We all know it’s important to challenge our patients with load during the exercise progression of a rehabilitation plan.
Many people like to poke fun at the concept of 3 sets of 10 repetitions, probably because some abuse it, but there is a time and place for everything.
In this episode, we discuss set and rep schemes and how we periodize our exercises during physical therapy and even the gym.
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#AskMikeReinold Episode 345: How to Periodize a Rehabilitation Program
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Show Notes
• Does Periodization of a Program Help Improve Strength?
• Periodization for Strength Training and Rehabilitation
Transcript
Tyler Farr:
So Samantha from Canada says, “I always see people on social media say that three sets of 10 reps isn’t functional and that we need to have a different set in rep schemes. When in a rehab patient’s program do you mix up the sets and reps and why?”
Mike Reinold:
That’s a great question, Samantha, is there nothing better about social media where you can just log on anytime you want, 24/7, and feel shamed and bad about yourself at any moment in time, anytime you want? You have the ability to do that with social media. So it’s kind of crazy what’s out there. Just be careful who you follow, people. I don’t know.
Every time you see questions like this from people, you get mad. She feels bad about herself because somebody said she’s a bad physical therapist because she gave somebody three sets of 10. It’s absurd.
So anyway, all right off that one. That was my heart rate monitor, Len. I hate seeing this stuff on social media.
Lenny Macrina:
I agree.
Mike Reinold:
But I think this is a really good question because there’s a few ways we can go about this, but I don’t know who wants to start and talk about, I don’t know, anything. I can lead this a little bit. My first thought on this is, does anybody think three sets of 10 is inherently bad or wrong? And then why would you change it, is the question, because there’s criteria to change those set reps and you’d figure it out. But who wants to start this one? Dave, you want to jump in?
Dave Tilley:
Yeah, I’ll just jump in. I think Jonah’s going to talk a little bit from the performance side, but three sets of 10 when someone has a pretty acute issue going on and you’re trying to load a good amount but not push somebody too much, I think you follow the three to four sets, eight to 12 for hypertrophy. But sometimes on the medical side, we’re just trying to load somebody to move in general. It’s not really about getting super strong.
It’s not about a power thing. It’s not about an energy system thing. It’s about this person’s knee hurts and they had surgery or they haven’t done anything in a while and we’re just trying to find a variety of exercises that can help them just move in general.
So leg raises, knee extensions, hamstring curls, that kind of stuff when you’re doing in circuits, three sets of 10 is pretty solid to start because it’s not a crazy amount of reps. It’s not five sets, it’s not one set, it’s right in the middle.
So, I think three sets of 10 got its place for a reason because a lot of people maybe had acute or subacute injuries that you can’t load them like crazy, but you also don’t want to do nothing. You’re trying to find a variety of stuff to give them in a circuit and it’s a really good application. And then of course it kind of leans in or away from that based on your goals and what’s the goal of the actual physiological loading, which I can let Jonah knock out. But yeah, it’s solid for many, many situations early on in the rehab process.
Mike Reinold:
All right, so who wants to say now, how do you progress somebody at three sets of 10? So obviously we’re not changing set rep schemes. Do we just keep loading? What’s your criteria to load somebody with three sets of 10? What do you think, Dan? You want to jump in on that one? On a rehab, how do you load somebody that’s three sets of 10? Is it always light to moderate? Do you try to push the envelope? Do you try to get them to failure at the 30th rep? What’s your thoughts on sets and reps?
Dan Pope:
I know other things. I’m going to say that it probably just depends a lot on what you’re trying to get out of the exercise. I hate to say that, but let’s use a more specific example.
Let’s say someone has patellar tendinopathy and you start off with sets of 10. If someone’s really painful, they might not be getting to a true failure just because what happens is the pain gets so severe that they can’t really complete a given set. When that’s the case, I think that a lot of the ideas we have about program and periodization, they fall out the window a little bit because we’re not even kind of getting close to that failure because we’re looking for, I would say somewhere between four to six reps in reserve to complete failure to actually make a change in the muscle or the strength.
If we’re not getting close to failure, we’re not really accomplishing that. But you take someone that just has so much pain that can’t tolerate doing heavier loads, then you work lighter. And I think what you’re trying to do is build a little tissue capacity or just getting the analgesic effect of exercise. Just by moving that person and doing some exercise helps to get the tissue to feel a little bit better.
I think 10 to 12 is a great place to start. And I’d also say that I actually favor a little bit of a higher rep range early on just because most of the folks we work with are pretty athletic. We want to build strength, we want to build hypertrophy, we want to push them a little bit, we want to get that train effect, but if you go lower with your rep range, the load has to go up. The person’s going to approach their true failure.
So, if I prescribe them three sets of 15, I know the loads are automatically going to go down a little bit if I’m expecting that athlete to work towards failure. So I think that’s a big one.
And then on top of that, you just know the basics about set and rep ranges. And I think that all starts with an understanding of your patient’s goals and needs analysis. And I don’t want to steal too much of Jonah’s thunder, I think he’s going to go into this, but do you want hypertrophy? Do you want strength? Do you want power? What are you looking for? And then you basically can go from there.
But I think from a physical therapy standpoint, we’re very much trying our best not to aggravate that injury and we’re trying to respect the healing. So that’s what we do first and foremost. But once we do that, now you can get fancy with your programming stuff, I think.
