Despite the growing amount of scientific evidence supporting exercise as an effective rehabilitation intervention for clients, translating that research into practice has proven challenging for clinicians. The result is that clients aren’t having their impairments appropriately assesses for the best object outcomes. Rather, clients often guide the progress based solely on their subjective biases. In more extreme cases, we see individuals who need intervention to assist with their impairment who are turning solely to exercise and attempting to rehabilitate without the guidance and skill or a licensed therapists.

It is time for a reset.

We must translate evidence-based rehabilitation into daily clinical practice to ensure that all clients receive adequate, intense, and progressive exercise rehabilitation.

Course Content
Building on Level I Fundamentals, this 2 day course furthers the step-by-step approach for therapeutic exercise dosing and delivery by adding precision design concepts for the lower quadrant. As hands-on
professions, practical lab components using real clinical scenarios are mixed with interactive discussion-based lectures for skills that can be applied right away in the clinic. To help therapists build advanced clinical reasoning skills in exercise prescription, therapeutic exercise design is taught with an emphasis on the “why”, “how”, and “when” rather than on specific exercises. Hands-on skills for the clinical application of hand-held dynamometry in comprehensive assessment, documentation of objective strength measures, and precision exercise dosing are practiced and mastered.

We urge clinicians to move beyond symptom moderation alone, and this course focuses on delivering clinically meaningful improvements to clients in all 4 outcome domains: symptom moderation; impairment correction; subjective functional performance; and objective functional performance. Further, we teach a systematic structure to the order of interventions provided to a client within one session as well as the progression from session to session.

Our framework, the MET MET-odology, is a contemporary development of medical exercise therapy concepts introduced by Oddvar Holten. It does not replace your current treatment practices (the tools in your toolbox), rather it provides structure to them (your very organized toolbox).

Topics: hand-held dynamometry, exercise prescription, exercise design, optimal improvement, 4 outcome domains; local / semi-global / global therapeutic exercises; three-dimensional approach to spine
stabilization exercises; spine


  • Apply the 2 guiding principles of the MET MET-odology in therapeutic intervention selection for the spine.
  • List 3 factors to achieve optimal patient improvement.
  • Recognize 3 factors from the clinical interview which help create patient buy-in into the treatment plan.
  • Develop 1 spine treatment session plan.
  • Identify measurement tools for the spine to achieve meaningful improvements in 4 outcome domains.
  • Apply the 4 training principles to therapeutic exercise prescription for the spine.
  • Apply the biomechanical concepts of torque and length tension in therapeutic exercise design for the spine.
  • Operate a hand-held dynamometer (HHD) in 1 biomechanical examination for the spine.
  • Execute Clinical Fatigue Tests (CFT) in 3 clinical scenarios for the spine.
  • Interpret the results of the CFT to appropriately dose 2 therapeutic exercises for the spine.
  • Design 1 precision therapeutic exercise prescription for the spine.


All modules are a combination of lecture and lab

Day 1

07:45 AM Registration
08:00 AM Introduction; Pre-course reading discussion; Clinical Scenarios
09:00 AM The MET-odology: Review and updates
10:00 AM Break
10:15 AM Optimal Patient Improvement for Spine
– Change the story
– Outcome domains (Symptoms / Impairment)
12:30 PM Lunch
01:30 PM Optimal Patient Improvement for Spine
– Outcome domains (Subjective and objective performance)
– Training principles
03:30 PM Break
03:45 PM Design considerations for Spine
– Biomechanical considerations
– Functional Integration
– Tissue response
05:30 PM Adjourn

Day 2
07:45 AM Check-in
08:00 AM Design considerations for Spine
– Muscle bias tests for Spine
10:00 AM Break
10:15 AM Dosing considerations for Spine
– Dose the weak link in the movement pattern
– Dosing for Symptom moderation and ROM
– Exercise-bias tests for Spine and CFT
12:15 PM Working Lunch – Clinical Scenarios
01:00 PM Delivery considerations for Spine
02:00 PM Revisit Clinical Scenarios (practical interaction)
03:00 PM Post- course interaction / Q&A
04:00 PM Adjourn

Required Readings

Course reading materials provided by MET following registration. 

  1. Bertozzi L, Gardenghi I, Turoni F, et al. Effect of therapeutic exercise on pain and disability in the management of chronic nonspecific neck pain: systematic review and meta-analysis of randomized trials. Phys Ther. 2013 Aug;93(8):1026-36.
  2. De Ridder EM, Van Oosterwijck JO, Vleeming A, Vanderstraeten GG, Danneels LA. Posterior muscle chain activity during various extension exercises: an observational study. BMC Musculoskelet Disord. 2013 Jul 9;14(1):204.