Distal Biceps Tendon Repair

Physical Therapy Protocol

Brace

• Initially blocked at 70 degrees.
• Worn at all times except during bathing and physical therapy.
• Discontinue brace at 8 weeks and after achieving full ROM.

Range of Motion (ROM)

• Active extension: 45 degrees.
• Passive flexion: 135 degrees.
• Week 3: Begin physical therapy, progressing extension 10–15 degrees weekly.
• Adjust brace settings to maintain a block 10–15 degrees short of the patient’s maximal achieved extension to protect the repair.

Phase 1 – Protection (Post-Op Weeks 1–2)

Goals:

• Protect the surgical repair.
• Minimize swelling and pain.

Guidelines:

• Rest, ice, and elevate.
• Perform hand and wrist exercises to improve circulation and minimize swelling.

Phase 2 – Range of Motion and Strengthening (Weeks 3–6)

Physical Therapy:

• Begin at Week 3, starting with progressing motion 10–15 degrees per week, as outlined above.

Exercises:

• Continue hand and wrist activities to support circulation.

Precautions:

• Avoid supination exercises.
• Avoid resisted elbow activities.
• Engage in shoulder strengthening exercises that do not involve elbow activity.

Phase 3 – Strengthening (Post-Op Weeks 6–12)

• Week 6: Begin isometric tricep strengthening.
• Week 8: Begin concentric tricep strengthening and gentle resisted elbow flexion and supination.

Phase 4 – Elbow Flexion (Post-Op Weeks 12–16)

Goals:

• Begin isolated elbow strengthening.

Exercises:

• Week 12: Initiate isometric elbow flexion.
• Week 16: Start concentric elbow flexion.
• Add rotator cuff (RC) strengthening and stabilization exercises.

Phase 5 – Functional Return (Post-Op Week 16+)

Goals:

• Progress through advanced strengthening and prepare for functional activities.

Exercises:

• Eccentric strengthening.
• Sports-specific exercises.
• Upper extremity (UE) plyometric activities.