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Lower Extremity & Total Joints Protocols

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Physical Therapy Protocols

Lower Extremity & Total Joints Protocols

Come experience physical therapy in the Issaquah area and learn about treatments for knee, ankle, and other lower extremity injuries.

Achilles Repair

0-2 Weeks

  • No Achilles stretching
  • AROM: DF to 0 degrees only, PF as tolerated
  • Seated heel raises
  • WBAT with crutches, CAM Walker

2-6 Weeks

  • Wean from crutches, FWB in boot
  • Progress to shoe with heel lift
  • Bilateral standing heel raises
  • Stationary bike (in boot initially)
  • PF with resistance tubing/band
  • AROM all planes

6-12 Weeks

  • Initiate single- leg heel raise as able
  • Functional agility training: steps, SLS/balance activities
  • Ankle theraband exercises

12+ Weeks

  • Heel raises with weights
  • Light jogging if full ROM, strength and no pain
  • Sport specific activities

Ankle Fracture

0-6 Weeks

  • GT with appropriate assistive device- weight-bearing status as determined by MD
  • ROM and strengthening for proximal joints

6-8 Weeks

  • CAM Walker/boot as prescribed by MD
  • Ankle AROM/gentle theraband exercises
  • Progress weight-bearing status as allowed
  • Initiate stretching
  • Stationary bike
  • Modalities PRN

8-12 Weeks

  • Normalize gait mechanics
  • Progress ankle TB exercises
  • Initiate/progress CKC exercises
  • Balance/propriception activities
  • Joint mobilization as needed

ITB Syndrome


  • Modalities for pain modulation and decreased inflammation
  • LE stretches for ITB, gluteals, hamstrings, quads, and hip flexors


  • Continue LE stretches
  • Initiate hip abduction strengthening
  • Return to activity as symptoms allow

Care should be taken to accurately assess causative factors to determine need for further intervention such as footwear recommendations and/or orthotics.

Patella Tendon Repair

0-2 Weeks

  • Brace at 0 degrees
  • Crutches for ambulation, WBAT
  • PROM: full extension, Flexion to ______
  • Patella mobs
  • Exs.: SLR in brace, quad sets, ankle TB
  • Edema control

2-6 Weeks

  • Wean from crutches
  • Flexion to 90 degrees
  • Increase brace ROM

6-12 Weeks

  • D/C brace when good quad control and functional stability
  • LE PREs with light weight, high reps
  • Stationary bike
  • Full ROM
  • CKC exs.: SLS, balance/propriocetion, mini-squats, step ups

3-6 Months

  • Progress CKC and strengthening
  • Agility/Sport specific training
  • Initiate plyometrics

6 Months

  • Return to play

Patellafemoral Pain Syndrome

There are a number of etiologies of anterior knee pain; therefore, effort should be made to accurately determine the etiology of pain to direct treatment.

Acute Phase

  • Avoid aggravating activities
  • Modalities may be used for pain control
  • Patella taping/bracing
  • Orthotic/shoe evaluation and recommendations
  • LE stretching
  • Patella mobilizations
  • Initiate strengthening as able (pain-free)


  • Continue stretching
  • Progress strengthening within tolerance
  • Continue patella mobilizations/manual therapy as indicated
  • Return to activity as tolerated
  • Modalities PRN

ACL Reconstruction

0-2 Weeks

  • Full TKE
  • Edema control
  • Patella mobs
  • WBAT-minimize gait deviations, crutch use PRN
  • Quad facilitation (NMES PRN)

2-6 Weeks

  • 0-120 degrees ROM
  • Normalize gait- weight shifting, SLS proprioception activities
  • CKC exercises- mini squats, wall squats, lunges
  • Stationary bike when ROM allows

6-12 Weeks

  • Full ROM
  • Normal Strength
  • Progress proprioception and strengthening activities
  • Agility training

12 Weeks

  • Initiate jogging/running progression, if full ROM, strength and no pain
  • Progress agility
  • Elliptical

6 Months

  • Return to full sport participation

Hamstring Strain

0-2 Weeks

  • RICE
  • Crutches if needed
  • Modalities for pain modulation, decreased edema and inflammation
  • Gentle stretching
  • Prone AROM short-arc knee flexion (pain-free)

2-6 Weeks

  • Normalize gait- discontinue crutches
  • Progress stretching as tolerated
  • Full range AROM- progress to light weights as tolerated
  • Initiate stationary bike
  • Progress walking to light jogging as able

Knee Microfracture Chondroplasty

Femoral Condyle

  • Full ROM as quickly as possible
  • Edema/pain control
  • TTWB with crutches x 6-8 weeks, then WBAT
  • Low resistance bike beginning 1-2 weeks post-op
  • Full weight training at 16 weeks


  • Edema/pain control
  • WBAT immediately
  • Brace 0-20 degrees x 8 weeks
  • Strength training- avoid defect contact angles x 4 months

Total Hip Arthroplasty

  • No adduction beyond neutral
  • No internal rotation
  • No flexion >90 degrees with LE in neutral or adducted
  • No SLR x 6 weeks

0-2 Weeks

  • WBAT with appropriate assistive device
  • PROM
  • AROM- abduction
  • Prone lying
  • Bridging

2-6 Weeks

  • Wean from assistive device when no Trendelenburg
  • Balance/Propriception training
  • PREs- abduction and extension
  • Stationary bicycle/TM

6-12 Weeks

  • Functional activity training
  • Progress toward HEP

Total Knee Arthroplasty

0-2 Weeks

  • WBAT with appropriate assistive device
  • A/AA/PROM- knee hangs for full TKE
  • Patella mobilizations
  • Pre-gait and gait training activities as needed
  • LE PREs

2-6 Weeks

  • Wean from assistive device as gait pattern normalizes
  • Stationary bicycle when ROM allows
  • Balance training- single limb stance
  • Progress PREs
  • Progress flexion ROM

6-12 Weeks

  • Balance/Proprioception activities
  • Flexibility
  • Functional activity training