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RSH Physical Therapy Houston Orthopædics & Sports Medicine OakBend Medical Center
1601 Main Street # 602 1601 Main Street # 601 1705 Jackson Street
Richmond, TX 77469 Richmond, TX 77469 Richmond, TX 77469
281.341.2874 281.565.8800 281.341.3000
David Edell, LAT, ATC, CSCS
Cellular: 713.858.3802 • Fax: 281.341.3012 • E- Mail: dedell@athleticadvisor.com
Progress to Phase II when a 20 yard walk can be completed with little or no discomfort.
Phase II
A. Ice Massage before and after exercise
Inversion: Loop band over ball and instep of foot. Turn ankle & foot (not
leg) inward as far as possible. Repeat 30 to 60 times one time daily.
Eversion: Loop band over outside edge of foot just below the toes. Turn
ankle & foot (not leg) outward as far as possible. Repeat 30 to 60 times
one time daily.
Achilles Tendinitis, Pg. 2
Dorsiflexion: Loop band over top of foot at base of toes. Pull foot and toes up toward shin as far as
possible. Repeat 30 to 60 times one time daily.
ABC’s: Loop band around ball and sole of foot while holding ends of the band. Write ABC’s with,
moving o nly foot and ankle, as in #1. Perform 1 to 2 sets of the alphabet one time daily.
CALF RAISES: Stand with feet shoulder width apart and toes pointed forward. Left heels off of the
floor as high as possible. Slowly lower heels to the floor and repeat as described below.
Friday - Saturday 3 x 20 3 x 20 3 x 20 3 x 20
Both Legs 2 Legs, Toes Elevated 1 Leg 1 Leg, Toes Elevated
Progress to Phase III when 3x20 heel raises can be completed with little or no discomfort.
Phase III
A. Continue ice massage before and after exercise.
F. Begin light jogging on flat, smooth surface and progress in distance or time as pain allows.
G. Progress to normal activities when 3x20 one leg elevated heel raises and a 40 yd jog can be
completed without pain within 24 hours after activity.
Friday - Saturday 3 x 20 3 x 20 3 x 20 3 x 20
Both Legs 2 Legs, Toes Elevated 1 Leg 1 Leg, Toes Elevated
5
Perform these exercises for 4 weeks to ensure a full return to participation!
The Sports Medicine Specialists
RSH Physical Therapy Houston Orthopædics & Sports Medicine OakBend Medical Center
1601 Main Street # 602 1601 Main Street # 601 1705 Jackson Street
Richmond, TX 77469 Richmond, TX 77469 Richmond, TX 77469
281.341.2874 281.565.8800 281.341.3000
David Edell, LAT, ATC, CSCS
Cellular: 713.858.3802 • Fax: 281.341.3012 • E- Mail: dedell@athleticadvisor.com
Post-Op: Day 1
1. Continue ice, elevation, and compression wrap.
2. Continue range of motion exercises 2 - 3 times per day and add:
a. Stationary bike riding with seat height as low as tolerable with low resistance.
3. Continue strengthening exercises and add:
ACL-Hamstring, Pg. 2
Post-Op: Day 2 - 7
1. Continue ice and elevation.
2. Discontinue crutches no later than day three.
3. Continue range of motion exercises.
4. Continue strengthening exercises by utilizing PRE principle and add:
a. Weight to all SLR’s, Knee Extension, Hip Flexion, and TKE, and
b. Side Step-Ups.
5. Ice before and after exercise and continue use of compression wrap.
6. Physician examination 6 - 8 days post-op for evaluation and suture removal.
Post-Op: Week 1 - 3
1. Continue ice and elevation as needed.
2. May shower or bathe after sutures have been removed.
3. Continue range of motion exercises (Full ROM allowed).
4. Continue strengthening exercises and add:
a. Gait training program on smooth, flat surface,
b. Squats progressing to Single-leg parallel squats,
c. Calf Raises progressing to Single-leg, then elevated heel raises,
d. Balance and proprioception activities, and
e. StairClimber exercises.
5. Ice before, if indicated, and after exercise.
Post-Op: Week 4 - 12
1. May apply lotion to incisions sites using heel of thumb and pressure as tolerated.
2. Continue range of motion exercises if needed.
3. Continue strengthening exercises utilizing PRE principles, add
a. Active Hamstring Curls,
b. Seated Leg Press 0° - 90°,
c. Squats in weight room with emphasis on form over weight,
d. Slide Board (week 6), and
e. Swimming with straight kicks only, after full wound healing.
4. Discontinue brace for daily living activities at 6 weeks post-op or as directed by physician.
5. Begin Jog program at 10 weeks post-op, with physician approval, on smooth flat surface, jog
straight-a-ways only, walk curves. Slowly increasing time and/or distance. If painful or a limp is
present, do not increase intensity until pain-free and gait is normal.
ACL-Hamstring, Pg. 3
Patients heal at different rates, possess various pre-operative deficiencies, and require specific
attributes to perform normal function. Due to these factors, this protocol must be individualized to
each patient to allow for optimal return to desired activities.
The Sports Medicine Specialists
RSH Physical Therapy Houston Orthopædics & Sports Medicine OakBend Medical Center
1601 Main Street # 602 1601 Main Street # 601 1705 Jackson Street
Richmond, TX 77469 Richmond, TX 77469 Richmond, TX 77469
281.341.2874 281.565.8800 281.341.3000
David Edell, LAT, ATC, CSCS
Cellular: 713.858.3802 • Fax: 281.341.3012 • E- Mail: dedell@athleticadvisor.com
A. Mild Lower let & foot compression with wrap or compression hose for initial 48 - 72 hours.
F. Static calf & Achilles tendon stretching 5 - 8 times per day. Hold stretch for 10 seconds and
repeat 5 - 10 times per session.
Calf Stretch: Stand 12” - 18” away from a wall with trunk and
knees straight. Slowly lean into wall, keeping knees locked and
heels on the floor. Slowly move heels away from wall as stretch
becomes easier.
Active Exercises:
Ankle ABC’s: Using the big toe like a pencil, write the letters of the alphabet
moving only the foot and a nkle. Make the letters as large as possible.
Repeat as often as possible throughout the day.
Paper Pick-ups: Crumple several pieces of 3”x3” paper into balls about the
size of marbles. Place the balls of paper on the floor, using the toes, grasp
one ball at a time , pick up and place in opposite hand. Repeat 20 - 40 times.
Towel Push/Pull: Lay out a towel on a smooth, slick surface and position the
foot at one end. Curl toes to pull the towel toward the body without moving the
heel. When the end of the towel is reached, use toes to push the towel away
from the body. Progress by increasing repetitions or by adding a weight to the
end of the towel.
Calf Strain, Pg. 2
Stationary Bicycling and Swimming are excellent rehabilitative and cardiovascular exercises.
Build up to 30 minutes of continuous activity.
B. Mild lower leg & foot compression with ace wrap or compression hose for weight bearing
activities.
D. Continue NSAIDs.
F. Begin ultrasound or electrical stimulation when danger of internal bleeding has passed (3 - 6
days).
