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February 23, 2011
You Should Lift Heavy in Rehab
When we opened Sparta, we made a conscious decision to only train athletes not because they are a superior subset, but because they do represent a different species, requiring different training protocols than the general population. And like any industry or pursuit, the more you focus on one thing, the better you can address those specifics. Perhaps the greatest example of the need for this differentiation is the rehabilitation process. Most elite athletes need more than basic therapeutic exercises, even during the first couple of weeks after injury. Therapy protocols are usually aimed at the general population and fail to achieve sufficient neuromuscular stimulus, the key to athletic movement (see Sparta Point 1/26/11). I’m not saying athletes need to resume aggressive training throughout the injury process, but research continues to support the need for heavier exercise that can sufficiently stimulate the nervous system. A 2006 study out of the Institute of Sports Medicine in Copenhagen, Denmark compared conventional therapeutic exercises with heavy resistance training. The basis behind the study was the nervous system depression that occurs after injuries, and the subsequent risk for reinjury due to this lower global functioning. It makes sense; the body gets traumatized, and the nervous system subsequently shuts down the joints and associated muscles as a form of protection against further injury. Fortunately, heavier resistance exercises have been shown to be superior in activating the neuromuscular system. This landmark study found the therapy exercise to provide less than half of the activation of heavy strength movements like squatting. So if you’re an athlete and you’re injured, the answer is to still incorporate basic therapeutic exercises, without neglecting heavier strength movements that do not aggravate the current injury. One of the best examples we use for injuries are isometric pulls to the knee, as these barbell holds (see Sparta Point 2/2/11) allow the athlete to avoid any sudden stretches to the muscle or tendon. Perhaps more obvious, and concerning, are athletes with an upper body injury, that are quarantined in rehab despite being perfectly fine to perform heavier lower body movements like a squat. There are many options, but the key is to find a way to include some higher levels of activation, even from the start of the rehabilitation process. You also cannot overemphasize the psychological benefit of resuming some sort of “routine” strength training, which should always involve something heavy. So get your mind right, find a way to lift something heavy without stressing your injured joint or muscle.
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February 23, 2011
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2 thoughts on “You Should Lift Heavy in Rehab”

  1. I’m an Exercise Physiologist working as a PTA in outpatient physical therapy clinic. I fully agree that when much more resistance is appropriately during recovery gets optimal results. Your right that isometrics are exellent, However it is Proprioceptive NeruoFacilitation PNF that reducates specific muscle recuitment and hone neuromusclar control. For strength we have a dosing scheme based on the target tissue such as ligament,tendon, cartilage or fascia. All uninjured extremeties are either on a maintaince or cardio based proram. Thanks DG
    sweateq@comcst.net

  2. Great Point DG. We use PNF with all of our athletes, both for joint range of motion, as well as recruitment/activation.

    Heavy lifting is only one piece, just happens to be the one avoided the most in rehab.

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