Rehab and Performance Lab: A Medbridge Podcast Rehab and Performance Lab Episode 24: Applying Performance Principles: How Do You Modify for the Rehab Setting?
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Mar 13, 2026 Robert Panariello, a PT/ATC/strength coach who led NFL health performance initiatives, shares how to adapt elite performance ideas for rehab. He discusses progressing load and velocity safely. He explains a rehab-adapted Vermeil hierarchy and practical plyometric and Olympic-lift progressions. Real-world timelines and testing strategies for ACL recovery round out the conversation.
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Sequence Load Then Velocity Then Direction
- Progress rehab by load then velocity and linear before COD: two feet before one and low load/velocity before high.
- This sequencing readies tissue and motor control so patients tolerate intensity safely as they progress toward sport.
Apply Submaximal Unaccustomed Stress
- Do not avoid intensity completely; apply submaximal but unaccustomed stress (eg 75–80% effort) to drive adaptation while limiting frequency of very high intensity.
- Remember day-one 'high intensity' can be a maximal quad set for a post-op ACL.
Rehab Modified Vermeil Hierarchy
- Vermeil's hierarchy adapted for rehab: evaluate/test → remove noxious stimuli → mobility/motor re‑education → work capacity → strength → power → plyometrics → speed.
- Each quality depends on optimal development of the previous (e.g., strength before elastic plyos).