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Physiotherapist treating a woman

Mike James — Rebooting Robot Rehab — Injury Rehab Network

The Injury Rehab Network, in partnership with BASRaT and Sterosport, recently welcomed Mike James (aka The Endurance Physio) for an eye-opening presentation. Focusing on the art and science of exercise prescription, Mike challenged attendees to rethink how they assign rehab programs, prioritising patient adherence over complex, “gold-standard” exercises.

The online event took place on the evening of Wednesday 18th March with 245 practitioners in attendance. Mike’s presentation argued for a return to the fundamentals of exercise prescription. The recording is available to watch here.

Mike James head shot in black and white

Mike James MSc MCSP – The Endurance Physio

Mike is an experienced physiotherapist, educator and speaker with a background spanning the military and elite sport. A former Military Physical Training Instructor and rehabilitation specialist, he holds master’s degrees in Physiotherapy and Sports Medicine, alongside undergraduate qualifications in Sports Rehabilitation, Strength and Conditioning, and Sports Science.

Widely known as The Endurance Physio, Mike is a regular contributor to national publications and a speaker at conferences, professional events and universities across the UK and internationally. He also designs and delivers specialist workshops and CPD for clinicians, coaches and athletes. Over more than 20 years, he has supported practitioners and performers from grassroots to world-class level.

His main interests include athlete monitoring, exercise prescription, and behaviour change, with a focus on helping therapists build effective, engaging rehabilitation plans. He lectures full-time on the Physiotherapy programme at the University of South Wales, while running a busy clinical and coaching practice.

Rebooting Robot Rehab

Did the Patient Fail Rehab, or Did Rehab Fail the Patient?

Therapists often document that a patient was “non-compliant” or “failed to engage” with their exercises. Mike encouraged practitioners to invert this thinking: Did rehab fail the patient? A theoretically perfect plan is useless if it does not fit the patient’s lifestyle. Mike noted that rehab success ultimately rests with practitioners.

Mike highlighted two common traps therapists fall into:

  • “Monday Morning Rehab”: Pre-printing generic exercise sheets for patients before even assessing them, to save time.
  • “Friday Afternoon Rehab”: Giving a tired, recycled plan from a previous patient to the final patient of the week, ignoring differences in their age, goals, and activity levels.

“Training in the Presence of Injury”

Drawing on the words of Dr Phil Glasgow, Mike reminded the audience that rehab is fundamentally “training in the presence of injury”. Rather than searching for an endless encyclopedia of new exercises, practitioners should focus on mastering the basic principles of exercise progression and regression. Often, the best approach is simply modifying the movements, daily activities, or job tasks the patient is already doing to reduce load and symptoms.

The “Stickiness” Factor and Minimal Effective Dose

The ultimate goal of any rehab plan is adherence, or “stickiness”, achieved through behaviour change. Mike explained that ticks, not crosses, are the key to adherence.

To improve stickiness, Mike emphasised the Minimal Effective Dose (MED). This can be put in place by agreeing on the non-negotiables (core components) with patients and may even be in the form of a verbal or written contract. Research shows that patients given 1 to 3 exercises are twice as likely to stick to their program compared to those given 6 or more. He challenged attendees with two tests:

  • The Tom Goom Test: Can you actually complete your own prescribed patient rehab plan for a week? Most therapists cannot.
  • The Mike James Challenge: When a patient is successfully progressing, instead of adding a new exercise, see if you can take one out.

Mike recommends that patients be helped to stay connected to their practitioner through easily accessible communication. Social support via friends and family is also valuable.

Physiotherapist treating someone

Managing the “Stress Cup”

Mike highlighted that patients only have one “stress cup”.

Factors like poor sleep, financial struggles, and family dynamics all fill this cup, directly impacting a patient’s capacity to take on complex rehab. For example, a shift worker going into a block of night shifts may need a heavily modified, simplified program during that time.

Q&A Highlights

The session concluded with a robust Q&A, tackling real-world clinical challenges:

  • Dealing with unmotivated patients: In military or occupational settings, find out what matters to the individual (e.g., playing with their kids without back pain) rather than just focusing on their ability to work.
  • Managing expectations for passive treatments: If a patient is insistent on passive therapies like massage or adjustments, meet them halfway. Provide the requested relief, but use the opportunity to educate them on the “why” and gradually introduce active strength testing or exercise.
  • Elite Athletes: Even in elite sports where there is pressure to throw the “kitchen sink” at an athlete, relying on the minimal effective dose and careful training load management remains the ideal approach.

Conclusion: Mike’s final piece of advice to practitioners was simple but profound: Stop trying to master advanced, complex exercises and instead focus on becoming “world-class at the basics”. Practitioners should remember to make sure exercise is fun too!

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Presentation Recording

The recording of Mike’s presentation is available to watch here

2026 Injury Rehab Network events

The next Injury Rehab Network event is on April 15th, featuring a Q&A with Mark Leather, a physiotherapist who will share insights from his career in elite sport and professional football.

Find out about and register your interest for all the Injury Rehab Network events with BASRaT planned for 2026

Please enter your details into the form below, along with any questions or comments, and a member of our team will be happy to provide you with more information:

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