Rehabilitation Principles

When injury strikes, the path back to full training requires patience, strategy, and a solid understanding of rehabilitation principles. Rushing the process leads to re-injury; being too conservative delays your return unnecessarily. This chapter covers the evidence-based principles that guide successful rehabilitation.

The Rehabilitation Mindset

Accept the Situation

The first step is acceptance:

• Denial prolongs the problem
• Anger doesn't speed healing
• Accepting reality allows you to take constructive action

Reframe the injury:

• Not "time lost" but "time for growth"
• Opportunity to address weaknesses
• Chance to build foundations
• Learn about your body

The Long-Term View

Rehabilitation is not lost training time:

• Proper rehabilitation now prevents worse problems later
• Rushing back often means multiple re-injuries
• Patience in rehab = consistency in the long run

Consider the timeline:

• A few weeks now is better than recurring issues for years
• Full recovery enables full training
• Half-healed injuries lead to compensations and new problems

Progressive Loading

The Principle

Tissues adapt to load:

• Muscles, tendons, ligaments, and bones respond to stress
• Appropriate loading stimulates healing and strengthening
• Complete rest often leads to tissue weakening

The Goldilocks zone:

• Too little loading = tissue deconditioning
• Too much loading = tissue damage
• Just right = optimal healing and adaptation

Applying Progressive Loading

Start conservatively:

• Begin with pain-free activities
• Use isometrics if dynamic movement hurts
• Accept that you're starting from a reduced baseline

Progress systematically:

• Increase one variable at a time (load, reps, range)
• Follow the 10% rule (approximately)
• Progress based on response, not schedule

Variables to manipulate:

1. Load/resistance: Start light, add gradually
2. Volume: Start with fewer reps and sets
3. Range of motion: Start partial, build to full
4. Speed: Start slow and controlled
5. Complexity: Start simple, add skill demands

Example Progressions

For a shoulder injury (rotator cuff):

1. Isometrics in neutral position
2. Isometrics at multiple angles
3. Light resistance through pain-free range
4. Full range with light resistance
5. Progressive loading with weights
6. Dynamic movements (slower than training)
7. Training-specific movements at reduced intensity
8. Return to full training

For a tendinopathy (e.g., elbow):

1. Isometrics (holds)
2. Slow heavy eccentrics
3. Full range slow tempo
4. Normal tempo with moderate load
5. Sport-specific movements
6. Full return to training

Pain Monitoring

Understanding Pain in Rehabilitation

Pain as a guide:

• Pain provides information about tissue tolerance
• It's not always a perfect indicator of damage
• Learning to interpret pain signals is important

Pain can be:

• A warning of tissue damage
• Nervous system sensitivity
• Normal healing sensation
• Fear or anxiety manifesting physically

The Pain Scale

Use a 0-10 scale consistently:

• 0: No pain
• 1-3: Mild (can be worked through)
• 4-5: Moderate (should modify)
• 6-7: Significant (stop and reassess)
• 8-10: Severe (stop immediately)

The 24-Hour Rule

Key principle: Pain should not be significantly worse 24 hours after training.

Acceptable during rehabilitation:

• Mild discomfort during exercise (1-3/10)
• Brief increase in symptoms after exercise (< 1 hour)
• Same or better by next day

Concerning (too much load):

• Symptoms significantly worse for 24+ hours
• Pain levels above 4/10 during exercise
• Swelling or visible changes after session
• Progressive worsening over sessions

Daily Baseline Assessment

Before each session:

• What is your baseline pain today? (0-10)
• How did you respond to the last session?
• Any changes since yesterday?

During session:

• Is pain increasing, decreasing, or stable?
• Does pain change with specific movements?
• Are you compensating to avoid pain?

After session:

• Immediate response
• How do you feel in 2-4 hours?
• How do you feel the next day?