G. Continue previous static calf & Achilles Tendon stretching. Progress stretch as pain allows.
Balance: Stand on affected leg only, near an object that can be used to regain balance if you begin
to fall. Perform this for 5 minutes. When it becomes easy, perform with eyes closed.
Inversion: Loop band over ball and instep of foot. Turn ankle & foot (not
leg) inward as far as possible. Repeat 30 to 60 times one time daily.
Eversion: Loop band over outside edge of foot just below the toes. Turn
ankle & foot (not leg) outward as far as possible. Repeat 30 to 60 times one
time daily.
Dorsiflexion: Loop band over top of foot at base of toes. Pull foot and toes
up toward shin as far as possible. Repeat 30 to 60 times one time daily.
ABC’s: Loop band around ball a nd sole of foot while holding ends of the band. Write ABC’s with,
moving only foot and ankle, as in #1. Perform 1 to 2 sets of the alphabet one time daily.
CALF RAISES: Stand with feet shoulder width apart and toes pointed forward. Left heels off of the
floor as high as possible. Slowly lower heels to the floor and repeat as described
below.
Friday - Saturday 3 x 20 3 x 20 3 x 20 3 x 20
Both Legs 2 Legs, Toes Elevated 1 Leg 1 Leg, Toes Elevated
Calf Strain, Pg. 3
Progress to Phase III when 3x20 heel raises can be completed with little or no discomfort.
I. Begin agility activities, such as carioca and zig-zag running as pain allows.
The Sports Medicine Specialists
RSH Physical Therapy Houston Orthopædics & Sports Medicine OakBend Medical Center
1601 Main Street # 602 1601 Main Street # 601 1705 Jackson Street
Richmond, TX 77469 Richmond, TX 77469 Richmond, TX 77469
281.341.2874 281.565.8800 281.341.3000
David Edell, LAT, ATC, CSCS
Cellular: 713.858.3802 • Fax: 281.341.3012 • E- Mail: dedell@athleticadvisor.com
Flexibility Training
A good preventative for injuries remains adequate conditioning. This should include aerobic training and strength
training that ensures a balance in strength and endurance. The flexibility of the muscles is also a major factor in
preventing hamstring injuries. Having proper muscle flexibility will make the athlete perform at a higher competitive
level. Proper stretching before and after exercise will: decrease injuries, enhance performance, improve joint range of
motion, and decrease post-exercise soreness.
Flexibility improvement and maintenance is often overlooked when an exercise program is instituted. Muscle
flexibility is important to everyone due to its relationship to health and the body's working capacity. Poor flexibility of
joints and muscles can cause injuries, or make daily living painful. The best examples of this are seen in the shoulder
and lower back.
Proper stretching should include both upper and lower extremities and the back for any competitive activity or training.
Remember do not bounce when stretching, this can, in some cases, result in injury. Stretching should be performed
following a gentle warm-up, such as 5 - 10 minutes of cycling or walking. Muscles will respond better to flexibility
training when warm and pliable. The "core" stretches for all people should include: hamstrings, quadriceps, calves,
gluteals, and shoulders. Volleyball and basketball players should add more specific shoulder stretches, while
sprinters should add more specific lower extremity stretches. Hold each stretch for 10 - 30 seconds, repeat the
stretch 3 to 5 times for each body part, and stretch 3 - 5 times daily.
Calf Streth:Stand faciong a wall, with one foot in front of the other. Lean forward
with your hands on the wall. Bend front leg, leaving the rear leg straight and
keeping both heels on the floor. Continue until a gentile stretch is felt in the calf.
Hold 10 seconds, then repeat with other leg forward. A second stretch si
performed in the same manner, but with a slight bend in the knee of the back leg.
This stretch will be felt lower in the calf, near the Achillies Tendon. Repeat each
stretch 3 times, with a 10 sec hold.
Quadriceps Stretch: Stand with the knee bent , foot held in hand, gently pull foot towards
buttocks. The stretch is felt in the front of the thigh. Do not bend over at the waist, this will make
the stretch less effective. Hold 10 seconds and repeat 3 times for each leg.
Groin (Butterfly) Stretch: Sit on floor, bend knees so that soles of feet are touching.
Gently draw feet towards the groin. Relax, and let the weight of the legs allow knees to
move towards the floor. If a stronger stretch is desired, use the elbows to gently push
the knees to the floor. Hold for 10 seconds and repeat 3 times.
Flexibility Training, Pg. 2
Hamstring Stretch: Sit on floor, with legs straight out in front, toes pointing up. Gently lean forward, causing a
stretch in backs of legs. Do not allow the back to “hump” as you reach for your toes. Hold for 10 seconds and repeat
3 times.
(For variation, try this with the legs spread apart. Stretch to the left leg, middle, and right leg. Hold 10 seconds each,
and repeat 3 times.)
Trunk Twister: Sit on floor. Cross leg over thigh at the knee and place opposite elbow on
outside of bent knee. Gently stretch back and buttock muscles by pushing bent knee across
body while looking in the opposite direction. Reverse arm and leg position for opposite side.
Hold for 10 seconds, and repeat 3 times.
Advanced Back Stretch: Lay on back, bend knees and lift legs over head.
Straighten knees, causing a gentile stretch in backs of legs, buttock, and back muscles.
Hold for 10 seconds, relax, and repeat 3 times.
Horizontal adduction stretch (left): Grasp elbow of arm to be stretched with opposite hand.
Gently pull arm across front of chest, just below the throat. Hold for 10 seconds, relax and repeat 3
times for each arm.
Tricep Stretch (right): Lift arm to be stretched so that elbow is next to ear, allow elbow to
bend. Grasp bent elbow with opposite hand and gently pull arm behind head. Hold for 10
seconds, relax, and repeat 3 times for each arm.
Biceps/Chest Stretch: Stand grasping door frame with both arms at shoulder level. Slowly lean
away from door, gently stretching chest and shoulder muscles. Hold for 10 seconds, relax, and
repeat 3 times.
Wrist Flexion (left): With elbow straight and palm facing down, grasp back
of hand, and gently pull hand back, stretching forearm. Hold for 10 seconds,
and repeat 3 times.
Wrist Extensi on (right): With elbow straight and palm facing up, grasp palm
of hand, and gently pull hand back, stretching forearm. Hold for 10 seconds,
and repeat 3 times.
Sit and Reach: Sit on floor with legs straight and spread
shoulder width apart or greater. With a flat back reach across
body with leg hand to right foot to feel a comfortable stretch.
Alternate and repeat to left side.
Quad Stretch: While standing, grasp top of right foot with left
hand and gently pull heel with left hand toward buttocks. Hold
and repeat with other leg.
PHASE II
A. Begin moist heat application before exercise after danger of internal bleeding has passed (2 - 4
days).
B. Begin physician prescribed ultrasound with or without electrical muscle stimulation before
exercise when danger of internal bleeding has passed.
C. Continue NSAIDs and muscle relaxants as prescribed by a physician.
D. Continue stretching.
E. Begin Groin Strengthening Exercises:
2) Hip Flexion:
Sit on edge of table with feet resting on floor. Lift involved leg towards chest. Hold
and slowly lower to beginning position. Repeat 30 times, increasing repetitions
as strength improves.
