Physical Therapy Protocols
A Proactive Approach to Rehabilitation
We believe that rehabilitation should never be delayed. To ensure a seamless transition from surgery to recovery, we integrate therapy into your surgical plan from day one. In orthopaedic surgery, there must be a balance between immobilization to protect the tissues repaired in surgery and motion, so that you don’t get too stiff. Everyone develops some shoulder stiffness when they have to wear a sling. The goal of each protocol is protect you just long enough and then begin regaining motion as soon as it’s safe. Once you have full motion then strengthening can begin.
1. On-Time Rehabilitation
Pre-Scheduled PT: Physical therapy is ordered and scheduled at the same time your surgery is booked. This prevents any delay in starting your recovery.
Procedure-Specific Protocols: Every patient is provided with a hard copy of their specific PT protocol. This same protocol is sent directly to your physical therapist and included in your operative report.
Because every procedure is different, the time when PT can and should safely start is different. This will be specified on the protocol we give you, along with other restrictions and precautions you will need to follow.
2. Restoration of Function
The focus of our protocols is to move you through biological milestones:
Protection: Allowing tissues to heal while maintaining basic mobility.
Activation: Re-learning how to fire specific muscles
Motion: Regain full range of motion
Strengthening: Regaining the ability to perform activities of daily living, recreation, and sport.
To separate each of these milestones, your physical therapy protocol is divided into “phases.” Each phase listed on your PT protocol will have some weeks listed next to them. These weeks start on the day of your surgery. Depending on how well you are recovering, Dr. Wall may start a new phase early or delay a new phase until later. This is also a collaborative effort with your physical therapist who may advance you to the next phase when you reach that week’s timepoint, so long as you are doing well and if you don’t have a visit back with Dr. Wall for a while. You must not choose to start a new phase on your own as this can reinjure you or prevent you from healing. Be mindful of the restrictions for the phase you are in at all times. PLEASE CALL WITH QUESTIONS.
3. Physical Therapy Abbreviations:
Your PT protocol may use some terms that you are unfamiliar with. Please see the below explanations:
PT: physical therapy
ROM: range of motion, moving your arm in any way
PROM: passive range of motion, when something else besides the muscles of your surgical arm (such as your other arm, a therapist, etc.) moves your arm for you. Your arm should stay limp at all times and someone else should provide all the strength.
AAROM: active assist range of motion, one step up in recovery from PROM. The muscles of your surgical arm are allowed to help a little bit with. They must always be assisted by your good arm or a therapist
AROM: active range of motion, one step up in recovery from AAROM. You may now use the muscles in your surgical arm to lift it in the air, against the pull of gravity only. Unless otherwise specified, you may still not lift any objects.
WBS: weight-bearing status, the amount of weight you are allowed to lift with your surgical arm
NWB: non-weight-bearing, you may not lift any objects or use your arm to push, pull, prop yourself up, etc. No force may be applied to your arm.
WBAT: weight-bearing as tolerated, you may lift as much weight as you can tolerate now, but it still is “as tolerated,” which means if it hurts to do it, you still should not, especially if not under the supervision of a therapist at the time you try to do it
ER: external rotation, rotating your forearm away from your abdomen
IR: internal rotation, rotating your forearm toward your abdomen
FF: forward flexion, raising your arm straight out in front of your body
Extension: raising your arm behind you, down and past your hip