Rehab After

Regenerative
Medicine
Brittney Braegelmann, PT,
DPT, SCS
Physical Therapy Director
 Objectives

Review the Review the

Understand tissue Cervical Spine Thoracic Spine
healing and how
this affects activity SC/PRP SC/PRP
Protocol Protocol

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Evolution of SC/PRP Protocols
April 2014: No protocols
Inconsistent restrictions
Difficulty educating patients and fellow PTs
A lot of phone calls from confused patients and PTs

November 2016:
Standardized our Regen Protocols to create consistency and optimization
14 Protocols were developed for joints and tendons
Exercises provided for Days 1-7

Currently:
15 Protocols for joints and tendons
4th version of many of these
Includes common exercises to help guide other PTs through the entire rehab course
New exercise pictures
Chiropractic Regen Protocol
 Developing the Protocols
Research

Review of other protocols available

MD Preference

PT experience with surgical and SC/PRP patients

 Balancing Rest and Activity.
Respecting the Healing Process

Docheva, Denitsa & Müller, Sebastian & Majewski, Martin & Evans, Christopher. (2014). Biologics for tendon repair. Advanced Drug Delivery Reviews. 84. 10.1016/j.addr.2014.11.015.

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 Week 0. Days 1-3 After PRP

Home Exercises*** Brace Wear*** Restrictions***

• Start range of motion (ROM) exercises • Wear at all times • No lifting overhead
for the neck, chin tucks, scap squeeze except for sleeping, • No running,
self-cares, and PT pushing/pulling
exercises exercises

Goals: Decrease activity as much as possible. Control swelling and pain; use ice for the
day of the procedure, otherwise heat only. Initiate basic exercises

CERVICAL
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CERVICAL
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 Week 0. Days 4-7 After PRP

Home Exercises*** Brace Wear*** Restrictions***

• Start neck isometrics • Wear at all times • No lifting > 5 pounds

except for overhead
sleeping, self- • No running,
cares, and PT pushing/pulling
exercises exercises

Goals: Normalize ROM. Initiate strengthening exercises

CERVICAL
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CERVICAL
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CERVICAL
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 Week 1. Days 8-14 After PRP
PT Exercises/Instructions*** Brace Wear*** Restrictions***

• Start PT • Wean out of • No lifting > 5

• Continue Week 0 exercises if needed brace pounds overhead
• Postural and stabilization exercises for cervical spine • Wear during • No running,
(deep neck flexion, chin tucks) vulnerable pushing/pulling
• Begin scapular strengthening (rows, pulldowns) activities (ex. exercises
• Walking or recumbent bike for cardio shoveling,
• No deep tissue massage to treated area. Edema gardening)
massage, cupping and dry needling are OK
• Modalities for pain and swelling management:
electrical stimulation, ultrasound, heat, compression.
No ice
• Cervical traction OK to decrease muscle spasm or
stretch soft tissues
• Joint Mobs if needed: Grade 1 - 3
Goals: Normalize ROM. Add modalities for pain management as needed. Initiate postural exercises
and strengthening. Educate patient on recovery process and expectations.

CERVICAL
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 Week 2. Days 15-21 After PRP
PT Exercises/Instructions*** Brace Wear *** Restrictions***

• Continue walking; biking OK • Wear during • No lifting >

• Continue postural exercises and scapular vulnerable 10 pounds
strengthening (bent over shoulder extension or activities (ex. overhead
horizontal abduction) shoveling, • No running,
• Begin shoulder strengthening (arm raises, external gardening) pushing/pulli
rotation) ng
exercises

Goals: Initiate gentle cardio. Start weight bearing exercises and proprioceptive training if no
increase in pain. Continue with modalities as needed.

CERVICAL
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 Week 3-6. Days 22-42 After PRP
PT Exercises/Instructions*** Brace Wear *** Restrictions***

• Increase cardio intensity as able. Elliptical OK • Wear as needed • No high

• Advance postural and upper extremity strengthening impact
(prone stability ball, laser mazes) activities
• Cervical traction OK to provide joint distraction.
Moderate inversion table OK
• Joint mobs if needed: Grade 1 - 4

Goals: Focus on exercises targeting functional limitations. Passive interventions as needed

CERVICAL
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 Week 7-8+. Days 43+ After PRP

PT Exercises/Instructions*** Brace Wear Restrictions***

• Sport specific/high intensity training as able • NA • No strict

• Grade 5 or high velocity, low amplitude restrictions by
manipulations OK @ week 8 week 8
• Deep tissue massage OK

Goals: Running, jumping, sport specific exercises. Passive interventions only if needed

CERVICAL
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 Week 0. Days 1-3 After PRP

Home Exercises*** Brace Wear*** Restrictions***

• Start range of motion (ROM) • If prescribed, wear at • No lifting overhead

exercises for the thoracic spine, scap all times except for • No running,
squeeze sleeping, self-cares, pushing/pulling
and PT exercises exercises

