If you participate in sports, there is a good chance injury will occur and how to prepare for a return to competition matters. Marc Luko PT, DPT, CSCS, discusses this topic is his most recent blog.
Check it out here: ARE YOU READY FOR WOLVES??
Happy Reading!!!
Everyone has spent some time training or working out over the years. Many times those sessions are under a time restraint leading to minimal rest between sets in order to hit every component of the training program or workout for the day. Does that have an impact on overall results? Do you really need to rest between sets? This blog will aim to answer those questions and possibly shed some light on why rest between sets is actually a necessary component of every workout or training program.
Rest between sets is determined by the goal of your training. Whether you are training for strength, power, hypertrophy, or endurance will determine the overall length of your rest between sets. Many times people are not giving themselves enough rest during their workouts because of time restraints. This can lead to improvements in areas someone may not actually be looking to improve and frustration about why his or her training goals are not being met.
Let’s give some background information on the baseline parameters for each type of training. When training for muscular endurance, training volume starts between 1 to 3 sets of 10 to 15 repetitions with less than 30 seconds rest between sets. As one builds some overall tolerance to the training, volume will change to 3 or more sets of 10 to 15 repetitions with less than 30 seconds rest between sets. The number of repetitions can go as high as 25 when looking to improve overall muscle endurance. All of these sets and repetitions should be performed at a certain percentage of the individual’s 1RM (repetition max) and this percentage usually falls between 65 to 75% of 1RM for endurance training.
| Muscular Endurance Variables | Beginner | Intermediate | Advanced |
| Duration | 2-4 weeks | 2-4 weeks | 2-4 weeks |
| Sets per Exercise | 1-3 | ≥3 | ≥3 |
| Reps per Set | 10-15 | 10-15 | 10-25 |
| Rest between Sets | ≤30 seconds | ≤30 seconds | ≤30 seconds |
| Load/Intensity (% 1 rm) | 65% | 70% | 75% |
| Volume/Intensity Relationship | Moderate/Low | Moderate/Low | Moderate/Low |
When training for hypertrophy, training volume should start at 1 to 3 sets of 8 to 12 repetitions with 30 to 90 seconds rest between sets. These numbers progress to 3 or more sets of 6 to 12 repetitions with 30 to 90 seconds rest between sets. Hypertrophy training is performed between 67 and 85% of 1RM.
| Hypertrophy Variables | Beginner | Intermediate | Advanced |
| Duration | 2-4 weeks | 2-4 weeks | 2-4 weeks |
| Sets per Exercise | 1-3 | ≥3 | ≥3 |
| Reps per Set | 8-12 | 6-12 | 6-12 |
| Rest between Sets | 30–90s | 30-90s | 30-90s |
| Load/Intensity (% 1 RM) | 67-80% | 67-85% | 67-85% |
| Volume/Intensity Relationship | Moderate/Moderate | Moderate/Moderate | Moderate/Moderate |
When training for strength, training volume starts at 1 to 3 sets of less than 6 repetitions with 2 to 5 minutes of rest between sets. These numbers progress to 3 or more sets of less than 6 repetitions with 2 to 5 minutes of rest between sets. Strength training is performed at loads greater than or equal to 70% of 1RM. The reason for such a longer rest period during strength training deals with the energy system being depleted following a set of an intense exercise. This energy system usually takes at least 2 minutes to fully recover. Recovery depends on the individual’s overall training history and current level of fitness. Beginners may need up to 5 minutes to allow the system to recover.
| Strength Training Variables | Beginner | Intermediate | Advanced |
| Duration | 2-4 weeks | 2-4 weeks | 2-4 weeks |
| Sets per Exercise | 1-3 | ≥3 | ≥3 |
| Reps per Set | ≤6 | ≤6 | ≤6 |
| Rest between Sets | 2-5 min | 2-5 min | 2-5 min |
| Load/Intensity (% 1 RM) | ≥70% | ≥80% | ≥85% |
| Volume/Intensity Relationship | low-high | low-high | low-high |
As for power training, training volume starts at 1 to 3 sets of 3 to 6 repetitions with 2 to 5 minutes of rest between sets. These numbers progress to 3 to 6 sets of 1 to 6 repetitions with 2 to 5 minutes of rest between sets. Power is performed at 30 to 70% of 1RM. When training for power, an individual should not be training near or at his or her 1RM. The component of power that gets overlooked the most is speed. And more times than not when someone is training close to his or her 1RM, the load is being moved at a slower pace so power is not being trained.
