Rehabilitation Protocols

Show this screen to your physical therapist or use the Share button below. No patient information is included.

Patient-specific orders, operative findings and therapist clinical judgment take priority. Do not advance activity or exercises based only on time. Use only the exact protocol selected by your care team.

Base orders

• Diagnosis: Total Knee Replacement (Arthroplasty).
• Weight bearing as tolerated unless different instructions were issued; ambulate with crutches or walker and wean with therapist guidance as gait and confidence improve.
• TED hose as much as possible for at least 2 weeks; continue through week 3 if swelling persists or the surgical team directs.
• Outpatient PT generally begins 3–5 days after surgery unless a different date was provided. Home PT only when included in the individualized plan.

Post-op days 0–3 — goals

• Minimize swelling, inflammation and pain.
• Establish quadriceps control.
• Safe, independent ambulation.
• Regain full extension immediately. Clinical ROM goal: 0–90°+. This is not a patient deadline or permission to self-advance.

Post-op days 0–3 — exercises

• Initial ROM work: 0–70°.
• Quad sets, straight-leg raises, terminal knee extension and knee extension from 90–30°.
• Russian stimulation to quadriceps, ankle pumps with the leg elevated, gentle hamstring exercises and hamstring stretching.
• Support under the heel only for extension; no pillow behind the knee and no resting with the knee bent. Do not force motion.
• CPM only if specifically ordered: 5° hyperextension to 110° flexion for 6–8 hours/day; begin at 45° flexion and increase 5–10° as tolerated.

Days 4–10

• Continue ROM progression. If CPM was ordered, increase 5–10°/day toward 100–115° for 6–8 hours/day.
• Add passive knee-extension stretching, assisted active knee flexion, hip abduction/adduction and gait training.
• Criteria before Phase 2: straight-leg raise with quad control, active ROM 0–90°, minimal pain/swelling and independent ambulation.

Day 11–week 6 — goals

• Improve range of motion.
• Improve muscular strength and endurance.
• Develop dynamic joint stability.
• Establish return toward functional activities.

Day 11–week 6 — exercises

• Continue quadriceps strengthening; progress knee extension 90–0° and terminal knee extension 45–0°.
• Begin hamstring curls and quarter squats.
• Stretch hamstrings, gastrocnemius-soleus and quadriceps.
• Use a stationary bicycle for range of motion.
• At week 4, selected patients may begin low front/lateral step-ups and quarter front lunges when cleared. Pool work is therapist-directed and only after the incision is fully healed.
• Criteria before Phase 3: ROM 0–110°, voluntary quadriceps control and independent ambulation.

Weeks 7–12

• Goals: progress ROM toward 0–120°+, improve strength/endurance, and improve eccentric/concentric knee control.
• Begin progressive walking and pool-endurance programs.
• Add lunges, half squats and step-ups beginning at 2 inches.
• Progress toward functional activities.

Weeks 13–26

• Maintain or improve lower-extremity strength and endurance.
• Allow selected patients to return to an advanced level of function.
• Exercise goal: full non-painful ROM, approximately 0–115°+.

For isolated MPFL reconstruction only. Operative findings and patient-specific orders supersede this reference.

Patient-specific orders, operative findings and therapist clinical judgment take priority. Do not advance activity or exercises based only on time. Use only the exact protocol selected by your care team.

Exclusions

• Do not use with tibial-tubercle osteotomy, trochleoplasty, cartilage restoration, fracture fixation, multiligament surgery or another procedure requiring different restrictions.

Weeks 0–2

• TDWB with crutches. Brace locked in extension for ambulation and worn during sleep; unlock only for hygiene and assigned exercise.
• Flexion maximum 30°. Restore full extension, control effusion and establish quadriceps activation. Outpatient PT generally begins within 3–5 days.

Weeks 3–4

• Progress to 50% weight bearing with crutches. Brace remains locked for ambulation and worn during sleep.
• Flexion maximum 60°. Continue quadriceps activation, hip/core work and protected gait training.

Weeks 5–6

• Progress toward WBAT after week 4 when swelling, gait and quadriceps control permit. Flexion maximum 90° through week 6.
• Begin shallow closed-chain strengthening in week 6. Continue brace until after week 6.

Weeks 7–12

• Discontinue brace and wean crutches only when cleared, gait is safe and straight-leg raise/quadriceps control are adequate.
• Begin stationary bicycle after week 6 when flexion permits. Progress ROM, strength, balance and step control.

Months 3–4

• Advance single-leg strength, endurance, landing preparation and dynamic control. Consider straight-line running after month 4 only when objective criteria and clearance are met.

Month 6+

• Cutting, pivoting and unrestricted sport require progressive task preparation, functional testing and explicit surgeon clearance. No unrestricted sport before month 6.

Show this screen to the therapist. Individual orders, operative findings and clinical judgment supersede this standard protocol.

Patient-specific orders, operative findings and therapist clinical judgment take priority. Do not advance activity or exercises based only on time. Use only the exact protocol selected by your care team.

Base orders

• Weight bearing as tolerated in the brace with crutches.
• Brace 0–90° for 3 weeks, locked in extension for ambulation; wear during sleep through week 4 and discontinue by week 4 when cleared.

Week 1

• Control swelling and pain; establish quadriceps control; restore full extension; gradually improve flexion; protect the graft.
• Quad sets, terminal knee extension, straight-leg raises, hamstring/calf stretching, ankle pumps, patellar mobilization, prone hangs, seated flexion and weight shifting.

