Exercises Techniques

Upper Extremity Lower Extremity Head, Neck , and Trunk

Rationale:

To improve Protection Phase: Protection Phase: Protection Phase:

Flexibility
Shoulder: Hip: Cervical:
Wand Exercises Hamstring Stretch Suboccipital Muscle Stretch
Initiate A-AROM using a cane, wand, Sitting with the leg to be stretched extended to another Sitting, Identify the spinous
or T-bar in the supine position to chair, or sitting at the edge of a treatment table and the process with your thumb.
provide stabilization and control of opposite foot on the floor. Have the patient lean the Have the patient slowly nod,
the scapula. Motions typically trunk forward the thigh, maintaining the back in neutral. doing just a tipping motion of
performed are flexion, abduction, 30 secs x 3 reps the head on the upper spine.
elevation in the plane of the scapula, Guide the movement by
and internal/external rotation. 10 Knee: placing the other hand across
reps x 3 sets Patellar Mobilization the patient’s forehead. 10
The patella must have mobility to glide distally on the reps x 3 sets
Elbow and Forearm: femur for normal knee flexion, and glide proximally for
Passive or Active-Assistive ROM normal knee extension. X 2 minutes Thoracic:
flexion/extension and Foam Roll Stretch
pronation/supination within pain-free Ankle: Supine, with a foam roll
range. 10 reps x 3 sets Passive or Active-Assistive ROM placed longitudinally down the
Plantarflexion/dorsiflexion and eversion/eversion ROM length of the spine. The
Wrist and Hand: exercises within pain-free range 10 reps x 3 sets patient elevates both arms
Tendon-Gliding exercises overhead in a “touchdown”
Have the patient perform full motion position and allows gravity to
in the uninvolved joints and as much stretch the force. 30 secs hold
motion as possible in the involved x 3 reps
joints to prevent adhesions between
the long tendons or between the Lumbar:
tendons and their synovial sheaths. Self Stretching the Lumbar
10 reps x 3 sets/6 seconds hold Erector Spinae
Hook-lying. Have the patient
 first bring one knee and then
the other toward the chest,
clasp the hands around the
thighs and pull them to the
chest, elevating the sacrum
off the mat.

Controlled Motion Phase: Controlled Motion Phase: Controlled Motion Phase:

Shoulder:
Pendulum (Codman’s) Exercises Hip: Cervical:
Standing, with the trunk flexed at the Quadruped Stretch Self-Traction: Cervical
hips about 90 degrees. The arm On hands and knees. Have the patient rock the pelvis Spine
hangs loosely downwards in a into an anterior tilt, causing lumbar extension, then Sitting or lying down. Have
position between 60 and 90 degrees maintain the lumbar extension and shift the buttocks the patient place his or her
elevation. X 2 minutes back in an attempt to sit on the heels. 30 secs hold x 3 hands behind the neck with
reps the fingers interlocking; the
Elbow and Forearm: ulnar border of the fingers
Passive Joint Mobilization Knee: and hands under the occiput
Techniques/Peripheral Joint Mob Heel Slides and mastoid process. The
The intensity of stretching and Let the patient lie on back with knees bent and feet flat patient then gives a lifting
mobilization techniques is dedicated on the floor. Slowly slide one heel along the floor, motion to the head. X 2
to the healing tissues, the specific straightening the knee as much as possible. Hold for a minutes
pathology, and the surgical few seconds and then slide your heel back to the
technique, as well as the amount of starting position. Repeat with the other leg. 10 reps x 3 Thoracic:
pain, motion, and end feel. sets Self Stretch: Increase
X 2 minutes Thoracic Anterior Thorax
Ankle: and Pectoralis
Wrist and Hand: Long sitting towel stretch Sitting on a firm,
Joint Mobilization Techniques Long-sitting with a towel or belt looped under the foot. straight-backed chair with the
Apply Grade III sustained or Grade Have the patient pull on the medial side of the towel to hands behind the head or
IV oscillation techniques to stretch cause the heel and foot to turn inward held abducted and externally
the capsules. X 2 minutes 30 secs hold x 3 reps rotated 90 degrees. The
patient then brings the elbows
out to the side as the
scapulae are adducted and
the thoracic spine is
 extended. 3 secs hold x 3
reps

