Achilles Tendon Repair

Achilles Tendon Repair

Jun 16, 2016

Phase I (Weeks 0-2)

  1. Weightbearing: Non-weightbearing using crutches
  2. Brace: Patient in plantarflexion splint
  3. No formal PT

Phase II (Weeks 2-6)

  1. Weightbearing: As tolerated in CAM Walker Boot with heel wedges in place (first wedge removed at 4 weeks, second wedge removed at 6 weeks); discontinue crutch use
  2. Brace: CAM Walker Boot at all times except showering and when working with PT
  3. Range of Motion
    • PROM / AROM / AAROM of the ankle from full plantarflexion to neutral (no dorsiflexion past neutral)
    • Inversion / eversion
    • Toe flexion / extension
  4. Therapeutic Exercises
    • Seated heel raises
    • Isometric dorsiflexion to neutral
    • Resistance bands for plantarflexion, inversion, and eversion
    • Proprioception exercises – single-leg stance with front support to avoid excessive dorsiflexion
    • Soft tissue mobilization, scar massage, desensitization, and edema control

Phase III (Weeks 6-12)

  1. Weightbearing: Full weightbearing in sneaker
  2. Range of Motion
    • PROM / AROM / AAROM of the ankle with progressive dorsiflexion
    • Increase dorsiflexion in 10° intervals
    • 10° by post-op week 8, 20° by week 10, 30° by week 12
  3. Therapeutic Exercises
    • Standing heel raises
    • Single-leg eccentric lowering
    • Step-ups and side steps
    • Proprioception exercises – balance board

Phase IV (Months 3-6)

  1. Progress strengthening, proprioception, and gait training activities
  2. Begin light jogging at 12–14 weeks
  3. Running and cutting at 16 weeks
  4. Return to sports at 5–6 months
Quadriceps and Patellar Tendon Repair

Quadriceps and Patellar Tendon Repair

Jun 15, 2016

Phase I (Weeks 4-10)

  1. Weightbearing: As tolerated in the hinged knee brace locked in extension
  2. Hinged Knee Brace
    • Progressive increase in flexion allowed under guidance of PT
    • Week 4: 0–30°
    • Week 5: 0–40°
    • Week 6: 0–70°
    • Week 8: 0–90°
    • Week 10: Unlocked
  3. Range of Motion – PROM and AAROM as tolerated according to restrictions above
  4. Therapeutic Exercise
    • Begin isometric quadriceps strengthening and straight-leg raises
    • Patellar mobilization and scar massage

Phase II (Weeks 10-16)

  1. Weightbearing: As tolerated — in unlocked hinged knee brace until week 12
  2. Hinged Knee Brace
    • Completely unlocked for Weeks 10–12
    • Discontinue brace at Week 12 if patient can perform straight-leg raise with good quad control
  3. Range of Motion – AAROM → AROM as tolerated
    • Goal: Full flexion by weeks 12–14
  4. Therapeutic Exercise
    • Continue patellar mobilizations
    • Start stationary bicycle when ROM allows
    • Aquatic therapy
    • Begin progressive resistance exercises and therabands

Phase III (Months 4-6)

  1. Weightbearing: As tolerated
  2. Range of Motion – Full and painless
  3. Therapeutic Exercise
    • Continue quadriceps strengthening
    • Focus on single-leg strength
    • Start treadmill walking and progress to light jogging at month 6

Phase IV (Months 6-12)

  1. Gradual return to athletic activity as tolerated
  2. Maintenance program for strength and endurance
Arthroscopic Anterior Shoulder Stabilization

Arthroscopic Anterior Shoulder Stabilization

Jun 10, 2016

Phase I (Weeks 0-4)

  1. Sling immobilization at all times except for showering and rehab under guidance of PT.
  2. Range of Motion – PROM -> AAROM -> AROM as tolerated.
    • Restrict motion to 90° of Forward Flexion, 45° of Abduction, 30° of External Rotation and Internal Rotation to stomach.
  3. Therapeutic Exercise
    • Elbow/Wrist/Hand Range of Motion.
    • Grip Strengthening.
    • Isometric Abduction, Internal/External Rotation exercises with elbow at side.
  4. Heat/Ice before and after PT sessions.

Phase II (Weeks 4-6)

  1. Discontinue sling immobilization.
  2. Range of Motion – Increase Forward Flexion, Internal/External Rotation to full motion as tolerated.
  3. Therapeutic Exercise
    • Advance isometrics from Phase I to use of a theraband within AROM limitations.
    • Continue with Elbow/Wrist/Hand Range of Motion and Grip Strengthening.
    • Begin Prone Extensions and Scapular Stabilizing Exercises (traps/rhomboids/levator scapula).
    • Gentle joint mobilization.
  4. Modalities per PT discretion.

Phase III (Weeks 6-12)

  1. Range of Motion – Progress to full AROM without discomfort.
  2. Therapeutic Exercise
    • Advance theraband exercises to light weights (1-5 lbs).
    • 8-12 repetitions / 2-3 sets for Rotator Cuff, Deltoid and Scapular Stabilizers.
    • Continue and progress with Phase II exercises.
    • Begin UE ergometer.
  3. Modalities per PT discretion.

Phase IV (Months 3-6)

  1. Range of Motion – Full without discomfort.
  2. Therapeutic Exercise
    • Advance exercises in Phase III (strengthening 3x per week).
    • Sport/Work specific rehabilitation.
    • Return to throwing at 4.5 months.
    • Return to sports at 6 months if approved.
  3. Modalities per PT discretion.
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