Achilles Tendon Repair Rehabilitation Protocol



Shoulder Joint Replacement Rehabilitation Protocol

Phase 1: Weeks 0 – 4 Recovery and Passive Motion

Goals:

- Allow for tissue healing

- Control pain and swelling

Management / Precautions:

- Keep dressings clean and dry until your review appointment at 2 weeks

- Sling to be worn for 6 weeks, remove for exercises and hygiene only

- No lifting or weight bearing through the arm

- Avoid lifting the arm above 90◦ (shoulder height)for 4 weeks

- No external rotation past 30◦ for 12 weeks (see picture above)

- Use an ice pack over the shoulder for 20 minutes 4 times per day to minimise pain and swelling

Phase 1: Exercises

Remove sling to do these exercises 3 – 5 times per day

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Phase 2: Weeks 4 – 6 Active Assisted Range and Return to Light Function

Goals:

- Regain full pain free assisted forward shoulder elevation

- Regain functional use of the arm with light activities in front of the body

Management / Precautions:

- Gradually increase the time spent out of the sling when in controlled environments such as your home. Discontinue sling use at 6 weeks

- Start to use the arm for light activities as pain allows e.g. brushing your teeth, eating, dressing etc.

- Lifting: Maximum a cup of tea or mobile phone (approximately 250g)

- No weight bearing that is leaning through the arm

- Continue to limit external rotation to 30◦

- Avoid hand behind back activities such as tucking in your shirt

- Hydrotherapy: Can begin pool exercises once the wound has healed as guided by your physiotherapist or surgeon

Phase 2: Exercises

Continue Phase 1 exercises PLUS:

Do these exercises 3 – 5 times per day

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Phase 3: Weeks 6 – 12 Active Range and Gentle Strengthening

Goals:

- Gradually return to all daily activities

- Regain full shoulder range of motion

- Commence light strengthening

Management / Precautions:

- Lifting: Maximum 2kg in the operated arm

- Continue to limit external rotation to 30◦

- Begin gentle hand behind back activities as pain allows

- Commence light resistance training e.g. Yellow Theraband

Phase 3: Exercises

Continue exercises from Phase 1 and 2, PLUS:

Do these exercises 2 – 3 times per day

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Phase 4: 3 – 6 Months Advanced Strengthening

Goals

- Aim to achieve functional shoulder range and strength

- Gradual return to hobbies/sports (gardening, tennis, golf)

Management

- Lifting: Gradually increase the weight you can lift – no restrictions

- Continue progression of strengthening exercises as guided by your physiotherapist

- Begin light sport specific exercises or activities such as gardening, golf putting, tennis ground strokes etc.

Phase 4: Exercises

Continue exercises from Phase 1 – 3, PLUS:

Do these exercises 2 – 3 times per day

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Common Questions

When Can I…

- Return to work?

o Sedentary employment (i.e. desk job) when comfortable. However your duties may be limited in the first 4 – 6 weeks while wearing the sling

o Work that involves light use of the arm (i.e. retail), from 6 weeks however no lifting of more than 2kg until 12 weeks

o Manual labour (i.e. tradesman) in consultation with your surgeon and physiotherapist but generally 3 – 6 months

- Return to driving?

o After 6 weeks provided you are out of the sling and can safely manoeuvre the steering wheel

o Manual car: May be delayed to ensure your ability to complete gear changes

- Return to activities of daily living?

o You can begin light activities such as eating, brushing your teeth and dressing at approximately 4 weeks. This should be guided by pain

- Return to Hobbies?

o Light hobbies such as sewing, or knitting typically 4 – 6 weeks

o Sports such as tennis, golf or gardening as guided by your physiotherapist and surgeon but typically 3 – 6 months

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Shoulder Pendulum Exercises

Lean forward supporting your upper body with the good arm let the affected arm relax straight down. Gently swing the arm.

a. Left and right

b. Forward and backward

c. In circular motion (clockwise and anticlockwise)

10 – 20 times in each direction

Passive Shoulder Internal / External Rotation

Keeping the elbow tucked into your side, use the good arm to passively move the affected arm from the stomach out to the front then return to the start position. Don’t externally rotate past 30◦.

