Individualized Therapeutic Exercise Prescriptions

Exercise prescription is perhaps the most undervalued skill in physiotherapy, partly because it looks simple and partly because generic exercise protocols (the standard ten repetitions of the standard ten exercises printed on a generic handout) produce mediocre results that reinforce the perception that exercise doesn't really work. Properly individualised, progressively overloaded, and regularly updated therapeutic exercise prescription is one of the most powerful clinical tools in all of musculoskeletal medicine.

At this practice, exercise programmes are designed around an understanding of tissue biology (the loading thresholds and adaptation timelines of tendons, ligaments, muscles, and bone) and around the specific physical demands the patient needs to return to. A programme for a competitive cyclist returning from ITB syndrome is not the same programme as one for a desk-based worker managing chronic lower back pain, even if both happen to involve hip strengthening exercises. The loads, the progressions, the tempo, the sport-specific integration, and the return-to-activity criteria are different, and that specificity is what produces results.