| Power Variables | Beginner | Intermediate | Advanced |
| Duration | 2-4 weeks | 2-4 weeks | |
| Sets per Exercise | – | 1-3 | 3-6 |
| Reps per Set | – | 3-6 | 1-6 |
| Rest between Sets | – | 2-5 min | 2-5 min |
| Load/Intensity (% 1 rm) | – | 30-60% | 30-70% |
| Volume/Intensity Relationship | – | Low/High | Low/High |
All in all these parameters are just guidelines to help someone understand where to start when developing his or her own program. Individuals are individuals for a reason and need to be patient when exposing their bodies to a different level of stress through weight training. If someone is feeling like he or she is not making any gains, taking a look at how he or she is actually training can shed light on the reason for minimal change. Many times people believe they are training for strength when in actuality he or she is training for endurance. Meaning people do not allow themselves the adequate amount of rest when training for specific goals especially strength and power. So if you are lacking the improvements in strength and power, be honest with yourself about the amount of rest between sets and you may find your reason for the lack of gains.
Finally, look for guidance from a strength coach, physical therapist, or personal trainer when having trouble meeting your fitness goals or new to training all together. Just make sure the individual you seek advice from has experience with training parameters and programming for someone other than themselves.
Fitness level is usually determine by objective measures such as repetition max, VO2 max, faster time in 40 yard dash, and anaerobic threshold. But do those measures always equate to improved performance when it matters?
Check out this article by Joel Jamieson on his experience working with combat athletes and poor performance during competition even though all objective measures were improving. This is a great read!!!
Pre-participation screening (PPS) has become a routine procedure prior to any athlete beginning a sport of his or her desire. This screen can be as simple as a yearly physical to as complex as a multi-station screen designed to encompass all aspects of health and movement, not just basic vital signs. Sometimes governing bodies require a certain criteria be met to determine whether an athlete is healthy enough to participate in athletics.
Some of the main reasons for performing a PPS is to establish a baseline health of the athlete, identify conditions that may adversely effect participation in the desired sport, and meet the legal requirements of governing bodies and/or state laws. PPS consist of gathering a detailed medical history including musculoskeletal and sport-specific, respiratory disease screen, neurological screen especially in those athletes with a history of concussion, cardiac screen, and injury risk profile.
This blog will focus on the injury risk profile portion of the pre-participation screen and how after a more generalized screen, there is reason for each screen to be specific to the athlete being screened. As discussed by Joyce and Lewindon, there are 2 equations to determine overall injury risk. “Injury risk equation 1 is predisposed individual + extrinsic risk factors = susceptible individual.” A predisposed individual is an athlete who is more exposed to the possibility of injury secondary to their own intrinsic risk factors. Those intrinsic factors include past injury, age, decreased ROM, and musculature weakness. Extrinsic factors include training regimen, weather, and the sport itself. An example is a female athlete who lacks lower body strength and participates in soccer. The demands of soccer including deceleration and pivoting are extrinsic factors along with the intrinsic factor of decrease lower body strength leading to the female athlete being susceptible to an ACL injury.
“Injury risk equation 2 is susceptible athlete + injury mechanism = injury.” This goes hand in hand with equation number 1 because as the athlete participates in soccer, the injury mechanism is present, and the possibility of injury can occur. Without intervention to correct the limitations creating a predisposed athlete, the ability to decrease overall injury risk is minimal. However, screening allows healthcare professionals the opportunity to identify these limiting factors and possibly minimize the chance of injury risk.