Lumbar:
Self Stretch of the Lumbar
Spine
Quadruped. Have the patient
perform a posterior pelvic tilt
without rounding the thorax
(concentrate on flexing the
lumbar spine, not the thoracic
spine). Hold the position then
relax. Repeat; this time bring
the hips back to the feet, hold,
then return to the hands and
knees position

Return To Function Phase: Return To Function Phase: Return To Function Phase:

Shoulder:
Doorway Stretch Hip: Cervical:
Standing and facing a door frame Walking Lunges Scalene Muscle Stretch
with the palm of the hand against the Take a step forward with your right foot and lower your Standing next to a table and
edge of the frame and elbow flexed body into a lunge position, with both knees at a holding to its underside. The
90 degrees. While keeping the arm 90-degree angle. Push off with your right foot, bring patient positions the head in
against the side or in slight your left foot forward, and repeat the lunge on the axial extension, side bends
abduction, have the patient turn other side. Continue walking forward, alternating legs, opposite, and rotates toward
away from the fixed hand. 30 for a set distance or number of repetitions. 30 seconds the same side as the muscle
seconds hold x 3 reps hold x 3 reps being stretched. 30 secs hold
x 3 reps
Elbow and Forearm: Knee:
Self Stretch: Long Head of Triceps Rocking Forward on a Step Thoracic and Lumbar:
Sitting or standing. Have the patient Standing with the foot of the involved knee on a step. Prone Press Ups
flex the elbow and shoulder as far as Have the patient rock forward over stabilized foot, Prone, with hands placed
possible. The other hand can either flexing the knee to the limit of its range, then rock back under the shoulders. Have
push on the forearm to flex the and forth in a slow, rhythmic manner. the patient extend the elbows
elbow, or push the shoulder into and push the thorax up off the
 more flexion. 30 seconds hold x 3 Ankle: mat but keep pelvis down on
reps Standing on an Inclined board the mat. 30 secs hold x 3 reps
Standing on an inclined board with feet pointing
Wrist and Hand: upward and heels downwards. Greater stretch occurs Lateral Lower Thoracic
MWM of the MP and IP joints of if the patient leans forward. Because the body weight Stretch
the digits is on the heels there is little stretch on the long arches Heel-sitting. Have the patient
Gently radially or ulnarly glide the on the heels. lean forward so the abdomen
involved phalanx in a painless rests on the anterior thighs;
direction. Then have the patient the arms are stretched
actively flex or extend the finger and overhead bilaterally; and the
apply a pain-free, end range stretch. hands are flat on the floor,
10 reps x 3 sets then have the patient laterally
bend the trunk away from the
curve, hold for sustained
stretch. 30 secs hold x 3 reps

To improve Protection Phase: Protection Phase: Protection Phase:

Strength
Shoulder> Hip and Knee> Cervical , Thoracic ,
Isometric Exercises to activate Non-Weight-Bearing Exercises to isolate muscle LumbarRegion>
scapular muscles and assists the activity and control specific motions. Muscle Activation
circulation and fluid dynamics. 1. Deep Neck
Gluteus Maximus Flexors:Activation and
1. Depression on Lower 1. Gluteal Muscle Setting Training
Trapezius a. Use gluteal setting exercises to a. Supine.
a. Add resistance increase awareness of the contracting b. For
against the inferior muscle. craniocervical
angle of the scapula b. Position the patient prone or supine and flexion and
2. Protraction on Serratus teach the patient to “squeeze” (contract) gentle axial
Anterior the buttocks. extension,
a. Apply resistance teach the
against the Quadriceps Femoris patient to
axillary border of the 1. Quadriceps Setting perform slow,
scapula or coracoid a. Supine, sitting in a chair (with the heel controlled
process or indirectly on the floor) or long-sitting with the knee nodding
against the humerus extended motion of the
 positioned in the b. Have the patient contract the head on the
plane of the scapula quadriceps isometrically, causing the upper cervical
3. Retraction on Rhomboids patella to glide proximally; spine (“yes”
and Trapezius c. Hold for a count of 10 and repeat. motion).
a. Apply resistance 2. Lower Cervical and
against medial border Ankle> Upper Thoracic
of the scapula Dynamic Neuromuscular Control Extensor Activation
and Training
6 secs hold x 10 reps x 3 sets 1. Contracting major muscles (Anterior and a. Prone with
Posterior tibialis , peroneus muscles) forehead on
a. Long-sitting or with the knees partially the treatment
flexed. table and arms
b. Have the patient practice contracting at the sides.
each of the major muscles while b. Have the
concentrating on his or her actions, for patient lift the
example, dorsiflexion with inversion forehead off
(anterior tibialis), plantarflexion with the treatment
inversion (posterior tibialis), and table, keeping
eversion (peroneus muscles) the chin tucked
and eyes
focused on the
table to
maintain the
neutral spinal
position
3. Drawing-In Maneuver
a. The patient
hollows the
abdominal
region (“draws”
the belly button
toward the
spine

