Let’s be honest. If our goal is to get our clients stronger and more resilient, doing 3 sets of 10 with a theraband forever isn’t going to cut it. That doesn’t mean programming 3 sets of 10 and utilizing a theraband is necessarily a bad thing like it’s made out to be, however the issue lies when clients are doing the same exercises with the same set and rep scheme for weeks and weeks without change. In this case they simply aren’t going to be getting better if we are inducing the same response to our body every single session. Clients who are underloaded in rehab programs will not be fully prepared for the demands of their sport or fitness goals they are looking to get back to. In my opinion, physical therapy schools do a poor job at teaching the components of exercise selection and prescription although it is one of the main things we do as physical therapists. Make sense? Not really.
What is Periodization and what does it look like?
Periodization: Planned manipulation in your training variables like volume, intensity, or frequency but can also include things like range of motion as well as rest periods.
Types of Periodization:
Linear: This is the most common periodization scheme. It involves gradually increasing intensity and decreasing volume throughout a training plan. Linear periodization is great for beginners as well as people who are coming off an injury to build a foundation and progression.
Undulating/ Non-Linear: Unlike linear periodization, there is a constant change throughout training cycles manipulating volume and intensity frequently on a weekly or daily basis. This is more advanced than linear periodization and used with clients with a training background.
Block: This is where each block of training focuses on a specific skill. For example, focusing on hypertrophy in month 1, strength in month 2, and power in month 3, that build upon each other.
| Power | Single Effort event: 1-2 repsMultiple-Effort event : 3-5 reps | 3-5 sets | 2-5 min rest |
| Strength | ≤ 6 reps | 2-6 sets | 2-5 min rest |
| Hypertrophy | 6-12 reps | 3-6 sets | 30 s- 1.5 min rest |
| Endurance | ≥ 12 reps | 2-3 sets | ≤ 30 s rest |
Rep Max Continuum
Understanding the basic principles of set and rep schemes for specific training goals is a good place to start. However, there is much more overlap than once was thought and it’s important to realize that these often lie on a continuum and are not only set to one specific goal. Since all exercises are not equal due to level of difficulty, when choosing specific rep schemes, a good rule of thumb is to decrease the amount of reps from 8 with larger compound movements and to increase the reps from 8 with more isolated movements.
Example of periodization for a post-operative ACL client
Month 1-2: 2 x 10-12
Month 3: 3 x 8-10
Month 4: 3 x 6 main lifts, 2 x 10 secondary lifts
Month 5: 5 x 5 main lifts, 2 x 15 secondary lifts
Exercise Progressions/Regressions
Knowing how to progress and regress an exercise is crucial. Prior to improving performance, the first goal of any exercise program should be to decrease the risk of injury! Exercises shouldn’t be selected by the next flashiest thing seen on social media. Things like standing on one foot on a bosu ball with a band around your knees while you perform a med ball slam is what I am talking about. Rather a comprehensive movement based approach to activities we do everyday like push, pull, squat, hinge, lunge, and carry. Having a framework of movement pattern progressions is beneficial in order to be able to adjust and modify an exercise at any given moment during a session based on a client’s proficiency.
Here are some examples of main upper body and lower body movement patterns I like to incorporate during rehab with progressions for each:
Squat → Assisted TRX Squat→ Squat Press outs → Goblet Squat→ 2 DB Squat
Hinge→ Assisted SLDL → Cross reaching SLDL → Med ball reaching SLDL→ 1 KB/DB SLDL → 2 KB/DB SLDL
Lunge→ Split Squat→BW Lunge→ Goblet Lunge → 2 DB Lunge
Horizontal Push → BW Push up→ FE BW Push up→ Weighted Push-up→ Bosu Push-up
Horizontal Pull → TRX Row→ FE TRX Row→ Weighted Vest TRX Row
Vertical Pull→ X-Pulldown→ Band assisted chin up→ BW chin up→ Weighted chin up
Vertical Push→ ½ Kneeling landmine press→ ½ Kneeling KB alternating press→ ½ Kneeling one arm KB Press → Standing alternating KB press→ Standing one arm KB Press
DB= Dumbbell
KB= Kettlebell
SLDL= Single Leg Deadlift
FE= Feet Elevated
BW= Bodyweight
In addition to specific progressions/regressions like listed above, exercise prescription should also include basic progression principles:
Linear→ Lateral → Diagonal → Rotational
Two Legs → One Leg
Stable → Unstable
Slow → Fast
Build your Network
Having a network of strength & conditioning coaches that you can refer clients to after completing rehab is key. Whether you’re a rehab professional, personal trainer or strength & conditioning coach, we all have the same goal of helping people! Checking your ego at the door and realizing that it’s all for the betterment of the client is crucial as there will be a point in time when it would be beneficial to transfer a client to a strength coach to continue to progress towards their goals. Since starting my career I was lucky enough to work alongside and learn from many knowledgeable coaches where I was able to share clinical decision making processes. This allowed for better communication and ultimately a more successful return to play process for my athletes.
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