Steps to developing an appropriate screen start with gathering generic information about the common injuries associated with the athlete’s primary sport. Once this information for common injuries is established, then identifying modifiable versus non-modifiable risk factors becomes important. Understanding the common injuries associated with the sport along with modifiable risk factors helps to develop a better screening procedure. For example groin injuries are prevalent in ice hockey and one of the key indicators for sustaining a groin injury is lacking adequate hip internal rotation. So if an athlete you are screening wants to participate in ice hockey, screening his or her hip internal rotation is critical to minimizing risk of injury.
Once these guidelines are established, the next step is selecting appropriate tests to administer during the screening process. These tests need to be specific to the athlete and sport as well as valid and reliable. Along with selecting the appropriate tests, movement efficiency needs to be addressed as well. This could include landing technique, cutting strategy from and to various angles, and lunge mechanics to name a few. Again these movements should mimic the demands of the sport to accurately screen whether or not the athlete has a predisposed injury risk.
Finally, as the data is collected and reviewed, a baseline is established for overall movement capacity and quality leading to an understanding of areas of possible intervention to help minimize the risk of injury. So the next time you get your yearly physical for participation in sport, make sure it does not stop at general health baselines, but sport specific testing as well. Seek out further assessment especially for movement quality to get an accurate picture about your overall readiness to compete.
References:
Joyce, D., & Lewindon, D. (2016). Sports injury prevention and rehabilitation: integrating medicine and science for performance solutions. London: RoutledgeTaylor and Francis Group.
When an athlete sustains an injury requiring rehabilitation many factors are considered in order to return the athlete to his/her prior level of competition. These factors include protecting the injury site, gradual application of stress to the injury site, and restoring stress tolerance to the injury site for return to competition to name a few. How does nutrition impact the rehabilitation process? Does it have a role in tissue healing? How often is the interdisciplinary team thinking about the athlete’s nutrition as a “key” component of the rehabilitation process?
Nutrition DEFINITELY plays a role in the rehabilitation process and the types of food consumed during the different phases of rehab can either aid or hinder the process. According to David Joyce and Daniel Lewindon, the main stages of injury rehabilitation are point of injury, stabilizing the athlete, repair and remodeling, and return to competition. Nutrition has a different role in each phase and must be monitored throughout the rehab process. Addressing the athlete’s nutrition during rehab is not just a set it and forget it task.
POINT of INJURY
Focus after the initial injury is concentrated on not impacting the inflammatory process associated with the healing process along with promoting immune support and anti-catabolic (breakdown) effects. Additional consideration must be taken for total caloric intake secondary to the decrease in activity resulting in less energy expenditure.
For acute soft tissue injuries, nutrition considerations should not directly intervene with the inflammatory process for the first 72 hours. This increases to 14 to 21 days for bone injuries. After those time periods, balancing essential fatty acids as well as micronutrients can naturally regulate inflammation. Immediate consumption of essential amino acids (EAAs) and branch chained amino acids (BCAAs) should occur to aid in anti-catabolic processes within the body. Finally immune support should look to focus on addressing any nutritional deficiencies (magnesium, vitamin D, vitamin A) uncovered by red blood cell analysis.
STABILIZING the ATHLETE
As the acute phase of the injury progresses, continued monitoring of the total caloric intake is necessary to coincide with the level of energy expenditure to minimize effects on body composition. Other areas of focus include utilizing anti-inflammatory nutritional components and focusing on gut health. Key areas within the body’s system impacting inflammation production are acid/base balance and fat consumption.
pH levels are easily disrupted by mismatched consumption of acid-forming foods (excessive meat and grain) versus alkali-forming foods (fruits and vegetables). In order to maintain an appropriate pH level, calcium can be leached from bones leading to disruption in bone health and transportation of minerals in the body. Imbalances in omega-3 to omega-6 fatty acids provide the precursors for inflammatory compounds that regulate inflammation. If supplementation is warranted, special consideration for GLA (gamma linolenic acid) and AA (arachidonic) omega-6 fatty acids is necessary. Another way to have an impact on the body’s inflammatory process is through gut health. Inflammation can be regulated through the gut by consuming “good bacteria” (pre-and probiotics), minimizing the use of anti-inflammatory medication, and improving the permeability of the gut. Bone broth is a great way to improve gut health and its role on minimizing excessive inflammation.
