I quite often see posts and videos on social media about how to choose the right exercise for a specific musculoskeletal condition, or which exercise is best for some direct fitness application. Most of these videos demonstrate exercises and show proper “form” of execution — but almost never describe the specifics of why they chose that particular exercise, why it was appropriate for that specific individual, or what to do if the exercise causes pain, discomfort, or exacerbates pathology. With so much information and misinformation at our fingertips, exercise selection and execution can often become downright confusing. Because this is such an important topic, I think we should spend some time talking about it.
The first thing we want to do when considering an exercise is to start by asking some very simple questions. First: what joint and/or tissue am I specifically trying to load? This helps narrow things down to very specific categories of loading, eliminating movements and patterns that are temporarily unnecessary. When asking this question it is important to differentiate between which joint and which tissue is being loaded, as the means we use to get there may differ depending on the target.
The second question to ask is: what am I trying to accomplish? This allows us to define a specific adaptation we are attempting to elicit, so that we can choose the appropriate exercise as a vehicle to accomplish that goal. Another way to frame it is: what is the goal of the exercise? Quite often people choose an exercise that targets the correct joint or tissue, but because they have not appropriately defined the desired adaptation they are applying the wrong method — and then get inconsistent results. The first question tells us the target of load application. The second question allows us to determine the best-suited methods and means to get there.
After we have identified the specific joint or tissue we are trying to load, and the specific adaptation we are trying to elicit, we then want to determine the individual’s current tolerances to load. In a clinical setting we would have done this as part of our patient examination, searching for mechanical sensitivity through the use of orthopedic and neurological testing. These procedures tell us what joint or tissue is the site and source of the person’s pain, and give us some insight into what tolerance the individual might have to loading.
For purposes of this conversation, let’s use the example of someone whose chief complaint is knee pain. After orthopedic examination, you have determined that the patient has patellar tendinopathy. The site of pain is the knee (joint), and the source of pain is the patellar tendon (tissue). In making this determination we also have to take many other factors into consideration. When did the pain begin? What movements, postures, and positions cause aggravation? What makes it feel better? When is it worst, and how long does it typically last? All of these questions help us formulate a picture of how much tolerance to load the joint and tissue currently have, and allow us to be very specific in choosing a starting point for loading.
Before we choose a specific exercise or apply any kind of load, we always need to audit the problem to gain valuable information. If the individual is in pain and in the clinic for rehabilitation, the clinician would use the clinical audit process — which determines the site and source of the person’s pain, and current tolerance to load. As a hypothetical: if the patient has pain that is 7/10, then their current tolerance to load is 3/10. I discussed this previously in my post about “The Goldilocks Zone of Loading” and the Rule of 10.
If the individual is not in pain and is coming to the clinic to reach a specific goal or accomplish a terminal task, then the coach or trainer would use the fitness audit process. This helps us gain valuable information about the individual’s current status, past exercise history, loading preferences, and specific training goals. To help determine the appropriate exercise for this scenario, we must have a solid understanding of the individual’s least amount of accustomed activity — the amount and type of activity the person has actually been doing in the last two to three months.
Knowing this drives specificity. If an individual coming to you for training has done no knee-focused exercises in the last two to three months, their least amount of accustomed activity is zero. If they tell you they have been performing some variations of squatting exercises intermittently over the last three months, that is an entirely different starting point. The amount of accustomed activity matters greatly — these two people would have entirely different starting points, loading volumes and intensities, and possibly even different goals.
After we have determined what joint or tissue we want to load, and the individual’s current tolerances to load, we can move forward with choosing an exercise. As I have previously discussed, exercise is the process of applying force to a motor pattern — an elaborate formula that dissects the process of stimulation to achieve a very specific adaptation. I discussed this in detail in my post “What Is Exercise” on the Formula of Exercise. For the purposes of this conversation, let’s focus on exercise as a vehicle via which we apply load.
