ILLUSTRATED RECOVERY GUIDE
Post-procedure care guidelines.
PRP REHABILITATION PROTOCOLS
Seven illustrated field manuals — one per injury site. Select a protocol below to see the phase-by-phase timeline and the exact reference cards handed to patients after their procedure.
Protection & Healing
WEEK 1
-
Sling for 24 hours; no cryotherapy (ice) for 14 days
-
Begin pendulum exercises and scapular exercises
-
Begin PROM (passive range of motion)
Important: No nsaids for 5 days prior at a minimum for the alert — NSAIDs can prevent the PRP from working effectively. Take Tylenol and apply heat to the area. No ice for 14 days; cold can impact platelet effectiveness.
⚠️
Flexibility & Early Motion
WEEK 2
-
Sleeper stretch and cross-body stretch with scapula stabilized
-
Anterior shoulder stretch — corner or door jamb, hold 30 sec × 5 reps
-
Posterior shoulder stretch — cross-body adduction technique, hold 30 sec × 5 reps
Active Range of Motion
WEEK 3
-
Active assisted ROM using cane, pulley, or uninvolved arm
-
Postural exercises: shrugs and shoulder retraction
-
Active range of motion in front of mirror to prevent shoulder hiking
-
Criteria: pain at rest below 2/10, nearly normal range of motion restored
-
Internal/external rotation with arm adducted to side; rows and scapular press-ups
-
3 sets × 10 reps, increasing resistance as strength improves
Strengthening Phase 2
CRITERIA-BASED
-
Criteria: no pain at rest, 95% ROM of opposite side
-
Long lever arm exercises (standing scaption, prone horizontal abduction)
-
Scapular stabilizer exercises progressing to bodyweight push-up variation
ILLUSTRATED RECOVERY GUIDE
Strengthening Phase 1
Strengthening Phase 1
CRITERIA-BASED
CRITERIA-BASED
Important: No NSAIDS for 5 days prior at a minimum for the alert. Take Tylenol and apply heat. Perform non-weighted ankle ROM and calf pumps to limit DVT risk during the initial phase.
⚠️
Protection & Healing
-
Weight bearing in a boot only — no running or explosive activities
-
No NSAIDs for at least 14 days; Tylenol and heat permitted
-
Perform non-weighted ankle ROM and calf pumps to limit DVT risk
Range of Motion
-
Ankle range-of-motion circles — trace the alphabet with the big toe, 2 sets per day
-
Work on normal gait (heel-toe walking)
-
Pool running every other day, stationary bike, elliptical
Conditioning & Stretching
-
Soreness is acceptable in this phase; pain is not
-
Heel cord stretch (wall stretch) and towel stretch
Strengthening
-
Toe walks and heel walks — 2 laps up and down the gym floor
-
Toe raises and heel raises — 2 sets of 20
-
May begin easy treadmill running
WEEK 1
WEEK 2
WEEK 5
WEEK 3-4, PAIN FREE
ILLUSTRATED RECOVERY GUIDE
WEEK 1
WEEK 5
⚠️
Important: No NSAIDS for 5 days prior at a minimum for the alert. No icing of the affected area. Tylenol and heat may be used for comfort.
Protection
-
Days 1–3 on crutches, non-weight bearing; days 4–7 resume weight bearing
-
Wear knee brace (if provided) for the first week off crutches
-
No running or explosive activities; no icing of affected area
WEEK 1
ROM & Initial Strengthening
-
Straight leg raise — 3 sets × 10, 3×/day, 3–4 weeks
-
Hamstring curl, supine hamstring stretch, prone quadriceps stretch
WEEK 2 – CONTINUE THROUGH MONTH 1
Functional Strengthening
-
Stair climbing and treadmill walking (aim for 1 mile)
-
Leg press, one-leg squats, step-ups, partial lunges, wall sits
-
NSAIDs now permitted for pain relief
WEEKS 3–4, PAIN-FREE
Return to Running
-
Progress strengthening and eccentric exercises (isolated quads)
-
Side steps, crossovers, one- and two-leg jumping, agility ladder drills
WEEK 5, NO KNEE PAIN
ILLUSTRATED RECOVERY GUIDE
⚠️
Important: No ice and no NSAIDS for 5 days prior at a minimum for the alert. Avoid aggressive hip flexor stretching through Phase II.
