If you have been to a physiotherapist recently there is a good chance that a component of your program included exercise. This was most likely sold to you as a means to facilitate recovery, reduce pain, and return to or even improve on your previous level of function. Why is this you may wonder?! Your physiotherapist is likely expounding the wonders of exercise in light of the ever increasing evidence to support exercise as an intervention for multiple conditions and diseases (1, 2, 3, 4).
But is all exercise created equal? When your physiotherapist gives you 3 sets 10 repetitions, are you targeting strength or endurance? Or is this activation? Or a neuromuscular exercise? What about intensity, rest, or tempo of movement? And importantly, does this matter? Well, like all things when it comes to exercise and health, the answer is never black and white!
For this blog, lest us hone in one potential goal of treatment (full disclosure a clinic favourite of our’s) – Strength Training. Depending on the condition, disease, or performance variable that is the focus of treatment, strength may be an important variable to target specifically. Strength deficits are not uncommon following an injury. For example, in populations diagnosed with patellofemoral pain, gluteal dysfunction has been observed. Similarly, arthritic conditions can be associated with concurrent strength deficits and muscular atrophy. Whether an observed strength deficit is an important or contributing factor to the perpetuation of your symptom(s) and injury(s) is part of the clinical reasoning process that your physiotherapist will undertake.
So what does strength training look like and how best to achieve it? There are guidelines that outline this, such as the Guidelines for exercise testing and prescription, published by the American College of Sports Medicine (5). However there is quite bit of variability in the wider literature. If we look at the individual components of prescribing strength training, certain variables seem to be more important. Particularly higher intensities and higher volume may elicit great improvements of strength (7). Interestingly though, one session of 6–12 repetitions at approximate loads of 70–85% 1RM, 2 to 3 times per week, is able to produce significant, albeit, suboptimal strength gains (7). Frequency of training appears less important if volume and intensity of work are held constant (8). However, it is paramount to respect the fact that people adapt differently. For the same training session, 100 people will have 100 different responses, with big differences in improvements and recovery time (9).
Accordingly, a physiotherapist developing a strength program needs to consider an array of principles. I have adapted a general guide, informed by several of the aforementioned sources and expert opinion:
|Load||Effort||Time under tension||Rest||Frequency|
|Experienced||2-8 or 8-12||1-3||>80% 1RM||8-9/10||2s or >2s||2-3mins||2-3 week|
The take home message is that there is more than one way to improve strength, however 3 sets of 10 may not be the best way to go about it. It also important though to realise that perhaps strength is not the main target of your exercise program. Being clear what your main goal is when exercising is the most important starting point.
If you have a goal, whether performance, injury, or pain related, individualised assessment and programming can help you optimise your return for the time you spend exercising. Our physiotherapists can help develop a long term program working towards a goal that is meaningful to you. Stay tuned for more blogs relating to other important areas of exercise. Be sure to check our Facebook and Instagram regularly for videos providing great exercise tips. If you are unsure whether physiotherapy could benefit you, please feel free to come into the clinic for a free chat and assessment.
Mellor, R., Bennell, K., Grimaldi, A., Nicolson, P., Kasza, J., Hodges, P., ... & Vicenzino, B. (2018). Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. bmj, 361, k1662
Coombes, B. K., Connelly, L., Bisset, L., & Vicenzino, B. (2016). Economic evaluation favours physiotherapy but not corticosteroid injection as a first-line intervention for chronic lateral epicondylalgia: evidence from a randomised clinical trial. Br J Sports Med, 50(22), 1400-1405.
Foster, N. E., Anema, J. R., Cherkin, D., Chou, R., Cohen, S. P., Gross, D. P., ... & Turner, J. A. (2018). Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet, 391(10137), 2368-2383
Pieters, L., Lewis, J., Kuppens, K., Jochems, J., Bruijstens, T., Joossens, L., & Struyf, F. (2019). An update of systematic reviews examining the effectiveness of conservative physiotherapy interventions for subacromial shoulder pain. Journal of Orthopaedic & Sports Physical Therapy, (0), 1-33.
American College of Sports Medicine. (2013). ACSM's guidelines for exercise testing and prescription. Lippincott Williams & Wilkins.
Schoenfeld, B. J., Peterson, M. D., Ogborn, D., Contreras, B., & Sonmez, G. T. (2015). Effects of low-vs. high-load resistance training on muscle strength and hypertrophy in well-trained men. The Journal of Strength & Conditioning Research, 29(10), 2954-2963.
Lorenz, D., & Morrison, S. (2015). Current concepts in periodization of strength and conditioning for the sports physical therapist. International journal of sports physical therapy, 10(6), 734.
Androulakis-Korakakis, P., Fisher, J. P., & Steele, J. (2019). The Minimum Effective Training Dose Required to Increase 1RM Strength in Resistance-Trained Men: A Systematic Review and Meta-Analysis. Sports Medicine, 1-15.
Ahtiainen, J. P., Walker, S., Peltonen, H., Holviala, J., Sillanpää, E., Karavirta, L., ... & Hulmi, J. J. (2016). Heterogeneity in resistance training-induced muscle strength and mass responses in men and women of different ages. Age, 38(1), 10.
Colquhoun, R. J., Gai, C. M., Aguilar, D., Bove, D., Dolan, J., Vargas, A., ... & Campbell, B. I. (2018). Training volume, not frequency, indicative of maximal strength adaptations to resistance training. The Journal of Strength & Conditioning Research, 32(5), 1207-1213.