One of my favorite quotes from a well known fitness professional, Alwyn Cosgrove, is: “Exercise is a drug.  If we give the right drug in the right dose – everything works.  But, if we give the wrong drug or even the right drug in the wrong dose, we cause more problems than provide solutions.”  In essence, dosage matters a whole lot.  This means that getting it just right is also not by accident, but by careful analysis and exacting prescription.


After a thorough evaluation, exercise selection and progression must be predicated on the end goal for the athlete.  Where are they now?  How do I get him/her back to 100%  Understanding the injury itself, training and medical history as well as inflammation and healing time frames is important, but that is just one part of the equation.

For those with experience, you already know athletes heal differently and no two injuries are ever just alike.  Addressing the mental components outlined in my previous post, Return to Play: Part 1 (The Athlete’s Mindset), is the starting point.  Next, you must formulate a plan to physically mend, challenge and prepare the athlete’s body to return to its previous functional level.

Below are some BIG mistakes I have either made along the way or witnessed in my career:

  1. Prescribing exercise solely based on the diagnosis – while logical and not entirely off base, we must learn to think globally and make sure we assess the whole athlete as opposed to isolating one area.  In my early days, I tended to focus on the affected area where symptoms were prevalent.  Keep in mind the symptoms may simply be the result of another weak link in the chain.  The FMS, SFMA and myofascial chains have taught us the importance of kinetic linking
  2. Pushing too hard too fast – progressing sessions simply based on what the athlete tells me as opposed to properly moving through a sound functional progression with specific criteria needing to be met prior to moving on to the next phase of rehab can cause more harm than good.  While you may be able to go faster in some cases, do not get too greedy without satisfying set goals along the way.  You do not want to reinforce a poor movement pattern.  A misstep here may cause a recurrence of the injury, perpetuate inflammation or weaken healing tissue.
  3. Not pushing the athlete hard enough – it is paramount that we assess client response “in the moment” rep to rep and set to set as opposed to just session to session.  Observe form and fatigue, but do not let the athlete coast or get bored with the lack of progression.  Understanding and applying fundamental exercise physiology principles and recognizing periodization is necessary to ensure complete restoration.

Now, on the my next big point.  I strongly believe you need to know how HARD the exercises you suggest are in order to effectively prescribe them.  One of my primary philosophies is that I will not prescribe exercises I cannot do.  Not only is this critical for teaching proper form, it is a must to gage fatigue, workout demand, recovery needs and so on.

Possessing a solid grasp of volume and intensity is also essential.  For example, having an athlete who is 6 weeks post-op with a bone-tendon-bone ACL autograft reconstruction do too much eccentric quad loading will inevitably lead to anterior knee pain or patellar tendonitis.  Would you do 10 separate eccentric quad exercises (2-3 sets of 10-15 each) in one hour ?  I do not do this type of volume on my healthy knee, but I have seen rehab done this way.  We must always keep a watchful eye on load, time under tension and overall volume throughout the rehab process.  The proper balance is critical.

In the past, I have spoken about the concept of threshold training.  Click here to read that post.  Beyond this fundamental idea of expanding your body’s threshold of activity tolerance, I prescribe the following 3 golden rules of injury recovery:

  1. Always know why you do what you do – Every exercise or drill must have a purpose.  That purpose should always be to reduce injuries and improve physical performance.
  2. Activity is 100% pain level driven – This rule in effect says this: assess the baseline pain status of the affected body part on a scale of 0-10 and monitor the pain level during the activity noting whether it escalates, decreases or stays the same.  If it reaches a 5/10 at any time, the intensity or volume of the activity must be immediately diminished until the pain level decreases to a 4/10 or less.  Moderate pain (5/10 or more) is a precursor to mechanical failure.
  3. Observe the 24 hour recovery rule – Aside from monitoring during activity pain levels, it is essential to record post-activity the pain level.  The post-activity pain level should return to baseline or less in the following 24 hours.  If it does not, this means that the body did NOT absorb the increased stress effectively and safely and needs more time to recover. The intensity and/or volume of the next exercise session (s) should be reduced until the rule is met.

If we do it right, activity threshold and function consistently increase as pain and dysfunction resolve (inverse relationship). Getting it “just right” is where the magic happens.  In my experience, blending intuition with sound evidence based exercise progression leads to the best outcomes for our athletes.  With that said, the athletes must also be willing and honest participants in the experience as we need their feedback to allow us to accurately assess how the body is responding to the stresses we are imposing on it.

So, seek out this feedback and incorporate logical, functional and sequential exercises to restore your clients’ health.  I am confident that if you navigate away from the pitfalls I mentioned and incorporate the rules I set forth, that you will be able to safely effectively return to play.