This article is about the stage that begins long after discharge. The acute phase is over, doctors no longer see you every week, and the task has changed: getting back to work, to ordinary life, to real loads and, if you want it, to sport. Relatives and funders abroad should know this stage is real work with a real cost. If you are still at the early stage, you need a different text: physical therapy after a combat injury.

The information on this page is for general guidance and does not replace a doctor's consultation. A physical therapist does not diagnose and does not prescribe treatment.

Why "everything has healed" is not the same as "everything has recovered"

Medicine closes its part when the danger is gone: the wound has closed, the bone has united, the hardware sits where it should. That is an honest answer to "has it healed", not to "will it hold".

Tissue healing and functional recovery are different processes, and the second does not follow the first. The bone has united, but the muscle around it did not work for months. The joint moves, but not through full range — nobody notices until they have to kneel down.

Then there is arithmetic: for months, sometimes more than a year, the body lived with movement restricted. Endurance is not kept in storage for later — it fades, and strength, balance and coordination fade with it.

So the question here is different: not "has everything healed", which the doctors have answered, but "what does my body tolerate now, and how do I build it up to the load I need".

What gets in the way most often: four typical things

Old injuries that speak up later. A limitation that was easy to live with under low demands becomes obvious when real ones appear: a joint short of its last few degrees, an area with altered sensation, tissue around hardware.

The overloaded side that carried the work of two. The other leg or arm took over the job for months, so it is not "the healthy one" but the overloaded one. Very typically the pain is not where the wound was, but on the opposite side, or in the shoulder that leaned on crutches.

Pain that has moved house. The way of walking changed while the injured area was protected, and stayed that way. The asymmetry settles in the lower back, the hip, the neck: back, neck and joint pain.

Endurance that is simply gone. The most common complaint here is not pain but that energy lasts an hour instead of a day — and it is usually endurance, not pain, that stops the return to work.

Returning to work: physical labour and desk work

One boundary first: fitness for work, fitness for service and assessments for official commissions are not a physical therapist's business. Our part is to break the job into physical demands and compare them with what the body tolerates now.

If the work is physical

"Heavy work" on its own means nothing. The details matter: hours on the feet, what weight and how many times per shift, bending, ladder work, overhead work, night shifts. Lifting twenty kilograms once is usually not the problem; lifting it forty times in the eighth hour of standing is a different task, and that is the one that decides the shift. So preparation is not "general strengthening" but a gradual build-up of that job's demands, watching the next-day reaction.

If the work is sedentary

Desk work looks like the safe option, and that is a common mistake. Sitting is a static load: neck, lower back and shoulder girdle hold one position for hours, and a body just out of months of low activity tolerates that worse than before. What helps is boring detail rather than heroics: chair and screen height, forearm support, changing position, short movement breaks.

Returning to sport and load: why not straight back to where you were

This is the question people ask most often: "I used to press this much, run that far — when do I get it back?" We do not name timeframes. Three things are worth knowing before the first set.

The body does not remember your previous level. It knows only the one you start from today. The old programme was written for a different body; going back to it is the shortest route to a new injury.

The weak link is somewhere else now. It used to be strength or endurance that set the limit; now it may be a joint short of full range, or an area that tolerates impact badly.

The main mistake is a jump in volume. The trouble is usually not the exercise but the speed at which total volume grows.

A return to impact and heavy strength work with fixation hardware or nerve damage is agreed with a doctor, not a coach. For people with lasting limitations there are veteran and adaptive sport programmes — a separate field with its own specialists. We work on the base: strength, balance, endurance and load tolerance, not competition preparation.

Why progress comes in waves, and why a setback is not a failure

At the late stage, setbacks have different causes from the ones right after discharge, and they are almost always mundane.

Life hands out the load by itself. A working week, a house repair, a move, a child to carry, the commute. The week in which "nothing special happened" is often the hardest.
A good spell provokes a jump. Two good weeks in a row, after which the person suddenly adds a great deal — and the next week pays for it.
Background: sleep, stress, illness, season. The body has a smaller reserve, and background load eats the resource meant for recovery.

The right lens is not a week but a month or two. That is why baseline measurements are taken at the first appointment: they show movement across a quarter rather than one bad Tuesday — and for a funder abroad they are the only honest way to see whether anything is changing.

