This article is designed for all the sports therapists, physios, personal trainers and strength coaches out there who prescribe and design exercise programs.
As a therapist, rehab program design is a massive part of your service. Whether to be completed at home, gym or with you, these exercises should be designed for the clients benefit. Every exercise should be geared to strengthen, realign and correct the issues the body may be having. However these exercises must be appropriate to the client in front of you. It has to be SPECIFIC!
Specificity is absolutely crucial for rehabilitation of injuries. Everyone's injury is different. You will never have two cases the same, no matter what. You cannot simply think "lateral ankle sprain, I will give them the same 6 week programme I gave my last client that will fix them". Wrong. What sort of service is that? A lazy service that is what. So you know the client's problem, so pull up your sleeves and give them an appropriate rehab program.
However let's look at how you want to prescribe the exercises, in my opinion there are only three ways to address this...
Fact:
This is the process of using clinical education and research to support your theory as to why you are prescribing an exercise. You may have a client in the late stage of hamstring tear rehabilitation, you want their hamstrings to be stronger. You prescribe to them a hamstring bridge/thrust as oppose to a back squat. This is because a recent study by Roberts (2009), showed that EMG score of hamstring was greater in hamstring bridge than in a back squat. This is a fact, no getting around it.
This is a great way of prescribing exercise, however you cannot be too strict. What happens if your client has a hip flexor tendonopathy so either doesn't have hip extension range or finds the barbell painful to hold? Then you have an issue as your research journal you just downloaded off google scholar doesn't have an answer... So be ready to think on your feet and have multiple answers!
Opinion:
This where you use your opinion to form a rehab programme, usually from your former patients rehabilitation. For example in your opinion, most members in the public don't have the appropriate dorsiflexion in their ankle to complete a back squat to full depth. So instead of prescribing a back squat you would give them an exercise which takes the dorsiflexion load off - a trx/supported squat for instance.
This is a good way of addressing rehab and prescribing exercises as you are using your past experiences to benefit you. However you should still be treating each client differently and doing the best for their rehab. You may have some clients who do have that dorsiflexion range to back squat, so test that before immediately ruling it out. If you don't test it and find out later that they do have the ankle range, you will feel a bit silly for not giving them the back squat to complete in the first place.
Preference:
This both a useful yet dangerous tool in regards to rehabilitation. Preference is when you use your own personal experience when prescribing exercises. For example you may prescribe static squatting as oppose to walking lunges as you find walking lunges gives you too much variability in the knee position. That is from your personal preference when completing the exercise. However that might be inappropriate as your client might be an athlete who needs good tibia/knee stability to compete that sport.
Preference is a really insightful way of prescribing exercises as you have completed the exercises yourself. You know how it feels to do the exercise, how the muscle contracts, when the muscle contracts and most importantly you know how to do the exercise. Because of that you will have a much clearer picture in your head when it comes to instructing the client on how to do the movement and empathising how they might feel! As a therapist it is a must to have completed all the exercises that you have prescribed. However do not let this cloud your judgement. Just because you found hip bridges to be pretty remedial, doesn't mean your client won't!
To conclude, I believe that you should use a combination of fact, opinion and preference when designing and prescribing rehabilitation. That way you are drawing from clinically backed research, your previous experience with clients and your own experience doing the movement. That way you have a well rounded and balanced approach to your rehab, with your client's well-being as the ultimate goal!
Found this article useful or interesting? Have any questions for NRG? Feel free to leave a comment below or send us an email at rob@nrgsportstherapy.com. Thanks for reading! Want to keep up with our weekly content? Then simply sign up to our newsletter below and enjoy!
Interested in personal training, injury assessment or sports massage? You book now via email or phone! We look forward to hearing from you.