Keys to Building a Prescriptive Exercise Program

If you think about any project you’ve worked on, you’ve likely started with the end result or the vision of what completion would look like and then worked your way back to a starting point. One of the biggest points of contention I hear from coaches and rehab professionals when they enter the programming world is, “I don’t know where to start.” 

In order to start any project or task, you first need to figure out what resources you have, what strengths you have at your disposal, and where your weaknesses lie. In the programming world of prescriptive exercise, this is no different. An important starting point is zooming out, getting a lay of the land, and leveraging all the scenarios you can. 

Now that we understand we are going to build in a wide to narrow-fashion, here are some of the key components to putting the pieces together:

1. Audit the situation. What was your client doing when they got hurt, what are they looking to get back to, and what are they currently able to do/not do? This is known as a subjective history in the rehab field. It’s no different when using it in this instance. 
2. Gather objective data. It’s hard to know where to start if you don’t currently know where your client is at. This might come in the form of strength testing both unilaterally to compare sides and bilaterally to compare pattern dominance. Although this is only one piece of the puzzle, it helps us understand the strengths and weaknesses of the training profile. If your client is unable to perform any strength testing, you’ll want to assess their tolerance to certain variables such as patterns like the squat or deadlift, range of motion through those patterns, ability to load through those patterns, intensity or speed at which they can move, or even simply willingness to try. 
3. Interpret the subject and objective data and create a starting plan. In full transparency, you have no clue if this plan will work because you need a variable you cannot manipulate in the same way… you need time. Yes, that’s right, your plan needs to mature, and until it does, you won’t know if you’re on the right track. But remember, you created this plan for a reason using your process. Let it play out for a bit. 
4. Be willing to let some flare-ups play out. You need to identify if this is an outlier or a trend. The number 1 mistake I see coaches and rehab professionals make is abandoning the plan at the first instance of a flare-up. 
5. Monitor your dosing of the work in addition to the client’s other training programs. In most instances, the work that I teach is layered into a client’s existing training plan as their dedicated strength or accessory work - this is a key component of the Prescriptive Exercise Program. 
6. Allow a protective workload base to be formed. That means progressing at an appropriate speed. If we try and accelerate the process before the tissues are ready, we run the risk of re-injury/re-aggravation. Stick to the plan and instill the importance of patience with your clients.
7. Don’t over-prescribe! A Prescriptive Exercise Program is often a priming or mobility-based warm-up plus 1-3 exercises. In many cases, I advise the progression of Prescriptive Exercise Programming is removing work and replacing it with regular training, NOT adding more volume of prescriptive work, unless that is indicated for a specific reason. 
8. Trust yourself. You know what you’re doing, so be confident in it. You have to be willing to experiment, take calculated risks, and ultimately be willing to be wrong. Now, this doesn’t mean progressing irresponsibly, but no process is perfect. So if you’re looking for an exact algorithm of how you bat 1.000, you’re not going to find it. 

Boiling this process down to its simplest form requires figuring out what your client can continue to do in order to maintain their level of fitness while figuring out how to work in what they need… also to maintain their level of fitness, but in this case, for the long term. 

Remember, working with clients requires manipulating a blend of factors and weighing them appropriately for each individual client. What worked for one may not work for another. But when you get the reps in, you’ll start to notice the trends. You’ll start to create your formula, and you’ll start to be comfortable tweaking it.