The 3 Stages of Injury and Recovery and How They Influence Your Decision to Exercise
Years ago, a women in her 40's contacted me about helping her get back to exercise after a recent hip injury.
She'd attended a Pilates class and a had an unfortunate accident while using the reformer.
But I wasn't aware of the extent of her injuries until she came in for a consultation.
I had her lie down on the floor to assess her abdominal and hip function. When I had her simply raise her leg off the floor, I realized just how much pain she was in.
But more importantly, I knew right away that I was not the person she should be seeing.
Given her pain levels, I referred her back to her physician for a proper diagnosis and plan of care.
Here's the point...
Knowing what stage of healing you're in is critical to starting an exercise program after an injury or surgery.
Start exercising too soon...and you may cause more damage to tissues that haven't sufficiently healed.
Start too late...and you might miss out on the beneficial effects that physical activity can have in the healing process.
So today we're going to look at the three stages of injury and recovery:
Acute
Sub-acute
Chronic
Knowing the difference between these three stages and how they can influence your exercise decisions can help you get the most out of your recovery while improving function and reducing the risk of re-injury.
Acute Stage
The acute stage of injury and recovery starts the moment the injury has occurred. Common symptoms include swelling, pain, and reduced range of motion of the involved joint(s).
At this point, you should be working with your physician in obtaining a proper diagnosis. It's also where your physician will determine an appropriate plan of care.
Depending on the injury, the goals during this phase can include controlling inflammation and pain. And you may need to restrict mobility to prevent further damage.
The acute phase can last up to 30 days.
### Should You Exercise During the Acute Phase of Injury and Recovery?
In most cases, you should avoid resuming an exercise program when in the acute phase of injury. The only exception is if your physician has provided medical clearance for exercise.
The primary focus during this stage is to minimize further injury, manage pain and inflammation, and get the appropriate level of rest to allow the tissues to heal.
In cases where a person has received permission to exercise, it should be limited to low-intensity movement that improves joint mobility.
Sub-Acute Stage
The sub-acute stage comes after the acute stage and typically lasts anywhere between a few weeks to a few months.
At this point, inflammation is decreased and the body's tissues have begun to heal. You may already have experienced some improvements in strength, range of motion, and function.
It's also at this stage where progressive loading can begin. But keep in mind, you need to proceed with caution.
The focus should be on functional movements that improve activation of muscle fibers while improving cardiovascular endurance.
Pay attention to what your body can tolerate, and avoid going too fast too soon.
Monitoring by your physician, physical therapist, or other medical professional is crucial to making sure your program is appropriate for you and for making any necessary changes as you progress (or not).
"Now Can I Get Back to My Workout Routine?!"
Although you may want to get back to your regular exercise routine...or return to working with your personal trainer...your primary caregivers during the sub-acute stage of injury and recovery should be your licensed medical professionals.
This is still not the stage at which the personal trainer or post-rehab exercise specialist steps in, unless medical clearance has been obtained from the physician.
Chronic Stage
You've entered the chronic stage of injury and recovery when inflammation and pain have significantly decreased. This phase can last from months to years depending on the type and severity of your injury as well as your ability to heal.
Getting Back to Optimal Function
At this stage, the post-rehab or medical exercise professional may step in and help you implement an exercise program that addresses remaining functional limitations while improving strength, endurance, flexibility, and overall function so you can get back to your pre-injury activities.
Depending on your needs and goals, the focus of exercise should be on improving function through the use of resistance and proprioceptive exercises. (Think of proprioception as your body's ability to sense its position and movement in space. It's an important component of balance, coordination, and joint stability.)
You should also incorporate exercises that mimic your daily activities to ensure optimal function. The goal should be to prevent re-injury and improve overall fitness levels.
Keep in mind, too, that pain may still be present during the chronic stage. But the proper application of exercise can benefit the healing process.
Click image to expand.
How to Build a Strong Foundation for Future Outcomes
Returning to an exercise program after an injury or surgery starts with the screening and assessment process.
Undergoing a thorough assessment is the first step in resuming your exercise program after an injury, and once you've entered the chronic stage of healing.
Working with a Medical Exercise or post-rehab professional will ensure that you have a safe and effective exercise program to improve muscular strength and endurance, joint mobility, and cardiovascular health.
Even if it's been months since your injury, you should still obtain medical clearance from your physician. Your post-rehab exercise professional will establish and maintain communication with your physician, physical therapist, chiropractor, or other licensed medical professional to keep them informed on your progress.
The evaluation process typically includes an evaluation of your alignment, muscle strength, joint range of motion, and function.
This is the starting point of any exercise program that's been tailored to your unique needs and medical condition...as well as to the stage of recover you are in.
Remember, the post-rehab professional may step in during the sub-acute phase. But in most cases, they will begin once you've entered the chronic phase.
Regardless of the stage you're in, safety and thoughtful progression are key. Movement is medicine, and as such, it should be dosed appropriately.
That's one of the primary roles of the medical exercise and post-rehab professional you enlist to help you with your ongoing recovery needs.
Having a basic understanding of the acute, sub-acute, and chronic stages of injury and recovery will help you make decisions that lead you to positive functional outcomes.
Starting an exercise program at the right time and with the proper guidance will ensure that you can get back to doing the things you love sooner than later.
You'll be able to work and play without the fear of re-injuring yourself...and with the confidence in knowing that you can move past your injury or surgery and continue to build lasting health for years to come.
Darwin Ruiz is a post-rehab exercise professional specializing in helping clients improve function and health after they've completed physical therapy for a back injury or surgery. If you'd like to find out if a Medical Exercise program is right for you, contact Darwin and schedule a complimentary consultation call.