Physical Therapy Protocols

At OSMS we understand that Physical Therapy can be an alternative to surgery and always important for post-op rehabilitation. For your recovery and convenience, our Orthopedic Doctors have created a collection of PT Protocols design specifically to advance your recovery. These protocols should be adhered to, whether you are working with your Physical Therapist or self-exercising at home. If you have any questions please contact us.

ELBOW REHABILITATION PROTOCOLS

Distal Biceps Repair

Distal biceps rupture is a forced elbow extension while the muscle is tensioned in flexion. A distinct “pop” is often felt at the elbow, and a soft retraction of the tendon is palpable into the upper arm area.

Rehabilitation Goals: Achieve excellent hand and shoulder range-of-motion, reduce swelling in the limb, and control pain.

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Elbow MCL Reconstruction

Rupture of the elbow MCL is a devastating injury that can lead to elbow dysfunction, pain, and loss of throwing velocity.

Rehabilitation Goals: Promote gentle shoulder, hand, and wrist ROM.

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Lateral Epicondyle Surgery

Lateral epicondyle of the elbow can lead to elbow dysfunction, pain, and loss of grip strength.

Rehabilitation Goals: Promote gentle shoulder, hand, and wrist ROM.

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Medial Epicondyle Surgery

Problems with the medial epicondyle of the elbow can lead to elbow dysfunction, pain, and loss of grip strength.

Rehabilitation Goals: Promote gentle shoulder, hand, and wrist ROM.

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Triceps Repair

Rupture of the triceps tendon is a relatively rare injury that can lead to elbow dysfunction, pain, loss of strength.

Rehabilitation Goals: Promote gentle shoulder, hand, and wrist ROM.

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Ulnar Nerve Transposition

Problems around the ulnar nerve at the elbow can lead to stiffness, hand tingling, and loss of grip strength.

Rehabilitation Goals: Promote gentle shoulder, hand, and wrist ROM.

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At Home Elbow and Wrist Exercises

HIP REHABILITATION PROTOCOLS

Total Hip Arthroplasty

Total hip arthroplasty (THA) is an elective procedure to relieve pain and restore function to a joint with end-stage arthritis.

Rehabilitation Goals: Protection of post-surgical hip, restore hip ROM, normalize gait, restore leg control, transition from narcotic pain meds to NSAIDs, and prevent deep venous thrombosis.

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Anterior Hip Arthroplasty

Anterior total hip arthroplasty (ATHA) is an elective procedure to relieve pain and restore function to a joint with end-stage arthritis.

Rehabilitation Goals: Protect the repaired hip, restore hip ROM, normalize gait, restore leg control, transition from narcotic pain medications to NSAIDs, and prevent deep venous thrombosis.

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Arthroscopic Gluteus Medius Repair

Gluteus medius injuries can lead to chronic limping, pain, and stiffness.

Rehabilitation Goals: Protect the integrity of the repaired hip tissue, restore ROM, reduce pain and inflammation, and prevent muscular inhibition.

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Iliospoas Release

Iliopsoas tendinitis release attempts to restore hip motion and function and failure to address iliopsoas imbalance and pain can lead to stiffness and subsequent loss of hip strength.

Rehabilitation Goals: Protect the integrity of remaining hip tissue, restore ROM, reduce pain and inflammation, and prevent muscular inhibition.

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Open Gluteus Medius Repair

Gluteus medius tendon injury and muscle damage can lead to chronic limping, pain, and stiffness. Surgery attempts to restore hip motion and function.

Rehabilitation Goals: Protect the integrity of the repaired hip tissue, restore ROM, reduce pain and inflammation, and prevent muscular inhibition.

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Proximal Hamstring Repair

Hamstring injuries and muscle damage can lead to chronic limping, pain, and weakness.

Rehabilitation Goals: Protect the integrity of the repaired hip tissue, restore ROM, reduce pain and inflammation, and prevent muscular inhibition.

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At Home Hip Exercises

KNEE REHABILITATION PROTOCOLS

ACL Reconstruction

The ACL rehabilitation program emphasizes early restoration of symmetric knee ROM.

Rehabilitation Goals: Maintain stability, achieve full motion, safetly rehabilitate the knee, avoid harvest site complications, reduce swelling and  toe-touch weight-bearing in locked brace at 0.

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ACL Reconstruction with MCL Reconstruction

The ACL/MCL rehabilitation program emphasizes progressive restoration of symmetric knee function.

Rehabilitation Goals: Maintain stability, achieve full motion, safely rehabilitate the knee, avoid harvest site complications, reduce swelling and non-weight-bearing with locked brace in extension.