Goals: Decrease activity and elevate limb as much as possible. Control swelling and
pain; use ice for the day of the procedure, otherwise heat only. Initiate basic exercises

THORACIC
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THORACIC
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THORACIC
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 Week 0. Days 4-7 After PRP

Home Exercises*** Brace Wear*** Restrictions***

• Start elbow isometrics • Wear at all times • No lifting > 5 pounds

• Start transverse abdominis isometric. except for overhead
• Continue ROM exercises sleeping, self- • No running,
cares, and PT pushing/pulling
exercises exercises

Goals: Normalize ROM. Initiate strengthening exercises

THORACIC
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THORACIC
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 Week 1. Days 8-14 After PRP
PT Exercises/Instructions*** Brace Wear*** Restrictions***

• Start PT • Wean out of • No lifting > 5

• Continue Week 0 exercises if needed brace pounds overhead
• Begin scapular strengthening (rows, pulldowns) • Wear during • No running,
• Continue and advance thoracic AROM (child’s vulnerable pushing/pulling
pose) activities (ex. exercises
• Walking or recumbent bike for cardio shoveling,
• No deep tissue massage to treated area. Edema gardening)
massage, cupping and dry needling are OK
• Modalities for pain and swelling management:
electrical stimulation, ultrasound, heat,
compression. No ice
• Traction OK to decrease muscle spasm or stretch
soft tissues
• Joint Mobs if needed: Grade 1 - 3
Goals: Normalize ROM. Add modalities for pain management as needed. Initiate postural
exercises and strengthening. Educate patient on recovery process and expectations.

THORACIC
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 Week 2. Days 15-21 After PRP
PT Exercises/Instructions*** Brace Wear *** Restrictions***

• Continue walking; biking OK • Wear during • No lifting >

• Continue postural exercises and scapular vulnerable 10 pounds
strengthening (bent over shoulder extension or activities (ex. overhead
horizontal abduction) shoveling, • No
• Begin shoulder strengthening (arm raises, gardening) running,
external rotation) pushing/pu
lling
exercises
Goals: Initiate gentle cardio. Start weight bearing exercises and proprioceptive
training if no increase in pain. Continue with modalities as needed.

THORACIC
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 Week 3-6. Days 22-42 After PRP
PT Exercises/Instructions*** Brace Wear *** Restrictions***

• Increase cardio intensity as able. Elliptical OK • Wear as • No high

• Advance postural and upper extremity strengthening needed impact
(prone stability ball, bird dogs) activities
• Traction OK to provide joint distraction. Moderate
inversion table OK
• Joint mobs if needed: Grade 1 - 4

Goals: Focus on exercises targeting functional limitations. Passive interventions as

needed

THORACIC
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 Week 7-8+. Days 43+ After PRP

PT Exercises/Instructions*** Brace Wear Restrictions***

• Sport specific/high intensity training as able • NA • No strict

• Grade 5 or high velocity, low amplitude restrictions by
manipulations OK @ week 8 week 8
• Deep tissue massage OK

Goals: Running, jumping, sport specific exercises. Passive interventions only if needed

THORACIC
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Lumbar
Lumbar
Lumbar
Lumbar
Lumbar
Lumbar
Lumbar

Lumbar
Lumbar
Lumbar

Lumbar
 Patient Education
Progression/Protocol
No exercises should
may change based on
increase pain levels.
MD/PT restrictions,
Gentle with all ROM
per individual
exercises
procedure
If you experience increased
Contact PT or MD with calf pain, swelling of calf, or
any increased redness/warmth
questions/concerns of leg/lower extremity,
please contact MD ASAP
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Use heat and
Tylenol for pain
control as needed
This is a general protocol. All
patients advance at different rates
and your PT will help you progress
through this protocol
• If you are having < 2/10 pain with exercises
and activities, you may advance through the
protocol quicker
• If you have an unstable joint per the MD, you
may need to progress slower
 Patient Education Continued…
Physical Therapy frequency to be determined by your MD and PT:

Pre-procedure
• MD may recommend being evaluated by a PT prior to your PRP
• Visit frequency can range from 1 visit to 1-2 x week for 6-8 weeks based upon your
needs
Post-procedure
• Your PT will perform an evaluation and determine your frequency/duration. You will
continue physical therapy until you have met all goals established by your PT
• This is generally 1-2 x week for 8-12 weeks
• PT can start by Day 3 but no later than 1 week
• The listed and attached exercises are only guidelines. Your PT may change or add to
these based upon your symptoms and current status

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Chiropractic Protocol

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Chiropractic Protocol

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 Chiropractic Protocol
We avoid any treatments after a regenerative procedure that cause a cavitation or bringing the joint past end-
range to let the tissues heal with respect to the stages of tissue healing.

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QUESTIONS
?!

Thank you!

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