Anterior Cruciate Ligament Reconstruction Rehabilitation Programme ... - Static co-contraction of hamstring and quadriceps at 0 degrees, 60 degrees and 90 degrees continues. DO these with the tibia externally rotated. - Use of biofeedback for retrain
Patellar and Quadriceps Tendon Repair Post-op Protocol . You will follow-up with Dr. Robertson 10 -14 days after surgery. At this office visit you will also see one of his physical therapists. At that time, they will perform an assessment, review sev
• Patellar and scar mobilization ... • Lack of apprehension with sport specific activities • ≥ 85% limb symmetry with hop test and isokinetic testing . Precautions: • Avoid pain with ADLs • Avoid high-level sport activity until adequate strength and
Presentation: Symptoms. traumatic event causing dislocation; feeling of instability; shoulder pain complaints . caused by subluxation and excessive translation of the humeral head on the glenoid
90% strength of internal rotators/external rotators as compared to uninvolved shoulder according to isokinetic evaluation if throwing athlete.
GUIDELINES FOR ANtERIOR ShOULDER REPAIR REhABILItAtION The Shoulder Center of Kentucky uses a functional approach ... with elevation …
UW HEALTH SPORTS REHABILITATION UWSPORTSMEDICINE.ORG 621 SCIENCE DRIVE • MADISON, WI 53711 4602 EASTPARK BLVD. • MADISON, WI 53718 Rehabilitation Guidelines for Anterior Shoulder
Department of Rehabilitation Services Physical Therapy Anterior Stabilization of the Shoulder: Latarjet Protocol Shoulder instability may be caused from congenital deformity, recurrent overuse activity,
Anterior Shoulder Dislocation with Axillary Artery and Nerve Injury medial side of the left upper arm. Operative findings revealed a 2cm avulsed and thrombosed
Anterior Shoulder Reconstruction (Includes Capsular Shift, Plication, and Bankart Procedures)
Week Three and Four
Weeks Four to Six
Posture and position of the shoulder girdle Passive range of motion Effusion Inspect incision for integrity and infection Assess RTW and sport expectations.
Support Physician prescribed meds Discuss frequency and duration of treatment (23x/wk for 10-12 weeks is anticipated. Educate in avoidance of activity that places stress on shoulder (reaching in back seat of car, throwing, sawing, pull starts on lawn and garden equipment) Avoid Anterior directed forces x3 months (typically combined ABD/ER) Therapeutic Exercise
Active cervical ROM, shoulder shrugs, scapular retraction, wrist/elbow AROM and gripping are all permitted. May perform pendulums or “cradle the baby” cane assisted IR/ER in open packed position, table slides, cane flexion in supine, and pulleys. Sub maximal isometrics
Grade I and II joint mobilization as needed (No Anterior GH mobilization) Initiate gentle mobilization of incision when appropriate. Begin gentle rhythmic stabilization Do not force combined ABD/ER Modalities
Any modalities as indicated for reduction of symptoms and effusion
Control Pain Restore PROM Reduce effusion Independence with post-operative precautions
Initiate AROM without resistance or compensation (consider Prone, side-lying, and supine table exercises that limit stress on the anterior capsule) Continue self ROM activity and sub maximal isometrics Aquatics: Start at week 4. Begin exercises in chest deep water for comfort and maximum ROM. Progress to walking with all arm movements and ROM in prone or standing. For progression add buoyancy. Manual Techniques PROM and joint mobilization as needed (No anterior GH mobilization) Continue mobilization of incision as needed Continue rhythmic stabilization Initiate gentle PNF Modalities
Patient Education Educate regarding correction of abnormal movement patterns and posture Avoid Anterior directed forces x3 months (typically combined ABD/ER) Educate in avoidance of activity that place stress on shoulder (reaching in back seat of car, throwing, sawing, pull starts on lawn and garden equipment) Wean from sling at 4 weeks post-op Therapeutic Exercise
PROM Effusion Inspect incision for integrity and infection.
Any modalities as indicated for reduction of symptoms and effusion Goals
Full PROM (with exception of ER) NO pain with ADL’s Normal incision tissue mobility.
Weeks Six To Ten
Weeks Ten to Discharge
Passive ROM and AROM Compensatory patterns (early scapular migration, winging, and substitution. Patient Education Continue education regarding correction of abnormal movement’s patterns and posture. Avoid Anterior directed forces x3 months (typically combined ABD/ER)
Address any deficits that may limit return to work or sport goals HEP compliance Patient Education Continue education regarding correction of abnormal movement patterns and posture. Gradual return to activity that requires anterior GH forces is permitted at 3 months s/p Therapeutic Exercise
Initiate UBE if not already completed. Pain free isotonic exercises for periscapular and rotator cuff musculature Add closed chain proprioceptive exercises as indicated Incorporate trunk stabilization where able (Planks, planks with rows) Continue with self-stretches as needed Aquatics; Continue with ROM and walking exercise- may add resistance if pain free and increase speed. May move to shallow water if no compensation with shoulder movement. May add closed chain exercises with kickboard and stabilization exercise with ball toss. Add deep water cardio Manual Techniques
PROM and joint mobilization as indicated (No Anterior GH mobilization) Rhythmic stabilization PNF Modalities
Any modalities as indicated
Continue isotonic exercises for periscapular and rotator cuff musculature, progressing to shoulder height and above when indicated. Continue with self-stretches as needed. Establish independent HEP to include stretching of periscapular and rotator cuff musculature, selfstretches, interval training program at 7-8 months if indicated for RTS.
Manual Techniques Any techniques as indicated (No Anterior GH mobilization)
Any modalities as indicated Goals
Full AROM without compensatory movement 4+/5 strength throughout
Reinold MM, Escamilla RF, Wilk KE. Current concepts in the scientific and clinical rationale behind exercises for glenohumeral and scapulothoracic musculature. J Orthop Sports Phys Ther. 2009 Feb;39(2):105-17.
Guido JA Jr, Stemm J. Reactive Neuromuscular Training: A Multi-level Approach to Rehabilitation of the Unstable Shoulder. N Am J Sports Phys Ther. 2007 May;2(2):97-103.
Castillo-Lozano R1, Cuesta-Vargas A2, Gabel CP3. Analysis of arm elevation muscle activity through different movement planes and speeds during in-water and dry-land exercise. J Shoulder Elbow Surg. 2014 Feb;23(2):159-65. doi: 10.1016/j.jse.2013.04.010. Epub 2013 Jul 5.
Created 2011 Revised/aquatics added 1/19
Normal strength Return to work or sport Independence with HEP