Table 6.
Rehabilitation criteria protocol.
| Rehabilitation Goals | Interventions | Criteria for Progression | |
|---|---|---|---|
| Phase 1 | 1. Restore elbow AROM and PROM 2. Decrease elbow joint swelling 3. Initiate total arm strengthening while minimizing valgus stress at the elbow 4. Protect healing tissues |
1. AROM/PROM to involved and surrounding
joints 2. Resisted wrist flexion/extension, pronation/supination 3. Rotator cuff and peri-scapular strengthening 4. Grip strengthening 5. Manual therapy and instrument assisted soft tissue mobilization to relevant elbow soft tissue 6. Cryotherapy |
1. Full pain free elbow AROM/PROM 2. Minimal elbow swelling 3. Pain rating < 3/10 with strengthening exercises |
| Phase 2 | 1. Increase total arm strength and endurance 2. Initiate plyometric neuromuscular control exercises 3. Prepare athlete for Return to sport activities |
1. Progressive elbow, shoulder, scapular, and grip
strengthening 2. CKC weight bearing (Partial to full) 3. Open chain and partial weight bearing UE plyometrics |
1. Achieve 90% elbow flexion/extension strength
symmetry compared to the uninjured side 2. No elbow pain with closed kinetic chain exercises 3. Pain rating 0/10 with all functional activities and ADL's 4. DASH score < 5 |
| Phase 3 | 1. Initiate sport specific exercises 2. Improve neuromuscular control of affected UE 3. Prepare athlete to return to sport activity |
1. Full weight bearing UE plyometrics on stable and
unstable surfaces 2. Upper extremity stability in full weight bearing 3. Sport specific exercises including controlled falls and take-down maneuvers |
1. Achieve 90% limb symmetry with functional
testing (YBT- UQ test) 2. Achieve score ≥ 30 on CKCUEST 3. No elbow pain or subjective complaints of instability with plyometric exercises 4. Absence of elbow pain, instability or soreness with wrestling practice 5. DASH Sport score < 5 |
ADL, activities of daily living; AROM, active range of motion; CKC, closed kinetic chain; CKCUEST, closed kinetic chain upper extremity stability test; DASH, Disabilities of the Arm, Hand, and Shoulder; PROM, passive range of motion; UE- upper extremity, YBT-UQ, Y balance test-upper quarter