Imagine an individual with shoulder pain who wants to get back to lifting.
If you’re a therapist, maybe you assess them, provide treatment, give them some mobility work and a few rotator cuff exercises. Three sets of ten, right?
They come back the next week. You see how they’re doing. Maybe you progress an exercise or give them a different one. And repeat.
If you’re a trainer, you might have the opposite problem. Your client tells you their shoulder hurts and suddenly you’re thinking: “Okay…what can we still train?”
So you avoid pressing for a while. Focus on lower body. Maybe add some band external rotations.
And hope the shoulder improves enough that eventually you can start training it normally again.
And I want to be very clear: Neither professional is doing this because they don’t care.
The therapist wants their patient to get better.
The trainer wants to keep their client training safely.
The problem is that neither approach necessarily answers the bigger question:
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How are we progressively taking this person from shoulder pain all the way back to confidently pressing, pulling, lifting and performing at the level they want?
Because that’s not an exercise-selection problem.
It’s a programming and periodization problem.
THE PROBLEM ISN’T THE EXERCISES
Band external rotation isn’t necessarily bad. Three sets of ten isn’t necessarily bad. Manual therapy isn’t bad. And temporarily modifying painful exercises isn’t bad.
They’re tools.
But none of those things by themselves constitutes a rehabilitation process. The question shouldn’t be: “What’s a good exercise for shoulder pain?”
It’s:
How much load can they currently tolerate? What strength quality should I develop at this stage? How can I do this safely? What training methods should I use? How will I manage pain-monitoring and the load response? How will I progress them? When do I introduce speed or power?
That’s rehab programming.
AND WHAT DOES THE RESEARCH ACTUALLY TELL US?
And this isn’t just about how I like to practice rehab.
When we look at the research, there’s an important shift happening toward structured exercise, progressive loading and rehabilitation that takes place over time.
The principle is that rehabilitation is a process that needs to be planned and progressed.
In patients with rotator cuff tendinopathy, for example, studies have shown that a 12-week program of structured exercise rehabilitation has shown significant improvements in overall disability, pain, range of motion and strength.
And that’s the part I want you to pay attention to.
They didn’t simply identify a few weak muscles, prescribe three exercises and say:
“Do 3 sets of 10 and come back next week.”
The rehabilitation was planned over time.
There was a defined exercise program.
There was a prescribed dosage.
There was repeated exposure over multiple weeks.
And there was progression built into the process.
In other words, rehabilitation needs to be treated as a process that needs to create adaptation over time.
And that’s the bigger principle I think we sometimes lose in rehab.
If we’re trying to improve strength, load tolerance, tissue capacity or someone’s ability to return to demanding activities…
those adaptations don’t happen in single sessions.
That’s where periodization comes in.
Periodization is essentially the systematic manipulation and progression of training variables over time.
And that’s not a new concept in strength and conditioning.
The strength-training literature supports periodized training over non-periodized approaches, and this gives us a framework for something we absolutely need to do in rehab:
Plan progression.
Because if someone comes to you with shoulder pain today and their goal is to get back to heavy overhead lifting, there’s a huge amount of space between those two points.
Maybe initially we’re working on mobility, symptom tolerance, motor control and lower-load strengthening.
But eventually we need more load. More volume. More strength. More complex movements.
Overhead loading.
And depending on the person, maybe speed, power and sport-specific demands.
Those things shouldn’t just happen randomly when the shoulder starts feeling better.
They should be part of the plan.
Rehabilitation needs enough stimulus, enough repetition, appropriate progression and enough time for adaptation to occur.
And the program needs to evolve as the client’s/patient’s capacity evolves.
Because ultimately, we’re not trying to help someone become really good at doing three sets of ten band external rotations.
We’re trying to progressively prepare them for whatever they actually want their shoulder to be able to do again.
AND WE SEE THE RESULTS IN REAL PEOPLE
And this isn’t only something I’ve seen in research.
I’ve seen what happens when you apply these principles with real people.
Over the years, we’ve seen people return to activities they had sometimes been struggling to do for months — or even years.
But what’s even better is.
People actually start enjoying rehab. Because when rehab is structured and progressively loaded, it doesn’t feel like something they have to do instead of training… It feels like training itself.
They’re not stepping away from their normal workout to do three rehab exercises with a band in the corner of the gym. They’re progressively loading and challenging themselves again.
Obviously, what that looks like depends on the person, their injury and where they are in the rehab process.
But the mindset changes.
They feel like they’re training again. They’re seeing progress. They’re getting stronger. They’re accomplishing things.
And psychologically, that can make the entire rehab process feel very different. Instead of constantly being reminded of what they can’t do because they’re injured, they’re focused on what they’re progressively becoming capable of doing again.
That’s the kind of rehab experience I want people to have. I’ve seen it with hundreds of my own clients and patients. And our Rehab Career Accelerator students have seen them with their clients and patients. Not just better outcomes at the end. A better process for getting there.
Because ultimately, rehab shouldn’t feel like something that sidelines you from training.
Rehab is training — it’s simply training designed around where you are today and where you need to go next.
AND HERE’S THE OPPORTUNITY FOR TRAINERS AND THERAPISTS
And here’s what I think is really exciting about this for trainers and therapists.
There are a lot of people looking for exactly this kind of help.
And many of them are looking for someone who can take them through that entire process.
For therapists, that can mean thinking beyond treatment and the next appointment and building a complete pathway from injury back to performance.
And for trainers, it can mean developing the skills to work with people who are ready for progressive exercise and training, rather than automatically losing that client the moment pain or injury becomes part of the picture.
That’s an enormous opportunity to build a more valuable rehab service.
Imagine the difference between selling someone an individual appointment…
and offering them a complete process that includes:
A comprehensive assessment that identifies not only where they are, but where they ultimately want to go.
A structured 16-week roadmap for getting there.
Individualized programming based on their needs and goals.
Progressive loading and exercise progression over time.
Regular monitoring of their response and progress.
Feedback and communication between appointments.
Adjustments when things don’t go according to plan.
And objective criteria that help determine when they’re ready to progress toward the demands of training or sport.
That’s not the same service with a higher price tag.
It’s a fundamentally different level of service.
You’re taking greater responsibility for helping that client/patient move from where they are today toward the outcome that actually matters to them.
And when you create considerably more value, your service can also command a considerably higher price.
That’s why one of the principles we teach inside the Rehab Career Accelerator is:
Stop selling sessions. Start delivering outcomes.
Because when you stop thinking about rehab as a series of individual appointments and start thinking about it as a structured process designed to create an outcome…
you can potentially do something that’s better for both sides.
You can give clients/patients the complete rehab process they’re actively looking for.
And you can build a higher-value service that allows you to be compensated for the expertise, programming, planning, monitoring and support required to actually deliver it.
Better rehab for them.
And a more valuable, sustainable way to practice for you.
Mai-Linh Dovan M.SC., CAT(C)
Certified Athletic Therapist
Founder of Rehab-U
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