Fasciotomy for Chronic Compartment Syndrome

Days 1–14

Exercises

• Crutches – non weight bearing (NWB) x 4wks
• AROM hip and knee
• Wiggle toes, gentle ankle AROM DF/PF as tolerated
• Straight leg raise (SLR) x 4
• Upper body exercises (seated or bench only – no pushups)
• LE stretches – Hamstring, quads, ITB, Hip flexors
• Ice and Elevation
• TED hose

Goals

• Pain management
• Prevent swelling

Weeks 2–4

Exercises

• Crutches – NWB x 4wks
• Continue appropriate previous exercises
• Calf pumping, alphabet, rotations
• Gentle DF stretch w/ towel
• Light Theraband ex x 4
• Towel crunches and side-to-side
• Seated BAPS
• Stationary bike (no resistance)
• Leg Press < 25% body weight and painfree
• Calf Press < 25% body weight and painfree
• Ice as needed
• Compression stocking if persistent swelling

Goals

• DF/PF AROM WNL

Weeks 4–6

Exercises

• Crutches – WBAT (d/c when gait WNL)
• Continue appropriate previous exercises
• Scar massage (if incision well healed)
• Theraband ex x 4 – Gradually increase resistance
• Steamboats (Theraband x 4 while standing on involved LE)
• Mini-squats, Wall squats, Total gym
• Double leg heel raises – Progress to single leg heel raises
• Double to single leg BAPS, ball toss, and body blade
• Treadmill – Walking forwards and backwards
• Elliptical trainer
• Pool therapy – Chest or shoulder deep water running (optional)

Goals

• 10 single leg heel raises
• Normal walking gait on level surfaces x 1 mile

Weeks 6–12

Exercises

• Continue appropriate previous exercises
• Progressive strengthening program
  • Leg press and hip weight machine
  • Knee extension and HS curl weight machines
  • Fitter, slide board
  • Push-up progression
  • Sit-up progression
• Progressive low impact cardio program
  • Treadmill – Walking progression program
  • Stairmaster
  • Pool therapy – Unrestricted

Goals

• 45 minutes low impact cardio 5x per week
• Strength via weight machines 90% of non involved
• Walk 2 miles at 15 min/mile pace with min symptoms

Weeks 12–16

Exercises

• Continue appropriate previous exercises
• Running progression program when following criteria met
  • 3 x 20 heel raises and LE strength 90% of contra-lateral
  • painfree 2 mile walk at 15min/mile pace
  • no post exercise swelling
• Agility drills / Plyometrics
• Transition to home / gym program

Goals

• Run 1 mile at 12 min/mile pace with min symptoms at 3 months
• Pass a return-to-sport / fitness test at 4 months post-op

Abbreviations

AROM / AAROM / PROM: active / active-assisted / passive range of motion. ROM: range of motion. ER / IR: external / internal rotation. ABD / ADD: abduction / adduction. FLEX / EXT: flexion / extension. WBAT / PWB / TTWB / NWB: weight bearing as tolerated / partial / toe-touch / non-weight bearing. SLR: straight leg raise. HS: hamstrings. ITB: iliotibial band. UE / LE: upper / lower extremity. UBE: upper body ergometer (arm bike). BAPS: balance board. BFR: blood flow restriction training. PREs: progressive resistance exercises. D/C: discontinue. prn: as needed. POD: post-operative day. TENS: transcutaneous electrical nerve stimulation. ADLs: activities of daily living.

Source

Adapted from William Beaumont Army Medical Center, Physical Therapy Section, "Fasciotomy WB09", February 2009, published by William Beaumont Army Medical Center (a work of the U.S. Government in the public domain). Original: Fasciotomy WB09.pdf. Army-specific wording in the original (APFT) was replaced with civilian equivalents.

This protocol is general guidance for the rehabilitation team and does not replace the specific plan, restrictions and follow-up we set together. Your own situation may differ: if anything here does not match what we talked about, what we talked about wins, so please ask me.

Current version and every other protocol: aaronweymd.com/post-op-protocols