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Distal Femoral Osteotomy

A distal femoral osteotomy is useful in limb re-alignment and involves severing the bone with subsequent repair using pins, plates, or rods.

Rehabilitation Goals: Toe-touch weight-bearing in locked brace at 0, maintain full extension, progress to flexion, and reduce swelling.

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Knee Extensor Repair

Patellar/quadriceps tendon rupture or patellar fracture can be devastating for knee motion and strength of push-off. Functional recovery is critical to both balance, walking, stair climbing, and athletic activities.

Rehabilitation Goals: Excellent hip and ankle  ROM, reduce swelling, and control pain.

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Knee Meniscectomy

Arthroscopic meniscectomy is one of the most commom surgeries with 95-99% return to activities and a strong, pain-free knee with functional ROM with aggressive physical therapy.

Rehabilitation Goals: Rapid recovery.

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Meniscal Repair

The healing of this tissue is critical for long-term knee function.

Rehabilitation Goals: Maintain flexibility, function, cartilage integrity, avoid future knee surgeries, and return to activities. Non-weight-bearing in locked brace extension, reduce swelling, and restore quadriceps activation.

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Microfracture Femoral Condyle

Microfracture surgery attempts to restore articular cartilage for weight bearing activities.

Rehabilitation Goals: Protect the healing tissue, reduce swelling, control pain, and gradually restore knee ROM.

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Microfracture Patellofemoral

Microfracture surgery attempts to restore articular cartilage for weight bearing activities.

Rehabilitation Goals: Protect the healing tissue, reduce swelling, control pain, and gradually restore knee ROM.

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At Home Knee and Leg Exercises

SHOULDER REHABILITATION PROTOCOLS

Athroscopic Bankart Repair

The arthroscopic Bankart repair protocol is a soft tissue post-op program which allows shoulder instability patients to recover as safely as possible.

Rehabilitation Goals: Protect the repaired shoulder, full active and passive ROM for shoulder flexion, abduction, IR  to the abdomen, and ER to 20, and activation of the stabilizing muscles.

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Biceps Tenodesis

The biceps tenodesis protocol includes flexibility, stretching, and strengthening to prevent against stiffness.

Rehabilitation Goals: Full passive ROM for shoulder flexion, abduction, IR and ER, and achieve activation of the stabilizing muscles for the GH and scapulothoracic joints.

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Massive Rotator Cuff Repair

The emphasis for this massive rotator cuff repair (RCR) protocol is to prevent the loss of fixation and return to activities as quickly as possible.

Rehabilitation Goals: Progress to work/sport-specific activities as quickly as possible,  protect the shoulder, PROM for shoulder flexion, abduction, IR to abdomen, and ER to neutral, and limited removal of sling in safe environment at 10-14 days.

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Pectoralis Major Repair

Rehabilitation Goals: Progress to work/sport-specific activities as quickly and safely as possible,  and protect the muscular repair.

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Reverse Total Shoulder Arthroplasty

In patients with fracture or rotator cuff damage, reverse total shoulder arthroplasty is designed to relieve pain in the shoulder and restore motion.

Rehabilitation Goals: Pain control, one-handed ADLs, gentle ROM, and protect the surgical reconstruction.

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Shoulder Arthroscopic Debridement, SAD, and/or DCR

Rehabilitation Goals: protect the shoulder, recover safely, and return to work/sport-specific activities as safely as possible.

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Superior Capsular Reconstruction

Rehabilitation Goals: Protect the shoulder, distal extremity ROM, and gentle PROM within restrictions.

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Posterior Shoulder Stabilization

Rehabilitation Goals: Protect the repaired posterior capsule, and initiate early protected ROM.

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Small/Medium RCR

Rehabilitation Goals: Progress to work/sport-specific activities as quickly and safely as possible, protect the arthroscopically-repaired shoulder, PROM for shoulder flexion, abduction, IR to the abdomen, and ER to neutral, and limited removal of the sling in a safe environment at 10-14 days.

See Protocol

Total Shoulder Arthroplasty

Total shoulder arthroplasty is meant to relieve pain and restore function to a joint with end-stage arthritis or relieve pain due to a fracture or rotator cuff damage.

Rehabilitation Goals: Pain control and one-handed ADLs, gentle ROM, donning and doffing the sling, and protecting the surgical reconstruction.

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At Home Shoulder Exercises

CORE/LOWER BACK AT HOME EXERCISES

At Home Lower Back Exercises