4 Simple Rehab Program Templates

Single leg opposite arm row, an upper body “pulling” exercise which demands stance leg and trunk stability and control.

[Note: This is an expanded form of an excerpt from the manual from my workshop Introduction to Kettlebells for Rehabilitation, which I developed and teach with exercise sciencist and personal trainer James Ross. As a brief background, we categorised the exercises into either push/pull for the upper/lower/core. The concepts below can be applied however you categorise movement for programming purposes.]

It’s easy to find exercises online.

Whether you search by joint, muscle group, movement pattern, you will find hundreds, if not thousands of examples.

This alone should tell you something: there is no one way to exercise.

In fact, the only two rules for exercise that are anything close to written in concrete are:

  1. On adaptation: start where you are (i.e. your current ability), do what you can (i.e. don’t push too hard too soon) and progress over time (without progress you stop adapting).
  2. On specificity: you have to practice what you want to get better at (i.e. if you want to run faster, you have to practice running faster).

With that said, there are definitely better and worse ways to exercise, regardless of your goals.

Better ways are more efficient, more effective, safer and more enjoyable. Worse ways are the opposite.

When it comes to clinic rehabilitation for musculoskeletal pain, exercise is an important intervention. Increasing evidence is mounting showing that for many orthopaedic/musculoskeletal conditions, a well structured rehabilitation program yields similar outcomes to surgery over the long term.

Please don’t confuse this with me saying exercise is the only intervention required for clinical rehabilitation.

It stands to reason that structuring an exercise program optimally will yield better results.

With that in mind, the following are examples of templates I commonly use when designing exercise rehabilitation programs for clients in practice.

Bare Minimum

This is simply a single movement exercise “program”, which I often utilise when there are many barriers to adherence. It can also serve as a “gateway” to a more comprehensive program in early stage rehab.

I would typically advise 1-3 sets performed to fatigue as a minimal dosage. With a set/rep based approach we can manipulate intensity via the rep range. This can be a good way to develop strength, strength endurance or even speed/power.

Otherwise a time based approach (i.e. try and do as many sets of 5 in 10 minutes as you can). With a time based approach, we are using sub maximal loads and accumulating volume. This can be a good way to develop strength endurance and work capacity.

There are 2 main ways to design this single movement program.

  • Load the painful movement:
    • Pain management via local tissue effects and central inhibitory effects
    • Develop functional capacity in local tissues
    • Enhance physiological buffer zone
  • Load the non-painful movement:
    • Pain management via central inhibitory effects
    • Develop functional capacity systemically
    • Address weakness/limitations
    • Enhance physiological buffer zone

The bare minimum approach can also be used with multiple movements – i.e. one movement each day, performed for the prescribed sets/reps/time. These are then cycled through.

An example of a 3 day cycle might be:

  1. Squat
  2. Push up
  3. Inverted row

Each of which is performed for as many sets of 10 reps as possible in a 10 minute window on consecutive days. After the third day, start the cycle again.

Whichever approach you take, with bare minimum programming, you typically want to use compound movements, as they maximise efficiency. So for lower body, things like squats, lunges, step ups and hip hinge variations reign supreme.

Minimalist

Using two exercises allows as to train the whole body or agonist/antagonist movements across a joint. This is a great compromise between time efficiency and effectiveness.

Again, these can be prescribed for sets/reps or time periods (I wouldn’t go less than 10 minutes for two exercises, as the volume ends up being too low).

Some common ways to pair movements include:

  • Upper/Lower pairing
    • Use either complementary pairing i.e. upper push/lower pull or similar pairing i.e. upper push/lower pull or vice versa
    • Pain management via both local tissue effects and/or central inhibitory effects
    • Develop whole body functional capacity
    • Enhance physiological buffer zone
  • Agonist/Antagonist pairing
    • Upper or lower push/pull (e.g. push up and row or squat and kettlebell swing/leg curl)
    • Ideal when local tissue factors are the dominant clinical feature
    • Pain management via both local tissue effects and/or central inhibitory effects
    • Develops local tissue capacity which can enhance the physiological buffer zone

Whole Body

I use Chad Waterbury’s definition of a whole body workout: each workout consists of at least one lower body exercise, along with an upper body push and pull.

(you can have two or more workouts as part of the program, to ensure you develop a variety of movements)

The benefits of a whole body workout start shifting towards central pain inhibitory mechanisms and developing the physiological buffer zone.

Again, you can program this based on sets/reps or time. With more exercises you have the option to perform straight sets, a combination or straight and alternating sets or a circuit format.

As a general rule, straight sets will bias local tissue factors slightly more, while alternating and circuit formats will bias work capacity/central factors slightly more.

I like whole body rehabilitation programs as they allow for work on both strengths and limitations simultaneously, which is good for compliance. We all like to succeed and do what we are good at.

They are also great options for in-season maintenance for athletes. Training 2-3 times per week allows the use of 6-9 key exercises, while other areas can be prioritised – i.e. tactics, skills, recovery (and work, family, social life etc).

Comprehensive

The comprehensive program, using the principles outlined in this manual [referring to our rehab manual] simply means taking one exercise from each category: upper body push and pull, lower body push and pull and core.

You can perform these in a circuit form, paired sets or straight sets depending on the desired outcomes.

This type of program trends more towards maintenance of capacity and physiological buffer zone, as well as ensuring central pain inhibitory mechanisms continue to function optimally.

Comprehensive programs are fantastic for the following scenarios:

  • End-stage rehabiliation of athletes before the return to play
  • Mid-to-end stage rehabilitation of non-athletes who are not otherwise active
  • Health-promoting effects of older people, who may be suffering from age related sarco and ostepenia, as well as reduced cardiac capacity
  • Simple preventative home exercise programs for sufferers of chronic low back pain
  • A way to engage sufferers of conditions like fibromyalgia in strength training (you can minimise the dosage and spread the loading across the whole body)

Conclusions

Rehabilitation is complex, but it doesn’t have to be complicated.

By having a set of different templates you can draw on for different scenarios, you can make your exercise prescription more systematic and efficient, leaving more time and brain power to think about and discuss the more human variables surrounding rehabilitation.

Things like goals, interests, barriers and facilitators to adherence and everything else that is important in holistic pain management.

Nick Efthimiou Osteopath

This blog post was written by Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.