Orthopedic in Pt PT Protocol

7/31/2019 Orthopedic in Pt PT Protocol

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Modification and AdjustmentBy

Dr. Magdy shabanaSenior staff physical therapist

Orthopedic department


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Kaser elainiCairo University Hospital

Postoperative day 1

o Bedside exercises are initiated (eg, ankle pumps, quadriceps

sets, gluteal sets)

o Review of hip precautions and weight-bearing status

o Bed mobility and transfer training (ie, bed to/from chair)

Postoperative day 2

o Gait training is initiated with use of assistive devices (eg,

crutches, walker) and with the determined weight bearing

precautions.

o Continue functional transfer training

Postoperative day 3-5

o Progression of ROM and strengthening exercises to hip flexor

and abductor within the patient's tolerance

o Progression of ambulation on level surfaces and stairs (if

applicable) with the least restrictive deviceo Progression of ADL training

****This protocol is applicable to all types of hip

surgery with specific considerations regarding

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the approach, type of implant and the weight

bearing precaution.

Physical therapy rehabilitation fro knee replacement is

sometimes a slow process, because of age constrainsts and th

fact that the hips or other knee may also be involved in anarthritic process.

Patient needs to start to learn aboutrehabilitation before having the kneereplacement as the following : --

Preoperative 1-2 weeks prior to surgery

o Education on the surgical process and outcomeso Instruction on a postoperative exercise program

o Assessment of the home environment

It is worth visiting a physiotherapist some weeks

before to learn:-

how to walk with crutches

how to do quads sets and sitting extensions

steps for rehabilitation after surgery.

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Post-operative physical therapy

in-pt protocol

***After surgery, rehabilitation focus on regaining

range-of-motion and rebuilding quads and hamstrings

strength.

Postoperative day 1o Bedside exercises (eg, ankle pumps, quadriceps sets,

gluteal sets)o Review weight-bearing statuso Bed mobility and transfer training (ie, bed to/from chair)o CPM to be adjusted and set up for the reached ROM.

Postoperative day 2o Exercises for active ROM, active-assistive range of

motion (AAROM), and terminal knee extensiono Strengthening exercises (eg, ankle pumps, quadriceps

sets, gluteal sets, heel slides, straight leg raises, isometrichip adduction)

o Gait training with assistive device and functional transfer

training (eg, sit to/from stand, toilet transfers, bedmobility)

o CPM to be conyinued to reach 90of knee ROM

Postoperative day 3-5 (or on discharge to rehabilitation unit)o Progression of ROM and strengthening exercises to the

patient's tolerance

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o Progression of ambulation on level surfaces and stairs (ifapplicable) with the least restrictive device

o Progression of ADL training

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Initiate physical therapy as follow:

1- Rx. of modalities for pain and swelling asneeded.

2- Easy stationary bike for range of motion

(ROM's),

3- Quads, straight leg raises (SLR's), calf raises.

Gentle ROM's.

4- No valgus stress or open chain for 6 wks. No

inside leg raise. Ligament needs time to heal.

When working adductors stress point should be

superior to knee or work them in functional

position later in progression.

5-Generally, immobilizer is D/C'd at 2 weeks

pending physician exam.

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Post-op visit Number One at I week post-op:

Comfort level/Pain Rating on 1/10 scaleGuarding/apprehension with wt bearing

Proprioception

ROM

Strength

VMO quad control

Leg control

Gait

Compliance with p/o care instructions per physician

Swelling/Effusion and portal inspection for infection

:

3 or more of the below deficits require F/U in PT:

Pain> 4/10

2+ effusion

Partial Weight Bearing secondary to apprehension, pain,

poor proprioception

Unable to single leg balance > 20 secondsROM < 5-125 degrees secondary to pain

Strength < 4-/5

Poor-fair VMO control

Poor leg control with transfer/ADL activities

Moderate antalgia with flat surface fwd walking with no

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assistive device

Poor compliance with p/o instructions per P.T. and

physician

ANY SIGNS OF INFECTION REFERRED TOPHYSICIAN IMMEDIATELY

1- Strengthening ex's:

LE Control ex's with emphasis on VMO control

Weight shifting progression Single leg balancewith trunk shift/challenges T-Band squatprogression to step downs for aggressive quadwork Gait training FWD Retro High step Lat.shuffle step Instruction in proper bike set-upand resistance level Instruction in leg press, legcurls, and calf raises Pool therapy forstrengthening, endurance, and ROM asappropriate Discussion re: appropriate

progression through resisted ex's increasingweight, reps, and intensity at each session astolerated.