Mike Reinold:
I like that. And I would say some of the mistakes that I’ve seen online, two things with this… One is that some early career PTs, they’ll try to get fancy with their set rep scheme and go down and then underload people because the person doesn’t know intent or they’re not ready, they haven’t done any heavy load yet. So now they drop the six reps, but they’re not using enough weight to truly go to six reps. I mean just going down to five, six reps, it means that the load has to go up significantly for that to be worthwhile.
So I’ve seen people do that and then underload. You wonder why they even do that.
And then sometimes you see people do that, and then to Dan’s point, you have a raging patellar tendinopathy for example, and you’re going down to five reps, increasing the load, and just their pain shoots through the roof. You can see it from both ends of the spectrum. So you got to be careful I think with all those and just resist that urge.
So I like those “depends” answers because it always does.
So Jonah, let’s go to Jonah, right? Jonah’s probably laughing at us there a little bit here. So Jonah is our strength coach, our Director of Sports Science here at Champion. So this is his world with periodizing and stuff. How does it make you feel when you see our patients doing three sets of 10 all the time? And then what are your thoughts on… Do you have any advice for PTs on the whole concept of periodization and what they can do better?
Jonah Mondloch:
Yeah, I think first off, you guys all covered some really good things. Two quick ones from Dan that I think are really important was the idea of going to failure, where research is showing that strength gains, regardless of rep range, are very good as long as you are approaching failure. So I think when you have those clients or patients that can only handle lighter loads, you’re working with a younger kid where you just don’t need to put a ton of weight on their back, you can get the same adaptations or more or less the same adaptations as long as you are approaching failure. So I think that is a super important one and three sets of 10 is great for that. And it’s easier probably to just each week add a little bit of load, continue to push someone that way, than try to get too complicated and changing your set and rep scheme just for the sake of changing your set and rep scheme.
And then that being said, as Dan mentioned, once you start wanting to have different adaptations, that is when it does start to become important to change these things. And the way I kind of look at the rehab or return to sport aspect is like a condensed version of your long-term athlete development, where rather than in your case trying to get amazing at every single quality, you need to start to just make sure that you’ve exposed your athletes to various qualities.
So say you’re working with any sort of lower body injury, even something just like an ankle sprain, we need to make sure that we’re getting back into high-speed running. That’s something that you’re not going to accomplish if you’re trying to do 15 second long duration tempo runs. You need to truly sprint and then power is going to be something that’s important to get into.
Same thing, you don’t want to do three sets of 10 on box jumps. You want to pick an exercise that you can do at a really, really high intent, and maybe do four or five reps at a time.
Rate of force development I know is another big one that we had a podcast on not too long ago, so you can go back and listen to that. But same idea. If we know that somebody’s maximal strength levels are pretty good, but their rate of force development isn’t great yet, again, we’re going to want to cut back on the number of reps we’re doing, maybe increase the number of sets we’re doing and that way every single rep they do through it, every set can be performed at a really high intent so that you actually are working on the rate of force development.
So, I think the big picture with all of it is changing when it is a new adaptation that you want to work on, not changing just because you need to change and keep your client or patient entertained.
Mike Reinold:
I love that. And you do sometimes see that, that people just mix things up to mix things up for the wrong reason. So funny.
But Anthony, I don’t know, any thoughts from you, a younger PT on the call today with the strength and conditioning background. You’re an athlete yourself, or former athlete. I mean you’re always an athlete. Once an athlete, always an athlete, right?
Anthony Videtto:
Always, always. Yep.
Mike Reinold:
But I don’t know, I know this is the sort of thing that you see on social media and I know you’re directed by this. Any thoughts that you want to add or anything you’ve learned just from being around us at Champion?
Anthony Videtto:
Yeah, I think it’s really easy to get caught up in trying to change things too much, especially as an early clinician. I definitely found myself saying, “Okay, we’re going to start with three sets of 10 here.” And then I’d say, “Okay, we did that. Now I need to switch it up because I need to get fancy and show these people that I know what I’m doing.” So I’ll go to eight reps and then go to six reps. And then I think I found myself, like you guys said, underloading when I should have just stuck with that linear progression to start, go three sets of 10, load them as much as they can for those 10 reps. And then once they reach that point of, “okay, I can’t actually add any more weight on the bar for 10 reps,” then maybe decreasing the reps from there. So we’re getting into some more strength stuff if they can handle it at that time.
But like you said, I think it’s just not getting too fancy early on and really just kind of pushing that linear progression. I think that’s a great way to go about it for the first phase of rehab there.
Mike Reinold:
It always blows my mind at how long you can keep the set rep schemes the same in linear load. It’s way longer than people give it credit. We tend to mix it up way sooner than we probably need to for most rehab people and even some people with a low training age in the gym, right? You have a 12, 14, whatever year old kid, you can linear load for a long time before you drop down to five sets of 5. That kid has a lot of room to grow into his load scheme. So great stuff.
Samantha, hopefully that helped. That was some really good answers from the PT side, but I think having Jonah’s thoughts was really invaluable there. So thanks Jonah for that. Really great stuff.
If you have more questions like Samantha, ask away. Head to mikereinold.com, click on that podcast link and please, please, please subscribe so you get our future episodes on Apple Podcasts and Spotify and we’ll see on the next episode. Thank you so much.
