Strength Training in Rehabilitation

Designing Strength based Rehabilitation

Picture4When starting to design your strength program from a rehabilitation point of view -post injury, surgery and/or deconditioning for any reason – you have to observe – above all – the safety and the good technique.  What happens when you fatigue, and form goes out the window? Or, on the flip side, what if an exercise has become too easy?  We understand that no one wants to put themselves in harm’s way by doing an exercise incorrectly or waste their time on an exercise program that won’t achieve their goals.  You may be faced with altering the strength training initially!

These adaptations are exactly what our highly trained and experienced instructors/ physios at Pilates Power and Physiotherapy Cronulla are trained to do - straight from their exercise toolbox!!

Regression = an approach to decrease the demand of an exercise or movement.

Progression = an approach to increase the demand of an exercise or movement.

Modifications in:

1.   Intensity / Load

2.   Range

3.   Height

4.   Speed

5.   Body Position

BUT: while you adjust the variable you MUST always maintain the exercise stimulus (overload) that suits your strength level: specific training leads to specific outcomes!! Read the Principles of Strength Training!

Clinical adaptations:


  • Pain
  • Joint swelling
  • Range limitations
  • Surgical restrictions
  • Limb immobilisation


You may also require changing the mode of muscle activation:

  1.   Isometric work

Isometric training has shown to improve strength in other joint ranges as well as concentric strength (increased 12-15%) but only at long muscle lengths, f e quadriceps isometric near knee flexion 90 degrees is more beneficial that at 60 or 30 degrees of flexion.

Power and speed of contraction understandably did not increase with isometric work.

Noorkõiv M et al. J Sports Sci. 2015;33(18):1952-61. 7

  1.   Eccentric work

Meta-analyses: eccentric training performed at higher intensities vs concentric:

Total strength and eccentric strength increased significantly more! Eccentric work develops higher forces due to a specialised neural pattern and there is increased stimulus to build additional sarcomeres (muscle tissue)

Roig,et al. (2009). Br J Sp Med. 43, 556-558

Compound vs Isolation exercises:

Compound exercises recruit >1 muscle groups, are more functional as they ask for more coordination and can also share the load – result in a higher challenge

Isolation exercises are very focussed and less technical, thereby safer. Here it is generally easier to manipulate the range of motion – are less functional

Common isolation exercises: calf raises, biceps curls, quadriceps knee extension exercise

Common compound exercises: leg press, dead lift, squat and lunge.


Hierarchies of importance & determining rehabilitation focus:









Example Knee OA - Week 1-3









WHAT DO YOU WANT TO ACHIEVE? Strength, Power, Control, Endurance?

PLAN & DESIGN: Principles of Training: Specificity, Overload, Progression.

DELIVER: Clinical consideration/limitation, Patient characteristics, time & equipment.



If you have any further questions, please do not hesitate to ask!

Explore Our Range of Pilates Classes

Clinical Rehabilitation




Pilates Studio Classes

Pilates Studio...

Pilates Matwork Classes

Pilates Matwork...