Rehab to Fitness: Programming for Function and Performance

08/22/2026

Bird dogs: S tier. Superman: D tier.

Except for the person with lumbar stenosis, bird dogs might be too much load too soon — and Superman, modified to contralateral contractions, might be exactly what they need.

Context is everything in exercise prescription. This week I'm making that case exercise by exercise.

https://theperformancepractitioner.substack.com/p/context-is-everything-in-exercise?r=596p2c&utm_campaign=post&utm_medium=web&showWelcomeOnShare=true

08/13/2026

Most exercise videos show you good form. Almost none of them tell you why that exercise was chosen, whether it was right for that specific individual, or what to do when it causes pain.

This week I'm laying out a systematic framework for exercise selection and ex*****on — from the first two questions you should always ask, through audit processes, progressions and regressions, the ABCs of ex*****on, and variable manipulation.

Real exercise prescription is individualized, deliberate, and monitored. This is what that actually looks like.

A systematic framework for exercise selection, progression, and ex*****on in rehab and fitness

08/04/2026

For every additional month an athlete waits past nine months before returning to sport after ACL surgery, re-injury risk drops by 51%.

Patrick Mahomes' stated return date is September 15th — exactly nine months post-surgery.

This week I'm writing about ACL return-to-sport timelines, what the research actually shows, and what a complete criteria-based clearance process should look like. As a clinician, I have questions. As a fan, I have hope.

https://open.substack.com/pub/theperformancepractitioner/p/how-soon-is-too-soon

07/21/2026

Most people think the goal is to optimize performance.

I don't see it that way.

Performance is an outcome. You can't directly prescribe it. What you can do is train the specific physical qualities that make an athlete ready to perform — and then get out of the way.

In the Human Performance Model, the goal is peak physical potential. That means two things:

Readiness — the biological side. Health, recovery capacity, vital signs. How much charge is in the battery today.

Preparedness — the physiological side. Long-term adaptation. Breathing, mobility, stability, strength, speed, power, work capacity. How big the engine is.

Build both, consistently, over time — and performance follows.

Read more: https://theperformancepractitioner.substack.com/p/the-human-performance-model

07/19/2026

I was listening to a podcast recently when a colleague said something that stopped me.

"Once function has been restored, the patient can move on to higher loading strategies used during the training process."

I don't necessarily disagree with the thought. But I don't think it goes far enough — because it depends entirely on how you define function.

Webster's gives two definitions. The first: "to work or operate in a proper or particular way." The second: "to fulfill the purpose or task of a specified thing."

Most rehabilitation is built around the first definition. Get the tissue out of pain. Restore range of motion. Establish motor control. That is local function — and most patients are released from care the moment it's achieved.

But for an athlete, function isn't local. It's global. It means possessing the physical qualities required to perform the terminal tasks of their sport. A soccer player isn't rehabilitated when their ankle stops hurting. They are rehabilitated when they can compete in soccer again.

The difference between those two endpoints is significant. Local function is restored somewhere around the motor control stage. Global function requires moving through functional integration, progressive kinetics, and fundamental capacity — all the way to a structured sport exposure progression.

When we stop at local function, we've completed roughly half the rehabilitation puzzle. The half we've left undone is the part that actually determines whether the athlete breaks down again under fatigue, under load, under the chaotic demands of competition.

The fix is straightforward even if it asks more of us: redefine what rehabilitation is supposed to accomplish. Move the finish line from "no longer hurting" to "genuinely prepared."

What criteria do you use to decide an athlete is ready to move from motor control into functional integration?

07/15/2026

Last week's post on passive therapies versus exercise generated a lot of conversation — including some pushback and a few misconceptions worth clearing up.

This week, a DPT named Dr. Justin Farnsworth added a piece that explains why: therapeutic exercise isn't named once on the PT licensing exam blueprint. Passive modalities have their own weighted section with guaranteed questions. The most evidence-supported intervention in orthopedics doesn't get one.

What gets tested gets managed. In this week's essay I'm continuing the conversation — why the trend exists, what I wasn't saying last week, and why recentering load is the only way to actually restore capacity.

https://theperformancepractitioner.substack.com/p/the-problem-with-physical-therapy-c18?r=596p2c

07/09/2026

Pain-free is not the same as performance-ready.

That distinction is at the center of this week's essay, which starts with a physical therapist's viral observation — that physical therapy is no longer physical — and works through what it actually means to put progressive loading back at the center of every patient case.

If you've ever discharged a patient who you knew wasn't quite ready, this one is for you.

Why passive interventions alone leave patients pain-free but not performance-ready — and what it means to put the physical back in rehab

07/02/2026

The Latin root of the word rehabilitation means "to make fit again."

Not pain-free. Not mobile. Fit — as in capable of everything life or sport requires.

When we use that as our definition, the entire rehabilitation process looks different. The endpoint changes. The questions we ask at the start of every case change. And the work we commit to doing changes.

This week I wrote about what it looks like to run a rehabilitation program that actually goes all the way.

https://open.substack.com/pub/theperformancepractitioner/p/are-we-doing-rehab-the-wrong-way

06/19/2026

Pain 7/10. What do you do?

If you're in early rehabilitation with a patient who walked in significantly worse than last session, the answer is not "push through it" and it's not "do nothing."

The answer is to adjust — and to have a system for how to adjust.

Every intervention in rehabilitation is a load application. Dry needling. Low-level laser. Manual therapy. A direction-specific movement rep. Each one has a volume and an intensity. The presence of pain doesn't mean you stop applying load — it means you change how much.

In this week's essay I walk through the three tools I use to make those decisions: the Rule of 10, a readiness questionnaire, and the CNS Tap Test. Together they give us a repeatable, individualized method for quantifying load in the stages of care where we typically have the least guidance.

Link to the full post:
https://open.substack.com/pub/theperformancepractitioner/p/the-goldilocks-zone-of-loading

06/11/2026

Every practitioner I know understands load. The surgeon managing post-op inflammation is managing load. The PT prescribing isometrics is applying load. The strength coach programming a squat is applying load.

The problem is not that we lack the vocabulary. The problem is that we don’t share the grammar.

When a patient moves from a rehab clinic to a performance facility, a new framework takes over at every stop. New vocabulary, new priorities, new logic. The incoming team starts from scratch because the previous provider’s documentation doesn’t map onto their structure.

Nobody is working against the patient. But fragmented care is the predictable result of a system with no shared organizing principle underneath it.

That is what the Periodic Table of Performance Elements was built to fix. Four domains — audit, intervention, monitoring, recovery — that form a closed-loop system any practitioner can work from, regardless of their discipline or setting.

Full essay on Substack this week. Link in first comment.

What does your handoff process look like when a patient transitions from your care to another provider’s? Where does the continuity break down?