Physical therapy after a combat injury: first steps and regaining movement

This article covers the outpatient stage, which begins after discharge: treatment is finished, the paperwork is in hand, and an arm or a leg still will not do what it is told. If you are reading from abroad, as a relative or for a foundation deciding what to fund, the sections on the route of care and on what a physical therapist does not do are the ones to read first.

This page is informational and does not replace a medical consultation. A physical therapist does not diagnose and does not prescribe treatment.

How a combat injury differs from an everyday one

In movement terms the difference lies in four things.

It is usually multiple. Gunshot and blast injuries are rarely isolated: fragments and the blast wave affect several zones at once, and bone damage often comes with injury to soft tissue, vessels or nerves. A fall at home produces one problem in one place; here there are several, competing for priority.

Surgery comes in stages. A person is frequently operated on more than once: first to save the limb, later to reconstruct, later to deal with the consequences. Weeks or months pass between them, and every operation resets the starting point.

Immobilisation lasts longer. External fixation, casts and weight-bearing restrictions stay far longer than after planned surgery. Joints lose range of motion, muscles weaken, and the limb forgets how to take weight. That is not a sign that something went wrong; it is the expected result of immobilisation, and it is what physical therapy works with.

Several segments at once. When both an arm and a leg are injured, the arrangement in which the sound side helps the injured one stops working: there is nothing to lean on and nothing to hold crutches with. Add the state of the body after blood loss and several rounds of anaesthesia, and endurance rather than pain becomes the early limit.

If the injury is an everyday or sporting one — a fracture at home, a ligament tear in the gym, planned joint surgery — the route is different and described separately: rehabilitation after injuries and surgery.

The route of care, and where physical therapy sits in it

The logic of the stages is the same wherever a person goes through them.

1. Stabilisation and surgery

Doctors decide here, with one objective: save the life and the limb. The movement specialist's role is minimal and subordinate to surgical logic — breathing regimes, positioning, prevention of the complications of lying still. This is hospital team work.

2. The hospital stage

Once the person is stable, early mobilisation begins within the limits the operating surgeon allows: first movements, getting upright, first steps with support. One point families regularly miss: ask about rehabilitation before discharge, while the treating doctor can still issue a referral.

3. The outpatient stage

The longest part, and where a physical therapist does the work. Wounds have healed, fixation is off, the surgeon no longer sees the patient weekly — and movement has not returned on its own. What is decided here is whether the limb comes back to real-world load: stairs, weight, walking without support, daily life unaided.

The governing rule: a physical therapist works inside the corridor the surgeon set and does not widen it. If the discharge summary restricts weight-bearing or forbids a range of motion, that holds in the therapy room too.

First steps: what a physical therapist actually does

The first session is assessment and a reading of the paperwork, not exercise.

Establishing the starting point. Range of motion in each affected joint, strength, swelling, sensation, weight tolerance, balance, gait — and which everyday actions are out of reach: dressing, stairs, standing up from a low chair. These are recorded, and every later change is counted from them. Without a baseline, "it feels better" is a feeling, not a fact — and for a funder, not a report.

Reading the discharge summary. What is permitted, what is forbidden, whether there is hardware in the bone, whether another operation is planned. Where documents give no answer we ask the doctor rather than guess: injuries with the same name carry different restrictions.

The order of the work. Range of motion first where it is limited, with swelling and pain addressed alongside; then strength; then weight-bearing and endurance; only then complex domestic and occupational skills. A body that has had several operations cannot absorb work on every front at once.

Working with what was not injured. When one limb is out of action for months, the rest of the body reorganises around it: the sound side is overloaded, the load on the back changes, and a limp appears that often persists long after the reason has gone. These compensations are work in their own right, otherwise the pain relocates. Alongside them sits the home programme: two or three sessions a week cannot replace daily repetitions.

There are deliberately no exercises here: the choice of movements depends on what is damaged, which stage the person is at and what the surgeon permitted, and a generic routine found online can do harm after a combat injury. General principles: physical therapy.

Blast concussion: what falls inside a physical therapist's remit

Blast concussion is a separate matter. Its consequences, like those of traumatic brain injury, need a team — a neurologist above all. Within that team a physical therapist covers the movement component only: balance, steadiness when changing position, tolerance of load, and cervical spine work where a doctor has approved it. Everything else — headaches, disrupted sleep, reduced concentration, emotional state — is outside our remit. We work with the musculoskeletal consequences only by agreement with the treating doctor, and do not substitute for neurological follow-up.

Amputation and preparing a residual limb for prosthetics

We do work with people after amputation, including preparing the residual limb for prosthetic fitting. Our part:

• range of motion in the adjacent joints and prevention of contractures, so the joint is not locked by the time fitting comes around;
• strength in the remaining limb and the trunk — without it a prosthesis will not work, whatever it cost;
• balance and transfers: standing, sitting, turning, moving between surfaces, managing at home unaided;
• unloading the sound side, which at this stage carries almost everything;
• general endurance, since walking on a prosthesis costs far more energy than ordinary walking;
• residual limb care, within the doctor's instructions.

