The Goals of Rehabilitation

The Inflammation Phase & Repair Phase

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The Inflammation phase
Now that the tissues have started to heal on their own, what's next? Two important concepts must be prominent in the mind of your PT and of necessity yourself.

1. Never overstress the healing tissues. Stress is important to the process. "Just enough stress" is the critical point to remember. Too much can delay the healing and damage the new rebuilding structures. Too little, and damage results from the haphazard laying down of new tissue.
2. The injured person must meet stage specific healing objectives before moving onto the next phase of healing. These can be activity, flexibility, Range of Motion, (flexibility and range of motion are in fact two separate issues) and strength levels.

Keep these two concepts firmly entrenched in your mind. The prime goal in this phase is to prevent disrupting the growing of the new tissues. Adequate blood and prevention of further swelling is necessary.

To enable the fastest healing remember the acronym, RICE. It is the recommended method at this time.

Rice stands for:

• Rest; get off the limb, stop doing things with the injured area. Note, I did not say stop all activity. The rest of your body still needs to remain in peak condition. Strength and cardiovascular maintenance require attention and further development. Work around the injured area. For example, you would not stop doing squats just because you broke your finger. You can still use your legs, so use them.
• Ice; to reduce inflammation.
• Compression; help prevent further swelling in the area. Apply a light wrap over the injury (keeping in mind not to cut off circulation).
• Elevate; the injury above the heart if possible to help slow the influx of fluids.

Exercising the injured area is NOT recommended
during this phase of rehabilitation.

The Repair Phase
The prevention of excessive muscle atrophy and joint deterioration are the treatment goals of this phase. Keeping a balance between low-stress loads and disruption of the newly formed collagen fibers is essential. Introduction of low stress and active range of motion to the joint takes place.

Avoiding overly aggressive resistance loads to the area provides the needed protection to the new tissue formations. But, it also aids in helping the stage following repair; that of remodeling. Protected motions of the joint aids in the alignment of the collagen fibers and thus speeds up and promotes mobility in the tissues.

Therapeutic modalities are still used in this phase but now they are used to encourage collagen synthesis. Ultrasound, electrical stimulation and ice are each employed to assist in this effort to repair the tissues as quickly and efficiently as possible.

As before, the necessity of maintaining the other body functions in peak form is essential to the outcome of the rehabilitation process. Continue to work the cardiovascular, strength and ROM in the rest of the body.

Strategies of exercise in this portion of the rehab consist of isometrics, as long as it is pain free and permitted by the health care professional. Of course, sub maximal contractions are advised. Another option is an Isokinetic machine, which provides movement at a given speed. Since strength training is velocity specific the level of resistance can be adjusted to match the individual's needs.

Proprioception is next on the treatment agenda.

Proprioception provides a sense of joint location and movement. It lets the body know where, in relation to the surroundings the joint is at the time. It is the body's ability to react to changing conditions and situations. Generally, after an injury the proprioception capabilities are impaired.

Regaining them is an important aspect of a full recovery to normal status. Setting; standing; walking; running on unstable surfaces; all help in regaining this function. Naturally, the progression is from stable to unstable, standing to walking to running. Easy to difficult to hard.

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About the author: Danny M. O’Dell, M. A. CSCS*D is the co-owner
of The WeightRoom Gym and Explosivelyfit.com, both located in
Nine Mile Falls, WA. He is a Certified Strength and Conditioning
Specialist, recognized with Distinction by the National Strength
and Conditioning Association. He has a Masters Degree in Human
Services and is a strength and conditioning coach in a local School
District along with being a member of the Washington State
Coaches Association.

Visit Danny's site at... ExplosivelyFit.com
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