Injury Rehabilitation: The Magical 80% Rule
80% is not 100% or 99% or 95%, but is the most talked about number in sports
rehabilitation. Why? When you look at the pain scale, the numbers are graded
from 0 to 10, with 10 being agonizing pain and 0 no pain. With most injuries,
it takes 20% of the overall rehabilitation to reduce the symptoms 80% (normally
between 0 and 2), and another 80% of the overall rehabilitation to knock out that
remaining 20% (to daily 0 with no re-flares). Therefore, sports medicine
providers attempt with most injuries to reduce the symptoms to between 0-2 (80%
better) and hold the symptoms there for a long time. The patient still has some
symptoms as they get back into activity. It can be quite unnerving to some
patients to still be experiencing pain while re-attempting to participate in an
activity. However, since it takes 20% of the overall rehabilitation to get
there, and for simplicity let us say it took 2 months to reduce the pain from
8-10 down to 0-2, then it will take 80% of the time (8 more months) to
completely eliminate all the pain. If we wait for no pain to begin activity,
the wait is much longer than necessary, and the body gets stiffer, weaker, more
deconditioned, and overall, more vulnerable to re-injury when starting up
again. So, 80% reduction in symptoms down to levels 0 to 2 pain is considered
the gold standard in treating injuries. Golden Rule of Foot: When 80% of symptoms are reduced, and normal walking occurs without
limping, a return to activity program can be initiated. This is the 80% related to the pain scale.
But, what about the 80% related to activity. 80% better for function is when
you can start running again. Running is the basis of almost all athletic
endeavors. The way I look at and discuss with patients the function scale is:
0 to 20% bed ridden,or non weight bearing on crutches or a knee scooter
20 to 40% from beginning to bear weight to off crutches (normally needs
removable boot/cast)
40 to 60% Gradually feeling less pain with walking with or without boot
60 to 80% Walking with increased speed with mild symptoms, beginning to do
sports specific activities like volleying in tennis, or shooting around in
basketball
80% Passed the 30 minute hard walk test without set back, can begin a walk/run
program, can begin to play sport with some idea of gradation back into full
activity.
It is the magical merging of these two 80%
scales that will allow the patient to begin their sport at a high level and
begin to feel normal again psychologically. Many patients the scales don't match for a while and the health
care provider must have them wait. For example, many patients have 80% pain
relief by icing, medications, activity modification, braces, orthotic devices,
etc., but when they attempt to walk hard for 30 minutes (standard test), or
attempt sport specific activities like solo volleying in a squash court, they
have definite increase in symptoms. They are still in the 60-80% range of function.
This is the time that physical therapy, injections, changes in orthotic
devices, chiropractic, acupuncture, etc., is utilized to get their function off
this plateau and onto the 80-100% plateau where they can dramatically increase
their activities. A good sports medicine provider is very skilled at this task
of raising the plateau. Since the 80-100% plateau can be filled with re-flares,
minor setbacks, and many good pain/bad pain decisions, it can be the most
difficult and challenging time in treating active patients. It is in this time
period that most treatment of all the possible causes of the problem
occur---short legs, flat feet, lordosis, weak muscles, tight muscles, dietary, etc., etc., etc. It is the fun part of rehabilitation.
I hope this post explaining the magical 80% rule used by most in the
rehabilitation world has been helpful. Do not wait until you have no pain to
begin to exercise you love, but there is so much thought that goes into on how to return to
activity during this 80-100% prolonged plateau safely. Good luck!!
