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How the “3 Phases of Recovery” Dictate Your Recovery
October 20, 2016
Just a few months ago, I had a patient come for her first PT appointment for pain in her left ankle, and this was how her story went:
= = = = = = = =
“I’m very active and walk frequently at work.  Then one day I developed pain along the muscle tendons behind my ankle…
 
My doctor referred me to a foot specialist, who stuck me in a walking boot for 4 weeks. After 4 weeks in the boot, my pain was gone…
 
BUT, when I took the boot off and started walking normally again, not only did my ankle pain come back, but it was even worse than before…
 
Now I’m back at square one!”
= = = = = = = =
Before this young lady (about 25 or so) even committed to coming in for PT, she interviewed us to see if we could help her.
And this is basically what I told her: when her doctor put her in the walking boot to take the strain off her ankle muscles, they successfully allowed the muscles to rest and for the irritation to subside…
BUT, and this is a big BUT, when she took the boot off and resumed her normal vigorous walking, she essentially took her ankle muscles from 0 to 60 mph, which put her right back where she started (and even a little worse).
So what’s the moral of the story? And what did her doctor’s approach leave out?
Answer: they neglected what we call the “3 Phases of Healing”.

What Are the 3 Phases of Healing?

  • Phase 1: Minimize Pain & Inflammation
  • Phase 2: Restore Mobility, Flexibility & Strength
  • Phase 3: Return to Normal Activity & Prevention of Future Injury
Can you tell where this young lady got messed up…?  She went from Phase 1 straight to Phase 3 and completely skipped the progressive stretching and strengthening that she should’ve been doing in Phase 2!
When you look at her recovery from this perspective, you can understand why those muscle tendons in her ankle got so irritated when she came out of the boot and went straight back to walking around 10,000 steps/day.
Now, you may be thinking that the 3 Phases make great sense for this lady with her ankle pain, but what about your shoulder pain or your low back pain?
Here’s the good news: this framework can be applied to any type of injury and pain.
Let’s take someone for shoulder pain as another example.  One of the most common complaints we see in the clinic is people with “insidious” shoulder pain.
That’s a fancy way of saying that these people have ongoing pain in one or both shoulders but didn’t suffer from any specific injury and typically have no idea what’s causing their pain.
And in most cases, these people have irritation of their rotator cuff muscles.  Now, if we try to start with some aggressive stretching and strengthening on their first visit, what do you think will happen…?
If you said something like “their shoulder is going to be really upset” or “they won’t be coming back for their next visit”, you’re exactly right!
Because by skipping to the exercises that should come in phase 2, we’ve kept them squarely in phase 1 (irritated and upset).
So what do we do instead? We acknowledge that we need to respect phase 1 and spend some time figuring out how to get out of it.  This usually includes identifying aggravating activities, which we eliminate or greatly reduce, in order to bring the pain level down.
If the person with shoulder pain can identify 3 specific movements or activities that increase their pain, we can temporarily avoid these movements until we get out of phase 1.
Once in phase 2, we can now comfortably start working on building their flexibility and strength, and then we can advance to phase 3, where we make sure that all of those previously painful movements and activities are comfortable again.
Sounds really simple right?  In most cases, the approach is quite simple, but the execution can be trickier.  And of course, that’s where physical therapy really comes into play.
I hope this article has helped shed some light on how you can manage your own pain or injury.  And if you need help getting through the 3 phases or figuring out why you’re stuck in phase 1, please give me a call at 509.892.5442 or email me at Luke@GordonPhysicalTherapy.com.
Best of luck!
-Luke

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Gordon Physical Therapy Spokane Valley

626 North Mullan Road #4, Spokane Valley, WA 99206

(509) 892-5442

© 2022 Gordon Physical Therapy

Monday   7:00 am - 6:00 pm

Tuesday  7:00 am - 6:00 pm

Wednesday  7:00 am - 6:00 pm

Thursday  7:00 am - 6:00 pm

Friday  7:00 am - 5:00 pm

Saturday  Closed

Sunday  Closed

Gordon Physical Therapy Spokane Valley

626 North Mullan Road #4, Spokane Valley, WA 99206

(509) 892-5442

© 2022 Gordon Physical Therapy

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