Platelet Rich Plasma Rehabilitation Guidelines for Tendon Procedure

PHASE I (0 to 3 days after procedure)

Appointments

• No appointments during this time (rehabilitation appointments begin 10-14 days after procedure)

Goals

• Protect the affected tendon
• Pain control with tylenol or prescription medications

Precautions

• Avoid NSAIDs (Advil, ibuprofen, Aleve, naproxen, etc)

• Immobilization of the affected joint:
◦◦ Sling for rotator cuff / biceps tendons / tennis or golfer’s elbow
◦◦ Partial weight bearing with crutches for patellar / quadriceps tendons
◦◦ Partial weight bearing with crutches and walking boot for Achilles / ankle tendons
◦◦ Partial weight bearing with crutches and walking boot for plantar fascia

Suggested Therapeutic Exercises

• Gentle active range of motion (AROM) exercises out of the immobilizing device

Progression Criteria

• 3 days after procedure

PHASE II (3 to 10-14 days after procedure)

Appointments

• No appointments during this time (MD and rehabilitation appointments begin 10-14 days after procedure)

Goals

• Increase tendon tolerance to daily activities • Discontinue immobilizing device

Precautions

• Avoid NSAIDs (Advil, ibuprofen, Aleve, naproxen, etc)

• Weight bearing as tolerated, gradually weaning from assistive and immobilization devices
• No overstressing of the tendon through exercise, lifting, or impact activity

Suggested Therapeutic Exercises

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• Continue with active range of motion exercises out of the device 3 times a day for 5 minutes a session.
• After an upper body procedure, lower body exercise are allowed. • After a lower body procedure, upper body exercise are allowed. Can start low grade closed chain (foot on ground) program as pain allows

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Jennifer Luz MD
The Bone & Joint Center Sports Medicine Ultrasound Clinic St. Elizabeth’s Medical Center
Cardinal Cushing Pavilion, 9th floor
736 Cambridge St.
Boston, MA 02135
Phone: 617-779-6500
Fax: 617-779-6555

Platelet Rich Plasma Rehabilitation Guidelines for Tendon Procedure

PHASE III (10-14 days after procedure to 6-8 weeks after procedure)

       

Progression Criteria

• 10-14 days after procedure

Appointments

• Start physical therapy with rehabilitation appointments once every 1 to 2 weeks

◦◦ If you need a therapy prescription call the office (617-

779-6500) to have it faxed to your physical therapy gym • Physician follow-up appointment 2 to 6 weeks after procedure

Rehabilitation Goals

• Attain full range of motion
• Improve strength and endurance
• Improve balance and proprioception

Precautions

• Avoid high velocity / amplitude / intensity exercise such as throwing, running, jumping, plyometrics or heavy weight lifting • If you have post-activity soreness you should decrease the level of activity

Suggested Therapeutic Exercises

• Stretching exercises for the affected muscle-tendon unit at least once a day, 3-4 reps, holding for 30 seconds
• Joint mobilization as needed to restore normal joint mechanics
• May start light open kinetic chain (foot off the ground) exercises. Strengthening with emphasis on isometric and concentric activities initially and with eccentric progression as symptoms allow: theraband drills for the rotator cuff, dumbbell exercises for the wrist and elbow, single leg press for the knee, heel raises for the ankle, 3-4 sets of 6-12 reps at moderate intensity

• Balance and proprioception activities: joint reposition drills for the upper extremity; single leg stand progressing to balance board drills for the lower extremity
• Peri-pelvic and Core strengthening.

Cardiovascular Exercises

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• Non-impact activities with progressive resistance, duration, and intensity: upper body ergometer, elliptical trainer, stationary bike, deep water running, swimming

Progression Criteria

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• Full range of motion
• No pain with activities of daily living
• Pain free 5/5 manual muscle testing of affected muscle-tendon unit
• Symmetric proprioception of the affected limb

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Jennifer Luz MD
The Bone & Joint Center Sports Medicine Ultrasound Clinic St. Elizabeth’s Medical Center
Cardinal Cushing Pavilion, 9th floor
736 Cambridge St.
Boston, MA 02135
Phone: 617-779-6500
Fax: 617-779-6555

Platelet Rich Plasma Rehabilitation Guidelines for Tendon Procedure

PHASE IV (begin after meeting Phase III criteria, usually no sooner than 6-8 weeks after procedure)

Appointments

• Physical therapy appointments are approximately once every 1 to 3 weeks
• Physician clinic appointment 3 months after the procedure

Rehabilitation Goals

• Good eccentric and concentric multi-plane strength and dynamic neuromuscular control to allow for return to work/sports

Precautions

• Post-activity soreness should resolve within 24 hours, if not decrease level of activity

Suggested Therapeutic Exercises

• Continued strengthening of the affected area with increases in resistance, repetition, and / or frequency
• For the upper extremity: progressive training in provocative positions and work/sport specific positions including eccentric, endurance, and velocity specific exercises

• For the lower extremity: impact control exercises with progression from single plane to multi-planar landing and agility drills with progressive increase in velocity and amplitude
• Sport/work specific balance and proprioceptive drills
• Continued peri-pelvic and core strengthening
• Progress to sport specific functional exercise programs (throwing, running, etc.) with symptom based progressions
• A long term home exercise program should be established to focus on injury prevention and long term functional goals, including correcting any biomechanical issues that contribute to the original injury

Cardiovascular Exercises

• Replicate sport or work specific energy demands

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Progression Criteria

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• Return to sport/work criteria
• Good dynamic neuromuscular control with multi-plane activities and without pain
• Approval from the physician and/or sports rehabilitation provider

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Jennifer Luz MD
The Bone & Joint Center Sports Medicine Ultrasound Clinic St. Elizabeth’s Medical Center
Cardinal Cushing Pavilion, 9th floor
736 Cambridge St.
Boston, MA 02135
Phone: 617-779-6500
Fax: 617-779-6555