REPAIR and REMODEL
This phase focuses on rebuilding the athlete. A big portion of rebuilding the athlete is protein synthesis and factors contributing to increasing protein synthesis include resistance training and intake of dietary protein. As the increase in protein occurs as the rebuilding process is initiated, modifications in carbohydrate and fat intake may need to occur to maintain caloric balance. This is especially important if overall energy expenditure is still relatively low.
RETURN to COMPETITION
As integration into full training and competition occurs, the nutritional strategies need to reflect the increase in physical demands. One of the biggest factors as an athlete returns to competition is cortisol levels. Cortisol can have a positive effect on inflammation but a chronic increase in cortisol levels can lead to muscle catabolism and prevent glucose uptake by muscles. The primary state leading to cortisol release is decreased carbohydrate availability, thus if carbohydrates are not adjusted appropriately with increased levels of physical activity, a plateau can occur in progress. Sometimes the reason for these plateaus are not attributed to nutritional deficiency and can lead to further over-training and possible re-injury.
All in all the role of nutrition plays a vital part in the rehabilitation process after an athlete suffers an injury. Every other aspect of the process may be correct, but poor nutritional considerations can lead to a prolonged time away from competition. Finally, no matter the level of participation (youth, high school, collegiate, professional), any supplementation even by natural means need to be screened by a governing body or the world anti-doping agency. If you have any concerns about a supplement, natural or manufactured, do NOT take it. Instead look at food as your first source of balancing out nutritional deficiencies.
References:
Joyce, D., & Lewindon, D. (2016). Sports injury prevention and rehabilitation: integrating medicine and science for performance solutions. London: RoutledgeTaylor and Francis Group.
Have you ever been told you need to improve stability around your knee? If so, did the individual stating you needed more stability give you any recommendations? Did they include knee extension exercises?
Stability is not gained by performing isolated movements in one direction targeting just one specific muscle. Stability is created by joint structure, ligament integrity, and muscular activation/control. Joint structure and ligament integrity are passive restraints to create stability, while musculature activation is active. We want to rely on active measures to maintain joint integrity rather than passive measures. Passive measures are there for the “oops” moments in life or during competition but cannot be the primary means to create stability.
The primary way to create knee stability is through strength training. An individual must have a sound base of strength to withstand the stresses that can compromise joint integrity. Many times individuals are either given isolated movements or strictly balance exercises to improve overall stability. The isolated movements have little to no effect on joint stability. Performing balance on a single leg will have some impact on improving stability but the action needs to be more dynamic because life and sports are dynamic activities.
Strength training needs to be performed in a safe, productive manner with a sound foundation in technique under no external load. Once technique is adequate, an external load can be added to develop strength correctly. In order to focus on strengthening, training loads need to be between 70 to 90% 1RM (rep max), repetitions between 2 to 6, and sets between 4 to 6.
Next area of focus for creating stability is jumping and landing mechanics. Each individual needs to learn how to transfer force from the ground and absorb force when landing. There are going to be moments of valgus stress to the knee and how a coach/therapist reacts and what they say when this occurs can have an impact on the athlete. These moments do occur in a variety of sports and to drill into an athlete that it should never occur can create hesitancy in an athlete. Hesitancy in an athlete creates a window of opportunity for an injury to occur.
All in all knee stability is an intricate blend of adequate hip and ankle range of motion, hip strength, and sound mechanics with jumping/landing to minimize the forces directed to the knee joint. Performing just knee extension, hamstring curls, or static balance will not create the resiliency needed to perform daily tasks let alone the requirements for the field/court/track/pitch/diamond.
Everyone knows the age old technique of handling acute injuries, RICE (Rest, Ice, Compression, Elevation). As more and more research is performed, is this method still the preferred way to handle these acute injuries?