Protection
-
Days 1–5 non-weight bearing with crutches; days 5–6 advance to partial weight bearing
-
Day 9: weight shifts and single-leg balance; Day 10: begin prone quadriceps stretch
DAY 1-10
Flexibility
WEEK 2
-
May begin stationary biking for ROM
-
Piriformis stretch and hip flexor stretch — 2–3 sets × 4 reps, 5–7 days/week
Strengthening & Mobilization
-
May begin ice and NSAIDs if needed
-
Light pain-free aerobic activity: underwater or unweighted treadmill
-
Hip abduction, adduction, and extension — progressing to 3 sets × 15–20 reps
WEEK 3
Functional Activity
WEEK 4-6
-
Continue eccentric activity such as the elliptical
-
Jogging and shuffling as tolerated
Return to Activity
-
Return to previous activity level as tolerated
-
Progress running, sport-specific drills, and full training load gradually
WEEK 6-8
ILLUSTRATED RECOVERY GUIDE
ILLUSTRATED RECOVERY GUIDE
⚠️
Important: No ice and no NSAIDS for 5 days prior at a minimum for the alert. Avoid aggressive hip flexor stretching through Phase II.
-
Non-weight bearing with crutches days 1–5; partial weight bearing days 5–6
-
Day 9: full weight bearing, weight shifts, single-leg balance; Day 10: prone quad stretch
Protection
WEEK 1
-
May begin stationary biking for ROM
-
Supine hamstring stretch and piriformis stretch, 2–3 sets × 4 reps
Flexibility
WEEK 2
-
May begin ice and NSAIDs if needed
-
Hip extension and hip abduction — 2 sets × 10, progressing to 3 sets × 15–20
Strengthening & Mobilization
WEEK 3
-
Jogging and shuffling as tolerated
-
Hip flexor stretch — perform on each side unless directed otherwise
Functional Activity
WEEK 4-6
-
Return to previous activity level as tolerated
-
Advance to sport-specific training and full duty gradually
Return to Activity
WEEK 6-8
ILLUSTRATED RECOVERY GUIDE
ILLUSTRATED RECOVERY GUIDE
Important: No ice and no NSAIDS for 5 days prior at a minimum for the alert. Avoid aggressive hip flexor stretching through Phase II.
⚠️
Initial Healing
-
PRP injected directly into the joint; sling for comfort only, 1–2 days max
-
No cryotherapy for 7 days; pendulum and scapular exercises
WEEK 1
Active ROM & Initial Strengthening
-
Sleeper stretch — hold 30 sec, 2–3 sets × 4 reps daily
-
Glenohumeral/scapulothoracic joint mobilization and passive ROM
WEEK 2
Joint Mobilization & Resistance
WEEKS 3–5
-
Add light resistance (theraband or light dumbbells) as movement control improves
-
Prone rowing, serratus "punches," external rotation
Gym Machines & Full Strengthening
WEEKS 6–8
-
Add gym machines: chest press, rowing, latissimus pulldown, triceps, biceps
-
IR/ER at 90-degree abduction
ILLUSTRATED RECOVERY GUIDE
ILLUSTRATED RECOVERY GUIDE
⚠️
Important: No NSAIDS for 5 days prior at a minimum for the alert or ice for at least 4 weeks. Sling for no more than 24 hours. Underhand grip recommended throughout rehab. Tylenol and heat permitted.
Inflammatory Phase
DAYS 0-5
-
Rest and elevation; sling for up to 3 days (no driving in sling)
-
May lift up to 5 pounds; Day 3: begin gentle active ROM, 4×/day
Proliferative Phase
-
Weeks 2–4: may lift up to 20 lbs; begin isometric wrist and elbow strengthening
-
Weeks 4–6: wrist flexion/extension stretches, forearm supination/pronation
DAY 5 – WEEK 6
Remodeling Phase
WEEK 6+
-
Progressive isotonic strengthening; integrated chest press, rows, hammer curls
-
Begin eccentric training and sport-specific activities
ILLUSTRATED RECOVERY GUIDE
⚠️
Important: After PRP or TendoNova + PRP, avoid NSAIDS for 5 days prior at a minimum for the alert, or longer if directed by the proceduralist. Acetaminophen may be used if medically appropriate. Do not stop prescribed aspirin or anticoagulation without your prescribing clinician. Cryotherapy after PRP is provider-specific; follow the proceduralist rather than using ice routinely.
-
First 48 hours: arm only for light activities of daily living.
-
For the remainder of Week 1, limit lifting to approximately the weight of a coffee cup.
-
No resisted elbow flexion or forearm supination.
-
Avoid curls, rows, pull-ups/chin-ups, heavy gripping or carrying, throwing, lifting from the floor, and explosive movements.
