Clinical Tools
Exercise Prescription Guide
A clinical decision tool to help you choose the most appropriate exercise prescription based on patient presentation, goal, and stage. Jump to a specific body region below, or use the framework sections for general prescription principles.
Region-Specific Exercise Guides
Top exercises, clinical goals, and pearls for each body region. Click a region to expand.
Clinical Goals Framework
Select the primary goal driving your exercise prescription. Each goal has a distinct approach, dosage, and rationale.
Best Approach
- Isometric exercise at low-to-moderate intensity (pain-free or ≤3/10 NRS)
- Graded exposure to movement — avoid complete rest
- Sub-threshold loading to stimulate analgesic response
- Breathing and relaxation integration to reduce central sensitisation
- Avoid high-load eccentric in acute/irritable presentations
Dosage
Sets
3–5
Reps / Duration
10–15 (or 30–45 s holds for isometrics)
Load
Low — 20–40% MVC
Frequency
Daily or twice daily
Why This Works
Isometric contractions at low load produce cortical inhibition of pain pathways and reduce central sensitisation without provoking tissue irritation.
Clinical Modifiers
Adjust your prescription based on the patient's current clinical presentation.
Progression Rules
When to progress
- Pain ≤3/10 during and after exercise for 2 consecutive sessions
- Patient can complete all sets and reps with good form and no compensatory strategies
- No increase in symptoms within 24 h of the previous session
- Outcome measure score improving (e.g. PSFS, NPRS, GROC)
How to progress
- Increase load by 5–10% (strength) or 10–20% reps (endurance) — not both at once
- Reduce rest periods to increase metabolic demand
- Increase range of motion or add end-range loading
- Reduce external support (e.g. remove TheraBand, reduce surface stability)
- Add speed, direction change, or dual-task demands for functional goals
- Move from bilateral → unilateral → dynamic → sport-specific
Clinical Pearls
Pain during exercise is not always harmful — but pain that persists or worsens after exercise is a red flag for overloading.
Isometrics are your best friend in acute and irritable presentations — analgesic, safe, and immediately applicable.
Motor control before strength — a patient who cannot activate their deep stabilisers will compensate under load and reinforce poor patterns.
Tendinopathy requires load, not rest. Progressive heavy slow resistance (HSR) is the most evidence-supported approach.
Dosage matters as much as exercise selection — the right exercise at the wrong dose will fail.
Chronic pain patients often need pacing and quota-based exercise rather than symptom-contingent exercise to break the boom-bust cycle.
Always explain the 'why' to patients — adherence is significantly higher when patients understand the rationale behind their programme.
One variable at a time when progressing — changing load, reps, and range simultaneously makes it impossible to identify what caused a flare.
Home exercise programmes should be simple: 2–3 exercises maximum for high adherence. Complexity kills compliance.
If a patient plateaus, consider whether the goal has shifted — pain reduction → strength → return to function require different prescriptions.