continue active flexion and encourage full extension
- Progress ROM 10 deg per week to achieve 90 deg by 6 weeks
- Gait training with assistive device
- Begin WBAT with brace locked in extension at 4 weeks
- Start the following open chain exercises
- Side lying hip abduction and adduction
- Sitting hip flexion
- Ankle theraband
- Standing hamstring curls to tolerance
- Encourage upper extremity strengthening for overall conditioning
POW 6-12
- Continue as above
- Be sure to advance knee to full ROM starting at 6 weeks
- Unlock brace at 8 weeks
- D/C brace at 10 weeks
- Aquatic therapy may start at 8 weeks for LE strengthening
- Stationary bike with low resistance and seat up high to avoid hyperflexion
- Standing terminal knee extension with theraband
- May increase resistance on stationary bike at 10 weeks
POW 12-16
- Begin closed chain knee exercises
?ENCOURAGE PROPER TECHNIQUE AT ALL TIMES.- Single leg stance: level to unlevel surfaces
- Therakicks: progress resistance, speed, arc of motion
- Walking forward, retro, and sidestepping
- Standing calf raises, wobble board
- Wall slides
- Leg press with very light weights at 12 weeks
- Stationary bike
- Jog Progression
- Fast walk
- High knee march
- Figure 8
- 4 way reaction drill
- Jog
- Continue modalities
- Encourage upper extremity strengthening for overall conditioning
POW 16-20
- Continue as above
- Progress exercises for building strength and endurance
- 4-6 sets of 15-20 reps
- Progress from double to single leg and concentric to eccentric
- Emphasis on closed chain activities only
- Squats, leg press
- Lunges (front/side/back)
- Step-ups
- Leg curls
- Hip strengthening
- Resisted walking
- Exercises for balance and proprioception
- Progress from local to whole body
- Mini-tramp
- Sport cord
- Slide board
- Swiss ball
- Progress from local to whole body
- Exercises for endurance
- Bike
- Stairmaster
- Elliptical trainer
- Treadmill walking
- Aquatic exercise
POW 20 return to sport
- Progress jump roping to line jumps, then box jumps, and then distance jumps
- Begin sport specific drills
- Progress speed and intensity of above activities
Return to athletics criteria
- Satisfactory clinical exam
- <10% isokinetic strength deficit (Leg Press)
- Completion of sport replication activity
- Single leg hop test
Physical therapy protocol for quad tendon repair
POD 1
- Ankle pumps: 20-25 per hour
- Strict NWB. Brace locked in extension at all times unless performing exercises.
- Gait with crutches
- Patellar mobilizations
- Polar care/ cryotherapy
- Dressing change
- Quad sets in brace
POW 1-6
- Continue as above
- Start SLR’s: start standing, then sitting, then supine in brace
- May use e-stim to promote quad recruitment
- Encourage full extension
- Progress ROM 10 deg per week beginning week 4 to achieve 90 deg by 8 weeks
- Gait training with assistive device
- Begin WBAT with brace locked in extension at 4 weeks
- Start the following open chain exercises
- Side lying hip abduction and adduction
- Sitting hip flexion
- Ankle theraband
- Encourage upper extremity strengthening for overall conditioning
POW 6-12
- Continue as above
- Be sure to advance knee to full ROM starting at 8 weeks
- Unlock brace at 8 weeks to ambulate
- D/C brace at 10 weeks
- Aquatic therapy may start at 8 weeks for LE strengthening
- Stationary bike with low resistance and seat up high to avoid hyperflexion
- Standing terminal knee extension with theraband.
- May increase resistance on stationary bike at 10 week
POW 12-16
- Begin closed chain knee exercises
?ENCOURAGE PROPER TECHNIQUE AT ALL TIMES.- Single leg stance: level to unlevel surfaces
- Therakicks: progress resistance, speed, arc of motion
- Walking forward, retro, and sidestepping
- Standing calf raises, wobble board
- Wall slides
- Leg press with very light weights at 12 weeks
- Stationary bike
- Jog Progression
- Fast walk
- High knee march
- Figure 8
- 4 way reaction drill
- Jog
- Continue modalities
- Encourage upper extremity strengthening for overall conditioning
POW 16-20
- Continue as above
- Progress exercises for building strength and endurance
- 4-6 sets of 15-20 reps
- Progress from double to single leg and concentric to eccentric
- Emphasis on closed chain activities only
- Squats, leg press
- Lunges (front/side/back)
- Step-ups
- Leg curls
- Hip strengthening
- Resisted walking
- Exercises for balance and proprioception
- Progress from local to whole body
- Mini-tramp
- Sport cord
- Slide board
- Swiss ball
- Progress from local to whole body
- Exercises for endurance
- Bike
- Stairmaster
- Elliptical trainer
- Treadmill walking
- Aquatic exercise
POW 20 return to sport
- Progress jump roping to line jumps, then box jumps, and then distance jumps
- Begin sport specific drills
- Progress speed and intensity of above activities
Return to athletics criteria
- Satisfactory clinical exam
- <10% isokinetic strength deficit (Leg Press)
- Completion of sport replication activity
- Single leg hop test