5 ‘Well if you think you can do better, go ahead and try.’ (paraphrasing)
6 “Patients completed a standard physical therapy program” “S/P RCR- MOON Protocol”
7 Standard PT Program 0-2 Weeks 2-6 Weeks > 6 Weeks Pendulums Elbow AROMGrip Isometrics2-6 WeeksPROM/ AAROM> 6 Weeks“Strengthening”
8 Shari Shaffer’s Grandmother’s Recipe for Homemade Bread Step 1-“Put 2 scoops of flourinto the green bowl”Step 2-Keep buying bread atthe storeNormal RockwellFreedom from Want
9 What’s the goal? Dissect the black box of exercise prescription Supplement the ASSET RC GuidelinesSpur discussion among “seasoned” cliniciansServe as a guide for novice clinicians
10 Integral Features of an Algorithm “Delayed” and Standard on same algorithmROM Progression DetailedPROM, AROMROM “gate” to strengtheningStrengthening Progression DetailedDosingStaged elevation programEnd Point for Supervised Rehab“Maintenance program”
11 A million ways to fold them… But only two ways to use them Avoid getting lost…Prevent the most common problemsOr after you’re lost….Fix the problems to get back on track
12 “Typical Patient” 63 y.o. male Full thickness 3-5 cm2 SS and IS s/p arthroscopic RCRImmob. in standard sling or ultrasling2 week follow up visitPain = 4/10 at rest. Difficulty sleeping.PFE = 0-95°; PER = 0-10°
13 What are the rehab goals after RC Repair? Pain controlledFunctional ROM> 115° AFE> 140° PFE> 75° PER at 90°Functional strengthAble to complete 1) ADL’s, 2) Work, 3) HobbiesHealed repair (?)AFE = Active Forward ElevationPFE = Passive Forward ElevationPER = Passive External Rotation
25 ROM is the Gate to Strengthening 6 WeeksElastic ResistanceIRERExtension* (unilateral)Rowing* (bilateral)* to neutral*THERABAND INSTRUCTION: (For each exercise/motion)-Start with yellow Theraband (1x10 reps)-When patient “can complete the exercise without difficulty”, then progress to 2x10 reps-Eventually progress to 3x10 reps-Advance to next resistance level (color) and begin with 1x10 repsExpected recovery - Approximately 1 week/ color.
26 Other components Strengthening progressions Guide for… 9 Weeks12 Weeks“Advanced strengthening” (athletes, laborers)Guide for…Scapular hikingLimited active elevationReturn to work, sport criteria
27 What we need to move forward Your Feedback, but… What we need to move forward Your Feedback, but….. (Keeping in algorithmic format)NO“I do ______ with my patients after RC surgery.”YES“I do ______ with my patients after RC surgery when/ if they present like ______”
28 Thank You. Brian G. Leggin PT, DPT, OCS Chuck Thigpen PhD, PT, ATC Reg. Wilcox PT, DPT, MS, OCS
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