Ilizarov limb lengthening has been the new method to deal with a variety of orthopaedic problems. Ilizarov apparatus consists of stainless steel rings that surround the limb and are interconnected by threaded rods. Tensioned wires pierce the bone in the plane of each ring and are tightly attached to the ring. Ilizarov has reported distraction osteogenesis with the use of the typical fixator that allows functional loading. The purpose of this commentary is to introduce a four-stage rehabilitation protocol currently used by the authors in the physical therapy management of a post -limb lengthening. Each treament stage corresponds to a medical stage in the lengthening process. Treatment goals for each of the physical therapy treatment stage are presented to guide treatment planning. Two case examples are presented to illustrate the use of the management goals in treatment planning.