-
Begin gentle pain-limited elbow flexion/extension and pronation/supination with the elbow at 90° once local anesthetic has worn off.
-
Perform shoulder ROM, scapular retraction, wrist ROM, hand pumps, and gentle grip opening/closing.
-
Conditioning: walking, stationary bike, and lower-body exercise that does not require gripping, pulling, or supporting body weight through the treated arm.
Protection & Comfortable Motion
WEEK 1
-
Continue active elbow flexion/extension and pronation/supination.
-
Add only a gentle elbow-flexor stretch; no forced end-range or prolonged stretching.
-
Isometric elbow flexion: elbow at 60–90°, neutral forearm first, then supinated if tolerated.
-
Isometric forearm supination: elbow at 90°.
-
5 repetitions × 20–30 seconds at approximately 30–50% effort, 1–2 sessions/day.
-
Begin light triceps, wrist, grip, rotator cuff, serratus, and scapular strengthening.
-
2–3 sets × 12–15 repetitions.
-
Do not begin dynamic curls or resisted forearm rotation before days 10–14.
Restore ROM & Begin Isometrics
WEEK 2
-
Begin with neutral-grip curls, then progress to supinated curls.
-
Start in mid-range and gradually progress toward full range.
-
2–3 sets × 12–15 repetitions with a 2–3 second lowering phase, every other day.
-
Forearm supination/pronation with band, cable, or light dumbbell.
-
Elbow at 90°; 2–3 sets × 12–15 repetitions.
-
Continue triceps, wrist, grip, rotator cuff, serratus, scapular retraction, and light rowing.
-
Add light two-hand carries if symptom-free.
-
Avoid heavy rows, deadlifts, cleans, pull-ups/chin-ups, throwing, sudden catches, and sets to failure.
WEEKS 3–4
Low-Load Dynamic Strengthening
Progressive Strength & Endurance
-
Progress elbow flexion and supination to 3–4 sets × 8–12 repetitions, 2–3 days/week.
-
Use a controlled 3–4 second eccentric phase.
-
Progress from neutral to supinated loading and mid-range to full range.
-
Add lengthened-position loading only with light resistance and excellent control.
-
Progress neutral-grip rows/pulldowns, incline push-ups, carries, and low-load work or sport simulations.
-
Increase resistance by approximately 5–10% only after two symptom-stable sessions.
-
Continue avoiding maximal effort, ballistic lifting, sets to failure, and heavy repetitive arm use through Week 6.
WEEKS 5-6
-
Heavy-slow resistance: 3–4 sets × 6–10 repetitions, 2–3 days/week.
-
Include full-range elbow flexion and forearm supination.
-
Progress compound pulling from:
Neutral-grip row/pulldown → Assisted neutral-grip pull-up → Body-weight neutral-grip pull-up → Supinated/chin-up loading -
Once strength criteria are met, begin light power and plyometric work.
-
Increase only one variable at a time: load, volume, speed, or complexity.
-
Return to gym or manual work at approximately 30–50% of prior working load, with effort no higher than 6/10.
-
Maximal lifting, contact sport, and uncontrolled eccentric loading are generally deferred until at least 10–12 weeks.
-
Substantial partial tears or extensive TendoNova debridement may require 12–16+ weeks and explicit physician clearance.
Return to Heavy Loading, Work & Sport
WEEKS 7–12+
-
Criteria: pain-free daily activity, full motion, and no reactive tenderness.
-
Elbow-flexion and supination strength approximately 70–80% of the opposite side.
-
3 sets × 10 moderate repetitions without a 24-hour flare.
-
Progress resistance gradually while maintaining an acceptable 24-hour response.
Strengthening Phase 1
CRITERIA-BASED
-
No resting pain and minimal or no focal tenderness at the distal biceps tendon.
-
Full, symmetric elbow and forearm range of motion.
-
Resisted elbow flexion and forearm supination produce no more than 1–2/10 pain.
-
Strength at least 90% of the opposite side.
-
Complete a full work- or sport-specific session at planned intensity without pain escalation or next-day flare.
-
Clearance from the proceduralist and rehabilitation clinician.
Strengthening Phase 2
CRITERIA-BASED
-
No resting pain and minimal or no focal tenderness at the distal biceps tendon.
-
Full, symmetric elbow and forearm range of motion.
-
Resisted elbow flexion and forearm supination produce no more than 1–2/10 pain.
-
Strength at least 90% of the opposite side.
-
Complete a full work- or sport-specific session at planned intensity without pain escalation or next-day flare.
-
Clearance from the proceduralist and rehabilitation clinician.
