Physical Therapy After PRP Injections

PHASE I (0 to 7 days after PRP Procedure)

No physical therapy at this time as physical therapy begins 7 to 10 days after procedure

Precautions:

  • Immobilization of the joint
    • Injection to shoulder: shoulder sling
    • Injection to elbow: shoulder sling and wrist splint with provider discretion
    • Injection to wrist: wrist splint
    • Injection to hip and knee: crutches for non-weight bearing of affected extremity
    • Injection to ankle/foot: crutches for non-weight bearing of affected extremity and walking boot
  • No NSAID use (Advil, Motrin, Ibuprofen, etc.)
  • No ice use

For exercises, prevent the joint from stiffening with gentle passive, active assisted and active range of motion of immobilization device (PROM, AAROM, and AROM)

Your goal in phase 1 is to protect the treated area and minimize pain.

 

PHASE II (7 to 14 days after PRP Procedure)

Begin physical therapy at this time for light, soft tissue mobilization and range of motion work 1-2 times per week.

Precautions:

Body Part:

  • Shoulder: Discontinue use of sling (may occur at day 10)
  • Elbow: Discontinue use of shoulder sling/wrist splint
  • Wrist: Discontinue of use of wrist splint (may occur at day 10)
  • Hip/Knee: Weight-bearing as tolerated with discontinued use of crutches from 2 to 1 to none when able to ambulate pain-free (toe-touch)
  • Ankle/Foot: Weight-bearing as tolerated with discontinued use of crutches from 2 to 1 to none when able to ambulate pain-free (toe-touch)
    • DO NOT overstress the tendon, lift heavy objects, exercise with weights or perform high-impact activities at this time

Exercise:

  • Continue active range of motion exercises for all joints with pain-free range 3 times per day for 5-minute sessions
  • Upper extremity:
    • Arm bike (low resistance)
    • Lower body and core strengthening exercises
  • Shoulder:
    • Arm bike (low resistance)
    • AAROM/AROM of shoulder to pain-free range
    • Shoulder isometrics
    • Light stretching of shoulder musculature (pecs, lats, posterior cuff musculature, etc.)
  • Elbow/Wrist:
    • Arm bike (low resistance)
    • AAROM/AROM of wrist and elbow to pain-free range
    • Wrist and elbow isometrics
    • Light stretching to wrist/elbow musculature (wrist flexors/extensors, etc.)
  • Lower extremity:
    • Bike (low resistance)
    • Upper body strengthening exercises
  • Hip:
    • Bike (low resistance)
    • Pool walking
    • AAROM/AROM of hip
    • Hip isometrics
    • Light stretching to hip musculature (quads, hip flexors, glutes, hip ERs, etc.)
  • Knee:
    • Bike (low resistance)
    • Pool walking
    • AAROM/AROM of knee
    • Knee isometrics (quad sets)
    • Light stretching of knee/hip musculature (quads, hip flexors, glutes, hip ERs, hamstrings, etc.)
  • Ankle/Foot:
    • Bike (low resistance)
    • Pool walking
    • AAROM/AROM of ankle
    • Ankle isometrics
    • Light stretching of ankle/foot musculature (gastroc, soleus, foot intrinsics, etc.)

Your goals at this time are to discontinue immobilizing devices roughly 10-14 days after procedure.

 

PHASE III (2 to 4 weeks after PRP Procedure)

Joint and soft tissue mobilizations as needed to restore normal range of motion and joint mechanics 2 to 3 times per week with a Physician follow-up 4 weeks after procedure.

 

Precautions

  • Maintain low resistance while biking
  • DO NOT overstress the tendon, lift heavy objects, exercise with weights or perform high-impact activities at this time

 