Weeks 2–4

• Goal: full extension and 90° flexion with improving gait and neuromuscular control.
• Progress assisted heel slides, bicycle, closed-chain strength, balance and gait activities as appropriate.

Weeks 4–12

• Progress closed-chain strength, balance/proprioception and cardiovascular conditioning. Aquatic therapy only after incision healing and surgeon clearance.

Running and agility

• Do not start solely because a week number has passed. Require acceptable motion, swelling, strength, control and explicit surgeon/PT clearance.

Return to sport

• No automatic date. Require stable examination, satisfactory strength and functional testing, full motion, acceptable symptom response and surgeon clearance.

Show this screen to the therapist. Individual orders, operative findings and clinical judgment supersede this standard protocol.

Patient-specific orders, operative findings and therapist clinical judgment take priority. Do not advance activity or exercises based only on time. Use only the exact protocol selected by your care team.

Base orders

• Weight bearing as tolerated in the brace with crutches.
• Brace 0–90° for 3 weeks, locked in extension for ambulation; wear during sleep through week 4 and discontinue by week 4 when cleared.

Week 1

• Control swelling and pain; establish quadriceps control; restore full extension; gradually improve flexion; protect the graft.
• Quad sets, terminal knee extension, straight-leg raises, hamstring/calf stretching, ankle pumps, patellar mobilization, prone hangs, seated flexion and weight shifting.

Weeks 2–4

• Goal: full extension and 90° flexion with improving gait and neuromuscular control.
• Progress assisted heel slides, bicycle, closed-chain strength, balance and gait activities as appropriate.

Weeks 4–12

• Progress closed-chain strength, balance/proprioception and cardiovascular conditioning. Aquatic therapy only after incision healing and surgeon clearance.

Running and agility

• Do not start solely because a week number has passed. Require acceptable motion, swelling, strength, control and explicit surgeon/PT clearance.

Return to sport

• No automatic date. Require stable examination, satisfactory strength and functional testing, full motion, acceptable symptom response and surgeon clearance.

Show this screen to the therapist. Individual orders, operative findings and clinical judgment supersede this standard protocol.

Patient-specific orders, operative findings and therapist clinical judgment take priority. Do not advance activity or exercises based only on time. Use only the exact protocol selected by your care team.

Base orders

• Weight bearing as tolerated in the brace with crutches; discontinue crutches only when cleared.
• Brace 0–90° for 2 weeks, locked in extension for ambulation through week 2; wear during sleep through week 4 and wean by week 4 when cleared.

Week 1

• Control swelling and pain; establish quadriceps control; restore full extension; gradually improve flexion; protect the graft.
• Quad sets, terminal knee extension, straight-leg raises, hamstring/calf stretching, ankle pumps, patellar mobilization, prone hangs, seated flexion and weight shifting.

Weeks 2–4

• Goal: full extension and 90° flexion with improving gait and neuromuscular control.
• Add assisted heel slides, standing hamstring curls, bicycle and forward/retro treadmill walking as appropriate.

Weeks 4–12

• Progress closed-chain strengthening, balance/proprioception and cardiovascular work. Aquatic therapy only after incision healing and surgeon clearance.

Weeks 12–23

• Advance proprioception and strengthening. Running, agility, plyometrics and sport-specific work require objective criteria and explicit surgeon/PT clearance.

Return to sport

• No automatic date. Require full motion, stable examination, satisfactory strength and functional testing, acceptable symptoms and surgeon clearance.

This pathway is selected after surgery. Operative findings, individualized orders and clinical judgment supersede it.

Patient-specific orders, operative findings and therapist clinical judgment take priority. Do not advance activity or exercises based only on time. Use only the exact protocol selected by your care team.

Base restrictions

• Touch-down weight bearing with crutches for 2 weeks, followed by gradual progression based on gait, quadriceps control and symptoms.
• Brace 0–90°, locked in extension for ambulation and worn during sleep. Discontinue after week 4 when gait and quadriceps control are adequate.
• Limit flexion to 90° through week 4. Restore full extension immediately.

Weeks 0–2

• Control swelling and pain; establish quadriceps control; protect the graft and meniscus repair.
• Use approved ACL exercises without exceeding weight-bearing or flexion restrictions.

Weeks 2–4

• Progress weight bearing and crutch use by gait and quadriceps criteria.
• Stationary bicycle for range of motion may begin after week 2 within 90°.
• Begin shallow closed-chain work from 0–45° in week 4.

After week 4

• Progress flexion and discontinue the brace when criteria are met. Continue graft-specific strengthening, balance and conditioning.

After week 12

• Running and loaded flexion beyond 90° require objective readiness and clearance.

Return to sport

• No automatic date. Require satisfactory strength and functional testing, motion, stability, symptom response and explicit surgeon/PT clearance.

This pathway is selected after surgery. Operative findings, individualized orders and clinical judgment supersede it.

Patient-specific orders, operative findings and therapist clinical judgment take priority. Do not advance activity or exercises based only on time. Use only the exact protocol selected by your care team.

Base restrictions

• Touch-down weight bearing with crutches for 2 weeks, followed by gradual progression based on gait, quadriceps control and symptoms.
• Brace 0–90°, locked in extension for ambulation and worn during sleep. Discontinue after week 4 when gait and quadriceps control are adequate.
• Limit flexion to 90° through week 4. Restore full extension immediately.

Weeks 0–2

• Control swelling and pain; establish quadriceps control; protect the graft and meniscus repair.
• Use approved ACL exercises without exceeding weight-bearing or flexion restrictions.

