Four Phase of Recovery in Physical Therapy

April 27th, 2020

Experiencing pain? Recently injuredExperiencing chronic pain without signs of relief in sight? Recovering from a recent surgery? Experiencing pain or recently being injured comes with uncertainty and anxiousness regarding how, when, or if symptoms will subside to be able to return to your prior level of physical activity. Prior to starting physical therapy on your journey towards recovery, knowing what to expect along the way will help to ease concerns and anxiety while offers hope and reassurance to achieving your goals.  

The four phases include: 

  1. Decreasing pain and inflammation 
  2. Increasing mobility/flexibility and strength 
  3. Returning to normal function/activity 
  4. Maintaining strength and preventing injury 

It should be known up front that these phases are not a linear process of improvement, but rather phases that vary in duration from person to person. 

  • Most people are familiar with the RICE principles (Rest, Ice, Compression, and Elevation) following an injury; however, these principles have received a recent update where injuries/pain require PEACE & LOVE (Dubois & Esculier, 2019) that coincides and intertwines well within the four phases of recovery. 
  • Protect 
  • Elevate 
  • Avoid anti-inflammatories 
  • Compress 
  • Education 
  • Load 
  • Optimism 
  • Vascularization 
  • Exercise 

Decreasing Pain and Inflammation 

This stage focuses on the PEACE principle following recent injuries or recent “flare-ups” in pain.  

  • Protecting the irritated tissues involves initially avoiding aggravating activities to prevent further injury. We want to avoid long periods of rest to limit decreases in strength and flexibility that could result in compensations and further complications. 
  • Elevating the injured body part helps decrease any swelling that may occur throughout the day, being most beneficial when the limb is elevated above the level of the heart. 
  • Avoiding anti-inflammatories may offer pain-relieving and decreased inflammation effects; however, these medications can often disrupt the body’s natural healing process following an injury that require an inflammatory process to occur for optimal tissue healing. 
  • Compressing the inflamed or swollen region offers a better alternative to anti-inflammatories in preventing excessive swelling as compression does not interfere nearly as much with the healing process. 
  • Education regarding the injury itself, as well as understanding the importance of active recovery, help to improve long-term effects toward achieving your physical activity goals. Understanding realistic recovery times also helps to decrease the stress of the unknown when injured and experiencing pain. 

Increasing Mobility/Flexibility and Strength 

As the initial irritability of symptoms subsides and calms, we need to give our tissues some LOVE! 

  • Loading our muscles, tendons, and ligaments through gradual and specific stretching/mobility and strengthening exercises helps to build the tissues resiliency and capacity to meet the demands of your goals.  
  • Optimism and positivity actually help our bodies heal! Keeping a positive outlook throughout your recovery journey keeps our stress levels low, which in turn allows for decreased pain and an overall better prognosis toward recovery. Stay positive! 
  • Vascularization relates to cardiovascular activities (brisk walking, cycling, swimming) to help increase blow flow to the healing tissues. Staying active helps keep up motivation (see Optimism!) and can help to decrease the need for pain-medications due to the pain-relieving effects of light activity. 
  • Exercise comes with a multitude of benefits (physically, psychologically), as well as plays a crucial role in restoring mobility, strength, and balance following injury/pain. Along with exercise, restoring appropriate functional movements (squatting, lunging, pushing, pulling, carrying) during this phase will continue to prepare you toward your eventual return to fitness/activity. 

Returning to Normal Function/Activity 

Returning to normal function whether it is work, running, sports, strength training, etc., requires a gradual return to activity. You’ve put in so much hard work to this point, keep it going! Experiencing pain at this phase can be common, but using the traffic light pain guideline will ensure continued success. Pain that is < 4/10 is normal and expected and is “workable” pain when returning to your usual activity levels You still have to “green light” to keep moving! Pain in the 5-7/10 range should be taken cautiously (“yellow light”) with potential modifications needed (I.e. limiting time doing the aggravating activity, slower pace/less mileage with running, less repetitions during on-field drills, lifting lighter weights in the gym, etc.). Activities causing pain > 8/10 should be stopped (“red light”) and followed up with a healthcare provider. 

Maintaining Strength and Preventing Injury 

Continuing to maintain (and improve) your strength will build your body’s resiliency and decrease the likelihood of reinjury. This can occur in various forms from continuing a home program provided to you from your physical therapist, or you can continue your active lifestyle and achieving new goals with one our skilled strength and conditioning coaches. Whichever you chose, continuing to move 30-mins a day with two days of strengthening exercises helps to prevent injury, as well as provides a whole host of benefits! 

The journey of recovery following an injury/pain doesn’t have to be stressful or seem like an endless road! If you’re currently experiencing pain or have recently been injured, contact any of our Training Room locations (Cherry Hill, Haddonfield, Washington Twp) to speak with one of our highly-skilled physical therapist to schedule an appointment (telehealth included)! 

Reference: 

Dubois B, Esculier J. “Soft Tissue Injuries Simply Need PEACE & Love”. Blogs.bjm.com. British Journal of Sports Medicine, 26 April 2019. Web. 21 April 2020.