Treatment and Rehabilitation
Match the Modality to the Phase of Healing
Rehabilitation questions test whether you can set goals that match tissue biology. The acute/inflammatory phase (roughly days 0-4) aims to control pain, swelling, and further injury: protection, relative rest, ice, compression, elevation, and gentle pain-free motion. The proliferation/repair phase (roughly days 4 to 3 weeks) adds controlled loading, range of motion, and early strengthening. The remodeling/maturation phase (weeks to months) emphasizes progressive overload, sport-specific power, and return-to-play testing.
Know modality parameters and, more importantly, contraindications. Cryotherapy reduces pain and metabolism but must be monitored for sensation and cold hypersensitivity; superficial heat increases blood flow and is inappropriate in acute inflammation. Ultrasound uses continuous mode for thermal effects and pulsed for nonthermal; avoid growth plates, the pregnant uterus, malignancies, and areas of impaired sensation. Electrical stimulation can manage pain (TENS) or re-educate muscle (NMES); never cross the chest or place electrodes over the carotid sinus, the heart, or a pacemaker.
Therapeutic exercise progresses from passive to active-assisted to active to resisted, from isometric to isotonic to isokinetic and plyometric, and always includes proprioception and neuromuscular control. Return to play requires full pain-free ROM, strength near the contralateral side (commonly 90% or better), normal functional testing, and psychological readiness.
Trap: no pain, no gain is wrong. Pain that increases during or after exercise, or that lingers, signals excessive load.
Rule of thumb: choose the intervention that matches the healing phase and the patient's irritability, not the one that sounds most aggressive.