A lot of clients reach out to me after trying at some point to strengthen where they had an injury through standard protocols. This isn’t bad advice, but it is often incomplete.
Here’s the problem—not all injuries will respond to general, progressive loading if the nature of an injury is a load management problem in one or more tissues (load is not one thing). Conventional approaches to injury management can incorporate strength exercises that involve your rotator cuff, but they don’t consider all the individual variables in a rotator cuff injury—like whether it’s in the muscular vs. tendinous portion, or how different depths, directions, and tissue composition can be targeted beyond a general ‘rotator cuff’ exercise.
For example, cells in your supraspinatus tendon may not behave the same way as ones in your shoulder capsule. The architecture could be different based on your history, training, and injuries. The environment is different. The demands and capacities are different. That’s exactly why you need to target the appropriate cells, thereby leveraging the problematic tissue.
So why would we load them the same way?
As you’ll see in the video, I recorded a short video breaking down the basics of fibroblast behavior—specifically, what happens when connective tissue experiences low-level force versus no force at all. It’s an introduction to why tissue-specific training and rehab aren’t just optimization—they’re essential if you want to address injuries at the level where they actually occur.
(Note: This is educational. Stretch is not the only thing fibroblasts need—but it’s a good starting point for understanding how mechanical load influences tissue behavior.)
The generalized approach leaves anatomy on the table
When you take a broad, generalized approach to rehab or training, you’re likely missing specific structures that need targeted attention. A generic “strengthen your rotator cuff” protocol doesn’t account for whether your injury is in the supraspinatus tendon, the joint capsule, or the connective tissue of the teres minor. Each of those tissues plays a different role in your rotator cuff capacity.
The more specific you get with your anatomy, the more precision you have in your rehab. And precision matters when you’re trying to restore tissue-specific function.
What is fibrosis, and why does it matter?
Fibrosis is what happens when your connective tissue heals poorly—it lays down disorganized, suboptimal collagen instead of high quality tissue. Think of it like scar tissue that never quite integrates back into the surrounding structure.
If a tendon, ligament, or other connective tissue structure doesn’t experience the right kind of mechanical stimulus, fibroblasts (the cells that build connective tissue) still produce collagen—but it’s poorly organized and less elastic than healthy tissue. The body survives, healing mechanisms occur, but suboptimally.
It’s worth noting: while we’re focusing on fibrosis in response to injury, other factors can contribute to fibrotic tissue formation—chronic inflammation, repetitive microtrauma, aging, and metabolic factors. This is why someone with a 20-year-old shoulder injury might experience progressive stiffness over time, even without re-injury. The initial fibrosis from poor healing can compound with age-related changes, creating a cycle of reduced capacity and compensatory patterns.
Over time, this can create:
Reduced range of motion
Persistent stiffness
Increased risk of re-injury
Aches and pains
Compensatory patterns that lead to new problems
The solution? Tissue-specific loading that encourages fibroblasts to produce organized, robust collagen instead of disorganized tissue. This isn’t about “just moving more”—it’s about understanding how that specific tissue needs to be loaded to heal and adapt properly. This is exactly where your goals, capacities, and limitations matter. You aren’t like everyone else—why should your injury management or training be?
If you know someone dealing with a chronic injury...
Share this with them. A lot of people are stuck in generalized rehab protocols that don’t address the nuances of their specific injury. This might give them a new angle to explore.
And if you’ve been on the fence about subscribing—this is what you’ll get regular access to:
Joint Fundamentals: The core principles of joint maintenance and connective tissue health
Whiteboard sessions: Concepts and approaches to training your connective tissue, broken down visually
Joint-specific classes: Targeted work for shoulders, hips, knees, ankles, and more
And more
Thanks for reading. More to come.
—Alex
