There are some underlying principles and timelines that we follow with most injuries in physical therapy and rehabilitation. I will give the basic timeline and give some examples. If you are injured, this is what you have to do. Or, just call me, I will help. That is what I am here for.

You have to decrease the pain and/or inflammation.
If a tissue is hot, red, inflamed, and/or painful, etc., it must calm down first. Tissue rolling, rest, ice, NSAID’s, massage and other soft tissue techniques, topicals, modalities, and other treatments are initially used to make the area feel better. Have you ever had a swollen, sore, and injured knee? You had to decrease the pain before you thought about exercising again. This is what I am talking about. When the pain is reduced, you are able to begin to move again and start addressing the baseline mechanics in step 2.

You have to fix the mechanics.
You have to stretch what is tight. You have to strengthen what is weak. You have to train balance and endurance. If the pain is reduced, you are clear to work on any deficits that either caused the injury or may keep it from healing in a good position. This would also limit performance on the field. These are all the baseline physical traits that we measure. The muscle length in the area, the joint range of motion, the muscle strength, control, power, and endurance, the balance, the stamina, and many others. We call these “impairments.” They are the foundation of your house. You won’t have good function if you have impairments. You won’t ultimately have a sturdy house, without a good foundation. Once the building blocks (good mechanics) are in place, you try to improve form in step 3.

You have to correct form.
The pain and impairments are gone and it is time to restore proper function. Time to improve running form. Time to correct throwing arm angles. Time to land correctly and explode in every direction. Time to work on sports specific movement patterns that are integrated and complex. We use video at this time. This way the therapist and the athlete can see what is happening in slow motion, measure angles, and compare to either previous videos or to other athletes in the same sport. Sometimes this can improve performance at the same time. As volume increases, this is a good opportunity to make biomechanical changes to reduce pain, allow secondary prevention, and improve performance. Three for one!!! You can change your stride, change your delivery, change your swing, or otherwise optimize for long term success.

You have to go in that order and correct each thing to allow full recovery. Return to play happens when there is full motion, full strength, and no pain in the affected area or injured part. These steps of course overlap but you have to do them all and you have to do them in order. For instance, it is very difficult to strengthen inflamed tissue. It must settle down first. Conversely, if pain and inflammation are reduced, it is relatively very easy to improve strength, etc. that will allow you to work on form and return to play.

The trick is how and when to do each step. But, I went to school to learn this so you don’t have to. Don’t put the cart before the horse. Do each step, do each step well, and do each step in order, and you should have a successful episode of rehabilitation.

Happy Stepping……..

Kash Eagleton, DPT, SCS
Doctor of Physical Therapy
Board Certified Sports Physical Therapy Specialist
Fredericksburg, VA

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