Stages of Rehabilitation | Medvarsity

Summary

The video explains how rehabilitation progresses from targeted intermediate exercises to sport-specific preparation, while emphasizing individualized assessment, appropriate loading, and patient adherence.

Intermediate rehabilitation

This phase may begin around day five and continue for several weeks. After surgery or an ACL injury, it may last eight to ten weeks or longer. The program should be based on examination findings rather than a one-size-fits-all routine.

• Use movement and sensory feedback: Neuroplasticity or motor-control training may include mirror feedback, video analysis, or a metronome to help the athlete coordinate movement and engage the motor cortex.
• Address flexibility selectively: Assessment tests help identify which muscles need stretching and which need strengthening. Exercises should be prescribed for the individual rather than applied uniformly.
• Build strength and endurance progressively: Progress from isometric exercises to isotonic work and varied resistance.
• Add balance and proprioception: Increase the challenge gradually—for example, by standing on one leg, closing the eyes, or using an unstable surface.

Example: Hamstring tendinopathy

For pain near the hamstring’s attachment at the sitting bone, hip flexion may compress and irritate the tendon. The presenter therefore recommends strengthening without initially placing the hip in a position that aggravates it.

• Bridges and hip-extension exercises can work the hamstrings without substantial hip flexion.
• Abdominal and hip exercises should be chosen to avoid excessive compression at the tendon attachment.
• Resistance-band exercises such as hip abduction and external rotation can build strength while keeping the hip out of aggravating positions.

Assessing instability and hypermobility

The presenter stresses that instability should be evaluated through history-taking and objective examination.

• Ask about a history or signs of generalized hypermobility, including possible Ehlers-Danlos syndrome.
• Observe how the person sits, stands, and moves. Frequent shifting or difficulty maintaining a stable position may be relevant.
• Use the nine-point Beighton scale to assess hypermobility.
• Ask about other possible indicators, such as unusually elastic skin or a history of needing more local anesthetic at the dentist. These are clues to consider, not substitutes for an examination.
• Confirm instability with appropriate clinical tests. Examples mentioned include the shoulder apprehension test and tests of knee and ankle stability.

Starting strengthening after a rotator cuff injury

Rehabilitation should generally begin as early as appropriate; the patient does not necessarily need to wait until all pain has disappeared. Pain can help guide the amount of exercise.

• Start with low-irritation movements, often isometric exercises in a neutral position. For example, push gently against a wall for shoulder abduction or flexion, or use the opposite hand to resist rotation.
• Avoid aggravating positions, especially overhead activity. The presenter advises avoiding elevation beyond 90 degrees in acute or intermediate stages when it provokes symptoms.
• As a general guide for shoulder or other upper-quadrant exercises, keep pain mild—around one or two out of ten—and check that symptoms have not worsened the following day.
• If pain increases substantially or remains worse after 24 hours, reduce the load or exercise volume.
• The presenter’s general practice is to give patients at least one manageable exercise, even early in rehabilitation, so they have something to do to help manage symptoms.

Late rehabilitation and return to sport

Late rehabilitation can occur over a broad period—from early after injury to many months later—depending on the injury, surgery, and the athlete’s goals. The focus shifts toward preparing the person for the physical demands of their sport.

• Develop power, speed, agility, and functional movement.
• Assess biomechanical loading patterns and progressively make exercises more demanding.
• Reproduce the conditions and fatigue of the sport rather than judging readiness only in the clinic. For a swimmer, for example, this could include seeing how many laps they can complete without symptoms.
• Examples of higher-load exercises include resisted bird dogs, weighted Bulgarian split squats, weighted step-ups, and side planks with hip abduction.

Managing exercise load and adherence

The presenter recommends keeping programs manageable and progressing them deliberately.

• Promote adherence: Explain the purpose of exercises, teach correct technique, and limit the daily program to roughly four to six exercises or about 15–20 minutes.
• Use pain and movement quality as feedback: A painful functional movement—such as stepping down with knee pain—may signal that the movement or mechanics need adjustment. The presenter gives different general pain allowances for different contexts: no pain during some functional loading tasks, mild pain for upper-body exercise, and up to four out of ten for lower-body exercise, provided symptoms do not worsen over the next 24 hours.
• Distinguish excessive load from a “wrong” exercise: Increased soreness the next day may mean the exercise dose was too high or progressed too quickly, rather than that the exercise itself was unsuitable.
• Progress through a loading sequence: Begin with stabilization or motor control, then build strength, and finally power. Higher-load power work generally uses fewer repetitions and requires more recovery. The example progression moves from three sets of 15 repetitions toward heavier sets with as few as three repetitions, while reducing training frequency as load increases.

Speakers and sources featured

• Dr. Tanya Bell: Main presenter, discussing rehabilitation principles and answering questions.
• Unnamed moderator/host: Introduces audience questions and manages the session.
• Audience members: Ask questions; one is addressed as “VC,” while other names are unclear in the subtitles.
• Sources or resources mentioned: The Beighton scale, clinical instability tests, general current research on early rehabilitation, the presenter’s rehabilitation software, and the Brukner and Khan sports rehabilitation text.