The 4 Phases of Physical Therapy
Dr. David T. Neuman is an orthopaedic surgeon practicing in New York, New York. Dr. Neuman specializes in the diagnosis, treatment, and rehabilitation of injuries, diseases, and disorders of the body's musculoskeletal system. As an orthopaedic surgeon, Dr. Neuman tends to bones, ligaments, muscles, joints, nerves, and tendons.... more
The steps to a full recovery include diminishing swelling and pain, regaining range of motion, regaining strength, regaining endurance, and performing sports-specific exercises. A full recovery is the ability to move any way you want with your shoulder, without feeling reserve, pain, or fear. After surgery, some people have levels of function that are lower than others. This depends on their goals and lifestyles. A person's overall function postoperatively depends on the trauma found and treated during surgery, the body's response to surgery, and the body's genetic potential to heal.
In addition to the quality of tissue within the joint, the quality of the repair during the surgery, the person's pain tolerance, the work of the physical therapist, and home exercises performed by the patient. Sometimes, patients will stop getting better before gaining a level of function that allows participation in sporting events, or before reaching pre-injury function.
Using their knowledge of the human body, physical therapists utilize their hands and modalities to encourage blood flow to the area and fluid reabsorption in the area to diminish swelling and help pain relief. This includes electronic, ultra-sonographic, continuous passive motion, etc. They help educate the patient about exercises and activities that can be done to increase function and decrease pain.
Before starting a home exercise program and physical therapy sessions, warming the shoulder makes tissues more pliable and flexible. This can help alleviate stiffness. The warmth increases blood flow to the area and will help soften up some scar tissue formations.
After the movements of therapy or home exercises, there may be bleeding or increased fluid in the area. While at therapy or during home exercises the joint may reach places it has not been in quite some time. After the exercise program is finished, the individual can apply ice to help cool down the stretched-out tissues and diminish the pain and the swelling that may ensue if small scar tissue bands have been broken during the exercise.
Acute Phase - Phase 1 (Reduce Pain and Swelling)
About one to two weeks postoperatively is when rehabilitation begins. Passive range of motion, manual therapy, gentle rhythmic stabilization exercises, scapular stabilization exercises, and modalities are used as needed to reduce pain and increase range of motion. The individual will be instructed in the use of a sling. Modification of daily activities is reinforced to maintain and/or protect the integrity of the repair.
Intermediate Phase - Phase 2 (Initiate Active Range of Action and Activity Tolerance)
In order to continue healing the soft tissue, exercises are introduced to increase active motion. The full passive range of motion is gradually restored during this phase. Manual therapy and modalities are used as needed to continue to reduce pain and inflammation. The use of a sling is gradually diminished, with instruction to not overstress the healing tissues.
Advanced Strengthening - Phase 3 (Increase Muscle Strength and Endurance)
At the stage of healing, the patient should have a full passive and active range of motion. Exercises for joint strength and endurance are progressed here and more dynamic joint stabilization exercises are introduced. Manual therapy and modalities are used as needed. The exercises include eccentric contractions, proprioception, neuromuscular re-education, and multi-joint and multi-planar endurance exercises. The exercises are based on patient goals and occupational demands.
Return To Sports - Phase 4 (Return to Sport)
For the patient to return to their previous level of sports participation, advanced strengthening to increase muscle strength, power, and endurance are implemented. The maintenance of full, non-painful active range of motion and full strength is essential. Sports-specific loads and plyometric activities are then applied to the joint. Plyometric exercises enhance dynamic stability and proprioception. They should be chosen based on sport-specific demands.
