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Rehabilitation and Athletic Performance: Applying Vermil’s Hierarchy in Physical Therapy

As a sports physical therapy clinic we are obsessed with helping active people get back to the things they love. In order to do this, it takes a dialed approach with programming exercises in order to achieve an optimal result.

Recovering from an injury is a journey that requires patience, dedication, and a systematic approach. For athletes and fitness enthusiasts, this journey is not just about healing but also regaining and even enhancing their athletic performance. Vermil’s hierarchy of athletic performance provides a structured framework that can be seamlessly integrated into the realm of physical therapy and rehabilitation. Let's delve into how this hierarchy can guide individuals on their path to recovery and peak performance.

physical therapist in Covington performing a strength class

Understanding the Injury and Setting Goals

Before diving into the hierarchy, it's crucial to understand the nature and extent of the injury. A thorough assessment by a physical therapist will determine the starting point in the hierarchy. The goals of rehabilitation will vary based on the injury, but the overarching aim is to progress through the levels of Vermil’s hierarchy, ensuring each stage is optimally developed before moving to the next.

1. Work Capacity: Laying the Foundation

physical therapist doing mobility drills on a foam roller

For someone recovering from an injury, the initial focus is on regaining the ability to perform basic Activities of Daily Living (ADLs) without pain or discomfort. This stage is about building a foundation. Simple exercises and movements like walking, sit-to-stand, and basic range-of-motion exercises are introduced. The goal is to restore normal movement patterns and prepare the body for more demanding tasks.

2. Strength: Building the Pillars

Once basic movement proficiency is achieved, the focus shifts to strength training. However, it's not about lifting heavy weights immediately. Instead, it's about gradually increasing resistance to strengthen the injured area and surrounding muscles. For instance, someone recovering from a knee injury might start with bodyweight squats before adding weights. The key is to ensure that movements are pain-free and performed with proper technique.

3. Explosive Strength: Adding Dynamism

As strength improves, dynamic exercises are introduced. These exercises are designed to improve the ability to exert force quickly. Plyometric exercises, controlled jumps, and medicine ball throws might be incorporated, always ensuring that the injured area is not overstressed. It's essential to remember that explosive exercises should be introduced only when the individual is ready, both physically and mentally.

4. Elastic/Reactive Strength: Harnessing Energy

This stage focuses on exercises that utilize the stretch-shortening cycle. It's about training the muscles and tendons to store and release energy efficiently. For someone recovering from an ankle sprain, exercises like bounding, skipping, and drop jumps can be beneficial. However, these exercises require a high degree of neuromuscular coordination and should be introduced under the guidance of a trained therapist.

5. Speed: The Final Frontier

Once an individual has progressed through the previous stages, the focus shifts to speed and agility. This is especially crucial for athletes who need to return to competitive sports. Drills that focus on sprinting, changing direction, and sport-specific movements are introduced. The goal is to achieve pre-injury levels of speed and agility, if not better.

The Role of Energy System Training in Rehabilitation

Throughout the rehabilitation process, it's essential to consider the energy systems. Depending on the injury and the sport or activity an individual is returning to, training might focus on short explosive efforts, high-intensity efforts, or endurance efforts. The Rating of Perceived Exertion (RPE) can be a valuable tool in gauging the intensity of exercises and ensuring that the injured area is not being overworked.


Rehabilitation is a journey that requires a holistic approach. Vermil’s hierarchy of athletic performance offers a roadmap for individuals recovering from injuries. By progressing systematically through the hierarchy, individuals can not only recover from their injuries but also achieve peak athletic performance. Always remember, the journey of rehabilitation is unique for everyone, and while the hierarchy provides a framework, it's essential to listen to one's body and seek guidance from trained professionals.

Your Next Step

So, if you're in Seattle, Renton, Bellevue, or Covington and need physical therapy that goes the extra mile, HIDEF is the name you can trust. Don't just take our word for it; experience the HIDEF difference for yourself.

Feel like this is the right fit for you? Schedule your free physical therapy assessment today!

Our Locations:

  • Seattle, WA: Your partner in achieving your peak physical potential.

  • Bellevue, WA: Redefining recovery with cutting-edge techniques.

  • Renton, WA: Where athletes come to rebuild and regain.

  • Covington, WA: Comprehensive care for every stage of your journey.

Whether you are an athlete or someone striving for better physical health, HIDEF Physical Therapy is committed to providing innovative and personalized care that empowers you to live an active, healthy, and pain-free life.

Contact Us to schedule an appointment or learn more about how HIDEF Physical Therapy can be your guide to recovery and resilience. Follow us on Facebook, and Instagram for updates, tips, and success stories.

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