How to Structure a Rehab Session?

One of my biggest bugbears in the rehabilitation industry is that people who get given a rehab program tend to be given a shopping list of exercises with minimal thought process behind the implementation of the prescribed program. Something which doesn't help the situation is that these programs tend to be either scribbled onto a piece of paper in the last 5 minutes of a consultation (how the hell are you as a practitioner supposed to design an effective program in that time) or in the digital age of 2021 the software platforms that practices gravitate towards for exercise programs are incredibly poorly designed.

Having a structure towards how you build your sessions is not only important from an outcomes perspective but also from a systemisation of development point of view. I used to spend hours writing programs for my clients because I had absolutely no system that directed me towards funnelling specific components into particular areas!

In order to understand how you can best structure your session its important to consider the eight acute variables of resistance training that you can manipulate in your programs. These are:

1. The exercise (the most commonly manipulated variable)

2. The sets

3. The reps

4. The prescribed resistance

5. The order of exercises

6. The speed of the exercise

7. The rest periods between reps and sets

8. The periodisation across different weeks

The rest of this blog will be focused on and expanding on point number 5! Being able to categorise our exercises into particular 'blocks' that have a specific focus will make sure that you as the rehab professional are ticking off all your goals for the athlete in each session.

The structure that I utilise for my athletes is as follows:

Prep Work

Any immediate preconditioning that may assist in facilitating loading throughout the rest of the session, this may be isometric modalities for neural drive or pain relief; ROM work; BFR training for pre-fatigue and / or any kind of soft tissue therapy or mobility drills that you may want to prescribe the athlete. The important point to note is that the goal of this work should have a specific purpose so that they can get more out of their proceeding blocks

Gait Mechanics Block

Components of the session that reflect the athletes stage on a return to run continuum, this will also assist in acting as a central nervous system stimulus that would traditionally be present at the end of a performance based warm up!

Velocity Block

This block should be focused on prescriptions based around where the athlete sits on the plyometric continuum, for athletes in the early stages of rehab there may be no velocity block at all or the prescribed exercise(s) may be mundane and repetitive, but the point of this is to promote the foundational learning of positions that will later be exposed to more complex and chaotic environments

Strength Block

This block is the main focus of the session and should take up the bulk of the session, for a lower limb injury I typically target either a knee dominant or hip dominant day bias and all prescriptions should reflect their stage of rehab. Remember this is a rehabilitation program first and a performance program second so if they are suffering from a foot or ankle injury you want more stimuli specific to that tissue than global strength lifts.

Resilience Block

The final component of the session (if needed), this is where any extra stimulus that the injured limb / are of the body needs should be prescribed if for whatever reason you are playing catch up on the uninjured equivalent in the body.

There you have it! My structure for creating a rehabilitation session from start to finish! I hope you found this useful and if you have any questions regarding what I posted above, don't be afraid to reach out!