Returning to our example: we have an individual diagnosed with patellar tendinopathy. We know the site (knee) and source (patellar tendon) of the person’s pain, and we know their tolerance to load is 3/10. We now have to choose a vehicle to load the patellar tendon and the knee joint. For this patient, we might want to choose an exercise that explicitly loads the patellar tendon without excessive dynamic motion — since tendinopathy is most commonly caused by overuse. In this case we could choose a seated isometric knee extension for a non-weight-bearing option, or a 90-degree wall sit for a weight-bearing option. I would probably choose the non-weight-bearing option first to confirm tolerance, before moving to the weight-bearing option. But it all depends on how the individual responds to initial loading.
If an individual is coming through the fitness pathway and we have determined their relative accustomed activity, we can then choose a specific exercise to apply load to the desired pattern. Staying with the knee, we would need to pick a knee-dominant pattern. In my model there are six exercise categories in the knee-dominant category: the squat, deadlift, split-stance lunge, rear-foot elevated split squat, step-up, and single-leg squat. To begin, I would start with the pattern that provides the lowest system load — a bilateral, knee-dominant, weight-bearing exercise. A great starting point might be a squat. But once we have picked the exercise, that is where the real challenge begins.
Once we have settled on an exercise pattern that fits our goal, we must choose the appropriate starting point. If the individual is beginning a fitness program with no real accustomed activity, I will start them in the least stimulative progression of that exercise. If they come in with some intermediate to moderate training experience and accustomed activity, I will start them at the baseline progression. If they come with a large amount of training experience and accustomed activity, I may choose to start in one of the more advanced progressions.
Using the squat pattern as an example, there are five options — 1 through 5, where 1 is the least stimulative and 5 is the most stimulative:
Assisted TRX Squat
Bodyweight Squat
Landmine Squat
Goblet Squat
Barbell Squat
If the person has no experience or accustomed activity, I would start with an Assisted TRX Squat. The TRX straps unload some of the individual’s bodyweight — it has been estimated that TRX can reduce load by as much as 30% — making it a great starting point. If the person has some experience and accustomed activity, I would start at the baseline exercise, in this case the Landmine Squat. The baseline exercise is described as one that “80% of people should be able to do 80% of the time.” The landmine provides some external stability while allowing us to begin increasing load compared to a bodyweight squat. For an advanced individual with high accustomed activity, I would most likely start with barbell squats — and my preference is almost always the Front Squat. I find it easier to control for most people and better at keeping the individual’s center of mass over their base of support. If a Back Squat is required — because of sport demands or powerlifting — then that may be the appropriate choice. To be fair, I almost never prescribe Back Squats for general population or sport athletes unless it is a concrete part of a program prescribed by their coach or training staff.
Now we need to properly define progressions, regressions, and lateralizations. A progression makes something harder in order to force physiological adaptation — in most cases the appropriate landing spot for movement quality and strength development. A regression makes something easier to ensure that some positive physiological adaptation can still occur — usually the appropriate landing spot for motor skill acquisition and building reflexive stability toward movement competency. A lateralization maintains difficulty in order to ensure physiological adaptation continues to occur — usually the appropriate landing spot for movement competency and capacity simultaneously.
Choosing the right landing spot is critical to outcome success. Too much load too soon, and you create a risk problem. Not enough stimulation, and you fail to accomplish the goal. My general approach: if someone is transitioning from the rehab path into fitness loading, I start them at regression option 1 and progress forward when progress dictates. If the person is coming through the fitness pathway, I start them at baseline option 3 and then progress or regress based on exercise execution.
Once we have landed on the right pattern, exercise, and progression or regression, we need to make sure the individual can execute with proper integrity. For this conversation, integrity is defined by the ability to maintain the ABCs.
Alignment — approximating the diaphragm over the pelvis, stacking the joints, and maintaining proper joint contractions and length/tension relationships. This allows for optimal force production and transfer, which is necessary for developing strength.
Breathe and Brace — properly aligning the joints allows for optimal diaphragmatic excursion, expanding 360 degrees in the lumbar canister. After a proper breath, we optimize the brace according to the specific task. The brace maintains stability in the lumbar spine and pelvis and optimizes force transfer.
