Clinicians - Protonics Protocol

___________________

Chronic Knee, Hip or Back problems including pain and limited function?

These patients may be prescribed a Protonics Neuromuscular Device for long term usage at home or in conjunction with a clinic program.

___________________

Occasional Knee, Hip or Back problems including short-term pain and limited function?

These patients may be prescribed an in-clinic therapy program that includes use of a Protonics Neuromuscular Device in conjunction with the clinic protocol.

Clinician Information

Protocol

Initial usage Phase

Neuromuscular Repositioning Mode
It is essential that patients minimize active hip flexion and lumbar extension during Repositioning. The goal of Repostiioning is to maximally recruit hamstrings while inhibiting iliopsoas activity through reciprocal inhibition.

Patients should initially set the Protonics Resistance between five (5) and nine (9), using a setting of seven (7) for average strength individuals. Patients should perform each repositioning technique 2-3 times daily for the 2-4 weeks prior to reducing frequency.

1. Prone Hamstring Curl

Lie patient prone with the involved leg extended. Place a pillow under the lower ribs and a small towel roll under the distal thigh of the involved leg. Have patient actively flex their knee (hamstring curl) against resistance.
Repeat 10 - 15 times.
    •    Minimize back extension activity by adding a pillow under the stomach
         to increase lumbar flexion.

    •    Avoid active hip flexion - remove towel roll and have patient complete gluteal set if necessary.

2. Supine Hamstring Curl

Place patient in Thomas Test position. Have patient pull the non-system knee to their chest to stabilize the pelvis and neurtralize the spine. The leg with the system should rest on a small towel roll under the distal thigh. Have patient maintain this position while completing the hamstring curl.
Repeat 10 - 15 times.
• To avoid active hip flexion, instruct the patient to maintain thigh contact with towel roll.

• Do not allow patient to extend lumbar spine.

3. Seated Hamstring Curl

Have the patient sit on the edge of table with a neutral spine. Place small towel roll under distal thigh of the system leg. Instruct patients to gently push down into the towel while performing this exercise. The patient should sit comfortably without lordosis. Complete hamstring curl.
Repeat 10 - 15 times.

4. Standing Hamstring Curl

Have patient stand on the non-system leg. The thighs should be in line with each other and the shoulders maintained directly above the hips. Complete hamstring curl.
Repeat 10 - 15 times.
    •    Avoid active hip flexion. Do not block anterior thigh with object (this will
         only enhance hip flexor activity).

    •    Tip - To help avoid active lordosis, have patient slightly flex the weight-bearing knee.

    •    Involved knee must be equal to or behind the un-involved knee.

Neuromuscular Retraining Mode
After Repositioning, the patient should wear the system during normal daily tasks at a low setting )1 - 4) that does not impede the patients gait (see chart below).

Retraining activities should last between 30 - 90 minutes. After 2 - 4 weeks, the patient may be able to reduce Retraining activities to 1 - 2 times daily. If symptoms increase during Retraining, repeat Repositioning before continuing Retraining activities.

Retraining Resistance Level		Retraining Activities
Repositioning Setting	Retraining Setting	Housework	Yard Work
5 - 6	1- 2	Playing with the kids	Social Activities
7 - 8	2 - 3	Walking	Washing the car
9	3 - 4	Hiking in the park	Shopping
		Running errands	Preparing dinner

Neuromscular Conditioning Mode
In about 2 - 4 weeks (or as prescribed), the patient may begin the following Strength and Conditioning Activities while wearing the Protonics^® system (always after Repositioning first). These activites wil strengthen muscles around the pelvis to help maintain stability. No pain should be experienced. It is recommended that the patient set the Protonics system at a low resistance (1 - 4). Some suggessted activities include:
    •    Treadmill
    •    Retro Pedaling
    •    Backward Stair Climbing
    •    Wall Lift
    •    Side Stair Climbing

Periodic Usage Phase

After a certain period of time (usually 2 - 4 months), the patient can begin using Protonics on a periodic or as needed basis. Depending on the amount of physical activity and / or training the patient performs weekly, the following guidelines will help the patient maintain proper pelvic-femoral position.
    1.    Complete Repositioning before and / or after High-Level Activities.
    2.    Return to Protonics Repositioning and Retraining as needed.
    3.    Perform strength and conditioning workouts with Protonics involvement.

Protonics^® Dynamically Control Muscle Activation and Posture