Not WHAT, but WHY, HOW, and WHEN
In the world of sport performance and rehab, there is a tendency to seek out, create, and implement “sexy” exercises. I am referring to exercises that are unique, not commonly seen, and draw attention. An innate problem exists with this. Professionals are focused on WHAT they are doing rather than WHY they are doing it, WHEN it is being implemented, and HOW it is being performed. With physiology and philosophy guiding the WHY, HOW, and WHEN, the WHAT becomes an interchangeable piece.
Always start with WHY. Even little kids know “WHY?” is this most powerful question in the world. Ask “why” a patient is having pain with a particular movement. Ask “why” an athlete struggles with certain activities. If you can determine an answer to your “why?” then you can begin to build goals based on this why. From here, try to figure out various ways to achieve these goals. The answer to “why?” guides the process of designing programs and becomes the “WHY” behind exercise/activity selection.
HOW the movement/exercise is to be performed is crucial to the outcome of the programming. An obvious explanation of this is basic form or technique. That is a no brainer. But consider if the exercise is programmed with a certain emphasis. For instance, one may program an exercise to have “tempo” to work eccentric control or explosive concentric power. Perhaps one will need to increase or decrease the stability demands by increasing or decreasing their base of support or altering the surface they are on. These are rudimentary examples but I hope you get the idea.
Next consider WHEN it is appropriate to program and perform various activities. As a S&C professional this may depend on your macro/micro cycles, athlete’s current fitness levels, where they are at in the season, etc. As a rehab professional, this will depend on the phases of healing, ability to perform prerequisite movements, and goals. For instance, a patient cannot have their biceps loaded or enter certain ranges of motion immediately following a SLAP repair and this can be limited for 6-10 weeks depending on the size of the repair and physicians' protocols. Another obvious but often overlooked area I see in rehab and sports performance is prematurely progressing athletes to plyometrics or sport specific tasks. If athletes/clients are still unable to perform simple double or single leg squats, and hip hinges correctly, they do not have the proprioceptive awareness or coordination to perform these higher level exercises.
The WHEN can be more precise regarding order of exercises in a PT session or single workout. If you have a trainer or PT who tells you the order does not matter, they are either uninformed or lazy. For example, I have a particular order and flow to my rehab programs which generally looks like this: manual/soft tissue work, mobility/ROM work, core (including gluteal/scapular muscle) activation, movement integration, sport specific, power, strength. This order is not a rule and will be modified according to specific patient/athlete goals.
The point I am trying to make with this long winded explanation is WHAT exercise you program for your athlete/client/patient to perform is not nearly as important as WHY, HOW, and WHEN. If you have the WHY, HOW, and WHEN figured out WHAT exercise you decide to use becomes interchangeable. Understand the goals of the program, the goals of the exercise, and assuming you understand basic physiology and muscle action, you should be able to create a multitude of exercises that you could swap in and out of the program.