Weeks 2–4

• Progress weight bearing and crutch use by gait and quadriceps criteria.
• Stationary bicycle for range of motion may begin after week 2 within 90°.
• Begin shallow closed-chain work from 0–45° in week 4.

After week 4

• Progress flexion and discontinue the brace when criteria are met. Continue graft-specific strengthening, balance and conditioning.

After week 12

• Running and loaded flexion beyond 90° require objective readiness and clearance.

Return to sport

• No automatic date. Require satisfactory strength and functional testing, motion, stability, symptom response and explicit surgeon/PT clearance.

This pathway is selected after surgery. Operative findings, individualized orders and clinical judgment supersede it.

Patient-specific orders, operative findings and therapist clinical judgment take priority. Do not advance activity or exercises based only on time. Use only the exact protocol selected by your care team.

Base restrictions

• Touch-down weight bearing with crutches for 2 weeks, followed by gradual progression based on gait, quadriceps control and symptoms.
• Brace 0–90°, locked in extension for ambulation and worn during sleep. Discontinue after week 4 when gait and quadriceps control are adequate.
• Limit flexion to 90° through week 4. Restore full extension immediately.

Weeks 0–2

• Control swelling and pain; establish quadriceps control; protect the graft and meniscus repair.
• Use approved ACL exercises without exceeding weight-bearing or flexion restrictions.

Weeks 2–4

• Progress weight bearing and crutch use by gait and quadriceps criteria.
• Stationary bicycle for range of motion may begin after week 2 within 90°.
• Begin shallow closed-chain work from 0–45° in week 4.

After week 4

• Progress flexion and discontinue the brace when criteria are met. Continue graft-specific strengthening, balance and conditioning.

After week 12

• Running and loaded flexion beyond 90° require objective readiness and clearance.

Return to sport

• No automatic date. Require satisfactory strength and functional testing, motion, stability, symptom response and explicit surgeon/PT clearance.

This pathway is selected after surgery. Operative findings, individualized orders and clinical judgment supersede it.

Patient-specific orders, operative findings and therapist clinical judgment take priority. Do not advance activity or exercises based only on time. Use only the exact protocol selected by your care team.

Base restrictions

• 25% weight bearing with crutches through week 4; 50% during weeks 4–6; progress beginning week 7 only when cleared.
• Brace locked in full extension except for approved exercises and hygiene through week 6. Begin discontinuing in week 7 when cleared and walking safely.
• Limit flexion to 90° through week 6. Restore full extension immediately.

Weeks 0–4

• Control swelling and pain; establish quadriceps control; protect the graft and meniscus repair.
• Use approved ACL exercises without exceeding weight-bearing or flexion restrictions.

Weeks 4–6

• Maintain 50% weight bearing and the locked-brace restriction.
• Stationary bicycle for range of motion may be used without exceeding 90°.

Week 7 and beyond

• Progress weight bearing, brace weaning and shallow closed-chain work from 0–45° when cleared.
• Continue graft-specific strengthening, balance and conditioning.

After week 12

• Running and loaded flexion beyond 90° require objective readiness and clearance.

Return to sport

• No automatic date. Require satisfactory strength and functional testing, motion, stability, symptom response and explicit surgeon/PT clearance.

This pathway is selected after surgery. Operative findings, individualized orders and clinical judgment supersede it.

Patient-specific orders, operative findings and therapist clinical judgment take priority. Do not advance activity or exercises based only on time. Use only the exact protocol selected by your care team.

Base restrictions

• 25% weight bearing with crutches through week 4; 50% during weeks 4–6; progress beginning week 7 only when cleared.
• Brace locked in full extension except for approved exercises and hygiene through week 6. Begin discontinuing in week 7 when cleared and walking safely.
• Limit flexion to 90° through week 6. Restore full extension immediately.

Weeks 0–4

• Control swelling and pain; establish quadriceps control; protect the graft and meniscus repair.
• Use approved ACL exercises without exceeding weight-bearing or flexion restrictions.

Weeks 4–6

• Maintain 50% weight bearing and the locked-brace restriction.
• Stationary bicycle for range of motion may be used without exceeding 90°.

Week 7 and beyond

• Progress weight bearing, brace weaning and shallow closed-chain work from 0–45° when cleared.
• Continue graft-specific strengthening, balance and conditioning.

After week 12

• Running and loaded flexion beyond 90° require objective readiness and clearance.

Return to sport

• No automatic date. Require satisfactory strength and functional testing, motion, stability, symptom response and explicit surgeon/PT clearance.

This pathway is selected after surgery. Operative findings, individualized orders and clinical judgment supersede it.

Patient-specific orders, operative findings and therapist clinical judgment take priority. Do not advance activity or exercises based only on time. Use only the exact protocol selected by your care team.

Base restrictions

• 25% weight bearing with crutches through week 4; 50% during weeks 4–6; progress beginning week 7 only when cleared.
• Brace locked in full extension except for approved exercises and hygiene through week 6. Begin discontinuing in week 7 when cleared and walking safely.
• Limit flexion to 90° through week 6. Restore full extension immediately.

Weeks 0–4

• Control swelling and pain; establish quadriceps control; protect the graft and meniscus repair.
• Use approved ACL exercises without exceeding weight-bearing or flexion restrictions.

Weeks 4–6

• Maintain 50% weight bearing and the locked-brace restriction.
• Stationary bicycle for range of motion may be used without exceeding 90°.

