Anterior Instability Protocol (Post op anterior reconstruction)
Phase I: (0-2 weeks)
Goals:
- Protect surgery: Limit ER to 45 degrees and abduction to 90 degrees
- Decrease pain and inflammation
- Initiate safe ROM while protecting anterior capsule
- Patient education
Plan:
- ROM limited to 90° of flexion and abduction only
- Elbow and wrist ROM
- Modalities PRN
- Pendulum and scapular activities
- Light isometric activity
- Light resisted activity to wrist
Phase II (4-6 weeks)
Goals:
- Decrease pain and inflammation
- Achieve 60-80 of full ROM of flexion, extension and IR.
*****This DOES NOT include abduction/ER*****
Plan:
- Discontinue sling at 1 month
- Begin increasing forward elevation (flexion in scapular plane) beyond 90°
- Joint mobilization: avoid aggressive mobs/avoid inferior and anterior; external rotation directions
- AAROM
- Aquatic Therapy
- Gentle rotator cuff strengthening (ER to neutral)
**Check with physician on rotation limitations**
Phase III (8-16 weeks)
Goals:
- Near full ROM: EXCEPT ABDUCTION/EXTERNAL ROTATION
- Good scapulo-humeral rhythm
- 80-90% normal strength
Plan:
- PROM (full range; ER near full-range):
**NO FORCE IN ABDUCTION/EXTERNAL ROTATION
- Joint mobilization
- Progressive rotator cuff ~strengthening
- Begin machine weighted exercise
- Gentle PNF, eccentric cuff strengthening
- Biodex training if requested by M.D.
Phase IV (>24 weeks)
Goals:
- Maximum ROM
- Increase strength
- Return patient to sport/activity
Plan:
- Continue with progressive resistive exercises
- Continue with machine weighted program
- Sport Specific Training
PT sig:
Discontinue sling at 1 month
Limit ER to 45 degrees and abduction to 90 degrees
ROM and strengthening per protocol