Sue Falsone: Using Periodization in Rehab

Excerpted from
Bridging the Gap From Rehab to Performance,
pages 187-190

In the simplest terms, periodization is the manipulation of training stress over a period to produce a desired outcome.[i] It consists of several cycles over the course of the training year. Macrocycles are of periods of the year and comprise several blocks of mesocycles. Each mesocycle aims to achieve certain objectives and is made up of several microcycles, each of which generally lasts between five and 14 days. Several training days make up a microcycle, and several microcycles comprise a mesocycle.

A physical therapist in a traditional setting usually does not work with a patient long enough to see the person all the way through a full macrocycle. However, the rehab process itself might be considered a mesocycle.

It is important for the clinician to understand these strength and conditioning concepts to be able to work well with other sports-medicine professionals. This will help the entire care team create an actionable plan to help the athlete return to competition at full capacity, as soon as possible, but without increasing the risk of re-injury.

Rehab Periodization

The principles of periodization need not be confined to programming an athlete’s training. Periodization can also be applied to the various stages of rehabilitation as we bridge this gap between the two.[ii] We can think of rehab as being a mesocycle, with a goal of completing rehab. Microcycles are the smaller chunks of activity along the way.

For example, if someone is post-operative, the first microcycle goal could be to regain full range of motion. The second microcycle might focus on balance and proprioception. The third microcycle could concentrate on neuromuscular control.

This does not mean each microcycle can only focus on one physical attribute. There are many ways to periodize a rehabilitation program, such as the following concepts.


In this model, we use periodic sequencing to train one physical quality after another. We could work on range of motion first, then balance and proprioception, and then psychomotor control and strength.

Although every rehab may have a different linear progression based on the patient’s needs, most clinicians agree that regaining necessary motion is the priority. Strength and balance are addressed at any point, but range of motion must be regained early to prevent a slew of other issues later in the rehab process.


During concurrent training, we address several competing physical qualities in one mesocycle. Strength and endurance might be viewed as “competing” from a physiological standpoint, and could be part of a concurrent training program.[iii]

A large volume of endurance training has a negative impact on strength gains, while long-duration, lower-output work is only minimally affected by the introduction of strength training. If you are working with a marathoner, introducing strength activities should have minimal effect on endurance qualities.[iv]

However, when training a football player or someone who does not often function aerobically, performing long-duration, low-load activities can negatively impact strength and power gains. It is important to understand this idea: Strength and power training can greatly assist endurance athletes, while endurance training can negatively impact those who need more power.

In untrained people, the interference effect is minimal. However, in moderately or highly trained athletes, concurrent training affects the rate of force development or power more significantly than absolute strength.[v]


With conjugated programming, we are training several complementary qualities in one mesocycle. Examples might include strength and power, or somatosensory control and psychomotor control.

From a rehab perspective, we certainly can work on getting the right muscle to fire at the right time, while at the same time working to improve balance and proprioception for a given joint. Working on one of these would not interfere with the progress of the other. Therefore, these would be considered conjugated programming.


Concentrated training involves short periods of high training stress aimed at improving a single physical quality. We often use this method as an athlete is closing in on the strength training aspect of rehab.

For example, if an athlete is getting stiff at an injured joint, the clinician may have concerns that gaining this range of motion will only get more difficult or even impossible if left alone. The clinician may decide that one or two weeks are needed to dedicate every effort into regaining that active or passive range of motion back in the joint. All other concerns of strength or balance might be on hold until the athlete is able to restore the natural range of motion in the joint.

We can use also blocks, which are sequential chunks of concentrated mesocycles.

When an athlete is nearing return to competition, we might need to taper the program. This is a rapid reduction in volume or intensity to facilitate supercompensation before competition.

There might be no tapering phase or might be used exclusively when bridging the gap from rehab to performance. Since the athlete is usually progressing slowly and building up to the return-to-competition phase, we may only use a brief rest period of a day versus a true tapering prior to returning to competition.

Finally, we have the pre-competition phase, which comes at the end of the continuum, right before the athlete returns to competition.

For example, if a baseball player plays in AAA games for several nights, the taper might simply be one day off for travel before joining the big league club to play the following day. When discussing this with the team manager, you might decide it is best that the athlete only returns to competition for a few innings instead of an entire game. This decrease in volume, along with a rise in intensity, may suffice as the athlete’s taper prior to return to full competition.

This concept is planned in conjunction with the strength and conditioning specialist. Each situation needs to be evaluated by everyone involved in the care continuum. This way you can devise an appropriate return-to-sport plan that prepares the athlete for the return and safeguards longer-term health.


Strength is the fundamental building block to power. Ultimately, an athlete will need to be able to move at varying loads and speeds to return to competition. Preparing the athlete to do this is paramount when bridging the gap from rehab to performance. Strength and conditioning coaches can be significant resources to health care professionals who are not accustomed to applying these concepts to their rehabilitation programs.

It will benefit your athletes as they prepare to return to play if you understand strength-training principles and know how to safely apply them to your rehabilitation programs.

[i] Benjamin Rosenblatt, “Planning a Performance Programme,” High Performance Training for Sports, Dan Lewindon and David Joyce, editors, 248-249.

[ii] DL Hoover, “Periodization and Physical Therapy: Bridging the Gap Between Training and Rehabilitation,” Physical Therapy in Sport, March 2016.

[iii] Glenn Stewart, “Minimizing the Interference Effect,” High Performance Training for Sports, Dan Lewindon and David Joyce, editors, 246-247.

[iv] J Mikkola et al, “Neuromuscular and Cardiovascular Adaptations During Concurrent Strength and Endurance Training in Untrained Men,” International Journal of Sports Medicine, September 2012.

[v] JM Wilson et al, “Concurrent Training: a Meta-Analysis Examining Interference of Aerobic and Resistance Exercises,” Journal of Strength and Conditioning Research, August 2012.

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