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PEC Major Repair - Physical Therapy Protocol

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Preoperative Guidelines

  • AROM scapula, GH joint, elbow, hand
  • Decrease edema and pain
  • Educate Patient on post-op protocol

Note: Exercise prescription is dependent upon the tissue healing process and individual functional readiness in all stages. If any concerns or complications arise regarding the progress of any patient, physical therapy will contact the orthopedist

Phase I (Post-op Weeks 0-4)

  • No PROM, No Running
  • Shoulder Immobilizer at all times (except during exercises)
  • Hand squeezing exercises with ball
  • Elbow and wrist AROM with shoulder in neutral position at side (IR/ADD)
  • Stationary bike with immobilizer on – no weight bearing on involved UE (i.e. no stairmaster)
  • Week 3-4 – biceps curls and triceps ext (arm at side) with light weight (< 5#)

Goals: Pain control, full elbow flex and extension ROM, full wrist/hand ROM

Phase II (Weeks 5 – 6)

  • No PROM, No Running
  • Continue shoulder immobilizer (except during exercises)
  • Shoulder shrugs, protraction, retraction, scapular mobilization
  • Supine AAROM flexion to 90 degrees
  • Gentle box isometrics
  • Continue stationary bike

Goals: Supine AAROM: Flexion to 90 degrees, no increase in pain or edema

Phase III (Weeks 7– 8)

  • No PROM, No Running
  • D/C immobilizer
  • Continue appropriate previous exercises
  • AAROM in flexion > 90 degrees
  • AROM/AAROM in ER and ABD to tolerance
  • Submax isometrics
  • Treadmill – Walking progression program

Goals: Flexion 120 degrees, Abd 90 degrees, Active ER as tolerated

Phase IV (Weeks 9 – 12)

  • No PROM, No Running
  • Continue appropriate previous exercises
  • AROM, AAROM through full range
  • Wall push-ups with a plus (non-ballistic)
  • Body blade… begin bilateral UEs and progress to unilateral
  • Ball Toss with lightest ball (arm at side and chest pass)
  • Elliptical trainer
  • Treadmill – progress to jogging

Goals: Gradual progression to full AROM by 12 weeks, 50 wall push-ups

Phase V (Months 3 – 4)

  • Continue appropriate previous exercises
  • PROM as needed to regain full ROM
  • Gentle pec stretches
  • Theraband IR/ER; biceps, triceps resistance training as tolerated
  • Begin upper body workouts with VERY LIGHT resistance
    • No elbow flexion > 90 degrees on bench press, military press, “mini” dips
    • Light weight, dips on machine with max assist: not regular dips
    • No flys
    • Shrugs, RC exercises
  • UBE 10 mins forwards and 10 mins backwards at low resistance
  • Table push-ups (body at ~45 deg)
  • Fitter, BAPS on hands, scapular stabilization, light rhythmic stabilization, perturbations
  • Ball toss – advance as tolerated
  • Stairmaster
  • Treadmill – Running progression program

Goals: Full shoulder ROM with normal scapulothoracic and GH joint rhythm, 50 table push-ups

Phase VI (Months 5 – 6)

  • Continue appropriate previous exercises
  • Knee push-ups: progress to regular push-ups…(not > 90 degrees elbow flexion until after 6 mos)
  • Begin progression to heavier resistance upper body workouts
  • UE plyometric progression/sports specific drills/throwing progression
  • Continue ROM restrictions (no >90 deg elbows) on bench, p/u, mil press, dips
  • Advance to outside running program

Goals: 50 knee pushups or 30 regular pushups, Normal Pectoralis Major strength,

No contact sports until 6 months post-op


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