Controlled Motion Phase: Controlled Motion Phase: Controlled Motion Phase:

Shoulder> Hip> Cervical Region>
Multiple-Angle Isometrics to Closed-Chain Weight-Bearing Exercises Isometric Exercises-Self
initiate control and strengthening of Resistance
the muscles in the involved region in 1. Bridging to strengthen the hip extensor muscles
a nonstressful manner. a. Beginning in the hook-lying position, 1. Flexion
b. Have the patient press the upper back a. Have the
1. Internal and External and feet into the mat, elevate the pelvis, patient place
Rotation and extend the hips . both hands on
a. Position the humerus the forehead
at the patient’s side in Knee> and press the
slight flexion, slight Non weight-bearing Exercise forehead into
abduction, or scaption the palms in a
(plane of the scapula) 1. Straight Leg Raise nodding
and with the elbow a. Supine, with the knee extended. To fashion while
flexed 90. stabilize the pelvis and low back, the not moving
b. Apply resistance opposite hip and knee are flexed, and Thoracic and Lumbar
against the forearm the foot is placed flat on the exercise Region>
as if turning a crank table. Dynamic Strengthening
b. First, instruct the patient to set the
quadriceps muscle; then lift the leg to Abdominal Muscles
Self-Applied Multiple-Angle about 45 of hip flexion while keeping the
Isometrics for self resistance knee extended 1. Curl Ups
isometric c. Hold the leg in that position for a count a. First, instruct
>Subject can use the wall for slight of 10 and then lower it the patient to
resistance perform the
Ankle> drawing in
1. SH Flexion Isometric Exercises maneuver to
2. Abduction cause a
3. Rotation 1. Eversion and Inversion stabilizing
a. Long-sitting or sitting in a chair with contraction of
Elbow and Wrist> knees flexed. the abdominal
Low-Intensity Isometric Exercises b. To resist eversion, the ankles are muscles
by applying resistance in various crossed; instruct the patient to press the b. Then lift the
pain-free positions. lateral borders of both feet together head. Progress
against each other. by lifting the
1. Elbow Flexion and Extension c. To resist inversion, the medial borders shoulders until
 2. Pronation and Supination of the feet are placed beside each the scapulae
3. Wrist Flexion and Extension other; instruct the patient to press the and thorax
medial borders of the feet against each clear the mat,
other keeping the
arms
horizontal .

Erector Spinae and

Multifidus Muscles

1. Superman
a. Lifting the
trunk and legs
off the mat
simultaneously.
b. Greater
resistance can
be provided by
abducting the
shoulders to
90 or by
elevating them
to 180

Return to function Phase: Return to Function Phase: Return to Function Phase:

