Graded Exposure and a New Three-Stage Rehabilitation Framework

Peter describes his approach as graded exposure within a strength and conditioning framework, using activities relevant to the individual. Therapeutic exercise builds tolerance while running and jumping are load managed, then usual activities return and progress toward the person's goals. Adequate strength is a prerequisite before progressing stretch shortening cycle activity. He has replaced the older isometric, isotonic, then plyometric sequence with three overlapping stages. The first builds capacity and tendon stiffness through technique, holding and pushing isometrics, slow isotonic strength and, once concentric 6RM targets are met, maximal intent and maximal eccentric work. The second covers force generation and absorption, such as box jumps, stopping drills and landings, along with low intensity running. The third adds hopping, pogo hops, repeated jumps, cutting, gait drills and high speed running. Isometrics are undervalued if used only for short-term pain relief, which lacks good evidence. They are better for targeting range-specific weakness, such as inner range plantar flexion in the Achilles, and for driving tendon adaptation.