Phases of Rehab - Acute

Good Morning! And of course, Happy Monday! For us at Florida State, spring ball is here, with our first practice today! I’m excited for our guys to get a ball back in their hands. As well as for some of the newcomers to finally get to show their talents at the next level.

The inevitable and unfortunate side to this coin is that there may be some injuries throughout spring ball. Thats why today, and as we go through spring ball, I will be breaking down how I systemize and think about stages of rehab in a rehabilitation series.

I break rehabilitation down into 5 stages:

1. Acute/ Inflammation

2. Movement Literacy

3. Plyometric

4. Return to Play

5. Return to Performance

These are specifically for athletes, but can be applied to general orthopedics and other specializations of physical therapy. Today, I will be diving into the first stage, the Acute Phase.

*The injuries discussed in this newsletter are for general educational purposes only. I am not affiliated with the athlete’s medical team, and the information shared does not reflect any insider or team medical details. Specifics about the injury are often unavailable, which can significantly influence the estimated timeline for return to play.

Why Have Phases?

Before we get into the nitty-gritty of the acute phase, I wanted to explain to you why its important to establish phases in the first place. I’m sure you can think of plenty, but there are two big reasons I want to bring up.

Number 1, and extremely important in a sport’s team setting, is communication. Communication is key for the success of our athletes, whether thats within sports medicine, across the different disciplines of sports performance, or with coaches. It is important that everyone working on that specific athletes case are all on the same page. That will increase the success of the rehab and return to play. As well as prevent over or under taxing the athletes physically and mentally. Having different phases of rehab allows you to communicate in the same language for smooth transitions with the athlete and knowing where they are in their rehab process.

Number 2, it allows you to have a north star within your day to day programming. If I know this athlete is in the acute phase or in the return to play phase, the rehab will look very different. Maybe the acute phase’s dial will focus on modalities to reduce pain and isometrics while in the return to play phase, isometrics will just be a warm up and modalities not even included. My mentor once said, “if you don’t have phases in rehab, you’ll eventually catch yourself randomly choosing instagram workouts for your athletes.”

Acute Phase

The Acute and Inflammation phase is the first phase of rehab, hence “acute.” In this phase, the athletes body has just began the inflammatory response from the trauma. The main goal of this phase is to protect the healing tissue and control the body’s inflammatory response so healing can start properly.

After an injury, the body begins the inflammatory stage of tissue healing. Bleeding and clotting begin at the injury site and inflammatory cells migrate to the area. These cells clear damaged tissue and bacteria. Chemical signals trigger swelling, pain, and heat at the injured sight.

*Due to my professional association with the Atlanta Falcons during preseason and my current role with the Florida State Seminoles, I will not provide educational content or commentary on any injuries within these programs during or after the season.

In this stage of rehab, outside of protecting the healing tissue, the biggest goal is to reduce swelling and pain. Reducing these two will allow for the muscle around the injury to create a better contraction.

Swelling in a joint can cause whats known as arthrogenic muscle inhibition. This is the shutdown of a muscle acting on a joint due to the intrarticular swelling within it. When the swelling accumulates in the joint, the capsule stretches, mechanoreceptors within the joint become highly stimulated sending signals to the spinal cord which results in the spinal cord reducing motor neuron excitability to the surrounding muscle as a protective mechanism. The less motor neuron drive, the weaker the muscle contraction.

Muscle inhibition can occur from pain. Pain travels to the brain via nocioceptors causing a reduction in motor neuron excitability decreasing the drive from the brain to contract the muscle. And the same concept occurs, the less motor neuron drive, the weaker the muscle contraction.

Therefore, the biggest goals of this stage is to reduce swelling and pain to allow for appropriate muscle contraction while protecting the healing tissue so we can move on to the next stage. These modalities can include compression, ice, heat, some pain free range of motion, soft tissue mobilization, and much more if the athlete finds a reduction in pain. We can also include light isometrics at 25-50% max voluntary isometric contraction (MVIC) to begin building strength (getting the brain to activate more motor neurons).

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