Are We Doing Rehab the Wrong Way?
Why stopping at pain reduction leaves every patient half-rehabilitated — and what a full continuum of loading looks like
I constantly see posts online about how to rehab this condition or that pathology. There is a compendium of information about condition-specific rehab programs, and some of the professional organizations that promote rehab and performance even have courses about it. On the surface there is nothing wrong with these courses. As a matter of fact, they can be very helpful in guiding the process for how to treat specific problems that many clinicians encounter on a daily basis. But the problem is that I think we are performing rehab the wrong way. For the most part, I think we are entirely getting it wrong. Because this is such an important topic, I think we should spend some time talking about it.
Defining rehab
I have written previously about the definition I like to use for rehab. The simple definition of rehabilitation is the restoration of function. Webster’s dictionary defines rehabilitation as the restoration of something damaged to its prior condition. The most accurate definition comes from Latin — specifically, the word rehabilitation derives from re (again) and habilis (to make fit or suitable). Essentially, rehab means to make someone fit again. I like this definition because it focuses on restoring someone to a former state of health or fitness after injury, rather than simply reducing isolated musculoskeletal pain. If we look at the Greek definition, rehab means “to recover life” or “to live again.” I find this equally fitting, as it encompasses restoring all aspects of one’s life — not just addressing pain.
When we relate these definitions back to current rehabilitation practice, the gap becomes clear. In most cases, rehab today means reduction in pain and restoration of local function. If you have knee pain and you are released from rehab, your knee no longer hurts and can move through its full desired range of motion. Pain is usually the primary driver of this process. Once pain is gone, the clinician feels like the job is done. I think that is a significant mistake — yet we see it time and time again when patients are released from care after musculoskeletal injury.
Pain is always the last thing to show up and the first thing to go away. That is what makes it such a poor metric for measuring progress. It makes much more sense to measure progress through the lens of function. But function, as a concept, can also be misapplied. The definition of function is the action or purpose for which a thing is used or exists — more simply, doing what you are intended to do. During rehab, this definition of function is frequently applied in an isolationist manner. Returning to the knee pain example: I prefer a more global definition of function, one that includes the necessary physical qualities related to the individual’s fitness.
Fitness is defined as the quality or state of being fit, or the capacity of an organism to survive in its given environment. Fitness is having the physical qualities required to adapt to the conditions of the tasks relative to your environment. To be fit means, generally, to be able to do everything a human is supposed to do — and specifically, to have the physical requisites to complete a desired terminal task. At this point you may be asking: what does any of this have to do with musculoskeletal rehab? The simple answer is everything.
Start with the end in mind and work backwards
When discussing rehab and treatment plans, I have always said: start with the end in mind and work backwards. The end, in this context, is fitness — the ability to do everything a human is supposed to do, generally or specifically, and to complete the terminal tasks required for life or sport. The goal with every person I work with is fitness. I want to get their body back to a position where they can express physical fitness qualities. This connects back to the global definition of function we discussed earlier. When I start a rehab program, I define the end fitness qualities the person needs for life or sport, then create a plan from where they currently are (Point A) to where they need to be (Point B). Performing rehab this way goes beyond the traditional localized, pain-focused version of rehabilitation.
If you start your rehab process at the beginning and work forward, most clinicians will inevitably stop once pain has been reduced and mobility has been restored. Mapped against the stages of care in the rehabilitation process, this means care is usually stopped after foundational kinematics — and in some cases, after motor control. But that is not enough to fit my definition of rehabilitation. Just because the joint or tissue no longer hurts, can move through the desired range of motion, and can stabilize at the appropriate time does not mean that rehabilitation is complete. It means you have completed half of the rehabilitation puzzle. In most cases, there is still significant work ahead.