Repeat 3 x 10

Pendular exercises. Stand leaning on a table with the unaffected arm. Let the affected arm hang relaxed straight down, gently swing your arm

A) Left and right

B) Forward and backward

C) In circles clockwise and anticlockwise

Repeat 10 of each

Pendular exercises. Stand leaning on a table with the unaffected arm. Let the affected arm hang relaxed straight down, gently swing your arm

D) Left and right

E) Forward and backward

F) In circles clockwise and anticlockwise

Repeat 10 of each

Passive Shoulder Elevation

Lay on your back, use the good arm to passively lift the operated arm up to 90◦ then slowly lower.

Repeat 3 x 10

Shoulder Blade Squeezes

Squeeze your shoulder blades together. Hold for 5 – 10 seconds.

Repeat 10 times

Shoulder Circles

Move shoulder blades up towards the ears, then back and down.

Repeat 3 x 10

Elbow Range of Motion

Bend and straighten your elbow as far as comfortable. Use your other hand to help if needed.

Repeat 3 x 10

Hand Exercises

Move your wrist.

a) Up and down

b) Around in circles

Repeat 10 times each way

Make a fist then open your hand wide.

Repeat 20 times

Shoulder Flexion - Table Slide

Sitting at the table with your palms on a towel, slide your hands out in front as far as comfortable, then return to the start position.

Repeat 3 x 10

Active Assisted Shoulder Flexion

Lay on your back, use your good arm to assist the operated arm above your head as far as is comfortable then bring your arm back to the start position. Do not push into pain.

Repeat 3 x 10

ADVANCED: Shoulder Flexion - Wall Crawl

Once the above exercises become relatively easy progress to wall crawls.

Stand facing a wall, walk your fingers up the wall as far as comfortable, hold 5 seconds then slide back down.

Repeat 3 x 10

Pulley

Sit or stand holding a pulley, use the unaffected arm to assist the operated arm up and down.

Repeat 3 x 1 minute

ADVANCED: Active Shoulder Flexion

Once wall crawls from Phase 2 become easy progress to active shoulder flexion.

Lift your arm forward as high as comfortable, hold 5 seconds then slowly lower back down.

Repeat 3 x 10

Shoulder Abduction

Stand gripping the end of a stick with the operated arm. Guide the arm out to the side using the good arm to assist.

Repeat 3 x 10

Progression: Lift the arm out to the side without the stick

Shoulder External Rotation

Lay on your back with the elbow tucked into your side. Use a stick to gently guide the affected arm out to the side to a maximum of 30◦ then return to the start position.

Repeat 3 x 10

Hand Behind Back

Reach your hand behind your back as high as you can comfortably go. You may use your other hand to assist but don’t push into pain. Hold for 5 seconds.

Repeat 10 times

Exercise Band Pulls

Tie exercise band to a door handle. Stand facing the door holding the end of the exercise band in both hands. Pull the band towards you while squeezing your shoulder blades together.

Repeat 3 x 10

Exercise Band Pushes

Stand facing away from the door holding the exercise band with the operated arm, pull forward as far as comfortable then slowly return to the start position.

Repeat 3 x 10

Exercise Band Extension

Stand facing the door. Pull the exercise band backwards keeping your elbow straight. Relax back to the start position.

Repeat 3 x 10

Exercise Band Internal Rotation

Tie an elastic exercise band to a door handle.

Stand side on to the door with your operated arm next to the door. Bend your elbow to 90 degrees and tuck it into your side. Pull the band towards your tummy, then and slowly rotate back out to the side.

Repeat 3 x 10

Exercise Band External Rotation

As for the exercise above but face the opposite way, pull the band from your tummy out to the side stopping at 30◦.

Repeat 3 x 10

Chest Press

Lay on your back holding a light weight (0.5kg - 2kg) in your operated hand. Push up towards the ceiling then slowly lower.

Repeat 3 x 10

Wall Ball Rolls

Stand holding a ball against a wall with your elbows straight. Squeeze your shoulder blades together, and then roll the ball in a circle for about 60 seconds. Don’t lean your body weight on the ball.

Repeat 2 – 3 times

Wall Push Up

Stand with your palms on the wall, lean into the wall slowly then push back out.

Repeat 3 x 10

Exercise Band External Rotation

As per Phase 3 but you may now progress to full range of movement.

Repeat 3 x 10

Exercise Band Diagonal Pull Ups

Tie an exercise band somewhere close to the ground. Pull it diagonally up and out to the side then slowly return to the start position.

Repeat 3 x 10

Exercise Band Shoulder Flexion

Place exercise band under your foot. Use the affected arm to pull the band forward then slowly return to the start position.

Repeat 3 x 10

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