Control — the ability to maintain proper alignment and breathing/bracing as the individual moves from the starting point, through the movement pattern, to the endpoint. Simply put: maintaining proper form throughout.
The ABCs are important for determining the appropriateness of an exercise. If the person can maintain the ABCs during execution, this is probably the appropriate landing spot and we can begin progressing forward. If they cannot, we need to regress backward until we find the exercise where they can. This matters because the first rule of training is do no harm. Allowing an individual to execute an exercise with poor ABCs increases their risk of injury and decreases the likelihood that proper adaptation will occur.
Too often coaches have clients move through exercises with the sole focus on weight on the bar, strength, or hypertrophy. If the external focus is only on those factors, we are missing the whole point. Exercise is a complex formula that encompasses a multitude of neurological, endocrine, and musculoskeletal factors. Reducing it to “move the weight” is dismissive, if not irresponsible. Proper execution is so much more than what we observe externally as the person moves.
After we have landed on the right spot and confirmed the individual can execute the pattern with proper alignment, breathing, and control, we can determine which variables to manipulate in order to achieve the desired adaptation. Variable manipulation is the true art form of the training process. Knowing which variable to manipulate, when, and by how much is the key to adaptation.
The training variables that can change the outcome of an exercise include: body position, range of motion, position of the moment arm, contraction type, actual load, duration of the exercise, volume in sets and reps, rest periods between sets, and rest periods between training sessions.
Each of these variables creates an entirely different experience for the individual. When manipulating variables, it is best to change only one thing at a time — adding too many variables makes it difficult to determine what is driving progress, or especially what went wrong. When I prioritize variable manipulation, I usually start with the speed of movement, then range of motion, followed by changing the actual load, and finally changing the position of the moment arm. Usually one of these changes resolves the problem or creates the sensory experience you are after. For this reason, variable manipulation is an extremely important part of exercise selection and execution.
So now we have talked through how to choose the right exercise and execute it properly. The results come down to having a defined order of operations that you can follow to achieve specific adaptation.
Ask: what joint or tissue am I trying to load?
Ask: what is the goal of the exercise — what adaptation do I want to achieve?
Determine current tolerances to load:
Clinical audit process: mechanical sensitivity through orthopedic and neurological testing; Rule of 10
Fitness audit process: past medical history, training history, and exercise preferences; least amount of accustomed activity
Choose a pattern you want to load (e.g., knee dominant)
Choose an exercise within that pattern (e.g., squat)
Make sure the individual is at the proper landing spot (e.g., Landmine Squat)
Make sure the individual can maintain proper ABCs during execution
If they cannot, regress backward until you find the spot where they can
Manipulate the specific variables necessary to achieve the desired adaptation
Consistently monitor this process to ensure consistent progress toward the specific goal
Exercise selection and execution isn’t guesswork, and it isn’t something that can be reduced to a five-second clip of “good form.” It’s a process — one that starts by identifying the specific joint or tissue you’re trying to load, defining the adaptation you’re trying to elicit, and honestly assessing the individual’s current tolerance to that load, whether through the clinical audit process or the fitness audit process. From there, choosing the right pattern and exercise, landing on the appropriate progression or regression, and holding the line on the ABCs during execution isn’t extra credit — it’s the difference between an exercise that actually produces the adaptation you’re after and one that just adds risk without benefit.
This is exactly why so much of what circulates on social media falls short. Showing an exercise — even showing it performed with textbook form — tells you nothing about whether it was the right exercise for that person, at that tolerance, in pursuit of that specific goal. The framework above won’t fit neatly into a fifteen-second clip, and that’s the point. Real exercise prescription is individualized, deliberate, and monitored — and once you start asking the right questions in the right order, exercise selection and execution stops being confusing and starts being systematic.
When you're choosing an exercise for a patient or client, which of these steps is most likely to get skipped under time pressure — and what does that typically cost you down the line?
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