Week 7 and beyond

• Progress weight bearing, brace weaning and shallow closed-chain work from 0–45° when cleared.
• Continue graft-specific strengthening, balance and conditioning.

After week 12

• Running and loaded flexion beyond 90° require objective readiness and clearance.

Return to sport

• No automatic date. Require satisfactory strength and functional testing, motion, stability, symptom response and explicit surgeon/PT clearance.

For diagnostic arthroscopy, debridement or routine chondroplasty only. The operative report and individualized orders supersede this reference.

Patient-specific orders, operative findings and therapist clinical judgment take priority. Do not advance activity or exercises based only on time. Use only the exact protocol selected by your care team.

Eligibility

• Weight bearing as tolerated was permitted by the surgeon.
• No meniscus repair, ligament reconstruction, microfracture, MACI, osteochondral graft, brace requirement or protected-weight-bearing order.

Base orders

• Weight bearing as tolerated; crutches only as needed. No routine brace.
• Outpatient PT generally begins within 3–5 days.

Early rehabilitation

• Control pain and effusion; restore full extension and functional flexion; re-establish quadriceps activity and normalize gait.
• Progress bicycle, straight-leg raises, hip and knee strengthening, shallow squats, step-ups and balance work as symptoms allow.

Running, impact and sport

• No fixed starting week. Require minimal swelling, full functional motion, normal gait, adequate strength and single-leg control, and clinical clearance.
• Advance plyometrics, agility and sport-specific work only after objective criteria are met.

Show this screen to the therapist. Operative findings, repair pattern and individualized orders supersede this standard protocol.

Patient-specific orders, operative findings and therapist clinical judgment take priority. Do not advance activity or exercises based only on time. Use only the exact protocol selected by your care team.

Base restrictions

• Touch-down weight bearing with crutches for 2 weeks, then gradual progression by criteria.
• Brace 0–90°, locked in extension for ambulation and worn during sleep. Discontinue after week 4 when gait and quadriceps control are adequate.
• Limit flexion to 90° through week 4. No twisting, forced flexion, hyperflexion or loaded deep squatting.

Weeks 0–4

• Restore full extension, control swelling and establish quadriceps control. Use passive flexion only within the limit.
• Begin shallow closed-chain work from 0–45° in week 4.

Weeks 4–12

• Progress motion, gait, strength, balance and conditioning. Stationary bicycle may begin during weeks 4–6 within 90°.
• Light resisted hamstring curls may begin around week 9 when appropriate.

Months 4–6

• Month 4 running and loaded flexion beyond 90°; month 5 cutting/pivoting/agility; month 6 unrestricted sport—all require criteria and clearance.

Show this screen to the therapist. Operative findings, repair pattern and individualized orders supersede this standard protocol.

Patient-specific orders, operative findings and therapist clinical judgment take priority. Do not advance activity or exercises based only on time. Use only the exact protocol selected by your care team.

Base restrictions

• 25% weight bearing through week 4; 50% during weeks 4–6; progress beginning week 7 only when cleared.
• Brace locked in full extension except for approved exercises and hygiene through week 6. Begin discontinuing in week 7 when cleared and walking safely.
• Limit flexion to 90° through week 6. No twisting, forced flexion, hyperflexion or loaded deep squatting.

Weeks 0–6

• Restore full extension, control swelling and establish quadriceps control. Use passive flexion only within the limit.
• Stationary bicycle may be used during weeks 4–6 without exceeding 90°.

Week 7–12

• Progress weight bearing, brace weaning, motion, gait and balance. Begin shallow closed-chain work from 0–45°.
• Light resisted hamstring curls may begin around week 9 when appropriate.

Months 4–6

• Month 4 running and loaded flexion beyond 90°; month 5 cutting/pivoting/agility; month 6 unrestricted sport—all require criteria and clearance.

Show this screen to the therapist. Operative findings, repair pattern and individualized orders supersede this standard protocol.

Patient-specific orders, operative findings and therapist clinical judgment take priority. Do not advance activity or exercises based only on time. Use only the exact protocol selected by your care team.

Base orders

• Weight bearing as tolerated immediately; crutches only as needed. No routine brace.
• Outpatient PT generally begins 3–5 days after surgery.

Weeks 1–2

• Control pain and swelling; restore ROM and quadriceps activity; normalize gait.
• Stationary bicycle, quad sets, straight-leg raises, hip work, knee extension/curls, leg press, shallow squats, step-ups and balance work as tolerated.

Weeks 3–4

• Restore remaining motion and progress strength, endurance, proprioception and function.
• Progress bicycle, stair or elliptical conditioning, lunges, step-ups, calf raises and pool work when cleared.

Running, agility and sport

• No automatic starting week. Progress only when swelling, motion, strength, gait, single-leg control and clinical assessment are acceptable.

Show this screen to your physical therapist or use the Share button below. No patient information is included.

Patient-specific orders, operative findings and therapist clinical judgment take priority. Do not advance activity or exercises based only on time. Use only the exact protocol selected by your care team.

Base orders

• Diagnosis: posterior-approach total hip arthroplasty.
• Weight bearing as tolerated unless different orders were issued. Progress walker to cane to no device based on gait quality, balance, confidence and safety.
• Outpatient PT generally begins 3–5 days after surgery. Home PT only when included in the individualized plan.
• Posterior precautions for 6 weeks: no hip flexion beyond 90°, no adduction past neutral or crossing the legs/ankles, and no internal rotation.

Weeks 0–4 — goals

• Minimize swelling and pain. Restore motion within restrictions. Prevent muscular inhibition. Normalize gait safely.