2- ROM ex's: Terminal extension hangs

Standing terminal extensionFlexion stretch in standing and proneHamstring Stretch

3- Effusion Control:Manual therapyIce, elevation, massage, and rest intervals

throughout the day

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Pain < 2/10Minimal effusionFull wt bearing with no pain/apprehensionROM: 0- 135 degrees with minimal painStrength 4+/5Good VMO control

Good leg control with Activities of Daily Living(ADL's)/balance

:

1- single leg stance > 30 seconds2- Minimal antalgia (pain)3-Good compliance with home ex. program and activity

modification4- Return to functional activities without incident5- Pt able to demonstrate willingness and ability to progresswith all exercises at an appropriate pace, adding weight andreps as tolerated.

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General Considerations:

1-Passive and active range of motion between 30 - 70

degrees for 4 weeks. -Patient will be instructed to come out

of the brace once a day for extension range of motion

stretching beginning week 2.

2-Crutch assisted weight bearing progressing to as

tolerated.

3-Regular attention should be paid to the incisions to

decrease fibrosis and scarring--with particular emphasis on

the anterior and lateral incisions.

4-Exercises and manual treatments should also focus on

early quadriceps and VMO recruitment.

5-Patients are given a functional assessment/sport test at 2,

3, and 4 months post-op.

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1-Icing and elevation as much as able.

2-Straight leg raise exercises (lying, seated, and standing),

quadriceps/adduction/gluteal sets, gait training, passive and

active range of motion exercises within guidelines.

3- gait trainig with instructions of assistve device (crutches)

use and with weight bearing as tolerated on the affected

lower extremity.

4-Balance and proprioception exercises.

5-Soft tissue treatments and gentle mobilization to posterior

musculature, patella and incisions.

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PHYSICAL THERAPY

REHABILITATION PROTOCOL

PT must begin pre op to give the new graft the best chances of

giving a good result by giving education and training for the

following.

weight bearing on crutches

quads maintenance exercises - quads sets, straight leg raises

prone flexion

This period is usually spent in hospital and is focused onreducing pain and swelling, maintaining baseline muscle strength

and learning to cope with the CPM machine and crutches.

icing (eg cryocast)

static quads with rolled towel under heels gait training with partial weightbearing to weight bearing as

tolerated on crutches

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PHYSICAL THERAPY

REHABILITATION PROTOCOL

-Sling allowed as needed for comfort only, first 5-7 days, taking

arm out often 5-7 times a day for elbow ROM.-Posture education and postural exercises.

-Ball or putty squeezing throughout the day.

-Icing every two hours for 15-20 minutes first 5-7 days, 3 times a

day thereafter.

-CPM (constant passive motion) machine 4-6 hours per day for 1-

4 weeks.

-Soft tissue mobilization focused on periscapular musculature,

cervical spine, and rotator cuff.

-Scapular mobilization.

-Passive and active assisted ROM manually and using pulley at

home going for full motion as soon as able without increased

irritability

.

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Recommended PT Treatment for:

0-2 Weeks Post OpExercisesSling at all times, except for exercises

PROM limits to: 90 pure abduction, 20 extension, 70 internal rotation (notbehind back)

1. Pendulum exercises 3x/day minimum

2. PROM within limits and pain tolerance

3. Elbow and wrist AROM 4x/day minimum

4. Cryocuff/ice: days 1-2 as much as possible, then post activity or for pain

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Includes Treatment for:

*

0-2 Weeks Post OpExercisesSling at all times, except for exercises

PROM limits to: 90 pure abduction, 20 extension, 70 internal rotation (alsonot behind back)


2. PROM within limits and pain tolerance



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Includes Treatment for:

*Arthroscopic Acromioclavicular (AC) Joint Excision

*Arthroscopic Partial Thickness Rotator Cuff Debridement

0-1 Week Post OpExercisesSling worn for comfort




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POST-BACK SURGERY PHYSICAL

THERAPY REHABILITATION

PROTOCOL

*Most people who have spinal surgery experience good to excellent

results.

