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.

4 Major Exercise Programming Mistakes

Woman stretching hamstrings.

He who represents himself has a fool for a client. – Abraham Lincoln

In many cases, it could be also said that the person who writes his own training program has a fool for a trainer.

The reason, in both cases, is the difficulty of being objective in deciding your own needs.

It’s only natural to gravitate towards what we like and what we are good at (often one and the same), which means when we write our own exercise programs, we often neglect what we need.

In fact, if you coach yourself, chances are you are making (or have done so in the past) at least one of the following common exercise programming mistakes.

Now, if you are experienced enough, with the accompanying knowledge, you can write yourself good programs, but I would always argue, that these will generally be inferior to a program written for you by a coach with equivalent or greater knowledge and experience than you.

The problem with programming mistakes is that they compound over time (more on that later), and the risks they pose are not insignificant.

Risks of Poor Exercise Programming

Before I go on to describe some of the most common exercise programming mistakes I see, I want to outline the risks involved with making these mistakes:

  • Injury. This is far and away the biggest risk of poor programming. In my opinion, if you exercise for health, you should never get injured as a result of your exercise program. I understand that for competitive athletes, a certain amount of risk is assumed in order to push the limits of performance, and I also understand that on any given day, shit happens, so a random injury might occur. But often, what seems random, is not, and if you look at past workouts, there were modifiable factors that contributed to the injury. The other injury consideration is joint degeneration.
  • Negative postural changes. Posture is complex – it has psychological and emotional components to complement the physical components that are commonly talked about. One of the influences on posture are the activities and tasks we expose ourselves to on a regular basis. With poor exercising programming, you can develop poor postural habits.
  • Suboptimal progress. To be honest, the risk of getting injured is enough of a reason to ensure good exercise programming. However, even if you are a throw caution to the wind type, good programming will ensure you make the best possible progress towards your goals, whatever they may be.

The Most Common Exercise Programming Mistakes People Make

These 4 mistakes are not listed in any particular order, and I would say, based on experience only, that the majority of people who have poor (or no) programming when it comes to their exercise make more than one of these mistakes, if not all!

1. Improper or lack of warm up

There’s a popular quote in trainer circles:

If you don’t have time to warm up, you don’t have time to work out.

Unfortunately, like many things, the quote is more popular than the practice.

Too many people make the mistake of not warming up properly before exercising, or, even worse, not warming up at all.

Excuses range from “it’s boring” to “I don’t have time” and god knows what else.

Like many things, there is a disconnect between what most people do and what those who are succesful do.

For example: professional sports clubs, with million dollar athletes, have staff dedicated to optimising warm ups in order to maximise training and game performance and minimise injury risk.

The bottom line is, warming up is important.

During a warm up, there are 3 main goals:

  • Psychological preparation – a transition period from what you were doing, to what you are going to do.
  • Physical preparation – increase body temperature, address physical qualities like mobility and muscle activation
  • Skill practice to prime the nervous system for the upcoming task

If you don’t warm up properly (or at all), you decrease your subsequent performance and increase your risk of injury. A lose-lose situation.

2. Lack of Flexibility Work

Time magnifies errors in training. – Ian King

Ian King has been a physical preparation coach for more than 30 years, and is often outspoken about many topics. However, his opinion is based upon experiencing of producing real world results with both athletes and coaches over many years, so his opinion counts.

One of the biggest topics he is vocal about, is flexibility training.

I like static stretching. I know, I know…current trends in sport science have found favor in other methods, like dynamic stretching. But, in my opinion, it’s all part of a circle that’s slowly turning. Static stretching was the big hit in the ’80s, and I suggest that it will be again. – Ian King

Not only does Ian promote the less popular static stretching, he also promotes stretching before a workout.

Now, I’m not going to regurgitate his reasons for doing so – you can read the article for yourself – but the biggest take home was that if you are performing activities that stiffen your connective tissue (just about everything involving muscular contraction), then you should be performing activities that decrease this stiffness as well.

To counter the points above, people will cite research that demonstrates decreases in power and force production immediately after stretching (lasting up to 15 minutes).

To paraphrase Ian again, if you did a study that measured strength immediately after a weight training workout, you would see a decrease in strength, and the researchers would conclude, based on that data, that weight training makes you weaker.

The solution lies in watching how top level athletes have prepared for many years, which is generally a variation of the following sequence:

  1. 3-5 minutes of general warm up to elevate body temperature
  2. Static stretching
  3. Dynamic/specific warm up
  4. Workout
  5. Go home

The added bonus of this: after your workout, when you are tired, you don’t have to do anything else, except maybe walk around a bit to cool down and start recovering.

3. Ignoring structural balance

Structural balance is a term I first read about in the writings of Charles Poliquin, another highly experienced strength coach.

Whilst we know that posture is poorly correlated to pain, we also know that the body will adapt to repetitive activities.

Thus, if all you do is run, then your body will adapt to running, which is both good and bad.

Good, because your performance will increase, bad, because you need to do more than run in your life.

Wealso  know from various research, that relative strength imbalances can lead to injury, so the implication is clear: balance your training to reduce injury risk.

This means:

  • Exercising a variety of physical qualities – strength, power, endurance, flexibility etc.
  • Performing a variety of activities.
  • Moving across different planes of motion and different “levels” (ground, standing, kneeling etc).
  • Balancing stresses across joints as best as possible.
  • Allowing for periods of higher intensity/lower volume and lower intensity/high volume.

4. “Too Much”

This is not a specific claim, but rather, an observation that most people, once they cross the line from casual exerciser to exercise enthusiast simply do “too much”.

Whether it is too much strength work and not enough flexibility and endurance work, or too much exercise and not enough rest and recovery.

I’m a massive proponent of doing something everyday if possible, but that doesn’t mean smashing yourself every day.

In my experience, this simply stems from being overly emotional about the outcomes attached to exercise.

You are not your fitness.

If you have an overly emotional attachment to certain outcomes associated with your fitness, I’d suggest you do some deep contemplation to find more balance in your life.

Conclusions

It might seem that I keep repeating myself when I talk about training: warm up, manage your volume/intensity, work on all physical qualities, prioritise rest and recovery etc etc.

That’s because:

  1. This is what the vast majority of people need to do, but don’t
  2. Training isn’t as complicated as the internet makes it out to be.

What is complicated, is you as a person (we all are), and so a good coach helps you recognise where you are, what you need and what you don’t. In fact, many of the benefits of a coach are not that you have the best program (it doesn’t exist), but rather adherence, consistency and progression, regardless of the means.

To avoid making exercise programming mistakes, it’s best to enlist help. There are options to suit all needs and budgets, ranging from free programs online all the way to individualised coaching (both online and in person).

Whatever your scenario, even for a short time it’s worthwhile investing in coaching of some form, in order to learn skills that will stay with you for life.

 

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.

 



 

References

(1) Australian Institute of Sport – The Warm Up and Cool Down

(2) Ian King Blog

(3) Ian King – The Lazy Man’s Guide to Stretching

(4) Charles Poliquin Blog