URGENT REASSESSMENT / RED FLAGS
ILLUSTRATED RECOVERY GUIDE
CRITERIA-BASED
CRITERIA-BASED
⚠️
Important: No NSAIDS for 5 days prior at a minimum for the alert and ice for the first 14 days after PRP unless directed otherwise. Acetaminophen (Tylenol) may be used if medically appropriate. Advance based on symptoms, gait, tissue response, and clinician assessment.
-
Weight bear in the prescribed boot for days 1–7.
-
No running, jumping, plyometrics, or other explosive activity.
-
Do not use NSAIDs or ice for at least 14 days after PRP unless directed otherwise; Tylenol may be used if appropriate.
-
Open-chain hip exercises may begin if comfortable and if they do not increase foot pain.
-
Progress when pain is stable or improving, boot walking is tolerated, and there is no increase in swelling or altered sensation
Protection & Comfortable Motion
WEEK 1
-
Begin plantarflexion and dorsiflexion range of motion.
-
Perform ankle ABCs for up to 5 minutes; avoid excessive inversion and eversion.
-
Begin very gentle gastrocnemius and soleus stretching.
-
Continue gentle hamstring, quadriceps, and iliotibial-band flexibility.
-
Ice or cryotherapy may be used after day 14 as needed for pain, if consistent with the proceduralist's instructions.
-
Progress when motion is improving, daily walking is comfortable in the prescribed footwear, and stretching does not create a next-day flare.
Restore Range of Motion
WEEK 2
-
Continue range-of-motion and flexibility exercises in all four ankle directions; add towel crunches or similar intrinsic-foot work.
-
Progress quadriceps, hamstring, iliotibial-band, gastrocnemius, and soleus flexibility slowly.
-
Begin proprioceptive and balance activities from stable to unstable surfaces.
-
Add ball toss and balance-beam drills while emphasizing hip and knee flexion.
-
Work on normal heel-to-toe gait.
-
Increase hip, quadriceps, hamstring, and calf strength with double- and single-leg weight-bearing exercises.
-
Perform towel or resistance-band pumps in dorsiflexion and plantarflexion: 3 sets × 20.
-
Conditioning may include pool running, stationary bicycle, or elliptical training.
-
Begin pain-free resistance-band work in all four ankle directions: 3 sets × 10, starting around the middle of Week 3
Mobility, Strength & Proprioception
WEEK 3–4
-
Continue week 3-4 activities as long as they remain pain-free.
-
Toe walking: 2 laps up and down the gym floor.
-
Toe raises: 2 sets × 20.
-
Heel walking: 2 laps up and down the gym floor.
-
Heel raises: 2 sets × 20.
-
Increase the challenge of double- and single-leg strengthening exercises.
-
Easy treadmill running may begin when pain-free and cleared by the treating clinician.
Strength Progression & Return to Running
WEEK 5
WEEK 5
-
Initiate sport-specific drills and progressive plyometrics when cleared.
-
Increase only one variable at a time: volume, speed, direction change, surface, or complexity.
-
Monitor pain and stiffness during the session and the following day before advancing.
Sport-Specific Return
WEEK 6+
-
Pain-free walking and exercises.
-
No new limping.
-
No increase in morning stiffness.
Return-to-Activity Check
CRITERIA-BASED
-
Boot as prescribed in Week 1.
-
Tylenol if medically appropriate.
-
Ice only after day 14 unless directed.
Supportive Care
CRITERIA-BASED
-
Worsening pain or swelling.
-
New neurologic symptoms.
-
Repeated flares or failure to progress.
Clinician Reassessment
CRITERIA-BASED
ILLUSTRATED RECOVERY GUIDE
Return-to-Duty / Activity
CRITERIA-BASED
⚠️
Important: After PRP or TendoNova + PRP, no NSAIDs for 5 days prior at a minimum for the alert, or longer if directed. Acetaminophen may be used if medically appropriate. Cryotherapy after PRP is clinician-specific; follow the proceduralist rather than using ice routinely.
-
During the first 24–48 hours, use relative rest.
-
Weight bear as tolerated for uncomplicated PRP/fenestration; use crutches if walking is painful or antalgic.
-
No running, jumping, rucking, squats, lunges, leg press, kneeling, repeated stairs/hills, or resisted knee extension.
-
Begin ankle pumps, gentle heel slides, and quad sets after the local anesthetic has worn off.
-
Straight-leg raise only if specifically cleared, the knee stays fully straight, and there is no extension lag.
-
Conditioning may include short, level walks, plus pain-free hip, core, and upper-body exercise that does not load the knee.