5) Slide Board:
6) Front Step-Ups:
Stand directly behind a 4” - 6” box or step. Step up on box with involved leg
followed by uninvolved leg. Step down with involved leg followed by uninvolved
leg. Repeat. Progress by increasing repetitions then step height.
Note: During all exertional acti vities a hip spica compression wrap should be worn.
3 x 10
Day off
3 x 15
Add 1 - 2#
Day off
3 x 20
Day off
Phase III
A. Continue all activities from Phase II
B. Progress strengthening exercises as tolerated.
C. Begin functional activities to tolerance:
1) Carioca,
2) High Knee Running,
3) Backward Running,
4) Bounding Drills,
5) Vertical leaps progressing to horizontal jumping, and
6) Sprinting with running starts and coast-through stops.
D. Return to full activities as tolerated when Phase III can be completed with little or no discomfort
and bilateral groin strength is equal.
The Sports Medicine Specialists
RSH Physical Therapy Houston Orthopædics & Sports Medicine OakBend Medical Center
1601 Main Street # 602 1601 Main Street # 601 1705 Jackson Street
Richmond, TX 77469 Richmond, TX 77469 Richmond, TX 77469
281.341.2874 281.565.8800 281.341.3000
David Edell, LAT, ATC, CSCS
Cellular: 713.858.3802 • Fax: 281.341.3012 • E- Mail: dedell@athleticadvisor.com
G. Stationary Bicycle riding with seat as low as possible at a low to moderate intensity.
H. Progress to Phase II when a set of 10 prone leg raises can be completed with little or no
discomfort.
Hamstring Strain, Pg. 2
Phase II (2 - 7 days post injury)
A. Begin moist heat applications before exercise after danger of internal bleeding has passed (2 -
4 days)
B. Begin ultrasound or electrical muscle stimulation, as prescribed by physician, when danger of
internal bleeding has passed, preferably prior to exercise.
C. Continue NSAID and muscle relaxant medications as prescribed by physician.
D. Continue previous static and PNF stretching.
E. Begin hamstring strengthening exercises using light weight and high repetitions:
1) Straight Leg Raises
a. Prone
b. Abduction
c. Adduction
Phase III
A. Continue moist heat before exercise.
B. Continue ultrasound/EMS, preferably before exercise.
C. Continue NSAIDs as prescribed by physician.
D. Continue static and PNF stretching.
E. Progress strengthening exercises as tolerated.
F. Begin functional activities to tolerance.
1) High knee running,
2) Backward running,
3) Vertical leaps progressing to horizontal jumping, and
4) Sprints with running starts and coast-through stops.
G. Return to full activities as tolerated when Phase III can be completed with little or no discomfort
and:
1) Bilateral hamstring strength is equal, and
2) Quadriceps to hamstring ratio is 60 - 80%.
The Sports Medicine Specialists
RSH Physical Therapy Houston Orthopædics & Sports Medicine OakBend Medical Center
1601 Main Street # 602 1601 Main Street # 601 1705 Jackson Street
Richmond, TX 77469 Richmond, TX 77469 Richmond, TX 77469
281.341.2874 281.565.8800 281.341.3000
David Edell, LAT, ATC, CSCS
Cellular: 713.858.3802 • Fax: 281.341.3012 • E- Mail: dedell@athleticadvisor.com
3.
5.
4.
2.
1.
Phase II
Upon return to full activity the athlete will need to:
1. Perform all stretches.
2. Attempt activity until tightness (not discomfort) is felt on the outside of the knee.
3. Once the tightness is felt on the outside of the knee, stop activity and perform stretches. Do
not attempt any more activity that day.
4. Each day, do the stretches and try to activities until tightness is felt. Goal is to finish full work-
out without tightness.
5. Ice massage after activities.
The Sports Medicine Specialists
RSH Physical Therapy Houston Orthopædics & Sports Medicine OakBend Medical Center
1601 Main Street # 602 1601 Main Street # 601 1705 Jackson Street
Richmond, TX 77469 Richmond, TX 77469 Richmond, TX 77469
281.341.2874 281.565.8800 281.341.3000
David Edell, LAT, ATC, CSCS
Cellular: 713.858.3802 • Fax: 281.341.3012 • E- Mail: dedell@athleticadvisor.com
2 PATELLA MOBILIZATION: With leg straight and muscles relaxed, place two
fingers on either side of the kneecap and gently move kneecap side-to-side for
1 - 2 minutes. Repeat, moving the kneecap up and down for 1 - 2 minutes.
Repeat as often as possible
3 HEEL SLIDES: While sitting on a smooth surface, pull heel of injured leg
toward buttocks, flexing knee as much as tolerable. Hold and straighten leg by
sliding heel downward. Use hands to put pressure on leg above kneecap,
trying to make the knee as straight as possible. Repeat 30 times, 2 - 3 times
daily.
5 QUAD SETS: With leg as straight as possible, tighten thigh muscles, trying
to pull kneecap toward hip. Hold for 10 seconds contracting the muscles as
tight as possible. Relax and rest 2 seconds. Repeat as often as possible.
6 HAMSTRING STRETCH: While seated with legs straight and heels resting on
a book or rolled up towel, slowly lean over involved leg touching toes with
hands and nose to knee. Hold for 10 - 30 seconds and slowly return to start
position. DO NOT BOUNCE! Repeat as often as possible.
8 STRAIGHT LEG RAISES (SLR) — SUPINE: While lying on back or sitting with
hips flexed less than 90 degrees, flex ankle to 90 degrees. Tighten thigh
muscles and raise leg upward, keeping knee straight. Lift leg 12” - 18” off of
floor and hold 1 second. Slowly lower leg to floor. Repeat and progress as
detailed under PRE (#7).
KNEE EXERCISE PROGRAM Page 2
11 STRAIGHT LEG RAISES — PRONE: Repeat process used for Supine SLR
while lying on stomach and raise injured leg 6 - 12” off floor. Repeat and
progress as detailed under PRE(#7).
12 PRONE FLEXION: Lay on stomach and flex knee, bringing heel toward
buttocks. Hold and slowly lower leg. Repeat and progress as detailed under
PRE (#7).
14 SEATED EXTENSION: In sitting position, slowly extend lower leg until straight.
Hold, contracting thigh muscles as tight as possible, and slowly lower. Repeat
and progress as detailed in PRE (#7).
16 SEATED CORD EXTENSION: In sitting position with Sport Cord placed under
ball of involved foot, extend knee against cord pushing down and away, to -5
degree. of full extension. Repeat 3x10, 3x15, 3x20 then progress by increasing
cord density and returning to 3x10.
17 HIP FLEXION: Sit on edge of firm surface with feet resting on floor. Lift
involved knee toward chest, while keeping knee comfortably bent. Hold and
slowly lower. Repeat and progress as detailed in PRE (#7).
20 PARTIAL SQUATS: Standing with feet shoulder width apart and toes
pointing slight outward, bend knees and slowly squat down. Maintain upright
posture and do not allow thighs to go below parallel to floor. Hold and slowly
return to start position and repeat. Progress by increasing reps to 3x20 then
begin one -leg squats.
