The therapeutic exercise framework: an integrative approach to optimizing tissue capacity

Selecting and modifying the most appropriate therapeutic exercises at the optimal therapeutic parameters for each individual patient is a skill that can be challenging to learn and apply effectively. In this perspective, an integrative framework is presented that provides a straightforward paradigm on which to have a starting point for clinical decisions about therapeutic exercise in musculoskeletal conditions.

The therapeutic exercise framework is based on a combination of three foundational constructs - physical stress on tissue, stages of tissue healing, and tissue-specific mechanobiology - all considered in the context of person-centered care. These three foundational components of the framework are interconnected, enabling clinicians to more precisely identify a patient's potential loading tolerance, implement safe and evidence-based timelines, and optimize stress-strain zones. The ultimate purpose of applying these concepts is to build tissue capacity, using the framework as a guide, to either rehabilitate injured tissue or develop more robust tissue that can manage greater functional demands.