Protection & Comfortable Motion
WEEK 1
-
Continue heel slides, quad sets, and straight-leg raises only if there is no lag.
-
Stationary bicycle: high seat with no or very low resistance; start with 5–15 minutes.
-
Isometric knee extension at approximately 30–60° of knee flexion: 5 reps × 20–30 sec at 30–50% effort, 1–2 sessions/day.
-
A shallow wall-supported squat hold may substitute for the seated isometric if selected by the clinician.
-
Add bridges, side-lying hip abduction, calf raises, and core exercise: 2–3 sets × 10–15.
-
Continue to avoid loaded knee flexion deeper than about 60°, open-chain knee extension to fatigue, running, jumping, or forceful quadriceps stretching.
Restore Motion & Begin Isometrics
WEEK 2
-
Strength every other day with a slow tempo: about 3 seconds up / 3 seconds down.
-
Mini squat or sit-to-stand to 45–60°, light leg press from 0–60°, low step-up, band terminal knee extension, and clinician-selected short-arc or light seated knee extension.
-
Start with 2–3 sets × 10–15.
-
Continue hip, hamstring, calf, and core strengthening.
-
Add single-leg balance as tolerated.
-
Conditioning may progress from stationary bike to elliptical, pool exercise, or level walking.
-
No running, hopping, jumping, ballistic lifting, aggressive deceleration, or deep loaded squatting.
WEEK 3-4
Progressive Strengthening & Single-Leg Control
-
Perform heavy-slow resistance 2–3 days/week: squat or leg press, split squat, step-up/step-down, and seated knee extension as tolerated.
-
Use 3–4 sets × 6–12 repetitions with a controlled 3–4 second lowering phase.
-
Gradually deepen loaded flexion toward 70–90° only if symptoms remain acceptable.
-
Add loaded carries, incline walking, and job-specific strength that does not yet require impact.
-
Continue bike or elliptical conditioning.
-
No maximal lifting, sprinting, jumping, or cutting until running criteria are met and cleared by the clinician.
Heavy-Slow Strength & Eccentric Control
WEEK 5-6
-
Continue heavy-slow resistance 2–3 days/week and progress load before adding large increases in speed or volume.
-
Begin walk-jog progression on a flat, predictable surface every other day.
-
Common start: 1 minute easy jog / 2 minutes walk for 6–10 rounds.
-
Increase only one variable at a time: running time, total volume, pace, slope, or surface.
-
Progress impact from two-leg pogo or snap-down landing → squat jump → low-volume single-leg hopping and deceleration.
-
Add lateral shuffle, cutting, hills, speed, loaded stairs, lifting from a squat, kneeling, rucking, and other job/sport-specific tasks only after the preceding level is tolerated.
Return to Running, Impact, Work & Sport
WEEK 7-12
-
Continue quadriceps tendon loading at least twice weekly.
-
Gradually restore maximal strength, deep-flexion tolerance, speed, power, and fatigue resistance.
-
Complete a graded full practice, field event, or work-simulation session before unrestricted return.
Unrestricted Return & Tendon Maintenance
WEEK +12
-
Full, pain-free knee motion; normal gait; no effusion, warmth, resting pain, or extension lag.
-
No more than mild focal tenderness and pain no greater than 2/10 with deep squat, step-down, and required work/sport drills.
-
Quadriceps strength at least 90% of the opposite side.
-
Controlled single-leg squat and step-down; hop/landing symmetry at least 90% when required.
-
Completion of a full training or work-simulation session at planned intensity, with symptoms back to baseline the next morning.
-
Treating clinician clearance.
Unrestricted Return
CRITERIA-BASED
-
Desk or light duty may resume when post-procedure pain and medication effects permit.
-
Prolonged standing and walking require a normal gait and no symptom escalation later that day or the next morning.
-
Repeated stairs, ladders, kneeling, rucking, hills, jumping, and lifting from a squat should be cleared by successfully performing the matching graded rehabilitation task first.
-
Progression is criteria-based; calendar dates alone do not determine readiness.
Return-to-Duty / Activity
CRITERIA-BASED
-
Sudden pop, buckling, or loss of strength can't do a straight-leg raise, new extension lag
-
Infection or bleeding signs — spreading bruising/swelling, redness, warmth, drainage, fever, chills
-
Clot or vascular signs — calf swelling, numbness, chest pain, shortness of breath
-
Poor recovery trajectory — pain worsening after day 3–5, flares lasting >24h despite rest, motion not returning
CRITERIA-BASED
Urgent Reassessment / Red Flags
