Rehabilitative Exercise and Therapeutic Procedures
Match exercise to the healing phase
- Inflammatory (approximately days 0–5): protect the tissue, control pain and edema, maintain range in uninvolved segments, begin submaximal isometrics.
- Proliferative (approximately days 5–21): controlled loading, gentle active range, introduce light resistance.
- Remodeling/maturation (beyond 3 weeks): progressive resistance, eccentric loading, power, proprioception, and return-to-function training.
Principles that generate exam answers
SAID (specific adaptation to imposed demands), overload, specificity, reversibility, and progression. Exercise order typically runs range of motion, then strength, then endurance, then power, then functional/skill work.
Open versus closed kinetic chain: in closed-chain exercise the distal segment is fixed, producing more joint compression and co-contraction (squats, wall slides); open-chain exercise has a free distal segment and produces more shear (knee extension).
Traps
Stretching aggressively or applying heat during acute inflammation; prescribing resistance before adequate range and pain control; calling delayed-onset muscle soreness a lactic acid problem (it is not, and it peaks 24–72 hours after unfamiliar eccentric work); and forgetting that eccentric training is the mainstay for tendinopathy.
Worked example
A patient with patellar tendinopathy, 6 weeks post-onset, wants to return to jumping. Prescribe progressive eccentric or heavy-slow quadriceps loading 2–3 sessions weekly, 3 sets of 10–15 repetitions at a load producing mild discomfort that settles within 24 hours, advancing load roughly 5–10% weekly once symptoms are stable.
Rule of thumb
Progress one variable at a time - volume, then intensity, then speed - and let the 24-hour symptom response decide whether to advance or hold.