Shoulder> Hip> Cervical Region>

Dynamic Strengthening Exercises Progression of exercises done in controlled
to initiate dynamic dynamic motion phase 1. Sitting on the large
strengthening of the muscles that gym ball while walking
move the GH joint through the ROM. 1. Bridging with resistance against the anterior forward
>Application of submaximal to pelvis a. Sitting on a
maximal resistance (use free a. .Apply resistance against the anterior large gym ball,
weights, elastic bands for resistance) pelvis manually or by strapping a then
weighted belt around the pelvis. b. Walking
Scapular Muscles forward while
1. Scapular retraction and Knee> rolling the ball
protraction against resistance Progression of exercises done in controlled up the back.
a. Push Up with plus motion phase With the ball
i. Standing with behind the
arms against a 1. Straight Leg Raise with weights on ankle mid-thoracic
wall, leaning a. Increase resistance, place a cuff weight area, the
on a table or around the patient’s ankle cervical flexors
lying prone. must stabilize.
ii. Have the Ankle> c. Continue
patient place Dynamic Strength Exercises walking
his or her forward until
hands directly 1. Toe raises the ball is
in front or 2. Heel raises under the
slightly to the head; the
side of the cervical
shoulders and >Functional Activities extensors now
push the trunk must stabilize.
up (or away Hip> d. Walk back and
from the wall). forth to
iii. Instruct the 1. Marching and Resisted Walking alternate
patient to “give control
an extra push” Knee and Ankle> between the
to protract the flexors and
scapulae. 1. Push and Pull Carts extensors.
iv. Progress the 2. Climbing and descending step and ladders with
wall push-ups weights Thoracic and Lumbar
to table Region>
push-ups, then
prone 1. Curl Ups
push-ups with a. Curl ups on
knees as a unstable
fulcrum, and surfaces
 finally 2. Leg Lifts
prone-lying a. Initially have
push-ups, the patient lift
lifting the full only one leg,
body weight alternate with
v. Add weight the other leg,
around the and finally lift
trunk if the both legs and
patient is able extend the
to tolerate spine.
greater b. Stabilize the
resistance. thorax by
having the
Glenohumeral Muscles patient hold
1. SH Abduction and Scaption onto the side
a. Military Press of the
i. Sitting, arm at treatment table
the side in
external >Functional Exercises
rotation with
elbow flexed 1. Repetitive Lifting
and forearm 2. Repetitive Reaching
supinated a. Partial Lunging
(thumb forward,sidewa
pointing ys and
posteriorly). backward
ii. Have the 3. Repetitive Pushing
patient lift the and Pulling
weight straight a. Pushing and
up overhead pulling against
pulley
Elbow> resistance set
Dynamic Strengthening Exercises at heights
to prepare the muscles for functional b. Pushing and
demands. pulling a
weighted cart
Elbow
1. Elbow Flexion
a. Bicep Curls
i. Sitting or
standing.
ii. Have the
patient flex the
elbow while
holding a
handheld
weight and
keeping the
forearm
supinated and
the arm at the
side or with
the shoulder
moving into
slight
extension

Wrist

1. Wrist Flexion and Extension

a. Mechanical
resistance using
handheld weight
(Free weights)
i. Sitting, with
forearm
resting on a
table and hand
over the edge
of the table
holding a
small weight.
 ii. When the
forearm is
pronated,
resistance is
against the
wrist
extensors
iii. when
supinated, the
resistance is
against the
wrist flexors.

> Functional Exercises

1. Lawn Mower Pull
a. Bilateral or unilateral
rowing motions, such
as using a rowing
machine or simulating
starting a lawn mower

To improve SHOULDER HIP Phase I: Protection Phase

Proprioception Phase I: Protection Phase Phase I: Protection Phase ● Pelvic tilt/cervical
and ● Develop postural awareness ● weight shifting activities in bilateral stance retraction (passive —>
kinesthesia and control active assist —>
○ posture training Phase II and III: Moderate and Minimum Protection active in comfortable
Phase II: Moderate Protection Phase positions)
Phase ● progressive ambulation on various surfaces at ● Awareness of what
● Continue to emphasize varying speeds makes sx better vs.
cervical, thoracic, and worse
lumbopelvic alignment during KNEE ● Learn neutral spine (or
exercises and function Phase I: Protection Phase bias)
● Distribute weight equally on both LE and some
Phase III: Return to Fxn Phase: weight support on UE, pt should have a stable, Phase II: Controlled Motion
● Proprioceptive well aligned position and apply alternating Phase
Neuromuscular Facilitation resistance with varying directions and speeds ● Active spinal control
(PNF) to the pelvis (supine, prone,
● bilateral mini squats in the 0° to 30° range and quadruped, sitting,
WRIST AND HAND weight shifting activities w/ stepping and standing)
Phase I: Protection Phase marching mvmt, decrease UE support ● Dynamic maintenance
● Tendon-Gliding Exercise of pain-free position w/
(used to develop Phase II: Controlled Motion Phas activities
neuromuscular control and ● dynamic balance activities in unilateral stance
coordinated mvmt) and unstable surfaces Phase III: Return to Fxn
○ Flexor Tendon-Gliding Phase:
Exercise Phase III: Return to Fxn Phase: ● habitual use of neutral
● advanced neuromuscular, balance, and agility spine in all functional
training w/ directional changes, acceleration activities
and deceleration

ANKLE
Phase I: Protection Phase
● “draw” the alphabet in space, leading w/ the
toes but moving at the ankle

