When and how should I start rehab exercises?

Key points in 30 seconds

1. Start with exercises where you hold still — you can do them even if it still hurts.
2. Even while you're in a cast or brace, you can keep muscle from wasting away.
3. The order is: tensing → holding → moving → adding weight.
4. If it hurts while you're doing it, that stage is still too early.
5. If the place where you had surgery set restrictions, those come first.

What we often hear

• "I'm told I need to exercise, but I'm scared it'll hurt more."
• "I followed a YouTube video, and it actually hurt more."
• "I don't know when I should start."

When and how should I start rehab exercises?

You start by holding still against resistance. Because the joint doesn't move, you can do it even while it still hurts, and it's safer for that reason.

When people hear "exercise," they picture lifting weights or moving joints through big ranges. Doing that first during recovery leads to reinjury. What you do first is exercise where you use force but your body doesn't move.

In medicine, this is called "isometric exercise." The plank is a typical example — you're just holding a position, but you're using force the whole time.

Why start with holding?

Because the joint doesn't move, it doesn't disturb the tissue that's healing. At the same time, it can keep muscle from wasting away.

You can do it even while in a cast or brace. Muscle wastes away faster than you'd think. Waiting to heal while doing nothing and at least holding positions in the meantime make a big difference later.

Another reason is to keep your body from forgetting how to use that area. When it isn't used for a long time, the strength may be there but it's hard to switch on.

What are the stages?

Recovery moves up like this

1. The very first step is just lightly tensing and relaxing. Without resistance, you simply create the feeling of the muscle engaging. It doesn't build strength, but it protects the healing tissue and keeps it from stiffening.
2. Next is holding a position. You build the strength to stay steady without wobbling. At this stage, the strength that supports the joint comes back.
3. Once that's comfortable, you move on to exercises that move the joint. Adding weight comes last.
4. Finally, you add the movements of daily life or the sport you used to do. This is the stage of returning to everyday life.

How hard should I go?

It shouldn't hurt while you're doing it. If it hurts, that stage is still too early.

If it hurts during exercise, or pain lingers until the next day, we drop down one stage. Pushing through actually slows recovery.

On the other hand, if you feel fine, we raise it little by little. We go over this adjustment together at every visit.

Do I do this after surgery too?

It's especially needed then, because a lot of muscle is lost while you're immobilized and lying down.

Quite a few people go back to daily life after surgery without any particular strengthening, then come to us hurting more than before. By that point, it's often already past the stage where acupuncture or cupping alone can manage the pain.

But if the place where you had surgery set restrictions, those come first. If you check when you can start and what you can do, we'll work within that range.

What are the limits of this assessment?

The best order differs depending on the injured area and your condition. What's written here is the general order.

One more note. We don't have data comparing people who did the exercises with people who didn't.

We decide when to start based on your condition, not the calendar. Even with the same surgery or injury, if your current range of movement differs, the starting point differs.

If you're not sure whether you can start exercising, come in and get measured. We'll sort out what you can do now and what's still too early.

When to start differs from person to person depending on the injured area and their condition.