This is a great question and without doubt would be the one I am asked the most from people who are following one of our Online Rehabilitation programs for Knee Pain, Back Pain and Piriformis Syndrome. Unfortunately the answer is not as easy as saying, "after 4 weeks change it". The workouts are really a series of tests for you to learn and develop perfectly to prepare you for a more challenging program that will provide more skills and building blocks to change what created your pain in the first place. To know when to progress will be determined by your body's adaptation and recover to the challenges you are exposing it to. In this article I will provide many examples from each of the most common programs. This is also not limited to rehab as we adopt these same principles with sports performance in order to prepare the athlete for superior skill development.
Assess Don't Guess
Sounds quite simple, but it is amazing how many people forget to use this idea. In all of our programs our assessment is the VERY FIRST thing we do. Without it we have no starting point and we are just having a stab at what we think we can do based on similar cases or past programs. And while these past programs may be useful in giving us some ideas and things to look for we must treat each case on it's own for we may miss something by assuming.
My very first tip to know when to progress is to see if you pass your tests. If you pass you can progress. If you fail then the test becomes the exercise and you need to regress to easier movements. Also as I said earlier this is also a big part of our Sports Program and I encourage you to watch our video SPORTS SPECIFIC ASSESSMENT of how we do this as shows in great detail many of the things we cover with rehab.
Using the Success Formula is key here. For those unfamiliar with this it is:
Using this as a guide is extremely useful for knowing when to progress. For example when starting out most people are typically in a fair bit of pain, their movements are very restricted and stretching helps to calm tight muscles down as well as improve this loss of mobility. Once the pain begins to subside we can progress to stability movements that are usually low level body weight exercises and movement skills. After time completing this phase you can begin to strengthen and then ultimately finish the process by moving fast in the power phase.
The key is to use the assessments and tests to know when you are ready to progress!
Below is some of the assessments we use in the beginning taken from our E-book programs just to give you an idea of what I mean.
Working Backwards
In the business world this is known as reverse engineering. Picturing what you want it to look like and working out what you need to complete the job and working backwards. This is very much what we do at No Regrets. At the beginning of the rehabilitation process, exercises should be simple, aimed at correct movement skills and building up basic strength. But as the person progresses, they need more specific and more challenging exercises. If the person fails to achieve (or regain) high level training of their muscles in terms of strength, speed and type of activation, degree of muscle stretch and joint position, then they will remain susceptible to injury once they return to work, home or sport. By starting at the end you know exactly what they need. Determine an end point exercise that will convince you and your client that they are fully fit and safe to do what they need to do for life.
A good example would be for a client who has knee pain when walking up stairs. This particular movement is now our end game test. If we can perform this movement with weight or at high speed without pain or compensatory movement then their problem is more or less resolved. To get to this stage we need to break down what we need for this movement. We would need to various exercises for each step but this gives you an idea of how to move through a logical progression.
- Improved flexibility at hip and knee (flexibility)
- Improve abdominal stabilization of the pelvis (stability)
- Improved glute strength in isolation (stability & strength)
- Improve the movement skill of squats and lunges as these closely mimic the movement of stair climbing (Stability)
- Strengthen the posterior chain with integrated exercise (strength)
- Develop the skill of power (power)
You cannot move to the next phase until the previous phase is perfect or if pain is present! For example if you are still struggling with glute exercises in isolation it would be unwise to progress to integrated strength with squats and lunges. You can begin learning movement skills with squats but you would not try to strengthen yet as there is likely to be too much compensation present.
As I mentioned at the beginning this step by step process makes up many of our one on one programs and is featured in all of our Online resources you can get below by clicking on the images.
But How Long Does This Take?
The old saying, "how long is a piece of string" is so true here.
It is impossible to know exactly how long as we are all so different. Some people can move through the first two stages within 2-3 weeks, whereas others may stay in the flexibility stage for as long as 4-5 weeks. But to help you out I am going to give you some very rough guidelines based on the results of hundreds, if not thousands of rehab clients we have helped over the years. Before I share this I must state that CONSISTENCY IS THE KEY. If you are consistent and stick to your plan good results are guaranteed. It is just a matter of time. However a random approach will not provide the results you are looking for. There is no magic bullet! Sorry.
Okay here is a rough guideline to follow for each phase.
