most common post-surgical rehab protocols

Rotator cuff repair Phase I primary goal

Protect tendon-to-bone healing, maintain distal mobility, prevent scapular dyskinesis

Rotator cuff repair Phase I time frame

0-6 weeks

Rotator cuff repair Phase I allowed exercises

PROM (flexion, ER in scapular plane), pendulums (passive), scapular clocks with assistance

Rotator cuff repair Phase I contraindications

Active shoulder elevation, shoulder extension, sudden eccentric loading

Rotator cuff repair regression indicators

Pain >4/10, guarding during PROM, increased night pain

Rotator cuff repair progression criteria

PROM flexion ≥120°, minimal pain at rest, surgeon clearance

Rotator cuff repair Phase II focus

Active motion and neuromuscular control

Rotator cuff repair Phase II progressions

AAROM to AROM, closed-chain scapular stability, isometrics to light isotonic strengthening

Rotator cuff rehab regression sign

Loss of scapular control or upper trap dominance

Upper trap dominance indicates what in rehab?

Regress load and improve motor control

Rotator cuff repair Phase III focus

Strength and endurance

Rotator cuff Phase III progressions

Theraband to dumbbells, ER/IR at 0° progressing to 90°, rhythmic stabilization

Rotator cuff repair Phase IV focus

Return to function

Rotator cuff repair Phase IV activities

Plyometrics and interval throwing program

Labral repair key tissue at risk

Biceps anchor (SLAP) or anterior capsule (Bankart)

Labral repair early phase time frame

0-4 weeks

Labral repair early allowed activities

PROM only, scapular stabilization, elbow ROM without resistance

Labral repair early contraindications

Resisted elbow flexion, Speed's test, overhead lifting

Labral repair progression criteria

Pain-free PROM and no anterior instability signs

Labral repair late phase focus

Overhead endurance and sport-specific velocity control

Primary failure cause of labral rehab

Premature overhead loading

ACL reconstruction Phase I priority

Restore full knee extension

ACL reconstruction Phase I time frame

0-2 weeks

ACL Phase I exercises

Quad sets, heel props, NMES if quad lag present

ACL early contraindicated exercise

Open-chain knee extension from 40-0°

ACL rehab regression signs

Effusion increase >2 cm or extensor lag

ACL Phase II focus

Strength and proprioception

ACL Phase II progression pattern

Double-leg to single-leg, stable to unstable, sagittal to frontal plane

ACL Phase II regression sign

Dynamic valgus or poor landing mechanics

ACL Phase III focus

Power and plyometrics

Criteria to begin ACL plyometrics

Quad strength ≥80%, no effusion, proper deceleration mechanics

ACL Phase IV return-to-sport requirement

Limb symmetry ≥90%, hop testing, psychological readiness

Time alone determines safe ACL return?

No

Meniscus repair early restriction

Flexion >90° and deep squats

Meniscus repair priority

Tissue healing

Meniscectomy rehab priority

Early ROM and strengthening

Key difference between meniscus repair and meniscectomy

Repair limits motion; meniscectomy allows rapid progression

Achilles repair early phase time frame

0-6 weeks

Achilles repair early allowed activity

Boot immobilization and isometrics only

Achilles repair early contraindications

Stretching and resisted plantarflexion

Achilles mid-phase rehab focus

Eccentric calf loading

Achilles late-phase rehab activities

Plyometrics and sprint progression

Achilles rehab regression signs

Pain or swelling lasting longer than 24 hours

Ankle ORIF or syndesmotic repair progression

NWB to WBAT, open to closed chain, early balance training

Ankle ORIF rehab regression signs

Pain with push-off or inversion instability

Hip labral repair early contraindications

Hip flexion >120° and pivoting

Hip labral rehab progression sequence

Glute med strengthening, core control, rotational drills

Poor hip control increases stress where?

Lumbar spine

Post-surgical red flags requiring referral

Increasing pain despite regression, sudden ROM loss, DVT signs, infection symptoms