* They find significant relief of pain and the return of functional

movement and strength, enabling them to walk, sit and cope with

the activities of daily life.

*Patients often report improvements in the way they feel

immediately after they awake from the surgery.* Although many patients see and feel immediate benefits, they

maximize the benefits of surgery by taking part in a comprehensive

rehabilitation program.

Physical therapist may give pt ideas of ways to position your

spine for the greatest comfort. These positions help take pressure of

the surgical area by supporting spine and limbs with pillows ortowels.

Careful movements suggested by Physical therapist can safely

ease pain by providing nutrition and lubrication in the areas close to

the surgical area. Movement of joints and muscles also signals

the nervous system to block incoming pain.

Using safe body movements which will instructed and tought by

Physical Therapist can help pt to avoid extra strain on his/her

spine in the weeks after his/her spine surgery.

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Avoid lying in positions that twist or angle pt spine. Don't curl up

in the "fetal" position. Choose a firm mattress-not a soft bed or sofa.

Keep enough pillows nearby to support your head, shoulders, trunk,

and legs.

When getting in or out of bed, use the "log roll" technique. This

is a way to roll to side and sit up while keeping pt spine steady and

secure. Instead of twisting pts upper body when roll to one side, try

to roll whole body as a unit, like the rolling of a log. Then let legs

ease off the edge of the bed toward the floor as pt push his/herself

up into a sitting position. This reduces strain from twisting spine,

giving the surgical area time to heal.

it depens on surgen protocol for the starting and the precaution

to be take when sitting (time of sitting and usage of back brace).

Keep spine upright and supported when sitting. A safe, upright

posture reduces strain on the spine. Choose a chair that supports

your spine. Avoid soft couches or chairs. Place a cushion or pillowbehind back while riding in a car. When standing up, keep your

spine aligned by leaning forward at the hips.

patient may be restricted from bending for a few weeks after

spine surgery. Follow surgen's protocol. If pt is given the okay to

bend, do so safely. Try to keep back straight and secure as while

bending forward keep spine straight. Consider using a "grabber" toavoid bending over at the waist to put on socks, shoes, or pick up

items from the floor.

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Surgen and Physical Therapist may restrict pt from lifting or

carrying for a period of time after surgery according to protocol.

. (during IN-Patient period)

1- bed mobility trainig as turning from side to side.

2- Pt/care giver eduction for on/off back brace

if idicated.

3- AROM/STRENGTHENING EXS for

upper and lower extramities if pt has

developed neuro manifestations.

4- Transefer training in/out of bed as toleratedand with the proper assistance.

Pt may sit on chair with back support and for

time determine by surgen if the sitting is

permited.

5- Gait trainig when possible and per protocol

using roller walker and with weight bearing

as tolerated.

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POST-OPERATIVE PHYSICAL

THERAPY REHAB PROTOCOL FOR

SCHEUERMANN DISEASE

Rehabilitation after surgery is more complex. Although

some patients leave the hospital shortly after surgery, some

surgeries require patients to stay in the hospital for a few

days for F/U and to initiate Physical Therapy.

Soon after surgery, a physical therapist may visit

patients who stay in the hospital.

The treatment sessions help patients learn to move

including bed mobility , transefer training and gait

training using the proper assistive device and withWBAT and do routine activities without putting extra

strain on the back.

***During recovery from surgery, patients should

follow their surgeon's instructions about wearing a

back brace or support belt. They should be cautious

about overdoing activities in the first few weeks after

surgery.

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Orthopedic in Pt PT Protocol

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