aquatic therapy protocols with swimex pools

334 Pages·2015·60.89 MB·English

AQUATIC THERAPY PROTOCOLS
AQUATIC THERAPY PROTOCOLS
WITH SWIMEX POOLS
USING THE SWIMEX POOL
TABLE OF CONTENTS
UPPER EXTREMITY PROTOCOLS
Integrated Clinical Pathway for Adhesive Capsulitis 3
Integrated Clinical Protocol for Impingement Syndrome Rehabilitation 9
Integrated Clinical Protocol for Subacromial Decompression Rehabilitation 17
Integrated Clinical Protocol for Anterior Shoulder Dislocation 25
Integrated Clinical Protocol for Anterior Shoulder Reconstruction 35
Integrated Clinical Protocol for Less Than 5cm Rotator Cuff Repair Rehabilitation 47
Integrated Clinical Protocol for Total Shoulder Arthroplasty 59
Aquatic Upper Extremity Flexibility Protocol 69
Aquatic Upper Extremity Proprioception Protocol 77
Aquatic Upper Extremity Strengthening Protocol 81
LOWER EXTREMITY PROTOCOLS
Integrated Clinical Protocol for Total Hip Arthroplasty 88
Integrated Clinical Protocol for Knee Arthroscopy Rehabilitation
(Meniscectomy, Debridement, Plica Resection) 98
Integrated Clinical Protocol for Grade I MCL Injury 110
Integrated Clinical Protocol for Grade II MCL Injury 120
Integrated Clinical Protocol for Tibial Osteotomy 132
Integrated Clinical Protocol for Patellofemoral Dysfunction 144
Integrated Clinical Protocol for Acute Patella Dislocation 154
Integrated Clinical Protocol for ACL Reconstruction Rehabilitation 168
Integrated Clinical Protocol for PCL Reconstruction Rehabilitation 182
Integrated Clinical Protocol for Total Knee Arthroplasty 196
Integrated Clinical Protocol for Achilles Tendon Repair Rehabilitation 208
Integrated Clinical Protocol for Ankle Sprain Rehabilitation 224
Aquatic Lower Extremity Flexibility Protocol 236
Aquatic Lower Extremity Strengthening Protocol 246
Advanced Lower Extremity Proprioception/Plyometric/Agility Protocol 254
CORE PROTOCOLS
Integrated Clinical Protocol for Acute Cervical Herniated Disc Rehabilitation 270
Integrated Clinical Protocol for Thoracolumbar Sprain/Strain Rehabilitation 280
Integrated Clinical Protocol for Acute Lumbar Herniated Disc Rehabilitation 292
Integrated Clinical Protocol for Post-Op Lumbar Discectomy/Laminectomy Rehabilitation 302
Integrated Clinical Protocol for Cervical Sprain/Strain Rehabilitation 312
Integrated Clinical Protocol for Lumbar Spondylolysis/Spondylolisthesis Rehabilitation 322
UPPER EXTREMITY PROTOCOLS

