Platelet-Rich Plasma Injection Rehabilitation Protocol

PHASE I: 0 TO 3 DAYS POST-PROCEDURE

Appointments
- No appointments during this time as rehabilitation appointments begin 10-14 days after procedure
Goals
- Protection of the affected tendon
- Pain control
Precautions
- Immobilization of the affected joint
  - Sling for rotator cuff/biceps tendons
  - Wrist splint for medial/lateral epicondyles
  - Partial weight bearing with crutches for patellar/quadriceps tendons
  - Partial weight bearing with crutches and walking boot for Achilles/ankle tendons
  - Partial weight bearing with crutches and walking boot for plantar fascia
Suggested Therapeutic Exercises
- Gentle active range of motion (AROM) exercises out of the immobilizing device
Progression Criteria
- 3 days after procedure

Appointments
- No appointments during this time as rehabilitation appointments begin 10-14 days after procedure
Goals
- Increase tendon tolerance to daily activities
- Discontinue immobilizing device
Precautions
- Weight bearing as tolerated, gradually weaning from assistive and immobilizing devices
- No overstressing of the tendon through exercise, lifting, or impact activity
Suggested Therapeutic Exercises
- Continue with active range of motion exercises out of the devices
  - 3 x day, 5 minutes each
- Lower body exercise for upper body procedures/upper body exercise for lower body procedures.
  - Discuss the parameters of exercise with your physician, physical therapist or athletic trainer.
Progression Criteria
- 10-14 days after procedure

Appointments
- Rehabilitation appointments once every 1 to 2 weeks
- Follow-up with Dr. Engelen 1 month after procedure
Goals
- Attain full range of motion
- Improve strength and endurance
- Improve balance and proprioception
Precautions
- Avoid high velocity/amplitude/intensity exercise such as throwing, running, jumping, or heavy weight lifting
- Avoid post-activity pain
Suggested Therapeutic Exercises
- Stretching exercises for the affected muscle-tendon unit
  - 3-4 reps, hold 20-30 seconds
- Joint mobilization as needed to restore normal joint mechanics
- Strengthening with emphasis on isometric and concentric activities initially and with eccentric progression as symptoms allow: 3-4 sets, 6-12 reps
  - Theraband drills for rotator cuff
  - Dumbbell exercises for wrist/elbow
  - Single leg press for knee
  - Heel raises for ankle
Cardiovascular Exercises
- Non-impact activities with progressive resistance, duration and intensity
  - Upper body ergometer, elliptical, stationary bike, deep water running
Progression Criteria
- Full range of motion
- No pain with activities of daily living
- Pain free 5/5 muscle testing of affected muscle-tendon unit
- Symmetric proprioception of the affected limb

Appointments
- Rehabilitation appointments are approximately once every 1-3 weeks
- Follow-up with Dr. Engelen 2-3 months after procedure
Goals
- Good eccentric and concentric multi-plane strength and dynamic neuromuscular control to allow for return to work/sports
Precautions
- Post-activity soreness should resolve within 24 hours
Suggested Therapeutic Exercises
- Continued strengthening of the affected area with increases in resistance, repetition and/or frequency
- For the upper extremity:
  - Progressive training in provocative positions and work/sport specific positions – including eccentric, endurance and velocity specific exercises
- For the lower extremity:
  - Impact control exercises with progression from single plane to multi-planar landing and agility drills with progressive increase in velocity and amplitude
- Sport/work specific balance and proprioceptive drills
- Continued core strengthening
- Return to sport programs (throwing, running, etc.) with symptom/criteria based progressions
Cardiovascular Exercises
- Replicate sport or work specific energy demands
Progression Criteria
- Return to work/sport criteria
- Good dynamic neuromuscular control with multi-plane activities and without pain
- Approval from the Dr. Engelen and/or sports rehabilitation provider