shared.image.missing_image
A patient came to see me a few months ago with a familiar complaint: he had re-injured the same ankle ligament he had torn eighteen months earlier. He had done the rehab first time around, felt completely fine after about eight weeks, and stopped. He was frustrated and, honestly, a little embarrassed. I see this pattern all the time, and the explanation is simpler than most people realise: feeling fine and being fully healed are not the same thing.
When you injure a ligament, tendon, or muscle, healing happens in three overlapping stages. First is the inflammatory phase, then tissue repair, and finally remodelling. That last phase is where your body reorganises collagen fibres and progressively strengthens the repaired tissue, and it can last for months after your pain has disappeared. If you stop your rehabilitation exercises the moment symptoms resolve, you are stopping in the middle of this process. The tissue may feel fine, but it is not yet as strong or resilient as it was before the injury.
The exercises your physiotherapist prescribes are doing specific things: strengthening surrounding muscles to offload stress from the healing tissue, improving proprioception (your body's subconscious sense of where a joint sits in space), and applying the kind of progressive load that the remodelling process needs to mature properly. Stopping early withdraws all of that stimulus at exactly the wrong moment.
The evidence is fairly striking. For ankle sprains, exercise-based rehabilitation significantly reduces re-injury risk at 12 months compared to standard care. For ACL reconstruction, athletes who return to sport before nine months have a re-injury rate seven times higher than those who wait. And athletes who complete return-to-sport functional testing before going back to play show an 84% reduction in re-injury rates compared to those who skip it.
As a general rule, continuing your rehabilitation programme for at least three to six months after your symptoms resolve gives the tissue the best chance of maturing properly. It can be tedious, especially when you feel perfectly well, but the alternative of sitting in a clinic with the same injury and the same frustration as that patient of mine is considerably worse.
👋 For the new joiners: I’m Suraj, also known as Dr Sooj - a primary care doctor & health content creator. I love navigating the complex world of health and wellness and breaking down complicated concepts.
Every Sunday, I share something interesting that weaves together science and medicine with real life. The aim is to help you live happier and healthier, without any fear-mongering!
Feel free to share this newsletter on your socials, and it would be amazing if you can forward this email on to your friends & family who love learning random things about their health. You can find the subscribe link here.
If you ever have thoughts, questions, or just want to say hey, you can reply directly to this email 😀. I read every message I get!
Suraj (Doctor Sooj)
References:
1. Vuurberg G, et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med. 2018;52(15):956. PMID: 35134061
2. Beischer S, et al. Young athletes who return to sport before 9 months after anterior cruciate ligament reconstruction have a rate of new injury 7 times that of those who delay return. J Orthop Sports Phys Ther. 2020;50(2):83–90. PMID: 32005095
3. Grindem H, et al. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016;50(13):804–8. PMID: 27162233