Why Rehab Goes Wrong & The Real Reason Patients Pain Comes Back

Posted By: Andy Barker

When rehab goes wrong it is frustrating for your patient and for you as their therapist.

Usually this happens at two distinctive time points during the rehab plan.

It is either at the very start of the treatment plan or when patients go back to higher-level activities, like running.

Problems at the start of treatment plan, are largely the result of problems relating to your assessment, when you maybe have not been able to identify exactly what the patients real problem is and as a result, you are unable to get to grip with their initial symptoms.

More commonly, problems arise when patients go back to higher-level activities like running, the gym, back to work or return to sport.

Why is it when some patients and athletes return to these activities they break down?

You think you have progressed their rehab well…

…you have taken them from the bed to standing rehab, added resistance or gym-based exercises…
…they feel stronger, fitter and you think they are ready to go…

…but when they start running, when they get out on the field, go back to work or back to the gym their symptoms quickly return, and they are back in your treatment room asking you why…

Whilst there are numerous reasons why, there are some fundamental errors New Grad’s often make that are contributing to this problem.

This blog will discuss some of these issues and help you to understand how you can better serve your patients and reduce the chances of them having problems when they return to higher-level activities.

Get With The Plan

On the face of it, this is probably my BIGGEST success story as a therapist so far in my career.

I had a professional rugby player who had suffered a posterior shoulder dislocation in a game, and we were able to get him back on the field 7 days later.

It was that hard to relocate his shoulder he had to be taken to hospital and put under a general anaesthetic to put it back in place!

And this was not just any game…

This was a Grand Final; the biggest game of the season and he played the full 80 minutes in a winning team…

…just 7 days after being put under and his shoulder relocated in theatre.

Whilst this is an extreme example, a BIG turnaround and a great outcome, in what was a high-pressure environment…

It was easy…

What we did was simple…

Having completed the rehab steps we did that week we were confident he would get through the game.

It still was a BIG risk…100% but, with the right plan, executed well, we gave ourselves the best possible chance for the best possible outcome.

It all started with a plan.

The first thing we did at the start of that week was devise a plan to give the player the best chance of making the final.

Whether your patients’ rehab will take 1 day, 1 month or 1 year, you need a plan.

Unless you and your patient know what this plan is and the steps needed to take them from injury and back to their goal (sport, work, running, gym…) then it will always be difficult.

Having a plan takes out the guess work, stops you having to treat or prescribe exercises on the spot and helps keep your patients’ motivation and adherence to the plan.

I used the exact same ‘6 Step Rehab Plan’ with this professional rugby player that I use every day in my private practice or in the other sports I work with now.

It is the same rehab plan I teach in my New Grad Physio Membership and on my Lower Limb and Upper Limb Courses.

It is my blueprint for success.

It gives order and structure to my rehab, so I know how to progress (and regress) rehab, whilst being flexible enough to be used in any environment, with ANY patient or athlete.

This might be an elite athlete post shoulder dislocation preparing for a Grand Final or a middle-aged housewife struggling to sleep because of shoulder impingement.

Time Is Of The Essence

When I help New Grad’s with tricky patient cases, one common rehab error comes up time after time.

Whilst they have progressed their patients well through the rehab plan, they have progressed through the steps too quickly.

The body needs time to adapt.

If you progress too quickly through rehab you may not give your patient the time they need and that might cause their symptoms to return.

The body and the nervous system need time to adapt.

The time is needed to adapt to that new stimulus, that new load you have placed on the body, or you risk regression in patient symptoms.

The return of symptoms, like the return of pain or the loss of movement, is the body’s way of telling you it is not ready to progress.

There is no such thing as ‘accelerated rehab.’

You cannot skip steps with rehab.

You need to be respectful of the injury they have and the time that may be needed between steps to allow appropriate body and nervous system adaptation.

Mimic The End Goal

End stage rehab MUST replicate the end goal.

If you don’t expose your patients to something close to the activity you are sending them back into then it’s a lottery if they will be able to tolerate it or not – you have NO idea!!!

With the pro rugby player I was rehabbing for the Grand Final I needed to do that contact work with the player as part of his rehab, as obviously he was going to need to use his shoulder in the game, to tackle, by tackled, pass, catch and maybe even be put in a similar position that he injured his shoulder in the first place.

It would have been really DUMB of me not to do that and I certainly wasn’t going to risk the players long term health and career, my own reputation and the possible negative impact the player’s poor performance might have had in the teams biggest game of the season (and some players careers).

But by exposing the player to these situations as part of his rehab, we were confident that he was ready, and the rest is history.

Key Points

Get With The Plan: Without a plan it is almost impossible to know how to progress your patient and if your patient isn’t clear about how the plan will help them make a full recovery then you might struggle to keep them on track with their treatment plan.

Allow Time For The Body To Adapt: The body and the nervous system need time to adapt. Do not rush through rehab steps if your patient is not ready and allow them the time they need to adapt, or risk re-injury.

Mimic The End Goal: Include activities that are as close to the patients end goal as possible so you know they are ready and can tolerate the activities you are letting them return to.

Thanks for reading


>>> I detail the exact rehab method I used with the case study in this blog on my New Grad Physio Upper Limb Course.

On the course you will learn how to use this very same method yourself to take ANY upper limb injury through a full treatment plan, from start to finish, irrespective of the end goal.

So whether you have an elite athlete preparing for a final or an NHS patient with an upper limb or neck problem wanting to get back to work, you will have full confidence about how to structure their rehab and when they are ready for those higher level activities.

You can find out more information here www.newgradphysio.com/courses

If you don’t want to wait for my next event and want to access to this course right away get in contact with me at andy@newgradphysio.com and I will show you how.