21 SPORT CORD SQUATS: Stand with heels on Sport Cord. Squat down and
grasp Sport Cord handles stretching cord snugly. Slowly stand erect pulling
on cord. Slowly return to squat position against cord. Repeat as directed
and progress as for Seated Cord Extensions (#16).
22 ONE LEG SQUATS: Using chair or table for balance assistance, slowly
squat down on involved leg as far as possible — not to exceed 90 degree. of
knee flexion. Then slowly raise up to start position and repeat as directed.
23 SIDE STEP UPS: Stand sideways with involved leg next to 3 - 6” step.
Place involved foot on step and slowly lift body weight with involved leg.
Slowly lower body back to start position, gently touching heel on ground, then
repeat by slowly lifting body with involved leg. Repeat as by increasing
repetitions for 3 x 10 to 3 x 15 to 3 x 20, increase step height 2 - 3” begin with
3 x 10 reps, i ncreasing to 3 x 20.
26 HEEL RAISES: Stand with feet shoulder width apart and toes pointed
forward. Raise up on toes, lifting heels off floor as high as possible. Hold for
one second and slowly lower to start position. Progress by increasing reps,
placing balls of feet on 2 - 4” board (elevated), then progressing to one-leg
calf/heel raises.
KNEE EXERCISE PROGRAM Page 4
27 CHAIR WALK: Sit on a rolling chair or stool. Reach out in front of body as
far as possible with involved heel. Slowly pull body and chair toward heel
and repeat with opposite leg. Fully extend leg on each cycle and DO NOT
EXCEED 90 DEGREES OF KNEE FLEXION. Repeat as directed.
28 SLIDE BOARD: Begin at one end of slide board with knees bent and one
foot pressed against block. Maintaining a squatting position, use outside leg
to push body sideways across board, sliding to opposite side. Bring both feet
together when opposite block is reached and repeat.
32 ICE: Apply ice to the involved area before and after exercise to reduce
swelling, pain, and reduce the chances of aggravating the condition. Ice
massage is preferable if there are no open wounds. Massage the affected
area with ice cup until it becomes numb, this may take between 4 to 10
minutes. Ice bags may be used when placed over a wash cloth, and the
treatment time is 15 - 20 minutes.
The Sports Medicine Specialists
RSH Physical Therapy Houston Orthopædics & Sports Medicine OakBend Medical Center
1601 Main Street # 602 1601 Main Street # 601 1705 Jackson Street
Richmond, TX 77469 Richmond, TX 77469 Richmond, TX 77469
281.341.2874 281.565.8800 281.341.3000
David Edell, LAT, ATC, CSCS
Cellular: 713.858.3802 • Fax: 281.341.3012 • E- Mail: dedell@athleticadvisor.com
PHASE II
1. Continue all activities in Phase I as indicated.
2. Continue all strengthening exercises using PRE Principle
3. Begin Side Step-Ups with 1 1/2” - 3” step.
4. Begin StairClimber activities.
5. Begin static stretching as tolerable.
6. Progress to Phase III when Phase II can be completed with:
a. No increase in pain or swelling,
b. Normal Gait, and
c. Normal knee stability.
, Pg. 2
PHASE III
1. Continue ice after exercise sessions if pain and/or swelling is present.
2. Discontinue use of brace for daily activities with physician approval
3. Continue SLR PRE’s and add:
a. Standing sport cord TKE’s,
b. Leg Press 90° - 0° as tolerated, and
c. Slide Board.
4. Begin walk/jog program on flat, smooth surface
5. Progress to Phase IV when 50 yard jog can be completed with little or no limping and/or pain.
PHASE IV
Continue PRE’s.
1. Progress walk/jog program to include sprints and agility drills
a. Figure 8’s,
b. Carioca, and
c. Zig-Zag Drills.
2. Return to desired activity when:
a. Phase IV can be completed without pain, swelling, or limp,
b. Bilateral girth and range of motion measurements are equal,
c. Strength measurements are 85% of contralateral side, and
d. Clearance from physician.
Patients heal at different rates, possess various pre-operative deficiencies, and require specific
attributes to perform normal function. Due to these factors, this protocol must be individualized to
each patient to a llow for optimal return to desired activities.
The Sports Medicine Specialists
RSH Physical Therapy Houston Orthopædics & Sports Medicine OakBend Medical Center
1601 Main Street # 602 1601 Main Street # 601 1705 Jackson Street
Richmond, TX 77469 Richmond, TX 77469 Richmond, TX 77469
281.341.2874 281.565.8800 281.341.3000
David Edell, LAT, ATC, CSCS
Cellular: 713.858.3802 • Fax: 281.341.3012 • E- Mail: dedell@athleticadvisor.com
Post-Op: Day 1
1. Continue ice, elevation, and compression wrap.
2. Continue range of motion exercises 2 - 3 times per day and add:
a. Stationary bike riding with seat height as low as tolerable with low resistance.
4. Continue strengthening exercises.
5. Ice before and after exercises a nd 20 minutes every two hours while awake.
Post-Op: Day 2 - 7
1. Continue ice and elevation.
2. Continue range of motion exercises.
3. Continue strengthening exercises by utilizing PRE principle and add:
a. Weight to all SLR’s, Knee Extension, Knee Flexion, Hip Flexion, and TKE’s.
5. Ice before and after exercise and continue use of compression wrap.
Menisectomy/Plica, Pg. 2
Post-Op: Week 1 - 3
1. Continue ice and elevation as needed.
2. May shower or bathe after sutures have been removed.
3. Continue range of motion exercises to 90° of flexion limitation.
4. Continue strengthening exercises.
5. Ice before, if indicated, and after exercise.
Post-Op: Week 4 - 8
1. May apply lotion to incisions sites using heel of thumb and pressure as tolerated.
2. Continue range of motion exercises progressing past 90° to achieve full motion.
3. Continue strengthening exercises, and add:
a. Heel raises with balance assistance,
1. Progressing to elevated or one-leg heel raises.
b. Partial squats with balance assistance,
1. Progressing depth as tolerated, and
2. Progressing to single leg squats.
c. Side Step-Ups,
d. StairClimber exercises, and
d. Begin Walk -Jog program on smooth, flat surface, walking curves as tolerated at 6 weeks.
4. Return to full activities when:
a. Range of motion and girth measurements are bilaterally equal,
b. Bilateral strength measurements are 85% or better, and
c. Clearance by treating physician.
Patients heal at different rates, possess various pre-operative deficiencies, and require specific
attributes to perform normal function. Due to these factors, this protocol must be individualized to
each patient to allow for optimal return to desired activities.
The Sports Medicine Specialists
RSH Physical Therapy Houston Orthopædics & Sports Medicine OakBend Medical Center
1601 Main Street # 602 1601 Main Street # 601 1705 Jackson Street
Richmond, TX 77469 Richmond, TX 77469 Richmond, TX 77469
281.341.2874 281.565.8800 281.341.3000
David Edell, LAT, ATC, CSCS
Cellular: 713.858.3802 • Fax: 281.341.3012 • E- Mail: dedell@athleticadvisor.com
Post-Op: Day 1
1. Continue ice, elevation, and compression wrap.
2. Continue range of motion exercises 2 - 3 times per day and add:
a. Stationary bike riding with seat height as low as tolerable with low resistance.
