Distal Biceps Tendon Repair: SMOG REHAB PROTOCOL

Phase I: 1-3 weeks
Clinical Goals
♦ Elbow ROM from 30º of extension to 120º of flexion (this may vary depending on patient’s situation.).
♦ Maintain minimal swelling and soft tissue healing
♦ Achieve full forearm supination/pronation
♦ Bilateral elbow and forearm ROM
♦ Six times per day the patient should set his ROM hinged brace at 30º of extension and
120º of flexion and perform active assistive flexion and active extension exercises within
the brace. Two sets of 10 are performed.
− The brace is then reset at 90º, the forearm straps are loosened, and the patient
performs 2 sets of 10 forearm rotations. The straps should then be secured.
♦ Ice after exercise, 3-5 times per day
♦ A sling should be worn only as needed for comfort with the patient maintaining full
shoulder ROM.

Phase II: 3-6 Weeks
Clinical Goals
♦ Full elbow and forearm ROM by 6 weeks
♦ Scar management
♦ Bilateral elbow and forearm ROM
♦ Grip strengthening at 5-6 weeks
♦ 3 weeks:
− The extension limit in the brace is changed to 20º. Flexion remains at 120º, but
patient may remove brace to allow full flexion 2 times per day. The brace stays on at
all other times except when washing the arm.
− Scar massage 3-4 times per day.
♦ 4 weeks:
− Extension limit is changed to 10º.
− Continue the same exercises.
− Soft sponge ball may be used 3 times per day for 10 minutes to improve grip strength.
♦ 5 weeks:
− The extension limit is changed to 0º and exercises are continued in the brace.
♦ 6 weeks:
− The brace is discontinued, unless needed for protection.
− Passive elbow extension exercises are initiated if needed.
− Light strengthening exercises are initiated with light tubing or 2-3 pound weights for
elbow flexion, extension, forearm rotation and wrist flexion and extension.
− Ice is continued after strengthening exercises.
Clinical Follow-up
♦ The patient usually is seen at 3 weeks and at 5-6 weeks, then only as needed with doctor
appointments, until full motion is achieved and to monitor the patient’s strengthening

Phase III: 6 Weeks to 6 Months
Clinical Goals
♦ The strengthening program is gradually increased so that the patient is using full weights
by 3 months. It may be as long as 6 months before a patient returns to heavy work.
♦ Grip strengthening
♦ Elbow ROM
♦ Elbow ROM exercises are performed if ROM is not WNL
♦ Strengthening exercises to wrist, elbow, forearm, and possibly shoulder depending on
sport and/or work requirements
Clinical Follow-up
♦ The patient is seen only as needed, usually with doctor appointments, to monitor
progress with strengthening program.