Post-operative rehabilitation for patients who have sustained a laceration to their intrasynovial flexor tendon apparatus is an important factor in maximizing functional outcome. Quality rehabilitation is partially characterized by the development and implementation of a tailored exercise regimen. Though suggested stratagems are available for tailoring rehabilitation programs according to age, learning capabilities, and suture technique, there is currently no system available to tailor an exercise regimen for a person with an atypical physiologic response pattern (i.e. heavy or light collagen synthesis). If flexor tendon rehabilitation exercises were classified according to the criterions of force and/or excursion, and a clinical method were available to assist in the identification of optimal force and/or excursion application, then those individuals with atypical response patterns could be treated more efficiently and effectively.

Purpose: The purpose of this presentation is to classify rehabilitation exercises for the healing intrasynovial flexor tendon along the criterion of progressive force. A systematic method of exercise prescription to determine optimal force application will also be presented.

Methods: Literature review and case study.

Observations: A classification of progressive force exercises to the healing flexor tendon is conceptually developed. This classification consists of a pyramidal series of nine specific rehabilitation exercises in the following sequence: passive protected extension, place and hold, active composite fist, hook and straight fist, isolated joint motion, discontinuation of protective splinting, resistive composite fist, resistive hook and straight fist, resistive isolated joint motion. Systematic application of the theory is accomplished through the implementation of a novel three-point clinical adhesion-grading system. The uniqueness of the theory lies not in the exercises, but in the method of prescription. Therefore clinical reasoning is at the fore of all treatment progressions rather than predetermined time frames. Clinical application of the system is highlighted. Two case studies are briefly presented to illustrate application of the pyramid in high and low physiologic response patterns.

Conclusions: A theoretical classification system of progressive force exercises in conjunction with their systematic application has been developed. Further substantiation is necessary to validate the proposed theory.