3. Continue strengthening exercises and add:
a. Heel raises with balance assistance, and
b. Partial squats with balance assistance.
4. Ice before and after exercises and 20 minutes every two hours while awake.
Menisectomy/Plica, Pg. 2
Post-Op: Day 2 - 7
1. Continue ice and elevation.
2. Discontinue crutches no later than day three.
3. Continue range of motion exercises.
4. Continue strengthening exercises by utilizing PRE principle and add:
a. Weight to all SLR’s, Knee Extension, Knee Flexion, Hip Flexion, and TKE, and
b. Side Step-Ups.
5. Ice before and after exercise and continue use of compression wrap.
6. Physician examination 6 - 8 days post-op for evaluation and suture removal.
Post-Op: Week 1 - 3
1. Continue ice and elevation as needed.
2. May shower or bathe after sutures have been removed.
3. Continue range of motion exercises.
4. Continue strengthening exercises and add:
a. Walk-Jog program on smooth, flat surface, walking curves,
b. Single-leg parallel squats,
c. Single-leg, then elevated heel raises, and
d. StairClimber exercises.
5. Ice before, if indicated, and after exercise.
Post-Op: Week 3 - 6
1. May apply lotion to incisions sites using heel of thumb and pressure as tolerated.
2. Continue range of motion exercises if needed.
3. Continue strengthening exercises.
4. Return to full activities when:
a. Range of motion and girth measurements are bilaterally equal,
b. Bilateral strength measurements are 85% or better, and
c. Clearance by treating physician.
Patients heal at different rates, possess various pre-operative deficiencies, and require specific
attributes to perform normal function. Due to these factors, this protocol must be individualized to
each patient to allow for optimal return to desired activities.
The Sports Medicine Specialists
RSH Physical Therapy Houston Orthopædics & Sports Medicine OakBend Medical Center
1601 Main Street # 602 1601 Main Street # 601 1705 Jackson Street
Richmond, TX 77469 Richmond, TX 77469 Richmond, TX 77469
281.341.2874 281.565.8800 281.341.3000
David Edell, LAT, ATC, CSCS
Cellular: 713.858.3802 • Fax: 281.341.3012 • E- Mail: dedell@athleticadvisor.com
Post-Op: Week 3 - 6
1. Discontinue Sling Use.
2. Ice before and after exercise sessions.
3. Stretch before and after exercise as tolerated:
a. Horizontal Adduction Stretch,
b. Triceps/Inferior Cuff Stretch,
c. Internal Rotation with shoulder abducted and elbow bent 90°, and
d. External Rotation with shoulder abducted and elbow bent 90°.
4. Continue previous Active-Assisted exercises 4 - 5 times weekly, and add:
a. Progress towel squeezes to shoulder adduction using sport cord, and
b. Upper Body ergometer as tolerated with low resistance and low RPM.
5. Progress Active-Assisted Exercises to Active Exercises, as tolerated, 3 - 4 times weekly and add:
a. Prone Horizontal Abduction,
b. Prone Extension with internal rotation of shoulder, and
c. Supine dumbbell press (with no weight).
6. Full Active-Assisted Range of Motion is expected by 6 weeks post-op.
7. Physician examination at week 6.
Post-Op: Week 6 - 10
1. Continue previous stretching exercises before and after exercise sessions as part of a general
warm-up and cool-down.
2. Continue previous Active Exercises and add:
a. Biceps Curls,
b. Triceps Extensions,
c. Supraspinatus (Empty Can),
d. Parallel Dips,
e. Bench Press,
f. Push-Ups,
g. Bent-Over Rows,
h. Lat Pulldowns,
i. Behind the neck overhead press, and
j. Internal/External Rotation with shoulder abducted and elbow flexed to 90°.
3. Full return to athletic activities is expected at 3 - 4 months post-op.
Patients heal at different rates, possess various pre-operative deficiencies, and require specific
attributes to perform normal function. Due to these factors, this protocol must be individualized to
each patient to allow for optimal return to desired activities.
The Sports Medicine Specialists
RSH Physical Therapy Houston Orthopædics & Sports Medicine OakBend Medical Center
1601 Main Street # 602 1601 Main Street # 601 1705 Jackson Street
Richmond, TX 77469 Richmond, TX 77469 Richmond, TX 77469
281.341.2874 281.565.8800 281.341.3000
David Edell, LAT, ATC, CSCS
Cellular: 713.858.3802 • Fax: 281.341.3012 • E- Mail: dedell@athleticadvisor.com
Post-Op: Day 1 - 10
1. Arm in sling - out for exercises only.
2. Do not allow wounds to get wet while bathing or showering.
3. Ice before and after exercise sessions and as often as possible throughout the day.
4. Active Exercises, performed 2 - 3 times daily:
a. Codman’s Pendulum Swings,
b. Gripping Exercises,
c. Wrist Flexion/Extension, and
d. Elbow Flexion Exercises.
5. Passive Exercises: use involved hand to lift involved arm through a pain-free range of motion,
performed 2 - 3 times per day.
a. Bent-Arm Flexion,
b. Bent-Arm Abduction,
c. Bent-Arm Extension,
d. Seated Internal/External Rotation with arm adducted and elbow flexed to 90°.
6. Physician examination at 7 - 10 days post-op.
Post-Op: Week 4 - 8
1. Continue Sling Use in crowds or stressful situations.
2. Ice before and after exercise sessions.
3. Continue previous Active-Assisted exercises 4 - 5 times weekly, and add:
a. Supine Triceps Extensions with light weight,
b. Upper Body ergometer as tolerated with low resistance and low RPM.
4. Progress Active-Assisted Exercises to Active Exercises, as tolerated, 3 - 4 times weekly and add:
a. Supine Internal/External Rotations with arm adducted and elbow flexed to 90°.
5. Full Active-Assisted Range of Motion is expected by 6 weeks post-op.
6. Physician examination at week 6.
Post-Op: Week 8 - 12
Post-Op: Week 12 - 16
1. Continue previous stretching exercises before and after exercise as part of a general warm-up
and cool-down.
2. Full Active ROM is expected at end of Week 16.
3. Active exercises as tolerated (Low Weight, High Repetitions)
a. Biceps Curls,
b. Triceps Extensions,
c. Supraspinatus (Empty Can),
d. Bench Press,
e. Progressive Push-ups,
f. Bent-Over Rows,
g. Lat. Pulldowns, and
h. Supine Internal/External Rotation with arm abducted and elbow flexed to 90°.
4. Progress to normal athletic activities by 4 to 6 post-op with physician clearance.
Patients heal at different rates, possess various pre-operative deficiencies, and require specific
attributes to perform normal function. Due to these factors, this protocol must be individualized to
each patient to allow for optimal return to desired activities.
