Rehab to Performance – Recover Stronger After Surgery

Physical therapy, in a lot of ways, has made great strides as a profession in post-surgery rehabilitation and generating good outcomes for patients. Unfortunately, traditional rehab often stops at basic function and only begins to scratch the surface of performance.

The concept of “rehab-to-performance” goes well beyond the standard recovery exercises and instead takes a full holistic approach in helping patients to come back even stronger than before. By incorporating performance physical therapy into rehabilitation, patients seamlessly progress from recovery to strength-building, ensuring they regain both function and resilience. Rather than simply healing, they emerge more prepared for what life throws their way.

The Importance of a Structured Recovery Plan

Why does a structured rehabilitation plan matter?

• Reduces the Risk of Re-Injury – A phased progression helps rebuild stability and strength, preventing any potential setbacks.
• Restores Mobility, Strength, and Endurance Safely – Exercises are carefully designed to address deficits without overloading healing tissues.
• Supports a Gradual Return to Peak Performance – A step-by-step approach transitions individuals from basic movement to high-level activity with confidence.

Key Phases of Recovery

Acute Phase

Goal: Managing Pain and Restoring Movement

In the initial phase following an injury or surgery, the focus is on managing pain, reducing inflammation, and restoring basic movement. This phase typically lasts from a few days to several weeks, depending on the individual’s condition. The primary objectives include controlling pain and swelling, maintaining joint mobility through assisted and passive movements, and preventing muscle atrophy with low-intensity muscle activation. These foundational steps set the tone for a smooth recovery.

Strength Phase

Goal: Rebuilding Stability and Function

As pain decreases and mobility improves, rehabilitation progresses to the Strength Phase. This stage emphasizes controlled loading to promote tissue healing while reinforcing proper movement mechanics. Gradual introduction of resistance and weight-bearing activities helps in regaining strength, endurance, and coordination. Incorporating balance and stability training is crucial during this phase to prevent compensatory movement patterns and ensure a comprehensive recovery.

Performance Phase

Goal: Preparing for Return to Activity

The final stage of recovery focuses on preparing individuals for the physical demands of their specific activities, whether they involve sports, work, or other daily tasks. This phase introduces sport-specific drills and high-intensity movements to ensure a seamless transition back to peak performance. Emphasis is placed on enhancing speed, strength, and endurance through various exercises and drills. Reintegration into sport-specific training ensures the body can handle the dynamic demands of real-life situations, facilitating a confident and safe return to previous activities.

The Role of Performance Physical Therapy in Post-Surgery Rehab

Performance physical therapy goes beyond traditional rehab. Isolated muscle work is fine when you’re setting a foundation, but functional movement is where you’re implementing those gains. Custom programs implement proprioception training, reaction drills, and movement refinement tailored to the activity-specific demands.  This gradual exposure addresses the root cause of these limitations while enhancing muscle control, flexibility, and endurance. Of course, all these concepts fall under standard return-to-play protocols for safe progression and prevention of future injuries.

Recovery Exercises for Post-Surgery Strength-Building

Early-Stage Exercises (Mobility & Activation)

• Gentle range-of-motion movements
  • Ex. Wall-assisted shoulder flexion for rotator cuff repairs
• Isometric muscle engagement
  • Ex. Quad and hamstring isometrics for many types of ACL reconstructions
• Balance and stability drills
  • Ex. Single-leg balance following a knee meniscectomy

Mid-Stage Strength-Building Exercises

• Resistance band work
  • Ex. Banded 90/90 external rotation in the shoulder following a labral surgery
• Bodyweight exercises
  • Ex. Light-weight goblet squats or RDLs after an ACL repair
• Core engagement for stability
  • Ex. Light-weight farmers carry for a lumbar spinal fusion (when appropriate)

Late-Stage Performance Training

• Plyometrics for power development
  • Ex. Box Jumps and Multiplanar landing for ACL reconstruction
• Speed, agility, and sport-specific drills
  • Ex. Tempo Skater Jumps working on bounding for a hip labral repair
• Strength training with progressive overload
  • Ex. Barbell Sumo Deadlift High pulls for rotator cuff repair

Bridging the Gap: From Rehab to Full Performance

The process of returning to full performance after an injury is about more than just physical healing. It’s about ensuring that athletes can safely transition back to their sport with confidence and strength. Three essentials are needed for a proper “Return to Sport” Checklist:

1) Pain-free movement in all necessary ranges

2) Strength and endurance equal to or greater than pre-injury levels

3) Confidence in movement and the ability to handle sport-specific demands

Physical therapists play a vital role in customizing rehab for each athlete’s individual goals. They consider the specific demands of the sport, the athlete’s training load, and their biomechanics to create a tailored rehabilitation plan. Additionally, mental recovery is equally important. Regaining confidence in movement and trusting the body to handle the demands of the sport again is essential for a successful return to full performance.

What are some common pitfalls to avoid in post-surgery rehab?

• Skipping the last stages of rehab leads to chronic issues
• Pushing too hard, too soon, increases re-injury risk
• Ignoring mobility work reduces long-term strength potential
• Not addressing compensation patterns causes imbalances that may result in secondary injuries

Stacey’s Success Story:

Stacey was a mid-thirties Physician Assistant who was a mother of two, coach at her local Crossfit gym, and someone who made fitness a part of her daily life. After simply landing oddly while coming down from the pull-up bar, she felt a sharp pain in her knee and immediately felt it buckle as she fell to the ground. Stacey had suffered the first major injury of her life – an ACL tear.

After undergoing surgical reconstruction, Stacey worked so hard within the parameters of what fell under her protocol, building strength and stability from each stage. Seeing her determination and desire to push the envelope, her therapist programmed recovery WODs in the form of EMOMs which invigorated her spirit. Although she was still limited, she was participating in the same format of her normal training routine.

As Stacey progressed, gradual re-integration of barbell movements and plyometrics littered the recovery EMOMs in her therapy sessions. Unfortunately, one major factor had not been addressed – she had yet to actually jump down from the pull-up bar. She had disclosed that it was a mental hurdle she had yet to take on since really finishing out the final stages of her rehab. With elevated surfaces, more eccentric landing training, and visualization, Stacey and her therapist tackled that final obstacle.

Through a holistic approach, athletes can bridge the gap between rehab and peak performance, ensuring they’re ready to compete at their best. Tactful and concise implementation of strength, mobility, and activation can lead to tremendous strides in optimal performance

Seek out professional performance physical therapy for a structured and effective recovery every step of the way.

Book a consultation with our team of Doctors of Physical Therapy to build your custom post-surgery rehab-to-performance plan!