And now the boundary, which is firm. The prosthesis itself is made, fitted and adjusted by a prosthetist; timing of fitting, readiness of the residual limb and its medical management belong to the doctor and the prosthetic facility, and gait training on the prosthesis is delivered by the prosthetist with the rehabilitation team. A physical therapist prepares the body for the device but does not select it, assess its suitability, or decide when fitting happens — and paying for a prosthesis does not cover the movement preparation around it.

Why movement does not return in a straight line

Almost everyone asks this: two good weeks, then things get worse — has something been damaged? Usually not. Recovery after a multiple injury with several operations rarely looks like a clean upward line; it looks like steps with drops between them, for mundane reasons:

• A new operation or change of fixation. Every intervention returns the person to an earlier level.
• Plateaus. Nothing visible changes although the work continues: tissue and the nervous system adapt at different speeds.
• Fatigue, poor sleep, stress, illness. A body after a combat injury has a smaller reserve, and background demand eats the capacity meant for recovery.
• Getting ahead of the programme. The commonest cause of a setback: a run of good days after which the person sharply increases the load alone.

The right response is not to push through but to report it and drop back a level for a few sessions. Baseline measurements help here: they show movement across a month rather than one bad Tuesday.

A setback is not normal at all, and warrants a doctor without waiting for the next session, if there is increasing swelling, redness or heat around the wound, discharge, raised temperature, sudden sharp pain at rest, spreading numbness or weakness, a change in limb colour, or pain and tenderness in the calf. If we see any of these in a session, we stop the load and refer the person on.

We give no timeframes or prognoses: after a multiple injury with staged operations any date named in advance would be an invention, and an invented date is worse than none.

What a physical therapist does not do

The boundaries, plainly:

• Does not treat. Diagnosis and treatment are the doctor's. A physical therapist is not a physician: does not operate, prescribe medication, overrule the surgeon, or offer prognoses.
• Does not work with mental health or PTSD. That belongs to psychologists and psychotherapists. We do not provide psychological rehabilitation and do not ask about the circumstances of an injury beyond what the programme requires. Free psychological support for veterans and families in Ukraine comes from veteran spaces and state programmes.
• Does not manage blast concussion alone. Movement component only, in a team, by agreement with a neurologist.
• Does not make or select prostheses. The prosthetist's work — see above.
• Does not replace medical supervision. Where restrictions exist, the programme is agreed with the doctor rather than worked around.

If a question falls outside that remit, we say so on the first call.

Free options exist, and they come first

We say this plainly even though this is a fee-charging practice: if a state programme covers the task, go there. Rehabilitation care is included in Ukraine's medical guarantees programme, hospital rehabilitation departments operate, and cities including Zaporizhzhia run veteran spaces. Routes and documents: free rehabilitation for Ukrainian service members. Paid sessions are an addition — while waiting for a place, or where one therapist should run the whole course.

Practical details

What to bring: comfortable clothing and indoor shoes, the discharge summary, imaging and reports (X-ray, CT, MRI, ultrasound), the surgeon's conclusion and a list of prescribed medication. No referral is needed here.

Accessibility, stated honestly. Ground floor, no internal stairs, a ramp at the building entrance, parking alongside, doorways with no narrow points. However, the toilet in the building is not adapted for visitors with reduced mobility — factor this in when planning a visit, particularly a long one. Better to know in advance than on arrival. Home visits are not a standing service but are considered individually.

Terms. The first consultation is 300 UAH; for serving members of the Ukrainian Armed Forces and for veterans there is a 30% discount, making it 210 UAH — the final figure, not a starting price. Sessions are run personally by Oleksandr Kaliuzhnyi, a physical therapist in practice since 2012, one to one. More detail: rehabilitation for military personnel and veterans in Zaporizhzhia. Questions about a case: +380 97 824 48 01.

Questions and answers

Can sessions happen if another operation is still ahead?

That is the operating surgeon's decision. Work between stages often makes sense, to avoid losing range of motion and strength, but the scope is agreed with the doctor. Bring the discharge summary and we will say whether there is anything to do now.

Do you help with PTSD?

No — that belongs to psychologists and psychotherapists.

How long will it take to regain movement?

We do not name timeframes. The pace depends on the number of interventions, the state of the tissue, and whether the home programme is done. The therapist gives an indication for the next stage after assessment.

Do you work with a residual limb before prosthetic fitting?

Yes. That is movement preparation: range of motion in adjacent joints, strength in the remaining limb and trunk, balance, endurance and transfers. The prosthesis itself is made and adjusted by a prosthetist.

We are a foundation abroad. What can we expect?

An honest answer on whether physical therapy is likely to help, and — with the patient's written consent — short progress notes. The patient and the therapist decide the programme; whoever pays receives reporting, not decisions.

How does this differ from the page on injuries and surgery?

This page is about combat injuries: multiple wounds, staged operations, long immobilisation, residual limb work. Everyday and sporting injuries and planned joint surgery are on rehabilitation after injuries and surgery.