Graded Strength & Conditioning

Rehabilitation following an injury or surgery requires careful planning and monitoring of symptoms. So too does the management of long standing conditions such as chronic pain or rheumatoid arthritis, just to name two. Whether the goal is to better manage a chronic condition or rehabilitate from surgery or an injury, it is important that we apply the principle of graded exposure to the rehabilitation plan.

The principle of graded exposure simply dictates that:

  1. efforts to rehabilitate an injury, or desensitize a persistent pain state, should start well within the adaptive potential of tissues, and should start within limits of tolerance of pain.
  2. progression of treatment will involve some sort of increase in parameters of load intensity, frequency or duration, but should stay within the limits of pain tolerance and tissue adaptation potential.

In other words, we should start at a level that doesn’t cause pain and doesn’t risk re-injury to the body… and we should progress things slowly and steadily so that we minimise the risk of re-injury or re-aggravation of symptoms over the course of the rehabilitation program. The relative importance of an emphasis on a particular limit (pain tolerance vs tissue adaptive potential) will vary with the specific condition that is being treated. For example, if we were carrying out some exercises for a person with a chronic pain condition such as a longstanding back pain, the limit of pain tolerance is likely to be reached well before the adaptive potential of the structures in the lower back, such as muscles, joints or discs are reached. Conversely, if we were rehabilitating someone who has recently had, for example, a rotator cuff repair to the shoulder or ligament reconstruction within the knee, our exercise planning would also need to account for the increased potential for re-injury to the site of surgical repair.

Further complicating things is the cognitive and emotional state of the patient. If a patient happens to have a particular concern about loading an injured or painful region, it may be necessary to start at an intensity, frequency and duration of load that doesn’t even approach their limit of pain or tissue adaptation potential. Essentially, the exercise rehabilitation environment is a fluid one. Strength and conditioning rehabilitation programs need to be flexible and malleable enough to roll with the day to day and week to week variabilities in a patient’s symptoms. There doesn’t exist a clear set of instructions to follow from day one to discharge. For this reason, it is important that rehabilitation programs are designed and monitored by those who have sufficient background knowledge and experience to know when it is time to progress, when it is time to back off, and when it is time stop. I have been taking patients through rehabilitation programs for acute injuries, post-surgical cases and chronic conditions for 10 years.

If you have any questions about how an exercise program might assist you with your symptoms or condition, please call and speak with Patrick on 0296659667.

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