Athletic injuries are common, but too often the physical therapy world falls short for active individuals. Why should you be working on progressively loading your tissues in a rehab setting and what kinds of exercises are beneficial?

Dr. Matthew Styf is a clinical orthopedic specialist and CSCS out of Massachusetts. He’s also a certified TPI Medical L2 professional through the Titleist Performance Institute and enjoys working with athletes of all ages. Read on to learn more about his case for including strength work in your physical therapy.

Being Fit Means Managing Injuries

Most athletes or fitness enthusiasts have dealt with injury at some point. Standard protocol is to visit a physical therapist for help. If you’ve been through this, how was your PT experience? If it didn’t involve a kettlebell, barbell, or dumbbells, I’ll make the argument that physical therapy may have failed you.

Physical therapy’s reputation has been improving in recent years, but the majority of people continue to think of it as seeing a PT for 5 minutes, electrical tissue stimulation or hands-on work, and table exercises. As active individuals, this is not the type of physical therapy you should be looking for. 

You should be looking for a practitioner that understands your fitness goals and has the knowledge on how to load the tissues to improve your function coming off an injury. You’re looking to move weight, not just get back to baseline. 

Strength training belongs in the rehab setting.

Better PT Exercises for Athletes

Good quality PT needs to decrease your pain so you can move well and tolerate progressive loading for strength training. Having a physical therapist who understands lifting mechanics and knows when to progress (or regress) is extremely important for your return to fitness. 

Traditional physical therapy does not load the tissues in anticipation of hard effort. And if you’re not loading your tissues properly, your return to training could overwhelm them resulting in re-injury.

What exercises should you perform to ensure that you’re properly loading injured tissues? Well, it depends on your body, the movements, and your goals, but here are a few examples.

Knee Pain

If you have knee pain from running or jumping, slant board squats or banded Spanish squats are useful to help manage pain. Spanish squats load your quads and patellar tendon at a higher intensity than a wall sit, which is what a lot of PTs program. 

Slant board squats are also great at loading the quads, especially if you lack ankle mobility and are looking to work your posterior chain musculature. Both of these exercises are great for athletes and active patients. 

Back Pain

If you’ve been fighting persistent back pain that continues to derail your workouts, deadlifts may be your answer. Yes, I said deadlifts. Deadlifts are great for developing posterior chain strength and core bracing. They train the back extensors as well as the glutes and hamstrings. 

Improving your glute and hamstring strength is more beneficial in the long term for back pain compared to just stretching. Plus, there are a ton of deadlift variations like sumo style, RDLs, and deficit DLs. Picking 1-2 that work for you will help improve your back pain in the long run.

Hamstring Pain

If you have hamstring pain from sprinting, or feel like you tweak your hamstring every time you play in a pick-up game, they might not be getting the right rehab stimulus. Eccentrics (slow/tempo movements) and training fast bursts are very helpful in improving hamstring resiliency. 

Nordic hamstring curls are great, but you can also get the slow, controlled lengthening of the muscle through hamstring curls on an exercise ball, sliders, or TRX, loading or increasing the reps as they become easier. If your sport requires sprinting, you better train that too! Sprinting as a part of your training has been shown to protect against hamstring injuries.

Most physical therapists don’t check your sprinting form or even have you sprint before leaving their care, but sprinting is an intense/high-stress activity that most athletes should be able to do without pain.

The common rep and set scheme in physical therapy is 3×10 for rehab exercises, but is it right for everything? Probably not. Does it fit for some exercises? Sure. 

When looking to build strength while addressing form and mechanics in a rehab setting, a lower rep scheme is effective in most cases. To gain strength and tissue resiliency, fewer reps with careful, intentional form is generally more important. I tell many of my clients and patients that if you focus on form first, the weight will come.

I stand by my prior statement that strength training belongs in rehab. No matter where you are in your fitness journey, getting stronger will always help you. Whether you’re just starting out to improve your lifestyle, or you’ve been injured and are ready to start rehab, getting stronger and dialing in your mechanics will always benefit your fitness. 

I encourage athletes of all levels to find a medical professional who understands proper loading principles and will help you reach your goals!

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