Patients often have unrealistic expectations regarding their rehabilitation prognosis and symptomology throughout each stage of the healing process. Personally I am constantly looking for better visual depictions to explain their prognosis. Rod Henderson, Physical Therapist practicing outside of Houston, TX, uses this graph in his clinic. It is honest, realistic, and easy to follow for patients and healthcare practitioners alike.
During the first 12 weeks following trauma or onset of symptoms, patients are generally getting improving. From a physiological perspective, collagen is maturing, remodeling, and getting stronger. In this stage they are almost solely attending physical therapy and performing corrective exercises. At the end of 12 weeks, patients will have gotten 60-75% better. Individuals who perform sedentary jobs should be back at full duty; more strenuous jobs are still on modified duty.
From 3-6 months the patient usually begins their normal gym routine while performing rehabilitation concurrently. I generally think of this phase as someone attending PT 1x/week and performing their gym routine 3-4x/week. The individual is starting to feel significantly better, but they have not reached full strength yet. They still have some discomfort (not necessarily pain), but something is 'not quite what it used to be.' Ultimately, they still need more work!
From 6-9(12) months, the individual has typically ceased their formal rehabilitation program. They are now performing their normal gym routine and daily activities. The individual continues to progress strength, mobility, flexibility, but now has all the tools needed to be independent. The occasional flare up may occur, but is not anticipated. At the end of the 9-12 months, they should have reached life as usual.
I find this graph particularly useful because many patients do not realize how long rehabilitation takes. Most of my patient's have 'high pain tolerances and recover faster than the normal person." Strengthening and retraining movement patterns takes months. Reaching 100% pain free and 'normal' activity generally takes longer than someone anticipates. Being honest and giving appropriate education early on can change a patient's outlook on their condition. Use this graph when educating your patients! Thank you Rod.
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