Following an injury assessment with a healthcare professional, it’s very common to come out of that appointment with a list of exercises to do on your own at home. You might revisit those exercises at a follow-up appointment and do some other things for treatment, but if you find that after a few weeks you’re still doing the same things at home, then you might be limiting your progress. Even if the exercises themselves don’t change, something about the exercises should. The exercises that help you start rehab aren’t necessarily the exercises that will get you to where you want to go.
How Your Rehab Exercises Should Progress
What you need at the beginning of rehab will be very different from what you need a few weeks or months later. This is because the goals or aims of rehab change as you progress and recover. If you have an injury like an ankle sprain or hamstring strain, or even if it’s just a flare-up of low back pain, you may only be able to tolerate very low-intensity exercises or movements due to the pain and limited function. As symptoms become more manageable and function improves, you’re able to start gently loading the area a bit more to start to rebuild your strength. From here, your exercises should then start to progress — adding more weight, increasing the number of sets and reps, progressing from double- to single-limb exercises, or even more speed and power. The goal should be for the exercises to more closely match and prepare you for the movements and demands of the sport or activity you are returning to. Your exercise program should change to reflect your stage of rehab. If your program never changes, it can eventually stop being useful in preparing you for a return to sport.
When Should You Change Your Exercises?
There are a few circumstances in which changes to your exercise program could be useful:
It’s too easy. If you finish your exercise program feeling like you could easily repeat the whole thing, then it might not be challenging enough. Generally, we want to get to a point where we only have a few more repetitions in reserve. The exercise itself could be entirely fine, so the easy fix would just be increasing the amount of weight you’re using. If you’re limited by weight, then finding a more challenging variation of the exercise is the way to go.
It’s too hard. If you find you’re really struggling to complete the prescribed sets and reps of your program, then it’s too hard— either the weights are too heavy, or the exercises are too difficult. It is okay to take a few steps back here in order to make the exercise program more effective instead of just difficult.
It’s not relevant. If you've been given some exercises and you're not sure why you're doing them or how they'll help your injury, it's worth asking your therapist to explain why they've been included. It may just be that your therapist didn’t fully explain why they’re appropriate for your injury and rehab. But if you feel the exercises are not addressing your injury, not helping you achieve your rehab goal, or are not relevant to your sport or activity, then you should talk with your therapist about finding some exercises that do achieve this.
They’re not effective. You might understand why you’re doing an exercise, but you still may not feel it’s really working for you. There isn’t one best exercise for everyone, so it may take some tinkering with the exercise itself, or finding a different but similar exercise to make it more effective. We want to feel the exercise is involving the area we want and is helping our progress.
It’s not practical. If your exercise program requires equipment you don’t have, or it takes too long to complete, then how likely are you to actually complete it? This isn’t a failure on your part. Talk with your therapist about what equipment you have available, your experience with exercise, and how much time you have. Your program should be practical enough for you to actually complete it.
There’s no progression. As mentioned, your exercise program should evolve as your capacity improves through the stages of rehab, and it should prepare you for the next step in rehab. An exercise that doesn’t progress in any way can keeps you at that level of tolerance and prevent you from developing the capacity you need for the next stage of rehab.
When You Don’t Need to Change Your Exercises
There may, however, be times when you DON’T need to change your exercise program. Sometimes people like to have exercises they do as part of a “maintenance” program. Maybe they’ve had an injury before and it occasionally flares up, so doing some exercises regularly may help manage symptoms. Some sports also place particular areas of the body under greater demands, such as the shoulder and elbow in baseball, the hamstrings and knees in soccer, or the hips and groin in hockey. Having some exercises you perform regularly as “pre-hab”, either at the start or end of a workout, may help manage the risk of some of these injuries. In any case, though, there are two important considerations for a maintenance program:
It is an adjunct to a regular strength and conditioning program that continues to be progressed.
There is still some variability in the maintenance program, in terms of weight, sets, reps, and variations. For example, one training block might be 3 sets of 6 reps at 80% intensity, but then the next block is 3 sets of 15 reps at 60%.
There’s nothing wrong with having a staple exercise that you really like and that works well for you, as long as the way you perform it is progressed or varied as part of an overall strengthening program.
The Goal is to Keep Progressing
Just because you were given exercises from a therapist to do doesn’t mean you should be doing them indefinitely. A good rehab exercise program evolves as you recover and should have an end goal of helping you feel physically and mentally prepared to return to sport. But an exercise doesn’t become ineffective simply because you’ve been doing it for a while. Sometimes the best approach is to keep the exercise but change the loading, volume, speed, or complexity.
Similarly, just because an exercise becomes easy doesn’t mean you’ve finished rehab. During the early stages of rehab, we often see very quick and dramatic improvements in pain and function, but there is still usually a big gap before you’re ready to return to sport. By not continuing to progress your exercises, you may return to sport without having rebuilt the capacity needed to tolerate its demands.
Regularly reviewing your exercises with your therapist is a great way to keep moving forwards with your rehab. Your exercise program should always be at an appropriate level of challenge, as well as relevant, effective, and practical for you. As such, your exercises should adapt as you do to ensure a safe and confident return from injury.