The Sports Medicine Specialists
RSH Physical Therapy Houston Orthopædics & Sports Medicine OakBend Medical Center
1601 Main Street # 602 1601 Main Street # 601 1705 Jackson Street
Richmond, TX 77469 Richmond, TX 77469 Richmond, TX 77469
281.341.2874 281.565.8800 281.341.3000
David Edell, LAT, ATC, CSCS
Cellular: 713.858.3802 • Fax: 281.341.3012 • E- Mail: dedell@athleticadvisor.com
B. Friction massage over affected area for 5 minutes, pressing as hard as tolerable. Repeat 3 - 5
times daily.
F. Golf Ball Roll: Roll a frozen golf ball under the affected heel and arch, pressing down as hard
as tolerable for 5 minutes at a time. Repeat as often as possible throughout the day.
G. Arch taping: Tape arch to add stability to affected structures. The treating physician may opt
for prescription orthotics application.
I. Calf & Achilles Tendon Stretching: Stand 12” - 18” away from a
wall with trunk and knees straight. Slowly lean into wall, keeping
knees locked and heels on the floor. Slowly move heels away from
wall as stretch becomes easier. Perform with knees straight and
knees bent. Hold each stretch for 10 - 30 seconds, repeat 5 - 10
times, 5 - 10 times daily.
Post-Op: Day 1
1. Continue ice, elevation, and compression wrap.
2. Continue range of motion exercises 2 - 3 times per day and add:
a. Stationary bike riding with seat height as low as tolerable with low resistance.
3. Continue strengthening exercises and add:
a. Heel raises with balance assistance, and
b. Partial squats with balance assistance.
4. Ice before and after exercises and 20 minutes every two hours while awake.
Menisectomy/Plica, Pg. 2
Post-Op: Day 2 - 7
1. Continue ice and elevation.
2. Discontinue crutches no later than day three.
3. Continue range of motion exercises.
4. Continue strengthening exercises by utilizing PRE principle and add:
a. Weight to all SLR’s, Knee Extension, Knee Flexion, Hip Flexion, and TKE, and
b. Side Step-Ups.
5. Ice before and after exercise and continue use of compression wrap.
6. Physician examination 6 - 8 days post-op for evaluation and suture removal.
Post-Op: Week 1 - 3
1. Continue ice and elevation as needed.
2. May shower or bathe after sutures have been removed.
3. Continue range of motion exercises.
4. Continue strengthening exercises and add:
a. Walk-Jog program on smooth, flat surface, walking curves,
b. Single-leg parallel squats,
c. Single-leg, then elevated heel raises, and
d. StairClimber exercises.
5. Ice before, if indicated, and after exercise.
Post-Op: Week 3 - 6
1. May apply lotion to incisions sites using heel of thumb and pressure as tolerated.
2. Continue range of motion exercises if needed.
3. Continue strengthening exercises.
4. Return to full activities when:
a. Range of motion and girth measurements are bilaterally equal,
b. Bilateral strength measurements are 85% or better, and
c. Clearance by treating physician.
Patients heal at different rates, possess various pre-operative deficiencies, and require specific
attributes to perform normal function. Due to these factors, this protocol must be individualized to
each patient to allow for optimal return to desired activities.
The Sports Medicine Specialists
RSH Physical Therapy Houston Orthopædics & Sports Medicine OakBend Medical Center
1601 Main Street # 602 1601 Main Street # 601 1705 Jackson Street
Richmond, TX 77469 Richmond, TX 77469 Richmond, TX 77469
281.341.2874 281.565.8800 281.341.3000
David Edell, LAT, ATC, CSCS
Cellular: 713.858.3802 • Fax: 281.341.3012 • E- Mail: dedell@athleticadvisor.com
G. Stationary Bicycle: Ride with seat as high as tolerable and light to moderate resistance to
maintain quadriceps muscle function.
H. Straight Leg Raises (SLR): Perform with light weight and high repetitions in all 4 planes:
Supine, Abduction, Adduction, and Prone.
I. Progress to Phase II: When 10 supine SLR’s can be completed with little or no discomfort.
D. Hip Flexion: Sit on the edge of a firm surface with feet resting on floor. Lift
involved knee toward chest. Hold and slowly lower to beginning position.
Progress under PRE guidelines.
E. Seated Knee Extension: In sitting position, slowly extend lower leg until
knee is straight. Hold, contracting thigh muscles as tightly as possible, and
slowly lower to starting position.
F. Partial Squats: Stand with feet shoulder width apart and toes slightly
turned out. Bend knees and slowly squat down, keeping knees from going
in front of toes. Squat as low as tolerable, pause at lowest depth and raise
to beginning position. Do not allow thighs to go lo wer than parallel to the
floor.
I. Begin light jogging on smooth, straight surface. No sudden starts and stops.
J. Progress to Phase III when Phase II exercises can be performed with little or no discomfort.
Phase III
A. Continue Phase I and II activities as directed.
C. Return to full activities as tolerated when Phase III can be completed with little or no discomfort
and:
1. Bilateral quadriceps strength is equal and
2. Quad to Hamstring strength ration is 60 - 80&.
The Sports Medicine Specialists
RSH Physical Therapy Houston Orthopædics & Sports Medicine OakBend Medical Center
1601 Main Street # 602 1601 Main Street # 601 1705 Jackson Street
Richmond, TX 77469 Richmond, TX 77469 Richmond, TX 77469
281.341.2874 281.565.8800 281.341.3000
David Edell, LAT, ATC, CSCS
Cellular: 713.858.3802 • Fax: 281.341.3012 • E- Mail: dedell@athleticadvisor.com
C. Professionally fitted orthotic or arch supports used for any weight bearing activity.
D. Wear proper shoes for the activity. Old, poorly fitted or inappropriate types of shoes will
increase the stress placed on the lower leg bones and muscles.
E. Reduce the intensity and/or duration of activities that produce pain. Begin by decreasing the
activity level by half and slowly progress or regress as pain level dictates.
F. Change the location or type of surface where activities are performed. Avoid very soft or hard
surfaces and change direction or course to decrease lower leg stress.
G. Stretch the muscles of the lower leg 4 - 8 times daily, holding each stretch for 10 - 30 seconds,
repeat each stretch 3 - 5 times per session.
1. Dorsiflexion: Stand 12” - 18” away from a wall with trunk and knees
straight. Slowly lean into wall, keeping knees locked and heels on the floor.
Slowly move heels away from wall as stretch becomes easier.
2. Plantarflexion: Point toes down as far as possible with knees straight.
Progress by placing palm of opposite hand over the base of the toes and
applying slow downward pressure on the foot.
3. Inversion: Turn ankle/foot inward as far as possible without moving lower
leg. Progress by standing on outside edge of foot.
4. Eversion: Turn ankle/foot outward as far as possible without moving lower
leg. Progress by standing on inside edge of foot.
1. Paper Pick-ups: Crumple several pieces of 3”x3” paper into balls about
the size of marbles. Place the balls of paper on the floor, using the toes,
grasp one ball at a time , pick up and place in opposite hand. Repeat 20 -
40 times.
