Phase 1: Protection phase (Weeks 0-8)
Weeks 0-2
- Immobilization for 2 weeks Pendulum exercises
- Ice and pain modalities
- Hand gripping exercises Submaximal Isometric
- Triceps
- Shoulder rotators
Weeks 2-4
- Brace 0°-90°
- Passive Pronation to neutral only/Full Supination
(All elbow exercises done with the shoulder in 60° flexion/neutral grip) - Active ROM elbow flexion
- Gentle Passive elbow extension (Week 3) Wrist strengthening
Weeks 4-8
- Remove brace
- Submaximal isometric progressing to isotonic biceps exercises (neutral grip)
- Tricep isotonics to 10° from full extension Gentle (painfree) passive ROM Sup/Pron Pulleys
- UBE for AAROM
- Rhythmic Stabilization Flex/Ext & Sup/Pron
- Isometric Sup/Pron
Phase 2: Weeks 8-12 Intermediate Phase
- Submaximal isotonic Sup/Pron
- Progression to strengthening with the shoulder in adduction
- Joint mobilizations
- Restoration of full ROM (12 weeks)
- Strengthening of upper body musculature with neutral grip
- Biceps curls Three ways (Sup/Neutral/Pron)
- Use of Dumbbells may be better than barbell
Phase 3: Weeks >12 Advanced Strengthening Phase
- Strengthening of Sup/Pron (Hammer, golf club, pole)
- Move to strengthening with supinated grip Closed chain exercises
- PNF resistance patterns
- Isokinetics
- Plyometrics
- Return to sport at 4 months (Earliest)
Click here to download Printable Version of Distal Biceps Repair Rehabilitaion Guidelines.