Phase II: Controlled Motion Phase

● pulling a weighted towel along the floor w/ the
forefoot with the heel fixed on the floor
● stabilization exercises (applying resistance on
pts pelvis in various directions while pt attempts
to maintain control)

Phase III: Return to Fxn Phase:

● bilateral toe and heel raises then progress
unilaterally
● eccentric loading of the gastroc-soleus ms.
● resisted walking
To improve SHOULDER HIP NECK
endurance
Phase I: Protection Phase Phase I: Protection Phase Phase I: Protection Phase
● Short but frequent exercise ● Active-resistive exercises in UE ● Cervical manipulation
sessions Phase II: Controlled Motion Phase with low repetitions
● Low number of repetitions ● Open-chain exercises within permissible Phase II: Controlled Motion
per exercises ranges (emphasize increasing the no. of Phase
repetitions) ● Cervical manipulation
Phase II: Controlled Motion Phase Phase III: Return to Fxn Phase: with exercise
● Upper extremity endurance ● Integrate endurance training into simulated (progress repetitions)
training with stationary functional activities Phase III: Return to Fxn
ergometer (emphasize ● Increase the length of time and distance of a Phase:
progressive repetitions) low-intensity walking program 2 to 4 days a ● Cervical manipulation
● Portable reciprocal exerciser week (progress repetition
on table (emphasize KNEE that is aligned with
progressive repetitions) functional activities)
Phase I: Protection Phase
** 10 reps x 3 sets ● Patient education
Phase III: Return to Fxn Phase: Phase II: Controlled Motion Phase SPINE
● Closed-chain, resisted ● Progress pain-free, closed chain (bilateral mini Phase I: Protection Phase
shoulder exercises (increase squats, seated leg press) and open chain ● Engage pt. In activities
the amount of weight bearing resistance training to learn
through UE) Phase III: Return to Fxn Phase: self-management
● PRE’s of shoulder ● Closed chain and open chain resistance Phase II: Controlled Motion
musculature (pain-free, training (progress repetitions) Phase
low-load, high repetitions) ● Increasing the time
ANKLE & FOOT and number of
** 15-20 reps x 3 sets (can add repetitions during
weights/ resistance) Phase I: Protection Phase stabilization exercises
ELBOW & FOREARM ● UE ergometry Phase III: Return to Fxn
Phase:
Phase I: Protection Phase Phase II: Controlled Motion Phase ● Progress trunk
● Use of hand for light ● Initiate a progression of open-closed chain resistance exercises
 functional activities as early exercises for the hip, knee and ankle. emphasizing
as 1-2 weeks ** for acl reconstruction = possible use of elliptical functional goals
trainer
Phase II: Controlled Motion Phase Phase III: Return to Fxn Phase:
● Dynamic, open-chain ● Heel-lowering exercises in unilateral stance
resistance exercises (and (emphasizing gastrocnemius and soleus mm
later use lightweight or light group; progress repetitions)
grade elastic resistance) and
increase repetitions than
resistance
● Upper extremity ergometer
Phase III: Return to Fxn Phase:
● Dynamic, open-chain
resistance exercises c use of
2lb or elastic resistance and
increase repetitions
● Upper extremity ergometer
** UE ERGOMETER = 10-20 mins

WRIST AND HAND

Phase I: Protection Phase

● Pt. education regarding the
decreased strength in grip
and pinch

Phase II: Controlled Motion Phase

● Prehension patterns that are
aligned c patient’s job,
recreational and daily
activities
○ Increase the amount
of time against
resistance (1-3 mins)
Phase III: Return to Fxn Phase:
● Prehension patterns that are
 aligned c patient’s job,
recreational and daily
activities
○ Increase the amount
of time against
resistance (3-5 mins)

To improve WRIST AND HAND

dexterity
Phase I: Protection Phase
● Pt. education on expectations
for recovery
Phase II: Controlled Motion Phase
● Should begin once motor
recovery occur
● Picking small objects using
prehension pattern exercises
(pad-to-pad, tip-to-tip,
tip-to-pad)
Phase III: Return to Fxn Phase:
● Dexterity exercises like
stacking checkers, writing,
and having the thumb move
in circumduction motion

