Today I want to talk a bit about the seven stages of rehabilitation after an injury. Injury in sports vary in severity and many can be devastating. Some injuries require surgical intervention while others can be managed non surgically with bracing, casting, rest and therapeutic exercises. All injuries, both of those treated surgically and non-surgically, require a proper rehabilitation program. Almost all injuries cause some missed time from training and game play and if not rehabilitated properly can turn into long lasting chronic injuries that will be significantly detrimental to performance. For this reason it is absolutely imperative that one follows a proper rehabilitation plan to return to play. As mentioned above there are seven stages to rehabilitation and we will discuss them below.
- Decrease the pain and swelling
Stage one occurs immediately after an injury or operation and its aim is to decrease the pain and swelling that occurs with injury. This can last anywhere from 48 hrs to as long as 10 days. The mainstay of treatment is usually rest, icing, compression and elevation of the affected area. Other therapies include aquatic therapy, electrical stimulation, gentle muscle activation, and manual therapy.
- Achieve full range of movement and flexibility
Range of movement of the affected joints and contractile tissue should be mobilized as soon as possible. After an injury there will naturally be some stiffness due to immobilization and it is vital that mobilization be commenced early in order to prevent long term stiffness and loss of range of motion. The phase is usually led by the physical therapist and must be optimized before the athlete can proceed to the next phase.
- Achieve full power and endurance
With injury to joints, surrounding muscles have the tendancy to switch of and deactivate causing muscle atrophy and weakness. Phase three focuses on reactivation and re-strengthening of these muscles. Resistance exercises both with body weight and with weights are key in this phase. Isotonic and isometric are easily utilized in this phase. The athlete also starts working on building back both muscular and cardiovascular endurance. Aquatic exercises can be very effective during this phase.
- Achieve top level of proprioception and coordination
This is arguably the most important phase of rehabilitation. It focuses on neuromuscular control and building back up the athlete’s sense of their position in space. This phase includes exercises that focus on balance and coordination with the aim of optimizing body control. The practioner can be imaginative in this phase and include exercises that vary from balancing on an unsteady surface to more complex tasks such as some balancing on one leg while catching and throwing an object. The aim is to safely increase the complexity of the work.
- Achieve previous levels of skill and agility
This phase starts to incorporate some sport specific movements such as kicking, jumping, twisting, and sprinting. These movements are then gradually done with increasing speed and resistance. One can also start involving contact from other players or trainers. The movements are repeated until they match the demands of full training.
- Return to full training
At this point the athlete is strong enough and has enough endurance to return to training. Prior to beginning this phase, the athlete must be tested to ensure that they have met all of the criteria such as proper joint range of motion, muscle strength, no pain and swelling, speed, agility and technical ability. The criteria must at the very least match pre-injury levels as well as those of the uninjured limb.
- Return to Play
The decision to return to full play is a multifactorial one which involves input from the doctor, physical therapist, fitness coach, athletic trainer, head coach and most importantly the athlete. The athlete must feel confident that he or she is ready to return to play. From a medical standpoint, all the criteria must be met and the medical team should be confident that no recurrence of the same injury will occur and that the athlete can perform at the same level as, if not better than, prior to the injury.