Flexibility: 2 weeks
Usually the start of the program for you are in considerable pain. Find the stretches you need most, and do them EVERYDAY! Within 2 weeks you should be ready to start implementing the stability phase. I find 90% of clients respond very well to stretching and we can reduce their pain quite quickly using this strategy. You cannot stop doing your KEY stretches for the remainder of your program and if anytime you have pain go back to just stretching for a few days to a week again. Massage, chiropractic adjustments, acupuncture all fall in this category. This is also where the majority of the population stop with their rehab by the way. Looking for a therapist to "fix them". This is only halfway in our program and with all the big hitting stuff still to come. You can see why so many people remain in chronic pain all their life!
Remember your goal with this stage is to improve mobility of joints and reduce the tonic muscles from working too hard in preparation to learn movement!
Read this article to see a complete breakdown of how to know what stretches you need - How to identify mobility restrictions that affect your movement
Stability: 4-6 Weeks
This is much more delicate phase, and usually the most frustrating for it requires learning to move correctly.
The isolated abdominal exercises for many people, in particular back pain sufferers seem near impossible due to faulty recruitment of hips over abdominal muscles. Also learning to move correctly with movements like Squat, Bend, Lunge, etc is essential before you try to strengthen. If you skip this stage and try to strengthen your body with a compensatory movement you risk further injury or worse another new injury! Introduction of isolated strength training can be used in this phase to also prepare for the integrated strength training in the next phase. Exercises such as the clams for the glutes or VMO for the knee are perfect examples here.
Your goal with this stage is to prepare for strength training.
Read these two articles to see more on this phase.
Strength: 6-8 Weeks
In this phase you must start with the simple movements but gradually progress to more integrated complex movements with single leg or single arm.
It is in this phase most people will find the long term success for their problem, but make no mistake it comes with risk.
Perfect technique is critical which is where the previous phases will have prepared you for this day. These are the exercises that begin to mimic life movements or sports skills. If you can complete these movements with load over several sets, then the real life activity will be a piece of cake! Many of these exercises you will need to do for the rest of your life! Strength can be lost quicker than it can be gained, so once you have learned what you need to do, this now becomes your preventative injury exercise program instead of your rehab program. This is the longest phase of the program due to the amount of exercises you will need to learn.
Your goal with this stage is to prepare for the power phase.
Read this article to see more on this phase-
Power: 3-4 weeks
Many people don't see the need for this phase as they say to me, "I don't play sports or need to do things fast". Well unfortunately you do need this all the time. Walking up stairs is a power movement, you cannot do it slow. Watch an old person who has lost a lot of strength walk up stairs slow to see what I mean. Starting a lawn mower, throwing a ball, even lifting heavy shopping bags is easier if you move it quickly from the floor. The loss of this ability from not completing your rehab process sets you up for another turn at rehab. The good news is this phase is much quicker than the strength as many of the skills are already learned, you just need to learn how to do them fast and keep it safe.
Your goal with this stage is to regain confidence in completing the movement that you feel is likely to hurt you the most. Remember the stairs example?
Read this article to see more on this - Why power training is so important to include in your workout
Conclusion
It is impossible to put clear defined time frames on how long to progress through different stages of a health and fitness program, especially when we are talking rehabilitation. Use your assessments and tests to determine if you are ready to progress. If in pain go back a step, usually stretching and stability exercises are great when in pain. But also don't make the mistake of what most of the general population do and stay in the first two phases! The real answers to your problems lie in the last two phases that are also the riskiest. But if you can follow a well designed plan of how to get there the risk is less and results are greater. That is why we have gone to so much trouble to provide you with the step by step process.
For more ideas and information on specific topics I may not have covered in detail be sure to check out our INDEX PAGE on the website that has over 300 of our best articles. These are all sorted into categories for quick reference so you can find what you are after more easily. You can also subscribe to our FREE fortnightly newsletter by clicking here.
I hope this answers your questions but if not feel free book a Free Consultation by clicking the image below where I can go through our assessment process in more detail. 
About The Author
Nick Jack is owner of No Regrets Personal Training and has over 15 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specialises in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.
References:
- Movement - By Gray Cook
- Corrective Exercise Solutions - by Evan Osar
- Back Pain Mechanic - by Dr Stuart McGill
- Diagnosis & Treatment Of Movement Impairment Syndromes - By Shirley Sahrman
- Low Back Disorders - by Dr Stuart McGill
- Ultimate Back Fitness & Performance - by Dr Stuart McGill
- Assessment & Treatment Of Muscle Imbalance - By Vladimir Janda
- How To Eat, Move & Be Healthy by Paul Chek
- Scientific Core Conditioning Correspondence Course - By Paul Chek
- Advanced Program Design - By Paul Chek