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What is a Post-Operative Physical Therapy Protocol?

What is a Post-Operative Physical Therapy Protocol?

Date: August 29, 2022

My doctor told me that I need to have surgery and that there is a specific protocol that I will have to follow. What exactly is a protocol?


A protocol is the doctor’s guidelines that the physical therapist (PT) will follow during your recovery process. Protocols are created based on the physician’s preferences, evidence based research, and sometimes a physical therapists input on the progression through the phases of recovery to allow for optimal healing of the repaired tissue.

It usually consists of 3-5 phases depending on the surgery. For some surgeries, the 1st phase will occur with home PT and for other surgeries it starts with outpatient PT. Each phase has goals, precautions/restrictions, treatment suggestions, and home exercise program suggestions. Some protocols will also include criteria for progression that must be met prior to advancing to the next phase or beginning a new activity like running.

While all protocols vary, the phases are usually based on the motion that is allowed. In the example of a shoulder surgery, like a rotator cuff repair, phase 1 consists of passive range of motion (PROM) exercises. PROM is when the surgical limb’s muscles are not responsible for the motion. The surgical limb moves by the nonsurgical limb helping or another person moving it. Phase 2 starts with active assist range of motion (AAROM). AAROM is when the nonsurgical limb helps the surgical limb move. During this phase you are also progressing towards active range of motion (AROM) when the surgical arm moves on its own. The third phase is a progression of strengthening using weights, bands, and even your own body weight. Finally the last phase is generally a return to sports or function where you are working on higher level activities to help return you to the demands that are required in your desired activity.

In your protocol, there are various precautions and restrictions listed that can include:

  • Use of a sling or brace to prevent movement
  • Use of an assistive device like a cane, crutches, or walker
  • Restriction on how much weight you are allowed to put through the affected limb
  • Lifting restriction
  • Restrictions on motions allowed
  • Restrictions on driving

Even though protocols list many areas of restrictions, especially early after surgery, they also are a great resource to turn to towards goals. They help show you what to work towards especially what your range or motion or strength goals are by the end of each phase. This can be a great motivational goal as well as help to give you an idea of whether you are on track, ahead of schedule or behind schedule with your recovery.

Our therapists at Aligned Orthopedic & Sports Therapy are all trained on how to read protocols, progress patients through protocols and continually reassess to see how patients are doing. If you will be undergoing surgery and have questions about your protocol, schedule an appointment with a therapist at your closest Aligned Orthopedic & Sports Therapy location today!

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