Why Your Rehab Isn’t Working - Real Talk from Strive’s Physical Therapist

Does this sound like you? You begin physical therapy due to pain leading to activity limitations. While in PT, you progress through exercises that appear to be more challenging than last week’s. Things start to improve, and one day you notice your pain is basically gone with normal day-to-day activities. You are now discharged from PT, but after returning to exercise the pain returns. What gives? Today, we’re discussing why most rehab plans fail and how to truly become pain-free. 

The Core Problem

Most rehab programs don’t fail because they’re wrong. They fail because they are too easy. If your rehab exercises feel like a warm-up… they probably are. 

Bands, light weights, and body weight table exercises might check the box, but they don’t rebuild strength, capacity, or resilience. And if you’re trying to get back to lifting, running, or sport, easy rehab is exactly why you get stuck. 

Why traditional PT fails is a multifaceted problem. Many physical therapists don’t truly understand the concepts of strength and conditioning. PT schools also do a subpar job of teaching progressive overload and modifying training programs for high-level individuals. 

True strength gains that will actually get you back to your activity require challenging loads that truly mimic or feel like training. 

Most rehab programs focus on low load, high reps, minimal fatigue. But performance requires high force outputs, tissue adaptation, and challenging loads. 

Additionally, traditional clinics all have the same problem: dumbbells and kettlebells up to 12 pounds, no barbells or squat racks, benches or sleds, and a whole lot of stretchy therapy bands. 

And while you can be the most creative PT in the world, you can only load someone so much with bands and 12 pound weights. 

The reason you keep getting injured is because your rehab plan gets you pain-free, but that’s where it stops. It doesn’t build your tissues enough to return to your desired activity and intensity. 

What Should Physical Therapy Really Look Like?

YOUR REHAB SHOULD LOOK LIKE YOUR TRAINING! If you have pain squatting or benching, your plan of care should have some form of squatting or pressing variations. 

Having pain with deadlifting? Bird dogs and clamshells aren’t going to cut it. 

Rehab isn’t separate from training. Your body doesn’t know the difference between “rehab” and “training” - it only responds to stimulus. 

Your tissues need to be pushed hard enough to allow for adaptations. 

This can be achieved a few ways: 

• Using weights that truly challenge you (within an acceptable level of discomfort) 

• Performing enough total volume (work) to drive change

• Pushing closer to failure (within 1-3 reps vs. 10 reps left)

• Program specificity (runner vs. powerlifter vs. field athlete)

A Real-World Example

I was working with a client who is a competitive marathon runner. He came to me from traditional PT, who was working with him for several months for foot/ankle pain while running. It never got better (and was clearly misdiagnosed). 

Exercises included: 

• Bodyweight calf raises

• Picking up marbles with his toes

• Calf and big toe stretching

• Banded ankle raises

Here’s what we worked on: 

• Heavy, single leg barbell calf strengthening 

• Single leg plyometrics that mimicked running

• Lower extremity force production and absorption

• Program modification

What took them 5 months took us 4 sessions. 

The program was specific to his sport, challenging enough to drive adaptations, and complimented his current training regimen. 

This Doesn't Have to Be You

If this sounds like you - being stuck in a cycle of pain that limits return to activity - there are solutions. 

I’d strongly recommend a new PT. Sorry, but if your program is way too easy and doesn’t mimic your activity, you’re always going to be underloaded and underprepared. 

Find a cash-based clinic with someone who specializes in your sport. Cash-based clinics allow for more one-on-one time, usually have much better equipment, and tend to have PTs who are specialists. 

Visit the clinic. If it looks like a gym, then you’re in the right place. 

Drumroll please 

At Strive Performance in West Ashley, you work 1:1 with a Doctor of Physical Therapy for a full hour. Our clinic is a gym, so we’ve got the goods to properly challenge you ;) 

We specialize in helping runners, lifters, and weekend warriors get back to 100% and stay pain-free. 

If you are interested in working with us or want to find out more, send us a PT Inquiry and we’ll gladly help you!