Weeks 0–4 — exercises

• Day-1 patient program: ankle pumps, quad sets and gentle heel slides below 90° without forcing motion. Straight-leg raises and all additions are therapist-directed.
• Therapist-directed work may include gluteal, hamstring and transverse-abdominal isometrics; controlled abduction/extension; gait, balance and transfer training. Avoid hip-flexor irritation.
• Stationary bicycle no earlier than week 2, therapist-directed, beginning with a high seat.
• No passive, active or resisted internal-rotation exercises during the first 6 weeks.
• No aquatic exercise until the incision is completely healed and the surgeon explicitly clears the patient.

Weeks 5–6

• Restore a safe, efficient gait pattern and progressively increase strength while maintaining all posterior precautions.
• Avoid ballistic or forced stretching and hip-flexor or joint irritation.

Weeks 7–12

• Progress strengthening, endurance, balance and proprioception according to symptoms, gait and objective function.
• Therapist-directed treadmill walking may begin after week 6 when safe. Pool activity still requires a completely healed incision and explicit surgeon clearance.
• Progress bridges, side supports, partial squats, controlled step-downs, band work and low-impact conditioning as clinically appropriate.

Weeks 13–25 and beyond

• Continue progressive strength, endurance, neuromuscular control and functional activity.
• Running, agility, water plyometrics, sport-cord running and sport-specific drills are limited to selected patients after explicit surgeon clearance.
• Contact and other high-impact sports require explicit surgeon clearance and have no automatic return date.

This office-selected protocol reflects repair size. Operative findings, tissue quality, concomitant procedures and individualized orders supersede it.

Patient-specific orders, operative findings and therapist clinical judgment take priority. Do not advance activity or exercises based only on time. Use only the exact protocol selected by your care team.

Base restrictions

• Sling including sleep for 4 weeks.
• Remove the abduction pillow at week 4.
• No shoulder internal rotation or extension through week 4.
• No active shoulder motion until the size-specific progression permits it. No lifting, pushing, pulling or upper-extremity weight bearing.

Passive-motion phase

• Therapist-directed passive flexion in the scapular plane from approximately 60–90° and passive external rotation at 20° abduction from 0–15°.
• Avoid aggressive passive motion. Pendulums are hangs generated by body movement—not active shoulder movement.
• Progress passive flexion toward approximately 60–100° and external rotation at 20° abduction toward 0–20°.
• Continue to avoid shoulder internal rotation and extension.
• Progress passive flexion toward approximately 90–125° and external rotation at 20° abduction toward 15–40°, as tolerated and ordered.
• Avoid shoulder internal rotation and extension through week 4. If the subscapularis was repaired, external rotation may require a separate limit; follow the operative order.

Active motion

• Begin AAROM at week 5.
• Begin AROM at week 7. Progress only with acceptable mechanics and symptom response.

Strengthening

• Begin light resisted cuff strengthening at week 10 if criteria are met. Emphasize controlled mechanics and low load.
• With biceps tenodesis: active elbow motion is allowed, but no resisted elbow flexion or supination for 6 weeks.
• Do not use empty-can exercises at any stage.

Return to sport or heavy work

• May begin after month 7 only after adequate pain-free motion, strength, endurance and dynamic control are demonstrated.
• Requires explicit surgeon clearance; no date alone authorizes progression.

This office-selected protocol reflects repair size. Operative findings, tissue quality, concomitant procedures and individualized orders supersede it.

Patient-specific orders, operative findings and therapist clinical judgment take priority. Do not advance activity or exercises based only on time. Use only the exact protocol selected by your care team.

Base restrictions

• Sling including sleep for 6 weeks.
• Remove the abduction pillow at week 4.
• No shoulder internal rotation or extension through week 6.
• No active shoulder motion until the size-specific progression permits it. No lifting, pushing, pulling or upper-extremity weight bearing.

Passive-motion phase

• Therapist-directed passive flexion in the scapular plane from approximately 60–90° and passive external rotation at 20° abduction from 0–15°.
• Avoid aggressive passive motion. Pendulums are hangs generated by body movement—not active shoulder movement.
• Progress passive flexion toward approximately 60–100° and external rotation at 20° abduction toward 0–20°.
• Continue to avoid shoulder internal rotation and extension.
• Progress passive flexion toward approximately 90–125° and external rotation at 20° abduction toward 15–40°, as tolerated and ordered.
• Avoid shoulder internal rotation and extension through week 6. If the subscapularis was repaired, external rotation may require a separate limit; follow the operative order.

Active motion

• Begin AAROM at week 7.
• Begin AROM at week 10. Progress only with acceptable mechanics and symptom response.

Strengthening

• Begin light resisted cuff strengthening at week 12 if criteria are met. Emphasize controlled mechanics and low load.
• With biceps tenodesis: active elbow motion is allowed, but no resisted elbow flexion or supination for 6 weeks.
• Do not use empty-can exercises at any stage.

Return to sport or heavy work

• May begin after month 7 only after adequate pain-free motion, strength, endurance and dynamic control are demonstrated.
• Requires explicit surgeon clearance; no date alone authorizes progression.

This office-selected protocol reflects repair size. Operative findings, tissue quality, concomitant procedures and individualized orders supersede it.

Patient-specific orders, operative findings and therapist clinical judgment take priority. Do not advance activity or exercises based only on time. Use only the exact protocol selected by your care team.