2. Towel Push/Pull: Lay out a towel on a smooth, slick surface and position
the foot at one end. Curl toes to pull the towel toward the body without
moving the heel. When the end of the towel is reached, use toes to push
the towel away from the body. Progress by increasing repetitions or by
adding a weight to the end of the towel.
, Pg. 2
3. Theraband: Using an this elastic band perform the following exercises to increase strength
in the muscles of the affected ankle. Repeat 30 to 60 times one time daily.
4. Calf Raises: Stand with feet shoulder width apart and toes pointed forward. Left heels off
of the floor as high as possible. Slowly lower heels to the floor and repeat as described
below.
Week 1 Week 2 Week 3 Week 4
Monday - Tuesday 3 x 10 3 x 10 3 x 10 3 x 10
Wednesday - Thursday 3 x 15 3 x 15 3 x 15 3 x 15
Friday - Saturday 3 x 20 3 x 20 3 x 20 3 x 20
Both Legs 2 Legs, Toes Elevated 1 Leg 1 Leg, Toes Elevated
5. Backward Running: Run backward raising knees up as high as possible and pushing o ff
with the toes. Run 25 - 50 yards as tolerated. Emphasis should be on form, not speed.
I. Continue this program for 2 weeks. If improvement is not experienced during that time, consult
your physician, therapist, or Athletic Trainer. If the symptoms are becoming less severe, continue
the program for 2 weeks after all symptoms have ceased in order to reduce the chance of
recurrence.
The Sports Medicine Specialists
RSH Physical Therapy Houston Orthopædics & Sports Medicine OakBend Medical Center
1601 Main Street # 602 1601 Main Street # 601 1705 Jackson Street
Richmond, TX 77469 Richmond, TX 77469 Richmond, TX 77469
281.341.2874 281.565.8800 281.341.3000
David Edell, LAT, ATC, CSCS
Cellular: 713.858.3802 • Fax: 281.341.3012 • E- Mail: dedell@athleticadvisor.com
2. Wall Ladder: Stand next to wall ladder, brick wall, or louvered doors
and use fingers of involved hand to “walk” up the ladder as high as
possible and hold. “Walk” down ladder and repeat 3 - 5 times. Perform
this exercise by facing ladder and also by standing next to ladder.
3. Supine Flexion: Lie on back and hold T-bar or broom stick with both
hands at waist level, preferably with hands close together. Lift arms up
over head as far as possible and hold for 5 - 10 seconds and return to
start position. Repeat as directed. Weight may be added to T-bar.
4. Bent Arm Flexion: Rest involved arm in palm of uninvolved hand and
slowly and gently lift involved arm forward and upward as far as
possible. Hold and slowly return to start. Relax involved arm and
shoulder as much as possible and lift with uninvolved arm. Repeat 30
times.
6. Active Flexion: Stand with elbow straight and thumb pointing forward.
Raise involved arm upward in front of body as high as tolerable, hold,
and slowly lower. Repeat as directed.
10. Bent Arm Abduction: Rest involved arm in palm of uninvolved hand
and slowly and gently lift involved arm outward to side of body as high as
tolerable. Hold and slowly return to start. Relax involved arm and
shoulder as much as possible and lift with uninvolved arm. Repeat 30
times.
11. T-Bar Abduction: Loosely grasp end of T-bar with involved hand and
hold longer end with uninvolved hand. Use uninvolved hand to lift
involved arm outward to side of body as far as tolerable, hold, then
slowly return to start. Repeat 30 times.
12. Active Abduction: Stand with elbow straight and thumb pointing
outward.. Raise involved arm outward to side of body as high as
tolerable, hold, and slowly lower. Repeat as directed.
13. Prone Horizontal Abduction: Lie prone on table. Rotate arm and thumb
outward as far as possible. Raise arm out to the side. Do not raise higher
than paralle l to the floor. Hold, slowly return to start and repeat as
directed.
15. Side Lying Internal Rotation: Lying on involved side with elbow at side
and flexed to 90°, slowly raise hand to somtach. Hold, then slowly return
to start and repeat as directed.
18. Supraspinatus: Stand with elbow straight and arm rotated inward with
thumb pointing down. Raise hand to eye level at 30° angle to body. Do
not allow the hand to go above eye level! Hold, then slowly lower to
start and repeat as directed.
19. Shrugs: Standing with arms at sides. Lift shoulders up toward ears and
hold, then pull shoulders back, pinching shoulder blades together. Hold
and relax. Repeat as directed.
20. Towel Squeeze: Fold a towel into eighths and place between chest and
involved elbow. Slowly squeeze arm against towel and chest with
forearm crossing in front of body at 45° angle. Hold isometric
contraction for 5 - 10 seconds and relax. Repeat as directed.
21. Supine Triceps Extension: Lying flat on back with involved elbow bent
near head. Rest involved hand on uninvolved shoulder. Slowly extend
elbow as straight as possible without moving upper arm. Slowly return
to start and repeat as directed.
23. Seated Dips: Sit on edge of table or chair gripping sides of table with
hands. Slowly straighten arms, lifting buttocks off of seat. Hold for 3 - 5
seconds and slowly lower to table. Repeat as directed.
24. Chair Dips: Place hands behind body on front edge of chair with legs
out in front of body. Slowly lower body toward floor until upper arms are
parallel to floor and no further. Lift body up, carefully arms, and hold.
Slowly return to start and repeat as directed.
25. Biceps Curls: With arm straight and at side with palm facing forward,
slowly flex elbow bringing hand up toward shoulder as far as possible.
Hold, then slowly relax to beginning position. Repeat as directed.
Shoulder Program, Pg. 4
26. Supine Press: Lie on back with elbows next to chest and flexed to 90°.
Slowly raise and extend arm straight upward. Hold, then slowly return to
start. Repeat as directed.
27. Progressive Push-Ups: Grip sides of sturdy stable or countertop with feet
together about 3 - 4 feet from table. Slowly lower chest toward edge of
table by bending elbows and without allowing chest to touch table. Slowly
return to start position and repeat as directed. Progress by moving to
shorter tables and eventually to floor.
28. Bent Over Rows: While bent over with back parallel to floor and arms
hanging to floor, slowly pull arms up, bringing hands up to chest level.
This motion is similar to using a cross-cut saw. Slowly lower arms to start
and repeat as directed.
29. Ice: Apply ice to involved shoulder for 15 - 20 minutes before and after
exercise to reduce swelling, pain, and the chance of aggravating the
condition. This can be accomplished by use of ice bags, CryoCuffs, or ice
massage. Ice massage is preferable if there are no open wounds and will
take about 5 - 12 minutes.
The Sports Medicine Specialists
RSH Physical Therapy Houston Orthopædics & Sports Medicine OakBend Medical Center
1601 Main Street # 602 1601 Main Street # 601 1705 Jackson Street
Richmond, TX 77469 Richmond, TX 77469 Richmond, TX 77469
281.341.2874 281.565.8800 281.341.3000
David Edell, LAT, ATC, CSCS
Cellular: 713.858.3802 • Fax: 281.341.3012 • E- Mail: dedell@athleticadvisor.com
Corner
5. Standing Adduction Stretch: While standing, place involved
hand behind body. Gently grasp elbow across back with uni n-
volved hand and slowly pull. Hold 5 - 7 seconds and relax. Re-
peat 5 - 10 times.
