Rehab Is STRENGTH TRAINING
Let me explain.
If you’ve ever followed a strength training program, you probably understand the idea of progressive overload.
You don’t walk into the gym and choose completely different exercises every week.
You squat. You hinge. You press. You pull.
You practise those movements consistently and, over time, you gradually ask your body to do more.
Maybe you add weight. Maybe you add repetitions or volume. Maybe your technique improves. Maybe you increase the range of movement or make the exercise more challenging.
That repeated exposure is part of how we build strength over time.
That is progressive overload.
So why should rehabilitation be completely different?
One of the things we see in physiotherapy is the tendency to constantly change exercises.
Sometimes this is because the person is getting bored. Sometimes it feels like progress should mean receiving something new. And sometimes it’s easy to assume that a new exercise means the treatment is progressing.
But if we’re trying to improve strength, coordination or capacity, changing an exercise isn’t necessarily progression.
Most of the time, real progression is doing the same thing better. Sometimes it’s increasing your capacity by doing the same thing with another five kilograms. Sometimes it’s tolerating another set with the same level of soreness. Sometimes it’s moving through a greater range and increasing your mobility. And sometimes it’s simply giving your body enough exposure to a movement for it to stop feeling unfamiliar. That’s coordination.
There are absolutely reasons to change an exercise. It might not suit the person. Their symptoms may not tolerate it. Their goals might change. We may have developed the quality we were targeting and be ready for something more demanding, or it might simply be time to move onto the next thing.
But different isn’t automatically better.
Strength Takes Repetition
If we’re trying to build strength, we need to provide the body with enough stimulus to adapt. That means we need consistency. The same applies when we’re trying to improve coordination.
A movement that initially feels awkward, weak or uncomfortable may need repeated exposure before it starts to feel more natural. In scientific terms, this relates to motor learning and neuroplasticity. Put simply, we’re giving your nervous system repeated opportunities to practise and refine a movement.
If we replace an exercise before you’ve had time to practise it, build confidence in it and improve your capacity, you may never actually develop the skill we’re trying to build.
This is why a rehabilitation program might contain the same key exercises for several weeks. The exercise hasn’t been forgotten. It’s there because we’re trying to build something.
Every Exercise Should Have a Purpose
We don’t want to give you exercises simply for the sake of giving you exercises.
At By Design, we use our RAMS framework to help determine why an exercise or activity is in your rehabilitation program.
R is for Relief.
This might be an exercise based on a relieving factor we’ve identified during your assessment. It’s something you can use to help settle or modify your symptoms.
A is for Awareness.
Perhaps we’re trying to build awareness of a posture, position or movement you use throughout the day, and practise another option.
M is for Movement.
This might involve improving a movement pattern, building repetition and capacity within it, increasing mobility or becoming more confident performing a movement you need in everyday life or training.
S is for Strength.
We’re trying to increase the capacity of a particular muscle group, joint or movement to tolerate more load.
Your exercises should have a reason for being there. The challenge for the physiotherapist is choosing the right exercises for the person in front of them, considering their symptoms, movement, current capacity, goals and the demands they’re trying to return to. And once we’ve chosen an exercise for a reason, we need to give it enough time to actually do its job.
Progress the Exercise Before You Replace It
Instead of always asking:
“What’s my new exercise?”
A better question can sometimes be:
“How has this exercise progressed?”
We might keep a squat in someone’s program but gradually increase its load.
We might keep a calf raise but progress from two legs to one, increase the weight, change the range or increase the volume.
We might keep a shoulder exercise while gradually increasing the range, improving control or changing the challenge. That could mean using a band, a ball, a different load or asking you to perform another task at the same time.
The movement stays familiar, we just move up or down the movement pattern ‘continuum’.
The demand changes.
That’s progressive overload.
In simple terms, we’re progressively asking your body to do something new or harder. Something it hasn’t quite done before, but at a level where you can still achieve it with an appropriate amount of challenge.
Your body then has a reason to adapt.
Progressive overload belongs in rehabilitation just as much as it belongs in strength training.
Then We Build Around It
This is where rehabilitation can differ from simply following a gym program. We’re not necessarily trying to make one movement infinitely stronger. We’re also looking at what needs to exist around it. As someone becomes more capable in one movement, we can introduce other movements that expose the body to different positions and demands.
For example, we might continue progressing a squat as a baseline movement pattern while adding a split squat to continue building strength through the quads and glutes, or to challenge coordination between the foot, hip and the rest of the body.
We might keep building a calf raise for strength while introducing hopping for greater speed, coordination and the demands of running or sport.
We might continue loading a shoulder press while adding pulling, carrying or rotational work to expose the shoulder to different demands and build capacity around the joint.
We’re keeping the foundation while gradually increasing the body’s ability to do more.
More movement.
More capacity.
More options when life isn’t predictable.
Because Real Life Isn’t Controlled
The goal isn’t endless exercise variation.
The goal is capacity for what life throws at you.
Real life doesn’t happen in perfectly controlled positions. Neither does sport. You bend differently. You carry things awkwardly. You get tired. You move quickly. You step somewhere you weren’t expecting. Training changes. Work gets busy. You’re distracted. You decide to go for a walk at night when visibility isn’t great. Your child decides to jump on you. You don’t get to perfectly prepare your body before every movement you make. A good rehabilitation program, and ultimately a good training program, should gradually prepare you for more of that.
That doesn’t mean throwing random exercises at you every week.
It means having enough consistency to build strength and skill while progressively exposing you to more movement, more load and more complexity as you’re ready for it.
Over time, the gap between rehab and training should become smaller.
Because ultimately, the principles aren’t that different.
Build the foundation. Repeat it. Progress it. Then expand what your body can do.
Rehabilitation Is Training
At By Design, we don’t see rehabilitation as something completely separate from strength training or life.
The starting point might be different.
The amount of load might be different.
The movements we choose and the way we progress them will depend on the person, their symptoms, their goals and what they’re trying to return to.
But the underlying principle remains:
Give the body an appropriate stimulus. Allow time for adaptation. Then progressively ask for more.
You don’t always need a new exercise.
Sometimes you need more time with the right one.
This is general information only. If you're managing pain or an injury, speak with your physio about what's right for you.