Base restrictions

• Sling including sleep for 8 weeks.
• Continue the abduction pillow through week 8.
• No shoulder internal rotation or extension through week 8.
• No active shoulder motion until the size-specific progression permits it. No lifting, pushing, pulling or upper-extremity weight bearing.

Passive-motion phase

• Protect the repair and minimize pain and inflammation.
• At therapy, passive forward elevation in the scapular plane may progress only to 90°. Initially attend approximately once weekly unless ordered otherwise.
• Avoid shoulder internal rotation and extension through week 8. Do not perform active shoulder motion.
• Discontinue the sling when directed. Progress passive motion gradually in all planes.
• Begin active-assisted flexion after week 8 and progress toward active flexion with therapist supervision.
• Begin low-load periscapular work and submaximal isometrics with the elbow flexed, as permitted.

Active motion

• Begin AAROM at after week 8.
• Begin AROM at after week 8, following active-assisted progression. Progress only with acceptable mechanics and symptom response.

Strengthening

• Begin light resisted cuff strengthening at month 4 if criteria are met. Emphasize controlled mechanics and low load.
• With biceps tenodesis: active elbow motion is allowed, but no resisted elbow flexion or supination for 6 weeks.
• Do not use empty-can exercises at any stage.

Return to sport or heavy work

• May begin after month 8 only after adequate pain-free motion, strength, endurance and dynamic control are demonstrated.
• Requires explicit surgeon clearance; no date alone authorizes progression.

For arthroscopic debridement, subacromial decompression, acromioplasty or distal clavicle excision, with a conditional biceps-tenodesis restriction. Repair-specific operative orders supersede this protocol.

Patient-specific orders, operative findings and therapist clinical judgment take priority. Do not advance activity or exercises based only on time. Use only the exact protocol selected by your care team.

Base orders

• Sling for comfort only. Passive, active-assisted and active shoulder motion may begin immediately as tolerated without forcing pain.
• Outpatient PT generally begins within 3–5 days.

Biceps tenodesis modifier

• If tenodesis was performed, active elbow motion is allowed immediately. No resisted elbow flexion or forearm supination for 6 weeks.

Weeks 1–2

• Minimize pain and restore comfortable motion. Progress passive/active-assisted/active motion, gentle joint mobilization, scapular stabilization, capsular stretching and submaximal isometrics as appropriate.

Weeks 3–6

• Progress toward full pain-free ROM and normal arthrokinematics. Begin light resisted shoulder flexion, scaption, cuff and scapular strengthening with good mechanics.
• Do not violate the six-week biceps restriction if tenodesis was performed.

Weeks 7–12

• Advance strength, endurance, dynamic control, posterior-cuff eccentrics, PNF and appropriate plyometric progression.

Weeks 13–16

• Consider unrestricted work or sport only after motion, strength and functional criteria are met and explicit surgeon clearance is given.

For uncomplicated anterior arthroscopic Bankart repair only. Operative findings and patient-specific orders supersede this reference.

Patient-specific orders, operative findings and therapist clinical judgment take priority. Do not advance activity or exercises based only on time. Use only the exact protocol selected by your care team.

Base restrictions

• Outpatient PT generally begins within 3–5 days.
• Sling continuously, including sleep, for 4–6 weeks; surgeon selects discontinuation timing. Remove only for hygiene and assigned exercises.
• No lifting, pushing, pulling or upper-extremity weight bearing during the protection phase. Avoid extension behind the body and combined abduction/external rotation.

Weeks 0–3

• Assisted forward elevation: maximum 90°. External rotation at the side: maximum 30°.
• No active shoulder motion. Maintain distal ROM and gentle scapular setting without stressing the repair.

Weeks 4–6

• Progress assisted forward elevation toward 120° and external rotation at the side toward 45° without forcing pain or apprehension.
• Begin controlled AROM in week 5 within the same limits. Sling discontinuation occurs only when the surgeon clears it between weeks 4 and 6.

Weeks 7–12

• Begin light resisted cuff and scapular strengthening if motion, pain, apprehension and mechanics are appropriate.
• Progress endurance, proprioception and controlled closed-chain loading. Avoid aggressive anterior capsular stress.

After week 12

• Consider running when criteria and clearance are met. Continue progressive strength, dynamic stability and task-specific loading.

Months 4–6+

• Consider sport-specific training after month 4 when objective criteria are met.
• Contact or unrestricted sport no earlier than month 6 after functional testing and explicit surgeon clearance.

For combined anterior arthroscopic Bankart repair and remplissage only. Operative findings and patient-specific orders supersede this reference.

Patient-specific orders, operative findings and therapist clinical judgment take priority. Do not advance activity or exercises based only on time. Use only the exact protocol selected by your care team.

Base restrictions

• Outpatient PT generally begins within 3–5 days.
• Sling continuously, including sleep, for 6 weeks; remove only for hygiene and assigned exercises.
• No lifting, pushing, pulling or upper-extremity weight bearing during the protection phase. Avoid extension behind the body, external rotation in abduction and the combined apprehension position.

Weeks 0–4

• Assisted forward elevation: maximum 90°. External rotation at the side: maximum 20°.
• No active shoulder motion. Maintain distal ROM and gentle scapular setting without stressing either repair.

Weeks 5–6

• Progress assisted forward elevation toward 120° and external rotation at the side toward 30° without forcing pain or apprehension.
• Continue sling protection. No active shoulder motion through week 6.

Weeks 7–9

• Begin controlled AROM after week 6. Progress motion gradually without aggressive anterior or posterior capsular stress.
• Begin light resisted scapular work in week 8 if mechanics are appropriate.