To improve Phase I: Protection Phase Phase I: Protection Phase Phase I: Protection Phase
functional ● AAROM of Shoulder: Flexion ● Active-assisted ROM (A-AROM) progressing to ● Safe postures for
ability and Extension ABD, ADD, active ROM (AROM) recumbent, sitting,
internal and external rot ● PRE of non operated lower extremity and standing*
● AAROM of Elbow: Flexion ● ISOMS ● Stabile-spine
and Extension ● Bilateral balance exercise - unilateral balance techniques while
● AAROM of Forearm: Phase II: Controlled Motion Phase rolling over, moving
Pronation and Supination ● kneeling and getting up to a supine to sit, sit to
● AAROM of Wrist: Flexion standing position stand
 (Palmar Flexion) and ● ascending and descending stairs
Extension(Dorsiflexion); Functional exercises: Phase II: Controlled Motion
Radial (Abduction) and Ulnar ● backward walking Phase
(Adduction) Deviation ● side-stepping, ● Strengthen U/LE while
10 reps x 2 sets ● Marching stabilizing spine
*Resistance exercise. Resistance ● ascending and descending stairs ● Stable spine body
exercises may be applied at an mechanics
appropriate dosage to muscles not Phase III: Return to Fxn Phase: ● Environmental and
directly related to the injured tissue ● Stationary cycling ergonomic
to prepare the patient for use of ● Swimming adaptations
assistive devices ● Walking ●
Phase III: Return to Fxn
Phase II: Controlled Motion Phase Phase:
● AROM of Shoulder: Flexion ● High-intensity
and Extension ABD, ADD, functional
internal and external rot activities.
● AROM of Elbow: Flexion and ● Endurance and
Extension strengthening
● AROM of Forearm: Pronation activities that replicate
and Supination return to desired
● AROM of Wrist: Flexion activities
(Palmar Flexion) and ● Practice prevention
Extension(Dorsiflexion);
Radial (Abduction) and Ulnar
(Adduction) Deviation
10 reps x 2 sets

*ISOMS -Multiple-angle isometric

exercises are used during the
subacute stage to initiate control and
strengthening of the muscles in the
involved region in a nonstressful
manner
6sh x 10 reps x 3 sets

Phase III: Return to Fxn Phase:

 *Progress exercises from isolated,
unidirectional, simple movements to
complex patterns and
multidirectional movements requiring
coordination with all muscles
functioning for the desired activity

● Pushing/Pulling and
Lifting/Lowering Exercises
○ Strengthening
shoulder and elbow
musculature by
pulling (sliding) a
heavy object from one
position to another.
○ Strengthening
shoulder and elbow
musculature by lifting
or lowering a heavy
object to and from a
high and low surface

● Seated Push-Ups on stable

and progress to unstable
Surfaces
● Bilateral Chest Press and
Throw:standing and supine

Joint Phase I: Protection Phase Phase I: Protection Phase

protection and ● avoid activities that involve ● Avoidance of faulty ● Teach the patient
energy lifting or pushing off with the foot and ankle postures and protection of the signs of systemic
conservation involved upper extremity feet from fatigue (especially in
● stop when fatigue or deforming RA), local muscle
discomfort begins to develop ● Weight-bearing forces and trauma imposed by fatigue, and joint
● Conserve energy and improperly fitting footwear. stress and ways to
 perform activities in the most ● Teach the patient signs of systemic fatigue modify exercises and
economic way or do the most (especially in activities to remain
important activities first RA), local muscle fatigue, and joint stress and active within
ways to modify exercises and activities to safe levels.
Phase II: Controlled Motion Phase remain active within ● Continue to
● Avoid deforming positions or safe levels. emphasize the
one position for prolonged Phase II: Controlled Motion Phase importance of
periods ● Continue to emphasize the importance of protecting the joints by
● Avoid using strong grasping protecting the joints by modifying activity modifying activity
activities that facilitate the (splints, assistive devices, and environmental (splints, assistive
deforming force. adaptations for safe function. devices, and
● Encourage the patient to be Phase III: Return to Fxn Phase: environmental
active, but also to be aware ● Encourage the patient to be adaptations for safe
of pain and fatigue active, but also to be aware of pain and fatigue function
● avoiding heavy loads,
Phase III: Return to Fxn Phase: high-impact activities,
● modification of high-load and deforming forces
activities to minimize on the reconstructed
deforming stresses on the joints.
involved
Joints

Notes:
● Grade 4 = strengthening (no ROM)
● Tendon-gliding exercises (for CTS)
● Functional training x level ambulating
● If descending stairs = affected leg first
● If ascending stairs = good leg
● Flexion biased = williams; extension biased = mckenzie **
●