The sticking point
There are a few organizations within chiropractic and rehabilitation that promote the idea of rehab to performance. But the problem is they rarely get to the performance side of the equation — and when they do, it is incomplete and still missing essential pieces. These organizations typically hold events to expand your knowledge and build your skill set. They commonly focus on manual therapy, manipulation, taping, and soft tissue techniques, but never get into the actual training portion of the rehabilitation process.
As I have stated in previous posts, there are six stages of loading during the rehabilitation process: acute management, foundational kinematics, motor control, functional integration, progressive kinetics, and fundamental capacity. These are the stages an individual moves through if they are truly going from the table to the court or the field. These organizations do a solid job teaching acute management, foundational kinematics, and motor control — but that is where they stop. They occasionally address general physical preparation and resistance training in functional integration, rarely discuss rate of force development in progressive kinetics, and essentially never address motor skill acquisition and work capacity in the fundamental capacity stage.
Normally this would not be the most pressing issue, as this is how most rehab education is taught to clinicians today. But if an organization promotes the transition from rehab to performance, there had better be a detailed system in place to teach the back end of that equation. I make this point not to be dismissive of any individual or organization. Quite the contrary — my goal is for everyone to view rehab the same way I do. And in order to do that, we need everyone operating from the same framework and using the same language.
Viewing rehab through the lens of load
This problem is largely solved when we view rehab through the lens of load. Instead of viewing rehab through the lens of certifications or individual tools, if we view every intervention as an exposure to load, we can make the transition from traditional rehabilitation all the way through to the end of performance and competition without losing the thread. As I have said before: load is the language of human performance, and the Periodic Table of Performance Elements is the framework that holds everything together. If we truly want to perform rehab progressively in the way I have described, we need a system that guides the process and produces consistent results.
We have already discussed the concept of rehab and my current definition. But if we are going to do the rehab-to-performance model, we need to address the performance side of the equation. Human performance is about both readiness and preparedness. Readiness is biologically driven and relates to the health and recovery of the individual. Preparedness is physiologically driven and relates to the physical qualities necessary for fitness. So human performance is about readiness (availability) and preparedness (resiliency). Notice that a significant portion of performance is directly tied to fitness.
So if we are going to prepare someone for performance — and for the physical qualities necessary for fitness — then our rehab needs to reflect the entire loading continuum, starting at acute management and terminating at fundamental capacity. When we use load as the language, we shift focus from individual tools to overall exposures to load. The goal is always long-term physiological adaptation, and everything we do clinically is to get the body into a position to load. What we do in rehab is get the joints into the right positions to absorb forces and adapt to the stressors of training. We teach the body to absorb forces by building strength during functional integration and rate of force development during progressive kinetics — while simultaneously creating resiliency so the organism can effectively adapt to the ongoing demands of training.
One of the ways we ensure the organism is properly adapting is by having a robust monitoring system and efficient recovery strategies. These two domains of the Periodic Table directly correlate to one another. We apply load during rehabilitation interventions, then quantify that load through monitoring. Monitoring tells us how the organism is responding to load exposure, and then we create specific recovery strategies to help it return to homeostasis. All of this is simply considering the lifecycle of load as it travels through the four domains of the Periodic Table of Performance Elements.
Putting it all together
The goal of rehabilitation has never been to eliminate pain. Pain is a signal, not a destination. It is the body’s way of telling us that something has gone wrong, and while it absolutely demands our attention, it should never be the finish line. The moment we treat pain reduction as the endpoint of care, we have already failed the patient — because we have stopped asking the most important question in all of rehabilitation: what does this person need to be able to do?
The real goal — the one that has always been embedded in the Latin roots of the word itself — is to make someone fit again. To restore them fully. To get them back to doing everything a human is supposed to do, whether that means walking to the mailbox, keeping up with their kids on the weekends, returning to the field after a season-ending injury, or competing at the highest level of sport. Fitness is the target. Everything else is a milestone along the way.
This is not a radical idea. It is, in fact, the original idea. We have simply lost our way.
