Functional rehabilitation

Functional rehabilitation refers to a comprehensive treatment program, which aims to return athletes or non-athletes fully to their previous level of activity. In athletes, this includes the progress from fairly simple activities like jogging or walking to highly demanding sport-specific activities .

Typical protocols or concepts consist of different stages or phases, which build on each other. Progression from one phase to another within the rehabilitation protocol will require a certain amount of tissue healing, different degrees of pain control range of motion as well as successful an uneventful completion of the previous phase. Programs and protocols need to be designed with respect to the injury and related activity or sport and decisions have to be made with regard to the type, order, intensity and set number of exercises as well as resting periods .

Initial post-injury phase

Usually, the initial phase after the injury aims to protect the injured tissue, to prevent progression and to minimize pain and inflammation. For most uncomplicated ligamentous or muscle injuries, this period will usually last from 24 hours to one week and will end as soon as symptoms have improved enough for simple non-athletic activities.  For the subsequent management steps, it is important that the accurate diagnosis is established during this phase.

Recovery  phase

The second phase usually starts with the recovery from the acute symptoms and with the tolerance of basic non-athletic activities. This stage focusses on gradual progression in recovering the full range of motion, strength, agility and endurance.

During this phase, the rehabilitation aims at performing simple physical tasks rather than complex specific functional movements. This usually involves range of motion and flexibility training as well as specific exercises focusing on proprioception and neuromuscular control. Later balance training reflex control progressive strengthening and endurance exercises are added. It should also address potentially modifiable movement patterns possibly adding to or impairing the injury, including altered biomechanics, antagonist muscle imbalances. Rehabilitation activities and exercises directed at optimizing the kinetic chain might also be started during this phase.  This period usually ends when basic activities and range of motion exercises can be performed symptom-free and strength, agility and other basic performance parameters are near-normal.

Functional phase

The subsequent phases target the re-development of complex functional movement patterns with specific exercises and drills as well as integrated training. It also includes power and endurance training to return patients fully to their previous level of activity. This period should also reiterate and emphasize corrective strategies with regard to avoidance of reinjury and bring back athletes to their usual pre-injury performance. The decision when athletes are able to return to their sportive activity is done during this period, but this should be done gradually and care needs to be taken that athletes are not yet ready for full competition and still at risk for reinjury.