Injury Rehabilitation: The Three Phases Explained
Injuries can knock you sideways. There you are, going about your day when life suddenly changes. You trip over a tree root and twist your ankle, you get knocked sideways on the footie field and hear your knee go ‘pop’, you pull your hamstring while running and have to limp all the way home.
It’s happened. You can’t rewind, you can only go forward. So what does your rehabilitation look like? What should you expect?
Recovering from a soft tissue injury
Recovering from an injury is a complex process. Soft tissue injuries are very common – most of us will experience one at some point.
A soft tissue injury usually involves a sprain, strain, impact or overuse resulting in pain, swelling, bruising and loss of function to the area of the body. Common soft tissue injuries include sprained ankles, ACL / meniscus tear in the knee, tendonitis and bruising.
Recovering from any injury takes time, patience and perseverance. The duration of the healing process depends on the injury. Some injuries are more severe than others and some parts of the body are faster to heal than others. Of course, everyone is different too, so exactly how long it will take you to feel 100% again depends on a range of factors such as your age, medical history and overall heath and fitness.
Rehabilitation means restoring optimal form and function. Form relates to your anatomy – getting everything back to its normal position or shape. Function relates to your physiology, getting everything working properly again.
Whatever the injury, the rehabilitation process includes three phases of recovery.
Phase 1: Protection Phase
The protection phase refers to the first few days after the injury. It’s only just happened. You’re still in pain and may have noticeable swelling and bruising in the affected area.
You’re likely to be offloading the area simply because it hurts too much to put weight on it. It may even be strapped or immobilised in a walking boot. Your doctors may request an ultrasound or an MRI scan of the injury site to guide treatment decisions.
The protection phase – the first phase of recovery – can last from two to four days, depending on the severity of the injury. This is the ‘rest and protect’ phase of recovery. This stage includes swelling and possible bleeding around the affected area. Your body’s aim here is to protect your injury from further damage by limiting movement and recruiting supporting tissues to ease further pressure.
Your initial treatment will depend on your injury. Traditionally, soft tissue injuries and even breaks would be treated with the RICER protocol: Rest, Ice, Compression, Elevation and Referral.
The METH Method is now preferred and includes Movement, Elevation, Traction and Heat. This method aims to work with your body’s natural healing mechanisms – allowing inflammation to increase because this helps to break down and remove damaged tissue and debris from the injured area. Gentle movement, rather than complete rest, improves blood flow and stimulates tissue healing.
If you had sustained a bad ankle sprain, the protection phase may involve using a compression bandage or a crutch for a few days and avoiding activities that increase pain or swelling. If you’ve had a knee injury, the initial protection phase may involve strapping the knee and getting a scan to better understand the extent of the injury.
Phase 2: Repair Phase
The next phase of recovery is the repair phase. This happens after the swelling or bleeding has subsided and typically lasts up to six weeks post-injury. In this phase, your body is laying down new scar tissue. This reduces the need for you to protect your injury so much as the new scar tissue matures and strengthens.
At this stage, treatment is still needed for inflammation and swelling. The METH Method may still apply here, depending on the injury type.
Now, though, we can begin more active treatment, including starting physiotherapy using exercises appropriate to your injury.
If you’ve had a muscle injury, you might now start exercising with light weights to stabilise the area and slowly increase your function. If you’ve had a lower limb injury, you might now start putting more weight on it, carefully managing the loading to promote recovery without triggering further injury.
We also encourage you to keep exercising the rest of your body. It’s important to maintain your overall strength, conditioning and cardiovascular fitness. Your physiotherapist can advise you on suitable ways to exercise while nurturing your injured area.
Phase 3: Remodelling Phase
The next stage is the remodelling phase. This commonly lasts between six weeks and three months post-injury. In this phase, your body starts to teach the scar tissue to behave like the tissue it has replaced. It produces new additional tissue to help strengthen and support the healed scar tissue so you can keep up with the demands of your normal physical activity.
Your physiotherapist will gradually increase the intensity of your strengthening exercises, aiming to get you back to a pre-injury level of physical activity, prevent long-term impairment and prevent re-injury.
Exercises will focus on improving your:
- Range of motion
- Joint stability.
Exercises will obviously depend on the location and severity of your injury. Your progress will depend on how regularly you do them. Retraining your body requires commitment and perseverance – but it pays off.
Ongoing Repair and Remodelling
While not commonly included, there is a final stage of the healing process which involves the strengthening of scar tissue to prevent reinjury. This usually begins three months after injury and can last months to years, depending on the severity of the injury.
In this phase, your body is focused on strengthening scar tissue and improving its quality to prevent reinjury.
Physiotherapy may still be a treatment modality at this stage but its nature may become more tailored to your particular goals. Maybe you want to be able to walk your dog each day – or maybe you want to get back into footie training, swimming or triathlon. Your physiotherapist will talk to you about your lifestyle and goals then tailor your exercise program to help you achieve the condition you need.
It’s still important to follow your physio’s advice closely. Don’t push yourself beyond your advised exercise program, no matter how impatient you are to return to the playing field.
Though you’ve made great progress, you’re still highly vulnerable to a repeat injury. It’s still important that you pace yourself and rest regularly as you continue to rebuild your strength.
When the time is right, your physiotherapist will tell you that you can return to your usual level of activity, including your chosen sport. Your physiotherapy sessions may become less frequent but are still useful in identifying any early signs of overuse injuries and maintaining your strength and condition.
How The Brisbane Spine Clinic can help
At The Brisbane Spine Clinic, we can help you through the stages of injury rehabilitation so you can get back to doing what you love to do. We will work with you to introduce a physiotherapy plan which encompasses specific exercises suited to your lifestyle or chosen sports. We’ll also introduce other treatment modalities focused on your injury and recovery needs. Book an appointment today.