Excerpt from the book ‘Being Fit by J. Hoffman, PT.
Essay Nine: The 'Fix 1-2-3' Musculoskeletal Rehab Philosophy
Fix 1 might be suitable for situations in which functional movements are impossible due to pain or severely impaired range of motion. Fix 1 is therefore comprised solely of therapeutic interventions that alleviate symptoms. Fix 1 interventions might include manual mobilizations or manipulations, isolated therapeutic exercises, ultrasound therapy, electrotherapy, heat or cold therapy, shiatsu, acupuncture, medication, injections or even surgery. The condition usually determines which Fix 1 intervention is best. Fix 1 treatments must be chosen according to their efficiency in decreasing symptoms. Fix 1 opens the window of opportunity to start functional training.
Fix 2 commences when symptoms have decreased enough to initiate a basic level of full-body harmonious functional training. In the case of milder injuries, one might skip Fix 1 and begin with Fix 2. Symptoms will persist throughout Fix 2; therefore symptomatic interventions from Fix 1 are still employed in parallel or in combination with the introduction of full-body training. As Fix 2 progresses and the symptoms lessen, the ratio between symptomatic interventions and functional full-body training will shift to favor the latter.
Once symptoms are resolved in Fix 1 and 2, Fix 3, which includes only full-body, functional training, can commence. The body might still require special attention from a professional who was involved in Fix 1 and 2. The goal is to gradually and safely raise the level of training until sustainable healthy movement foundations are achieved. The ability to safely participate in Foundation training at a level suitable for healthy people marks the end of Fix 3 and, thus, the Fix stage. In milder cases, or if the client has substantial experience with Foundation training, Fix 3 can be brief or skipped.
Unlike in Foundation stage training for healthy people, Fix stage exercises focus on the specific movement impairments associated with injury. It is a great advantage if the Fix stage practitioner also has expertise in full-body training for healthy people, like yoga, Pilates or CoreAlign. This will ensure that he or she has the ability and experience to lead people with musculoskeletal injuries to a healthy active lifestyle. Provided that they work together, multiple professionals with different specialties can be involved in the Fix stage.
Fix 1, Fix 2 and Fix 3
As injuries are a natural part of life, the Fix stage should be considered a necessary and positive opportunity for correction rather than a disaster. There are not many Olympians, if any, who have made it to the podium without experiencing injuries and successful rehabilitation processes. People with extreme physical requirements like top athletes and dancers, or people with ongoing musculoskeletal disorders might need a combination of Fix and Foundation training on a regular basis.