INTEGRATED CLINICAL PATHWAY
FOR ADHESIVE CAPSULITIS
STAGE 1 – THE PAINFUL STAGE
GOALS:
1 Decrease pain
2 Decrease spasm
3 Increase range of motion
4 Increase strength
5 Restore joint mobility
WATER COMPONENT
Shallow Water – In chest/shoulder deep water
• Walking forward/backward/side with semi-squats with modifi ed arm motion to tolerance
with anterior/posterior/lateral laminar fl ow (Add buoyancy with sideways walking for
increased range of motion)
• Walking sideways with lateral fl ow with one arm in front of body/one arm behind back to
increase upper extremity fl exibility (Add buoyancy with sideways walking for increased
range of motion)
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Integrated Clinical Pathway for Adhesive
Capsulitis
• Trailing forward/backward with foam/kickboard/paddle with modifi ed hand position with
anterior/posterior fl ow
• Clap behind walking forward/backward with anterior/posterior fl ow
• Walking with breast stroke motion forward/backward with anterior /posterior fl ow
• Pendulum exercises with dumbbells/barbells in semi-squatted position with lateral fl ow to
increase shoulder abduction
• Supine/Prone overhead barbell pass with fl ow to increase shoulder abduction ROM and
increase strength
• Snow angels in supine/prone with fl ow to increase shoulder abduction ROM and strength
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Integrated Clinical Pathway for Adhesive
Capsulitis
• Simulated walking cane exercises with PVC pipe with anterior/posterior/lateral fl ow
• Prone with feet hooked onto front pool rails, active assistive shoulder fl exion/extension
with barbell - Incorporate laminar fl ow to increase shoulder range of motion/strength
• Prone/supine pendulums holding front rails - Incorporate laminar fl ow to increase
shoulder range of motion
• Prone/supine pull ups holding front rails - Incorporate laminar fl ow to increase shoulder
range of motion/strength
• Superman stretch/Spiderman stretch on front bars with fl ow
• Modifi ed breast stroke or side stroke for shoulder fl exion/abduction incorporating laminar
fl ow for resistance
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Integrated Clinical Pathway for Adhesive
Capsulitis
LAND COMPONENT:
• Passive/Active assistive range of motion exercises to include pendulum, cane exercises
for elevation/extension/internal rotation/external rotation with shoulder in modifi ed
position initially; Active assistive range of motion for shoulder fl exion/abduction/internal
rotation/external rotation
• Joint mobilization emphasizing posterior/inferior capsule - Initiate with Grade I-II
mobilizations and progress as dictated by patient’s tolerance
• Scapula mobilizations to facilitate normal scapula rhythm
• Modalities as indicated to reduce pain/infl ammation
• Instruction in home exercise program for active assistive range of motion exercises using
pendulum, cane, and pulleys
STAGE 2 – THE TRANSITIONAL STAGE
GOALS:
1 Decrease pain
2 Increase range of motion
3 Increase strength
4 Increase joint mobility
5 Increase patient education
WATER COMPONENT:
Shallow Water
• Continue as Stage One; however, add isometrics with paddle while walking forward/
backward/sideways with anterior/posterior/lateral fl ow
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Integrated Clinical Pathway for Adhesive
Capsulitis
• Walking forward/backward/sideways with 1-2 kg medicine ball pass behind back with
anterior/posterior/lateral fl ow
• Walking forward/backward/sideways medicine ball dribbling as well as under water
alternating hand passes with anterior/posterior/lateral fl ow
• Walking forward/backward/sideways medicine ball rhythmic stabilization for shoulder
fl exion/extension/abduction/adduction with anterior/posterior/lateral fl ow
• Kickboard push-downs, push-pull and shoulder depression with anterior/posterior fl ow
• Add shoulder isotonics utilizing dumbbells/paddles/hydro-tones for internal/external
rotation fl exion, abduction against anterior/posterior lateral fl ow as tolerated
• Add larger assisitive/resistive equipment as well as increased laminar fl ow for improved
shoulder strengthening and stretching at this stage
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Integrated Clinical Pathway for Adhesive
Capsulitis
LAND COMPONENT:
• Continue joint mobilization posterior/inferior glides and scapula mobilizations
• Continue range of motion exercises
• Initiate rhythmic stabilization either with manual cues or body blade or medicine ball
• Progress home exercise program to consist of isometrics, isotonics and rhythmic stabilization
as tolerated
STAGE THREE-THE LIGHT STAGE:
GOALS:
1 Increase range of motion
2 Increase joint mobilization at end ranges
3 Increase stabilization
4 Increase functional activities
WATER COMPONENT:
• Continue as in Stage One and Two; however, add increased rotational exercises, rhythmic
stabilization exercises, upper extremity plyometrics, medicine ball exercises, and progress
aggressiveness in water with larger assistive/resistive equipment and increased laminar fl ow.
LAND COMPONENT:
• Continue as in Stage Two; however, add medicine ball exercises with 1-3 kg ball using mini-
tramp and plyometrics - Can use body blade or short tubing for rhythmic stabilization and
proprioception
Developed by Dr Rick McAvoy PT, DPT, CSCS
©Copyright Rick McAvoy PT, DPT, CSCS 2009
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