Somewhere along the line, the rehabilitation process began organizing itself around tools, certifications, and condition-specific protocols rather than a unified framework for human performance and adaptation. We started asking “what technique do I use for this diagnosis?” instead of “what load does this person need, and how do I get them there?” The result is a system that does the first half of the job exceptionally well and then stops — leaving patients discharged from care at the exact moment when some of the most important work is still ahead of them.
To fix this, we have to change how we think about the process from the very beginning.
Start with the end in mind. Before you write a single exercise, before you apply a single technique, define what fitness looks like for this individual. What are the terminal tasks they need to perform? What are the physical qualities required to execute those tasks? What does Point B actually look like — specifically, measurably, functionally? Once you know where you are going, you can build the map that gets you there. Without that destination clearly defined, you are not running a rehabilitation program. You are reacting to symptoms.
Commit to the full continuum of loading. Rehabilitation is not a handful of stages that end at motor control. It is a complete progression — from acute management through foundational kinematics, through motor control, through functional integration, through progressive kinetics, and all the way to fundamental capacity. Each stage builds on the one before it. Each stage prepares the body for the demands that come next. Stopping at motor control because the pain is gone is like building the foundation and frame of a house and handing someone the keys. The structure exists, but it is not ready to be lived in. The patient is not ready to be sent back into their life.
Use load as your language. When you shift your lens from individual tools to load exposure, something clarifying happens. The artificial divide between rehabilitation and performance disappears. Manual therapy, corrective exercise, resistance training, rate of force development work, conditioning — these are not separate disciplines requiring separate certifications. They are all exposures to load at different points on the same continuum. When you understand that, you can guide a patient seamlessly from the table to the training floor to the field without ever losing the thread of the program. Load is not just the language of performance. It is the language of the entire rehabilitation process from day one.
Measure what matters. Load without monitoring is load without direction. One of the most critical — and most overlooked — components of a complete rehabilitation program is the feedback loop: the system that tells you how the organism is actually responding to what you are asking of it. Are they adapting? Are they recovering? Are they accumulating too much stress without adequate return to homeostasis? Monitoring gives you the data to answer those questions, and recovery strategies give you the tools to act on the answers. These two domains are not optional add-ons for elite athletes. They are essential features of any rehabilitation program that takes long-term physiological adaptation seriously.
Recognize that resilience is the real outcome. We talk a lot about readiness and preparedness in human performance, but the deeper goal beneath both of those is resilience — the capacity of the organism to absorb stress, adapt to it, and come back stronger. That is what we are building through every stage of the rehabilitation process. We are not just restoring what was lost. We are creating a body that is better equipped to handle what comes next — whatever load life, sport, or the passage of time decides to place on it. A resilient organism does not just survive its environment. It thrives in it.
When we step back and look at all of this together, the picture becomes clear. We are not talking about a niche philosophy or an elite performance model that only applies to professional athletes. We are talking about a better standard of care for every single person who walks through your door. The weekend warrior with a hamstring strain. The middle-aged parent with chronic low back pain. The high school athlete coming back from an ACL reconstruction. Every one of them deserves to be taken all the way — not just to the point where they stop hurting, but to the point where they are genuinely prepared for the demands of their life.
The framework exists. The language exists. The six stages of rehabilitation and loading exist. The Periodic Table of Performance Elements exists. What has to change is the mindset — and with it, the standard we hold ourselves to as clinicians. When we commit to the full continuum, we stop doing half the job and start doing all of it. When we start with fitness as the goal and use load as our guide, we stop managing symptoms and start building humans. When we operate from a shared framework and a shared language, the entire profession rises — and more importantly, our patients rise with it.
That is what real rehabilitation looks like. That is what it has always been meant to look like. And that is the standard every patient deserves.
At what stage do you typically discharge a patient from active rehabilitation — and what drives that decision: pain, function, or something else?
If you want to see what the full loading continuum looks like in practice — from acute management through fundamental capacity — the Language of Human Performance Guide is where it's laid out in detail. Check it out here.