Criteria for Progression

Milestones-Based Approach

Progress based on function, not time:

• Time guides are just estimates
• Individual variation is significant
• Function matters more than calendar

General criteria for progressing:

1. Pain ≤3/10 during exercise
2. No increase in symptoms 24 hours later
3. Full range of motion (or approaching)
4. Adequate strength for next level
5. Good movement quality without compensation

Phase-Based Rehabilitation

Phase 1: Acute/Protective Goals: Reduce pain, protect tissue, maintain what you can Criteria to advance: Decreasing pain, tolerating basic movements

Phase 2: Recovery/Strengthening Goals: Restore range, build strength, improve capacity Criteria to advance: Near-full range, adequate strength, pain-free daily activities

Phase 3: Functional/Return Goals: Return to training movements, build confidence Criteria to advance: Training-specific movements without symptoms

Phase 4: Full Return Goals: Full training, maintenance of gains Criteria to advance: (You've arrived—maintain and prevent recurrence)

Specific Return-to-Training Criteria

For calisthenics, consider:

• Can you perform the movement without compensation?
• Is the injured side within 90% of the uninjured side? (strength)
• Can you complete a training session without symptom flare?
• Have you progressed through all necessary preparation?

Key Rehabilitation Exercises

Isometrics

When to use:

• Early rehabilitation when movement is painful
• To maintain strength without movement
• For pain relief (tendinopathies)

How to apply:

• Hold contractions at specific joint angles
• 30-45 second holds
• Multiple times per day for pain management
• Moderate intensity (60-70% effort)

Eccentrics

When to use:

• Tendinopathies (strong evidence)
• After isometric phase
• To build tendon capacity

How to apply:

• Slow, controlled lowering
• 3-5 seconds eccentric
• Can cause some discomfort (acceptable)
• Progress load over weeks

Concentric and Full Range

When to use:

• After isometric and eccentric phases
• When pain-free through range
• To build full function

How to apply:

• Start with full control
• Progress to normal tempo
• Build volume, then intensity

Proprioception and Control

When to use:

• After acute phase
• For joint stability
• Before return to skills

How to apply:

• Balance exercises
• Perturbation training
• Reactive exercises
• Sport-specific drills

Common Rehabilitation Mistakes

Mistake 1: Doing Too Much Too Soon

The temptation: "I feel better, I should be able to train normally."

The reality: Feeling better ≠ fully healed. Tissues may be vulnerable even when pain has decreased.

The solution: Follow progression criteria, not feelings alone.

Mistake 2: Complete Rest for Too Long

The temptation: "I'll just rest until it's completely better."

The reality: Complete rest leads to tissue weakening and can delay healing.

The solution: Controlled loading is usually better than complete rest.

Mistake 3: Ignoring Red Flags

The temptation: "It's probably nothing, I'll push through."

The reality: Some symptoms require professional evaluation.

The solution: Know the red flags and respond appropriately.

Mistake 4: Not Addressing Contributing Factors

The temptation: "Once the pain is gone, I'm fixed."

The reality: Without addressing what caused the injury, it will likely recur.

The solution: Identify and fix root causes (programming, technique, weakness).

Mistake 5: Stopping Rehab Too Early

The temptation: "I can train now, so I'll stop the exercises."

The reality: Maintenance work prevents recurrence.

The solution: Continue prehab/rehab exercises as permanent maintenance.

Building a Rehabilitation Program

Structure

Daily:

• Pain monitoring
• Basic exercises (isometrics, mobility)
• Multiple short sessions often better than one long session

3-4 times per week:

• Strengthening exercises
• Progressive loading
• Sport-specific preparation (later stages)

Example Weekly Template (Mid-Stage Rehab)

Daily:

• Morning: Range of motion, light mobility
• Evening: Isometrics or light exercises

Monday, Wednesday, Friday:

• Progressive strengthening session
• 20-30 minutes focused work
• Sport-specific preparation

Tuesday, Thursday:

• Active recovery
• Mobility work
• Address other areas (train around injury)

Working with Professionals

When to seek help:

• Injury isn't improving as expected
• You're unsure about diagnosis
• You need guidance on progression
• You're returning from significant injury

What professionals offer:

• Accurate diagnosis
• Individualized programming
• Manual therapy
• Access to modalities and imaging

Key Takeaways

1. Loading promotes healing—controlled progressive loading, not complete rest
2. Pain is information—use it to guide progression, not as a reason to stop everything
3. The 24-hour rule—symptoms shouldn't be significantly worse the next day
4. Progress on function, not time—meet criteria before advancing
5. Address root causes—or the injury will return
6. Rehabilitation is training—apply the same principles of progressive overload
7. Maintenance matters—continue exercises after returning to training
8. Patience pays off—proper rehabilitation now means fewer setbacks later