RICE was developed by Gabe Mirkin in 1978 in his book The Sports Medicine Book. But in 2014 after reviewing the latest research, Mr. Mirkin changed his statement and even stated, “Icing does not increase healing, it delays it.” Now Mr. Mirkin recommends avoiding ice all together unless pain is unbearable. The use of ice to help control pain is still a preferred method because many pain medications (Advil, Motrin, Aleve) have an anti-inflammtory properties and these properties interrupt the overall healing process. If medication is necessary, make sure those medications have no anti-inflammtory properties (Tylenol),
As time has passed, more and more research has illustrated the importance of active recovery to aid in improving outcomes following acute injuries. As long as there are no open wounds, fractures, or tendon ruptures starting small movements within an individuals available range of motion is beneficial in aiding the healing process. Once pain is controlled, progressing movement and initiating some weight bearing activities will continue to help advance the tissue along the healing process.
There are 2 new acronyms that are gaining more traction with how to handle acute injuries especially any type of sprain or strain. These acronyms are MEAT (movement, exercises, analgesic, treatment) and POLICE (protect optimal loading, ice, compression, elevation).
MEAT
Movement and exercise can stimulate blood flow, reduce the formation of scar tissue, and improve overall recovery. Analgesics can be used to help control acute pain, BUT make sure not anti-inflammatory properties are in the pain medication. Anti-inflammatory medication can hinder the natural healing process, leading to an extended recovery time. Finally treatment, especially under the guidance of a skilled rehab specialist like a physical therapist, can help improve recovery by providing guidance for appropriate movement/exercise and performing other treatments such as joint mobilizations to minimize the effects of possible immobilization.
POLICE
Protection may be a necessary component during an acute injury to minimize the potential for further tissue damage. Even though the use of splints and/or other devices to minimize weight bearing may be necessary at times, these parameters should only be followed for the first 48 hours. If protection is warranted, the key point to recovery is ACTIVE REST or optimal movement. Muscle loses 3 to 5 percent of its strength daily with complete rest. Therefore, optimal loading should be utilized early on as well as supervised under the direction of a skilled rehab specialist like a physical therapist. Ice can still be effective by providing short term pain relief especially if someone has poor tolerance to pain medication but responds well to NSAIDs (non-steroidal anti-inflammatory drugs). Remember, we want to avoid anti-inflammatories because it can impact the overall healing process. Compression and elevation can control swelling, which in turn can improve the overall healing process. The more swelling is allowed to develop, especially in the lower leg, it can slow recovery secondary to increased limitation in movement of a joint. Inability to actively move a joint through a range of motion, even small, will prolong the overall recovery process from an acute injury.
All in all the concepts behind treatment for an acute injury have moved away from a passive to more active approach and there is plenty of evidence to support this change. Now someone may still require the use of rest and ice but complete immobilization or rest should not be a part of the recovery process especially if the affected area is stable (no fractures, tendon ruptures, open wounds). The assistance of the rehab specialist or health care provider should be highly considered for recovery. The guidance from these professionals can help improve the recovery process and decrease time away from the court/field/track/diamond/pitch.
References:
Doldron, M. (2016, Jan. 4). “MEAT” versus “RICE” in Acute Injury Treatment. Retrieved from: http://www.rebalancetoronto.com/meat-versus-rice-in-acute-injury-treatment/
Michel PJ, Peter AA, Blankevoort L, et al. What is the Evidence for Rest, Ice Compression, and Elevation Therapy in the Treatment of Ankle Sprains in Adults? J Athl Train. 2012; 47(4):435-443.
Mirkin, G. (2016, Oct. 13). Why Ice Delays Recovery. Retrieved from: http://www.drmirkin.com/fitness/why-ice-delays-recovery.html
With the rise of injuries, especially youth injuries, injury “prevention” programs have become a popular tagline for health and fitness professionals. Almost every week it seems as though I either read about an ACL injury or have a young athlete come into the clinic following ACL reconstruction. The sad part about the rise in ACL injuries is most of them occur as non-contact injuries from either landing incorrectly, decelerating after sprinting, or changing directions. As much as 75 percent of ACL injuries are non contact.
