In most cases, physical rehabilitation can be broken down into 5 phases.
This is where we assess and diagnose your injury. An accurate diagnosis will determine how much protection the injured structure needs and also how long before you can start increasing load. The goals of each next phase of rehabilitation is influenced by this initial assessment and diagnosis.
2. Active range of movement and movement pattern retraining
After reaching the goals of phase one, you progress to the movement phase. By now, inflammation has settled and the injured structure has started healing. This means that we can start increasing movement, but still within limits of pain to prevent reinjury. The goal of movement pattern retraining during this phase is to ensure that you can control the movement as it improves. Basically like testing and calibrating the brakes in a car to make sure you can move or stop when you need to.
3. Initial strengthening and endurance training
Your rehabilitation program will start to include resistance exercises and higher repetitions to start building muscle strength and endurance. This phase focuses on gaining strength in the new range and maintaining sufficient stability for the surrounding structures.
4. Strength training and full range of movement
By this phase you should have minimal pain, and we can start working for full movement of the injured structure. Your exercise program will include higher loads and more complex movements.
5. Return to full activity
The goals we set in the first phase of rehabilitation determines what return to full activity means to you. It might be back to weight training in the gym 5 days a week, walking your dog in the afternoons or hiking with your kids.
The timelines for each phase varies because every individual will have different goals and a different profile. Factors like age, gender, previous injuries, health, conditioning, and even your home and work environments influences your progress. But don’t despair, your physiotherapist is there to guide you through the ups and downs of rehabilitation.
Rehabilitation has many aspects and can be divided into 4 main categories, according to the goal of the treatment.
Preventative rehabilitation occurs shortly after an injury or, in some case, where there wasn’t an injury. The main goals will be to give you advice and information about your condition, treat symptoms and maintain or restore function.
If there wasn’t an injury, preventative exercise programs is used for specific age groups or conditions. For example, the risk of falling increases with age, so general strengthening and balance exercise programs are useful in older populations to decrease this risk.
Another example is screening someone who wants to start exercising after a long period of inactivity. In these cases, we use movement and strength tests to identify muscle imbalances or movement dysfunction that can put you at risk of injury. These tests are used as preseason screening for athletes. A individualized rehabilitation program is designed according to what we identify during the tests.
After surgery or an injury, rehabilitation will aim to restore what was lost. In the case of an ankle sprain or lower back disc injury, you lose mobility due to pain, so the initial aim of rehabilitation will be to restore movement using movement pattern retraining, mobility- and strengthening exercises. After an operation, like a rotator cuff repair or knee meniscus surgery, rehabilitation starts at the protection phase until the repaired structures are strong enough to handle movement. Information like what to do and what to avoid also plays an important role, especially in the early phases of rehabilitation.
As your pain and mobility improves, the focus of rehabilitation shifts to muscle strengthening and building resilience. In these later phases we aim to get you back to where you were before the injury and, very importantly, to limit your risk of reinjury.
Also known as adaptive rehabilitation, the focus is centered around helping you adapt and find alternative ways of performing an activity. For example injuries that don’t heal completely, like a stroke, or permanent impairments like amputations.
The aims of rehabilitation in terminal conditions or incurable diseases focuses on helping patients to be as comfortable as possible within the limits of their condition.