The Three Phases of Care
After my back surgery I began the long path to being whole. I began physical therapy immediately upon leaving the hospital and now am continuing to go regularly. My Physical Therapist, Corey Huff, the brains behind this article, and a therapist at Saylor Physical Therapy in Palm Beach Gardens, Florida, asked me what my goals were. “Simple,” I said. “I want to go back to playing pickleball, golf, and old man’s softball. He smiled that knowing smile of his, having faced many patients like me who are anxious to resume the life we led but without remembering how long ago it was since we were 100% — nor realizing how far away we are from reaching our goal.
At my most recent appointment I explained to Corey — and myself — that I was so much better. I could do all of the exercises he gave me and I didn’t always hate him the day after the visit. Corey then made it clear that there’s a difference between rehabilitating your body after surgery versus getting your body ready to resume playing sports.
“The way you have been working in the clinic is not the same as how you are using the muscles in sport,” he reminded me. Oh how right he is as I tried to play a little golf and even a little pickleball. Softball, even old man’s softball, is still a bit scary to me. But as Corey said, hoping to keep my spirits up, “You have to start somewhere. And in an ideal world, we would work you through, roughly, 3 phases of care.”
Three Phases of Rehabilitation
Phase 1: The acute phase. When recovering from an injury or surgery, regardless of the body part affected, the first phase is the acute phase. “In your case,” Corey says, “it was post-operative. And here we are simply trying to manage pain and allow for healing, while getting you to use muscles that haven’t been used much and may have atrophied.”
Phase 2: Functionality. In the 2nd phase according to Corey, when ideally, pain is under control, “we can start to load the muscles more. Here’s where we apply resistance, increase repetitions, ease functionality and mobility, gain speed, and work on endurance.”
Phase 3: “Once you have the foundational strength, we would work into more of a ‘sport specific’ phase. Here is when you would work on the types of movements required for your sport. This includes more of that deceleration, explosiveness, and multiplanar movements. We’d also increase your speed and get your body more able to handle the impact and the kinds of stress placed on your body when you’re landing or running.”
Time is your friend, he tells me, as long as you keep working. Although these phases are not necessarily linear — they can be fluid as we advance into the late stage of phase 2 and early stages of phase 3 — it’s going to take more time than he knows I want it to take. My surgeon always reminded me that it took months or years to get to the current limitation, so it’s going to take me more than just a few weeks to get back to where I was in my strength, mobility, and certainly my endurance. Unfortunately, Corey laments, and mostly due to limitations by insurance or time commitments, patients don’t always make it to that third phase.
Insurance, whether it’s Medicare or private insurance, will likely limit its coverage to getting patients able to successfully navigate the activities of daily living. “Despite its popularity, pickleball is still not a covered activity of daily living,” Corey joked. “While you’re welcome to continue therapy, and there is a lot more we can do, it would be on a self-pay basis, something few patients can choose.”
So I study the videos and try to set up a regimen of exercise where I’m repeating what the professionals have taught me. And I go out to the court or the field or the course and push my body to play the game I told my therapist early on was my main goal. With any luck, the work I had done while being supervised by the PT will have been enough to keep me on the right path and prevent injury. If not, well, I’ll just have to get a new prescription!