One of the biggest reasons why rehab will sometimes fail athletes is when the exercises are too easy, rudimentary, or generalized. It’s fairly common that new clients will come in and tell me what exercises they’ve been doing or have done in the past, or they’ll show me their rehab program from the last place person they were working with… and a lot of the time, the exercises are just not appropriate. Two very important rehab concepts are 1) specificity and 2) intensity.
Specificity of Exercise
A good example of poor specificity is when a climber with shoulder pain gets prescribed banded external rotation (the one where you rotate our arm with our elbow at your side). When the heck is a climber employing their rotator cuff with their elbow at their side? If an overhead athlete has shoulder pain with their arms overhead, then give them an exercise with the arms overhead!
Another example is a clam-shell exercise for a runner with hip pain. If a runner has issues with a moderately plyometric single-leg activity (“running”) then maybe we should give them single-leg exercises, some of which may be moderately plyometric? Duh. It’s not always that simple, but this is a great start and totally common sense.
Intensity of Exercise
Sometimes I look at the exercise program someone has been given by a previous rehab professional and I think to myself… “This is a GREAT exercise program for my GRANDMA.” No wonder why this person STILL doesn’t tolerate running or climbing.
I’ve heard Adam Meakins say before: “prescribing EXERCISES without considering INTENSITY is like a doctor prescribing MEDICATIONS without a DOSAGE.” It’s totally true! If a runner’s calf produces 6-8 times their body mass in FORCE during running, then a THERABAND is not an appropriate resistance for this athlete. Or if a climber can dynamically pull their entire bodyweight up the rock wall with one arm, once again, a THERABAND is not going to cut it.
The body adapts to STRESS at a certain INTENSITY, and rehab only works when it forces the body to adapt and get stronger at the level of the demands of the activity you wish to perform.