Exercise

  • Continue active range of motion exercises for all joints pain-free range 3 to 5 times per day for 5-minute sessions
  • Stretching exercises for affected area 2 to 3 times per day, 3 to 4 reps, 20 to 30 second holds
  • Strengthening isometric and concentric exercise progressing to eccentric exercise as tolerated
  • Upper extremity
    • Arm bike (low resistance)
    • Lower body and core strengthening exercises
  • Shoulder:
    • Arm bike (low resistance)
    • AAROM/AROM of shoulder to pain-free range
    • Shoulder isometric and concentric strengthening progressing to eccentric as tolerated
    • Light stretching of shoulder musculature (pecs, lats, posterior cuff musculature, etc.)
  • Elbow/Wrist:
    • Arm bike (low resistance)
    • AAROM/AROM of wrist and elbow to pain-free range
    • Wrist and elbow isometric and concentric strengthening progressing to eccentric as tolerated
    • Light stretching to wrist/elbow musculature (wrist flexors/extensors, etc.)
  • Lower extremity:
    • Bike (low resistance)
    • Upper body strengthening exercises
  • Hip:
    • Bike (low resistance)
    • Pool walking
    • AAROM/AROM of hip
    • Hip isometric and concentric strengthening progressing to eccentric as tolerated (low impact table exercises-SLR 4-way, LAQ, SAQ, bridges, clams, reverse clams, etc.)
    • Light stretching to hip musculature (quads, hip flexors, glutes, hip ERs, etc.)
  • Knee:
    • Bike (low resistance)
    • Pool walking
    • AAROM/AROM of knee
    • Knee isometric and concentric strengthening progressing to eccentric as tolerated (low impact table exercises-SLR 4-way, LAQ, SAQ, bridges, clams, reverse clams, etc.)
    • Light stretching of knee/hip musculature (quads, hip flexors, glutes, hip ERs, hamstrings, etc.)
  • Ankle/Foot:
    • Bike (low resistance)
    • Pool walking
    • AAROM/AROM of ankle
    • Ankle/foot isometric and concentric strengthening progressing to eccentric as tolerated (low impact table exercises-ankle 4-way, ankle pumps, ankle circles, foot intrinsic strengthening, etc.) Note: perform hip and core table strengthening exercises with this
    • Light stretching of ankle/foot musculature (gastroc, soleus, foot intrinsics, etc.)

Plan to achieve full pain-free range of motion (0/10 pain threshold on VAS) and decrease pain with activities of daily living (0-2/10 pain threshold on VAS)

 

PHASE IV (4 to 6 weeks after PRP Procedure)

Go to physical therapy 2 to 3 times per week. Joint and soft tissue mobilizations as needed to restore normal range of motion and joint mechanics.

 

Precautions

Avoid high velocity, high amplitude, high-intensity exercise at this time (such as running, jumping, plyometrics, throwing or heavy lifting)

 

Exercise

  • Moderate resistance on bike
  • Continue stretching exercises for affected area 2 to 3 times per day, 3 to 4 reps, 20-30 second holds
  • Focus on eccentric strengthening progression program as tolerated
  • Incorporation of balance and proprioception exercises
  • Upper extremity
    • Arm bike (moderate resistance)
    • Lower body and core strengthening exercises
  • Shoulder:
    • Arm bike (moderate resistance)
    • AROM of shoulder in pain-free range
    • Shoulder eccentric strengthening as tolerated
    • Stretching of tight muscles in affected area (pecs, lats, posterior cuff musculature)
  • Elbow/Wrist:
    • Arm bike (moderate resistance)
    • AROM of wrist and elbow in pain-free range
    • Wrist and elbow eccentric strengthening as tolerated
    • Stretching to tight muscle in affected area (wrist flexors/extensor groups)
  • Lower extremity:
    • Bike (moderate resistance)
    • Upper body strengthening exercises
  • Hip:
    • Bike (moderate resistance)
    • Elliptical (low progressing to moderate resistance as tolerated)
    • Pool walking/running
    • AROM of hip in pain-free range
    • Hip eccentric strengthening as tolerated
    • Stretching of tight muscles in affected area (quad/hip flexors/glutes)
  • Knee:
    • Bike (moderate resistance)
    • Elliptical (low progressing to moderate resistance as tolerated)
    • Pool walking/running
    • AROM of knee
    • Knee eccentric strengthening as tolerated
    • Stretching of tight muscles in affected area (quad/hamstrings)
  • Ankle/Foot:
    • Bike (moderate resistance)
    • Elliptical (low progressing to moderate resistance as tolerated)
    • Pool walking/running
    • AROM of ankle
    • Ankle eccentric strengthening as tolerated
    • Stretching of tight muscles in affected area (gastroc/soleus/foot instrinsics)

Goals are progression of isometric strengthening to concentric strengthening and eccentric strengthening as tolerated. Begin to incorporate balance and proprioception activities. Perform all activities of daily living pain free (0/10 pain threshold on VAS)

 

PHASE V (6 to 8 weeks after PRP Procedure)

Continue physical therapy 2 to 3 times per week.