The basis behind injury “prevention” programs are correct and well executed but the labeling is wrong. Prevention comes from the word prevent and prevent means, “to keep from occurring.” To say that we as health care professionals can prevent injuries is impossible. No physical therapist, strength coach, athletic trainer, chiropractor, physician, or any other fitness/sports guru can prevent injuries.
Injury “prevention” programs have been around way before the phrase became popular and were called strength and conditioning programs. These programs went through the phases of improving movement quality, building strength, and developing power to improve performance between the lines and minimize the chance of injury. Instead of labeling these programs as injury prevention, using phrases like injury reduction is a more appropriate term.
Components of an Injury Reduction program should include:
The components of the program should build on each other to help the athlete become the best version of him/herself and minimize the chance of injury. Emphasis should be placed on the quality of movement, not the quantity of movement especially in terms of external load.
All in all anyone who tells you they can “prevent” injuries is lying to you, injuries cannot be prevented. An athlete can help minimize the chance of injury by following a sound strength training program with the foundations above incorporated into the program.
Everyone has heard the moniker “NO PAIN, NO GAIN” but does that really apply to training? If you are pushing yourself when training, then it should be uncomfortable and create some soreness. There should absolutely be no PAIN when you are training. Pain is a request for change, not punishment and if you have pain when performing an exercise, stop that exercise.
Pain as defined by pain scientists is an unpleasant feeling in our body that makes us want to stop and change our behavior. We no longer think of pain as a measure of tissue damage – it doesn’t actually work that way even in highly controlled experiments. We now think of pain as a complex and highly sophisticated protective mechanism.
Another big point to get across about the human body and pain is that there are no pain receptors in the body. The human body has specialized nerves that detect dangerous changes in temperature, chemical balance, or pressure. These specialized nerves than send signals to the brain and the brain interprets the information based on prior experience, attention/expectation, mood, and neurochemical/structural changes. Sometimes the signal can be relayed back to the body as pain and does so to protect the body from a perceived threat.
What is overtraining?
Overtraining occurs in athletes, youth/collegiate/professional/recreational, who train beyond the body’s ability to recover. Training requires an adequate balance between rest and recovery to minimize negative impact on performance. Some signs of overtraining are fatigue, depression, lack of motivation, insomnia, weight loss, and increase incidence of injuries.
Overtraining can be monitored by tracking rest heart rate. To gain this objective measure, perform this test first thing in the morning. Lay down and rest comfortably for 10 minutes and record your heart rate. Stand up and record heart rate after 15 seconds, 90 seconds, and 120 seconds. Well-rested athletes will show a consistent heart rate between the measurements but an athlete reaching overtraining will have an increase of 10 beats/minute or more at the 120 second mark.
OR….
Overtraining can also be defined as extreme nonfunctional overreaching, but with longer performance decrement (> 2 months), more severe symptomatology and maladapted physiology (psychologic, neurologic, endocrinologic, immunologic systems) caused by a stressor not explained by disease.
There are two categories prior to overtraining called functional overreaching and nonfunctional overreaching. Functional overreaching is defined by increased training to a temporary performance decrement and with improved performance after rest. Whereas nonfunctional overreaching is intense training leading to a continued performance decrement even with full recovery after rest. This can also be accompanied by increased negative psychologic and/or neuroendocrinologic symptoms.
All in all many athletes, especially young athletes, will feel as though they are overtraining when in actuality they are likely overreaching. Overreaching can have a very positive effect on performance and educating athletes about the normal responses following training are important. When athletes start a true training program, many times they get a rude awakening about how hard they actually need to train to achieve the positive benefits.
References:
Kreher, J. B., & Schwartz, J. B. (2012). Overtraining Syndrome. Sports Health: A Multidisciplinary Approach, 4(2), 128-138.
Moseley, L. (2016, Jan. 5th). Explainer: What is Pain?. Retrieved from http://www.bodyinmind.org/what-is-pain/
Quinn, E. (2017, July 2nd). How to Know if You are Overtraining: Learn the Signs and Symptoms of Overtraining Syndrome in Athletes. Retrieved from https://www.verywell.com/overtraining-syndrome-and-athletes-3119386
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