When Should You Start Rehabilitation After an Injury ? What the Research Says.

One of the most common questions after an injury is:

  • “When should I start with rehabilitation?”

May people assume they should wait until the pain and swelling have completely disappeared before exercising again. In many cases that is not necessary.

Current sport-medicine research increasingly supports ealy, appropriate rehabilitation rather than prolonged complete rest. However, there is an important distinction:

  • Early rehabilitation does not mean immediately training the injured area hard.

It means introducing the right amount of movement and load at the right stage of healing.

The first step: Make sure the injure is safe to rehabilitate.

Before worrying about exercises, the injury needs to be appropriately assessed. Some injuries require protection, imaging, immobilisation, surgery or further medical investigation before exercise should begin.

This may include suspected fractures, dislocations, significant ligament injuries, tendon ruptures or injuries associated with severe swelling, deformity, neurological symptoms an inability to use the limb normally.

Once serious pathology have been excluded and the injury is medically appropriate for rehabilitation, the goal is normally not prolonged complete rest. Instead, rehabilitation gradually begins.

Why Do We Want to Start Rehabilitation Early?

When an injured muscle, tendon or joint is completely unloaded for too long, the body starts losing capacity.

  • Strength decreases.

  • Movement becomes restricted.

  • Confidence decreases.

  • Balance and coordination can deteriorate.

The injured tissue also eventually needs load in order to adapt and become strong enough for normal life or sport again. This is why modern rehabilitation focuses on finding the balance between:

  • Protecting the injured tissue and progressively exposing it to appropriate movement and load.

What Happens During the First Few Days?

Immediately after a soft-tissue injury, some protection may be necessary. The PEACH & LOVE approach described in the British Journal of Sports Medicine recommends protecting or reducing load during approximately the first 1-3 days when necessary, while avoiding unnecessary prolonged rest.

After the initial protective period, movement and exercise are gradually introduced according to symptoms and tissue tolerance. The goal is not to “push through” the injury. The goal is to give the body a stimulus it can successfully tolerance.

Rehabilitation Should Progress With the Injury.

A useful way to think about rehabilitation is a series of stages.

Stage 1 - Protect and Restore Movement.

Early goals may include:

  • Reducing excessive pain and swelling.

  • Regaining comfortable movement.

  • Maintraining movement in the surrounding joints.

  • Begining gentle muscle activation.

  • Maintaining as much normal activity as safely possible.

At this point, rehabilitation may look extremely simple. A small amount of movement can still be rehabilitation.

Stage 2 - Restore Strength.

As symptoms settle and movement improves, exercise become progressively more challenging. The goal is to rebuild the capacity that was lost after the injury. Depending on the injury, this may include:

  • Isometric exercises.

  • Resistance exercises.

  • Balance training.

  • Range-of-motion work.

  • Movement training.

The important word is progressive. The body adapt when it is gradually exposed to greater demands.

Stage 3 - Restore function.

Being pain-free is not the same as being fully recovered. A runner needs to tolerate running. A rugby player needs to sprint, accelerate, decelerate and change direction.

A person returning to work may need to lift, carry or remain on their feet for long periods. Rehabilitation therefore has to gradually become more similar to the activity the person wants to return to.

Stage 4 - Return to Performance.

For athletes, rehabilitation should eventually prepare the body for the actual demands of sport. This may includ:

  • Running.

  • Jumping and landing.

  • Acceleration and deceleration.

  • Change of direction.

  • Strength and power development.

  • Sport-specific conditioning.

  • Return-to-play testing.

The final question should not simply be: “How many weeks has it been?”

It should be: “Has this person regained the physical capacity required for what they want to return to?”

What Does the Research Say About Starting Early?

There is good evidence that appropriate early rehabilitation can improve recovery in certain musculoskeletal injuries.