Weeks 10–12

• Begin light cuff resistance in week 10 if criteria are met. Progress resisted external rotation cautiously.
• Advance endurance, proprioception and controlled closed-chain loading.

After week 12

• Consider running when criteria and clearance are met. Continue progressive strength, dynamic stability and task-specific loading.

Months 5–6+

• Consider sport-specific training after month 5. Contact or unrestricted sport no earlier than month 6 after testing and surgeon clearance.
• Interval overhead throwing begins only after month 6 with near-symmetric functional motion, appropriate strength and stability testing, and explicit surgeon clearance.

For uncomplicated arthroscopic posterior labral repair only. Operative findings and patient-specific orders supersede this reference.

Patient-specific orders, operative findings and therapist clinical judgment take priority. Do not advance activity or exercises based only on time. Use only the exact protocol selected by your care team.

Base restrictions

• Outpatient PT generally begins within 3–5 days. Sling continuously, including sleep, for 6 weeks.
• No behind-back internal rotation, horizontal adduction across the body, pushing, posterior pressure through the elbow or upper-extremity weight bearing during the protection phase.

Weeks 0–4

• Assisted forward elevation: maximum 120°. External rotation at the side: maximum 45°.
• No active shoulder motion. Maintain distal ROM and gentle scapular setting without stressing the repair.

Weeks 5–6

• Begin controlled AROM within the existing limits. Continue sling protection through week 6.
• Continue prohibiting posterior-loading positions and cross-body or behind-back motion.

Weeks 7–9

• Begin light cuff and scapular resistance if motion, pain, apprehension and mechanics are appropriate.
• Progress motion without aggressive posterior capsular stress.

Weeks 10–12

• Begin wall push-ups at week 10 when control is adequate; advance through elevated surfaces gradually.
• Progress strength, endurance, proprioception and dynamic control. No floor push-ups.

After week 12

• Consider running when criteria and clearance are met. Continue graded closed-chain, plyometric and task-specific work.

Months 4–6+

• Floor push-ups no earlier than month 4. Sport-specific training may begin after month 5.
• Contact or unrestricted sport no earlier than month 6 after functional testing and explicit surgeon clearance.

For uncomplicated Latarjet stabilization only. Operative findings, graft assessment and patient-specific orders supersede this reference.

Patient-specific orders, operative findings and therapist clinical judgment take priority. Do not advance activity or exercises based only on time. Use only the exact protocol selected by your care team.

Base restrictions

• Outpatient PT generally begins within 3–5 days. Sling continuously, including sleep, for 4 weeks.
• No lifting, pushing, pulling or upper-extremity weight bearing during the protection phase. Avoid extension behind the body and combined abduction/external rotation.
• Protect the subscapularis: no resisted internal rotation before week 10.

Weeks 0–4

• Assisted forward elevation: maximum 90°. External rotation at the side: maximum 30°.
• No active shoulder motion. Maintain distal ROM and gentle scapular setting.

Weeks 5–6

• Begin controlled AROM after the four-week sling phase. Progress assisted elevation toward 120° and ER at the side toward 45°.
• Begin light scapular resistance in week 6 if mechanics are appropriate.

Weeks 7–9

• Progress active motion and scapular strength. Begin light general cuff resistance in week 8.
• No resisted internal rotation. Avoid aggressive anterior capsular stress and heavy loading.

Weeks 10–12

• Begin light resisted internal rotation in week 10 if subscapularis function, pain and mechanics are appropriate.
• Advance strength, endurance, proprioception and controlled closed-chain loading.

After week 12

• Consider running when criteria and clearance are met. Continue progressive dynamic stability and task-specific work.

Months 5–6+

• Consider sport-specific training after month 5.
• Contact or unrestricted sport no earlier than month 6 after functional testing, clinical and imaging evidence of graft healing, and explicit surgeon clearance.

For uncomplicated isolated SLAP repair only. Operative findings and patient-specific orders supersede this reference.

Patient-specific orders, operative findings and therapist clinical judgment take priority. Do not advance activity or exercises based only on time. Use only the exact protocol selected by your care team.

Base restrictions

• Outpatient PT generally begins within 3–5 days. Sling continuously, including sleep, for 4 weeks.
• No lifting, pushing, pulling or upper-extremity weight bearing during the protection phase.
• Active elbow motion is allowed immediately; no resisted elbow flexion or forearm supination for 6 weeks.

Weeks 0–3

• Assisted forward elevation: maximum 90°. External rotation at the side: maximum 30°.
• No active shoulder motion. Maintain distal ROM and gentle scapular setting.

Weeks 4–6

• Progress assisted elevation toward 120° and ER at the side toward 45°. Begin controlled AROM in week 5.
• Continue biceps-resistance restriction through week 6. Avoid traction stress.

Weeks 7–9

• Begin light cuff and scapular resistance in week 7. Begin light biceps resistance in week 8 if criteria are met.
• Progress motion and strength without provocative superior-labral loading.

Weeks 10–16

• Advance strength, endurance, proprioception, closed-chain control and overhead mechanics.
• Do not begin throwing until functional criteria and clearance are met.

After month 4

• Begin interval throwing only after month 4 with adequate functional motion, strength and dynamic control and surgeon clearance.

Months 6–9

• Consider unrestricted overhead sport only after successful throwing progression, functional testing and explicit surgeon clearance.

Show this screen to your therapist. This is the CNY Orthopedics standard protocol; individualized orders and operative findings supersede it.