Adduction
Impingement, Pg. 2
6. Chicken: Place both hands behind head and slowly push
elbows straight back. Hold 5 - 7 seconds and relax. Repeat
5 - 10 times.
Chicken
8. Internal Rotation: While standing with shoulder abducted
to 90°, place T-bar or broom stick behind upper arm and
grasp lower bar with involved hand. With uninvolved hand,
slowly and gently pull upper bar down, forcing involved arm
back and up. Hold 5 - 7 seconds and relax. Repeat 5 - 10
times.
Phase 2
Strength Enhancing Exercises: Perform 3 times per week 3 x 10
using the schedule of sets x repetitions outlines to the right. Do Day off
not exceed 7 pounds for weighted exercises. 3 x 15
Add 1 - 2#
Day off
Complete range of motion stretching exercises prior to and 3 x 20
following strengtheni ng exercises. Day off
Biceps Curls: With arm straight and at side with palm facing
forward, slowly flex elbow bringing hand up toward shoulder
Shrugs
as far as possible. Hold, then slowly relax to beginning
position. Repeat as directed.
Bent Over Rows: While bent over with back parallel to floor
and arms hanging to floor, slowly pull arms up, bringing hands Biceps
up to chest level. This motion is similar to using a cross-cut Curls
saw. Slowly lower arms to start and repeat as directed.
It is not uncommon for your pain level to slightly increase Empty Can
during the first week of exercising. Continue the program for a
minimum of 4 weeks. At the end of 4 weeks, if you do not
notice improvement in your condition consult your physician or
therapist. If your pain is diminishing, continue the program for
2 - 3 weeks after your symptoms have ceased to ensure the
condition does not return.
The Sports Medicine Specialists
RSH Physical Therapy Houston Orthopædics & Sports Medicine Polly Ryon Hospital
1601 Main Street # 602 1601 Main Street # 601 1705 Jackson Street
Richmond, TX 77469 Richmond, TX 77469 Richmond, TX 77469
281.341.2874 281.565.8800 281.341.3000
David Edell, LAT, ATC, CSCS
Cellular: 713.858.3802 • Fax: 281.341.3012 • E-Mail: dedell@athleticadvisor.com
Stage I Ball just rolls into 2nd base. 1/2 speed at 30 feet.
Stage III Ball gets to 2nd base on 1 bounce. 3/4 speed at 60 feet.
Stage IV Ball gets to 2nd base on the fly. Full speed at 60 feet.
Stage V Ball gets to 2nd base on the fly. Return to respective position.
The Sports Medicine Specialists
RSH Physical Therapy Houston Orthopædics & Sports Medicine OakBend Medical Center
1601 Main Street # 602 1601 Main Street # 601 1705 Jackson Street
Richmond, TX 77469 Richmond, TX 77469 Richmond, TX 77469
281.341.2874 281.565.8800 281.341.3000
David Edell, LAT, ATC, CSCS
Cellular: 713.858.3802 • Fax: 281.341.3012 • E- Mail: dedell@athleticadvisor.com
Post-Op: Day 3 - 7
1. Do not allow wounds to get wet.
2. Ice before and after exercise and as often as possible between exercise sessions.
3. Continue range of motion exercises 2 - 3 times daily as tolerated.
4. Begin flexibility exercises 2 - 3 times daily as tolerated:
a. Horizontal Adduction Stretch,
b. Inferior Cuff Stretch,
c. Internal Rotation with shoulder abducted to 90° and elbow flexed to 90° stretch, and
d. External Rotation with shoulder abducted to 90° and elbow flexed to 90° stretch.
5. Continue previous strengthening exercises and add:
Acromioplasty/Decompression, Pg. 2
Post-Op: Week 1 - 3
1. May shower/bathe after sutures are removed and all wounds have sealed.
2. Ice, preferably ice massage, before and after exercises.
3. Continue range of motion exercises if indicated.
a. Full range of motion no later than 3 weeks post-op.
4. Continue flexibility exercises as tolerated.
5. Continue strengthening exercises, with weight, as tolerated 3 - 4 times per week and add:
a. Shoulder adduction with sport cord,
b. Progressive push-ups,
c. Bent-over rows, and
d. Weighted shoulder shrugs.
6. Physician examination at 3 - 4 weeks post-op.
Post-Op: Week 3 - 6
1. Ice after exercise.
2. Continue flexibility exercises.
3. Progress strengthening exercises, utilizing PRE principles, as tolerated and add:
Seated Dips.
4. Physician examination at 6 weeks post-op.
Post-Op: Week 6 - On
Patients heal at different rates, possess various pre-operative deficiencies, and require specific
attributes to perform normal function. Due to these factors, this protocol must be individualized to
each patient to allow for optimal return to desired activities.
The Sports Medicine Specialists
RSH Physical Therapy Houston Orthopædics & Sports Medicine OakBend Medical Center
1601 Main Street # 602 1601 Main Street # 601 1705 Jackson Street
Richmond, TX 77469 Richmond, TX 77469 Richmond, TX 77469
281.341.2874 281.565.8800 281.341.3000
David Edell, LAT, ATC, CSCS
Cellular: 713.858.3802 • Fax: 281.341.3012 • E- Mail: dedell@athleticadvisor.com
1) Pronation / Supination: With elbow straight and forearm supported by table, hold
a stick with the heavier end up. Slowly lower stick as far as possible to the right
and hold for 2 seconds. Slowly raise the stick back to the start position and then
lower as far as possible to the left and hold for 2 seconds. Return to starting
position and repeat.
2) Radial / Ulnar Deviation: With elbow straight and forearm supported by table,
hold a stick with the heavier end up. Slowly lower stick forward as far as possible
and hold for 2 seconds. Return stick to the starting position and then slowly lower
stick over shoulder as far as possible and hold for 2 seconds. Return to starting
position and repeat.
3) Wrist Curls (Flexion): With forearm supported on table and hand off of edge,
palm facing up, lower hand as far as possible. Slowly lift hand as far as possible,
return to starting position and repeat.
4) Wrist Curls (Extension): With forearm supported on table and hand off of edge,
palm facing down, lower hand as far as possible. Slowly lift hand as far as
possible, return to starting position and repeat.
Tennis Elbow, Pg. 2
5) Biceps Curls: With arm straight and at your side, palm facing forward, slowly flex
elbow bringing hand up toward shoulder as far as possible. Hold, then slowly relax
returning to full extension.
6) Supine Triceps Extension: Lying flat on back with involved elbow bent
near your head. Rest involved hand on uninvolved shoulder. Slowly extend
elbow as straight as possible without moving upper arm. Slowly return to
start and repeat.
Continue this program for 2 - 3 weeks AFTER all symptoms have ceased. It is common for
symptoms to worsen the first week of this program. To help prevent recurrence, continue the
stretching exercises (Wrist Flexion & Extension) before doing any repetitive activities.