Tell two things apart. Muscle fatigue and moderate soreness the day after a new load are expected. Pain that lasts more than a few days, grows from session to session, wakes you at night, or comes with swelling, fever or increasing weakness is a reason to stop and see a doctor — not to push through.

What a physical therapist does at this stage

Tests against your goal, not "in general". Right after discharge the question was whether movement had come back; here it is whether the body tolerates load — how the gait changes over distance, what happens in the eighth minute rather than the first, and whether general endurance carries a real working day. Compensations and the overloaded side are checked too, or the pain moves on.

Doses the load by plan, not by how the day feels. The main tool here is not an exercise but dosage: how much, how often, in what increments, and when to step back. This is where returning to activity alone most often breaks down.

Hands the wheel over to you. The goal is that you manage your own load: know how to add, when to back off, and when to see a doctor. That is the main difference from the early stage, where the therapist drives.

Amputation and prosthetics. We work with people after amputation: preparing the residual limb and gait training with a prosthesis. Later the task shifts — longer distances, uneven ground, stairs, endurance, taking load off the preserved side. The prosthesis itself is made and fitted by a prosthetist.

There are deliberately no exercises here: the choice of movements depends on the limitations that remain and the load you are working towards. General principles: physical therapy.

What a physical therapist does not do

Does not treat. The doctor diagnoses and prescribes treatment. A physical therapist does not operate, prescribe medication, overrule a doctor or give prognoses.
Does not work with mental health, PTSD or sleep problems. That belongs to psychologists, psychotherapists and doctors: we do not provide psychological rehabilitation and do not take on insomnia, anxiety or the effects of stress. Free psychological support for veterans and families is provided by veteran hubs and state programmes.
Does not investigate pain of unclear origin. If something hurts where it never hurt before, or does not feel like ordinary post-exercise soreness, the doctor comes first.
Does not assess fitness for work or for service. That is for the relevant boards.
Does not make or select prostheses. That is a prosthetist's work.
Does not replace medical supervision. Programmes are agreed with the doctor, not worked around.

Free options exist as well

Even though this is a paid practice, we will say it plainly: if a state programme covers your case, start there. Rehabilitation care is included in Ukraine's programme of medical guarantees, and Zaporizhzhia has municipal veteran hubs. Routes and paperwork: free rehabilitation for service members.

Practical: what to bring and what to expect

What to bring: comfortable clothes, indoor shoes, any discharge summaries and imaging, and a list of medication. No referral is needed.

Accessibility, stated honestly. The practice is on the ground floor with no stairs inside, a ramp at the building entrance, parking next to it and no narrow doorways. However, the toilet in the building is not adapted for visitors with reduced mobility — take that into account when planning a visit, especially a long one. Home visits are not a standing service, but are considered individually.

Terms. The first consultation is 300 UAH; for serving Ukrainian Armed Forces personnel and veterans there is a 30% discount, so 210 UAH. That is the final figure, not a starting price. Sessions are one-to-one, run by physical therapist Oleksandr Kaliuzhnyi. More detail: rehabilitation for service members and veterans and prices. Phone: +380 97 824 48 01.

Questions and answers

Can I go back to training in the gym?

It depends on the limitations that remain and on what the doctor has allowed. Our part is to build the base and show how to add volume without jumps. We do not promise to restore your previous form.

Will physical therapy help with PTSD, anxiety or insomnia?

No. That belongs to psychologists, psychotherapists and doctors. Our part is movement, strength and the return to ordinary loads.

How long will it take to get back to my previous level?

We do not name timeframes or give prognoses. The pace depends on what was damaged, how long the period of low activity lasted, and what limitations remain.

We are a foundation abroad. What can we realistically fund here?

Sessions, and the assessment before them. What cannot be bought is a guaranteed outcome or a completion date. A reasonable request: a baseline assessment, a block of sessions, then a repeat assessment against the same measurements.

How is this different from the article on physical therapy after a combat injury?

That one covers the acute stage: multiple wounds, staged surgery, long immobilisation, regaining movement straight after discharge. This one covers what begins much later — the wounds have healed, the paperwork is done, and the body cannot carry a working day, stairs or a gym session. The early stage: physical therapy after a combat injury.

The information on this page is for general guidance and does not replace a doctor's consultation. Decisions about load, return to work and return to sport are made by the treating physician.

Returning to activity after service: what physical therapy can do