Patient-specific orders, operative findings and therapist clinical judgment take priority. Do not advance activity or exercises based only on time. Use only the exact protocol selected by your care team.

Base restrictions

• Sling full-time, including sleep, through week 4; remove only for hygiene and approved exercises, then wean when cleared.
• No active shoulder motion, lifting, supporting body weight through the hands or hyperextension during the initial phase.
• No active internal rotation or behind-the-back motion through week 6. No resisted internal rotation through week 12 unless the surgeon clears it sooner.

Weeks 1–2

• Days 1–3: pendulum hangs; finger, wrist and elbow active motion without weight; passive flexion 100°, external rotation 30°, internal rotation to chest and abduction 45°.
• Days 3–10: progress passive flexion, abduction and external rotation in the scapular plane; no extension. Begin resisted hand/wrist/elbow motion, scapular and submaximal neutral shoulder isometrics.
• Days 10–21: continue passive progression without hyperextension and gradually add assisted active motion.

Weeks 3–6

• Continue passive motion; begin supine active flexion, abduction and rotation. Add assisted horizontal adduction, rotator-cuff/periscapular isometrics and scapular strengthening.

Weeks 6–12

• Continue active motion and rotation in the scapular plane. Add gentle assisted behind-the-back internal rotation and light functional activity.
• Week 8: light progressive supine elevation. Week 10: resisted flexion, abduction and external rotation; progress behind-the-back internal rotation without overstretching.

Weeks 12–24

• Progress strengthening, closed-chain work and functional activity as tolerated. Home program 3–4 times weekly.

Show this screen to your therapist. This is the CNY Orthopedics standard protocol; individualized orders and operative findings supersede it.

Patient-specific orders, operative findings and therapist clinical judgment take priority. Do not advance activity or exercises based only on time. Use only the exact protocol selected by your care team.

Base restrictions

• Sling for 3 weeks including sleep; continue as needed for 3 more weeks.
• No active shoulder motion, lifting or supporting body weight through the hands during the initial phase.
• Through week 12, avoid combined extension, adduction and internal rotation: no behind-the-back reaching, tucking in a shirt with the surgical arm or pushing up from a chair or bed.

Weeks 1–3

• Pendulum hangs in therapy; cervical-spine, elbow, wrist and hand active/assisted motion without weight.
• Supine passive flexion/abduction to 90° in the scapular plane and external rotation to 20°; no internal rotation.
• Begin pain-free submaximal periscapular and deltoid isometrics in the scapular plane.

Weeks 4–6

• Progress passive flexion, abduction and external rotation as tolerated. Gentle passive internal rotation to the belt line is allowed.
• No active internal rotation, behind-the-back reaching or extension. Do not lift the arm against gravity.
• Begin gentle resisted elbow/wrist/hand exercise and gravity-eliminated rotator-cuff and deltoid strengthening.

Weeks 7–8

• Progress passive motion; passive internal rotation may progress below 50° in the scapular plane.
• Begin assisted and active motion from supine toward upright positions; continue to avoid extension. Add gentle pain-free rotation isometrics and stabilization.

Weeks 9–12

• At week 10, add therapist-directed punch, rows, shrugs, curls and bear hugs. Begin gentle periscapular/deltoid isotonic work and light resisted active motion.

Weeks 12–16 and beyond

• Progress gentle standing resisted flexion/abduction; no lifting over 6 pounds through week 16.
• From week 17, continue strength and home exercise progression within surgeon-defined limits.

Patient-specific orders, tendon position, clinical findings and therapist judgment supersede this standard reference.

Patient-specific orders, operative findings and therapist clinical judgment take priority. Do not advance activity or exercises based only on time. Use only the exact protocol selected by your care team.

Weeks 0–2

• Strict NWB in prescribed plantar-flexed protection. No stretching or dorsiflexion beyond the permitted position. PT begins at week 2.

Weeks 2–4

• Continue strict NWB. Begin only surgeon-permitted protected ankle motion; no passive dorsiflexion and no motion beyond the current limit.

Weeks 4–6

• Gradual WBAT in boot with heel wedges. Continue crutches until gait is safe and controlled.

Weeks 6–12

• Remove one wedge every 2 weeks after week 6; aim for neutral around week 10. Shoe transition weeks 10–12 when cleared.
• Light seated plantar-flexion resistance week 8. No Achilles stretching or dorsiflexion beyond neutral through week 12.

After week 12

• Standing heel raises when cleared. Running months 5–6 with objective strength/gait criteria. Cutting and unrestricted sport months 9–12 after testing and clearance.

Patient-specific orders, tendon position, clinical findings and therapist judgment supersede this standard reference.

Patient-specific orders, operative findings and therapist clinical judgment take priority. Do not advance activity or exercises based only on time. Use only the exact protocol selected by your care team.

Weeks 0–2

• NWB in plantar flexion using fitted splint or appropriately wedged boot. No stretching or unprotected ankle motion.

Weeks 2–8

• Protected WBAT in wedged boot beginning week 2. PT begins at week 2. Remove one wedge every 2 weeks as directed.

Weeks 8–12

• Progress toward neutral around weeks 8–10; shoe transition only when cleared. Light seated plantar-flexion resistance may begin week 8.
• No Achilles stretching or dorsiflexion beyond neutral through week 12.

After week 12

• Standing heel raises when cleared. Running months 5–6 with objective strength/gait criteria. Cutting and unrestricted sport months 9–12 after testing and clearance.