In the bottom-up rehab pyramid, what is the bottom layer?

• A. Control pain and edema, provide education
• B. Range of motion / flexibility
• C. Strength and endurance
• D. Neuromotor control / proprioception

Answer: (A)

The bottom layer focuses on controlling pain and reducing edema while providing essential education. Pain and swelling limit healing and make many activities unsafe or ineffective, so establishing a foundation that minimizes inflammation and discomfort is essential before anything else. Education supports safe progression, home programs, activity modification, and recognizing warning signs, which helps the patient engage properly in rehab.

Once pain and edema are well managed and the patient understands how to protect the healing tissue, you advance to restoring range of motion and flexibility, then to building strength and endurance, and finally to neuromotor control and proprioception. The other options represent higher levels of the pyramid, which depend on a stable, well-managed foundation.