 

Precautions

Avoid high velocity, high amplitude, high-intensity exercise at this time (such as running, jumping, plyometrics, throwing or heavy lifting)

 

Exercise

  • Move to high resistance on bike and elliptical
  • Continue stretching exercises for affected area 2 to 3 times per day, 3 to 4 reps, 20-30 second holds
  • Strengthening with eccentric exercise focus at a moderate intensity (3-4 sets of 6-12 reps)
  • Balance and proprioception exercises
  • Upper extremity
    • Arm bike (high resistance)
    • Lower body and core strengthening exercises
  • Shoulder:
    • Arm bike (high resistance)
    • Shoulder eccentric strengthening (thera-band drills, manual resistance, etc. for RTC)
    • Stretching of tight muscles in affected area (pecs, lats, posterior cuff musculature)
  • Elbow/Wrist:
    • Arm bike (high resistance)
    • Wrist and elbow eccentric strengthening (thera-band, dumbbell exercises, etc.)
    • Stretching to tight muscle in affected area (wrist flexors/extensor groups)
  • Lower extremity:
    • Bike and elliptical (high resistance)
    • Upper body strengthening exercises
  • Hip:
    • Bike (high resistance)
    • Elliptical (high resistance)
    • Pool walking/running
    • Hip eccentric strengthening (single leg press, SLS, SL squats, etc.)
    • Stretching of tight muscles in affected area (quad/hip flexors/glutes)
  • Knee:
    • Bike (high resistance)
    • Elliptical (high resistance)
    • Pool walking/running
    • Knee eccentric strengthening (single leg press, SLS, SL squats, etc.)
    • Stretching of tight muscles in affected area (quads/hamstrings/glutes)
  • Ankle/Foot:
    • Bike (high resistance)
    • Elliptical (high resistance)
    • Pool walking/running
    • Ankle eccentric strengthening (heel raises, SLS activities, balance board activities etc.)
    • Stretching of tight muscles in affected area (gastroc/soleus/foot intrinsics)

Goals are to improve strength and endurance. Pain-free (0/10 pain threshold on VAS) 5/5 manual muscle testing on affected limb and symmetric proprioception of affected limb.

 

PHASE VI (8 to 12 weeks after PRP Procedure)

Physical therapy 1 to 2 times per week and incorporation of more sport-specific exercise at this time.

 

Precautions

Avoid pain post-activity

 

Exercise

  • Continue stretching exercises for affected area 2 to 3 times per day, 3 to 4 reps, 20-30 second holds
  • Strengthening with sport-specific eccentric exercise at a moderate intensity (3-4 sets of 6-12 reps)
  • Balance and proprioception sport-specific exercises
  • Can incorporate pre-plyometric exercise progressing to plyometric exercise as tolerated
  • Upper extremity
    • Arm bike (high resistance)
    • Lower body and core strengthening exercises
  • Shoulder:
    • Arm bike (high resistance)
    • Shoulder eccentric strengthening (thera-band drills and manual resistance, etc. for RTC)
    • Shoulder pre-plyometrics progressing to plyometrics as tolerated (ball throwing activities)
    • Stretching of tight muscles in affected area (pecs, lats, posterior cuff musculature)
  • Elbow/Wrist:
    • Arm bike (high resistance)
    • Wrist and elbow eccentric strengthening (dumbbell exercises, thera-band, etc.)
    • Wrist/elbow pre-plyometrics progressing to plyometrics as tolerated (ball throwing activities)
    • Stretching to tight muscle in affected area (wrist flexors/extensor groups)
  • Lower extremity:
    • Bike and elliptical (high resistance)
    • Return to run protocol (defer to PT)
    • Upper body strengthening exercise
  • Hip:
    • Bike (high resistance)
    • Elliptical (high resistance)
    • Return to run
    • Hip eccentric strengthening (single leg press, SLS, SL squats, etc.)
    • Lower extremity pre-plyometric exercise progressing to plyometric exercise as tolerated (mini squat jump, squat jump, skaters, single leg vertical jump, etc.)
    • Stretching of tight muscles in affected area (quad/hip flexors/glutes)
  • Knee:
    • Bike (high resistance)
    • Elliptical (high resistance)
    • Return to run
    • Knee eccentric strengthening (single leg press, SLS, SL squats, etc.)
    • Lower extremity pre-plyometric exercise progressing to plyometric exercise as tolerated (mini squat jump, squat jump, skaters, single leg vertical jump, etc.)
    • Stretching of tight muscles in affected area (quad/hamstrings)
  • Ankle/Foot:
    • Bike (high resistance)
    • Elliptical (high resistance)
    • Return to run
    • Ankle eccentric strengthening (heel raises, SLS activities, balance board activities etc.)
    • Lower extremity pre-plyometric exercise progressing to plyometric exercise as tolerated (mini squat jump, squat jump, skaters, single leg vertical jump, etc.)
    • Stretching of tight muscles in affected area (gastroc/soleus/plantar fascia/anterior tibialis)

Your goals are to return to sport pain-free.

Developed by:

Mehul Desai, MD, MPH
International Spine, Pain & Performance Center
2141 K St NW, Suite 600 Washington DC 20037
(202) 808-8295
www.iorthopain.com

Release Physical Therapy
1170 22nd St NW Washington, DC 20037
(202) 974-6621
www.releasept.com

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