Rehabilitation – Repair and Remodeling Phases

Usually these phases are separated. However, repair and remodeling do occur simultaneously if the muscle is taken care of properly. Thus, I am grouping everything together.

The body in this stage is basically repairing what damage it can, breaking down what it cannot repair, forming scar tissue and laying down new tissues.

This phase begins within about 48-96 hours after injury; however, we are going to take a bit more conservative measures. Basically, once the tissue starts to feel better with your movement that you are doing everyday from the acute phase, and the swelling is reduced we can consider ourselves in this phase.

1. Keep up the fish oil supplementation.
This is important again to help keep excessive inflammatory processes down. Vitamin C and B complexes in large amounts as well as enough of vitamins A, E, and other anti-oxidants are great.

2. Start using heat instead of ice.
Since the swelling is reduced and the anti-inflammatory fish oil should keep it in check, we can move towards heating up the muscles.

The benefits of heating is that it helps increase blood flow to the muscles. Heat will also loosen up the tightened muscles to allow improved movement capabilities. Keep up the painless movement.

3. Maintain the massage, but add light stretching afterwards
The massage is to be maintained, but the main focus of it now is to loosen up the tight muscles. Add in very light stretching work after to help increase the range of motion. This is in addition to the already frequent painless movement.

The massage + stretching here can be deeper, but still not harder to cause pain. You can start to hit those deeper tissues and stimulate blood flow to them as well as help reorganize the tissues more correctly.

Programming in this phase may follow these steps:

1. Heat to the affected muscle (10-15 minutes)
2. Massage to the muscle (10-15 minutes)
3. Light stretching focusing on improving range of motion without pain (5-10 minutes)

Restarting exercise
Like in tendonitis we first want to start with very light weights to give us a good degree of control over the movement to make sure we do not restrain. Remember, we are only a couple days or weeks out from major damage to the muscles, so it will be very easy to reaggravate it.

If it is possible to do some isolation work with the muscle go for it. Keep the weight very low and only do a few sets of 15-25 reps. Now is not the time to be aggressive with the weight increases. If there is any type of twinge back off immediately.

Likewise, with an injury that cannot be isolation such as a lower back strain, isometrics can be supplemented instead. For example, non-weighted squats or hyperextensions or very light deadlifts/good mornings can work. Be very careful.

At this phase we are looking to exercise, and then allow the body total healing over the next 24-48 hours. So only reintegrate exercise 3-4x a week, and keep the progressions small. Being extra cautious will save you more time than having to come back from a restrain which can often be worse than the first one since the tissues are already more vulnerable to take more damage.

From here, it is just a slow progression working your way back to full workouts.

For more experienced lifters Bill Starr’s method of rehabilitation may be effective.
Novice or even intermediate lifters should not use this technique, in my opinion, because you do not know how to differentiate between pain very well. Experienced lifters will often have had to go through periods of injuries or tendonitis, so they can differentiate between rehabilitation pain and reinjury pain much better. If you have any doubts as whether you should use this protocol, I would avoid it completely.