Hi,
Dr. Baraki’s recent blog post on pain (Pain in Training: What To Do?) gave an example of knee rehab programming for two days:
Day 1:
- 3-0-3 Tempo Low Bar Squat: 12 reps @ RPE 6, 12 reps @ RPE 7, 12 reps @ RPE 8
- 3-0-3 Tempo Split Squat: 15 reps @ RPE 6, 15 reps @ RPE 7, 15 reps @ RPE 8Day 2:
- 3-0-3 Tempo High Bar Squat: 12 reps @ RPE 6, 12 reps @ RPE 7, 12 reps @ RPE 8
- 3-0-3 Tempo Weighted Lunge: 15 reps @ RPE 6, 15 reps @ RPE 7, 15 reps @ RPE 8
As one can see from above, it emphasizes adding tempo to the movements and dialing up the RPE to a maximum of 8, with only 3 sets total.
The knee rehab template emphasizes hitting an RPE 10, with double the sets, and has no mention of adding tempo to movements.
I feel like these are not small differences in programming but major differences (much higher RPE, double volume, no tempo for the template). Why the discrepancy?
Thanks
I know this is going to come as a surprise, but the answer to this comes with the nuance of programming. There are layers to this inclusive of the individuals understanding and familiarity with RPE, how RPE is anchored (according to symptoms or absolute effort), what the person’s current programming resembles, etc. As Austin disclosed in his piece, he example is generic. The template is based primarily from the work of Kongsgaard and Beyer, whom I’m sure you are familiar with. Their protocols advocated taking athletes to their 12RM, 10RM, 8RM, 6RM which would be equivalent to RPE 10. This does not mean that all athletes need to push towards failure and RPE is not inherently a perfect system. I have conversations with athletes on a frequent basis with a perspective of an RPE 8 being “could you do 2 more reps” versus “should you do 2 more reps.” By the normal definition of RPE “could” should supersede however, if I am trying to use an exercise as a tool for symptom modification as well, I may undershoot to attempt to chalk up the series of small wins.
There are no absolute correct dosages for all individuals experiencing symptoms. We do know from the above mentioned papers that it is okay to work athletes into symptoms…some and to push towards failure. The tempo work is supported some by Mersmann et al and can be a useful place with which to start. There is low level evidence that isometrics could also be a viable first step but we often skip this as expectations can be set beyond this phase. Overall, none of this is an exact science and no one individual responds the same. While the template operates from the heuristic of the evidence, those studies populations were not solely individuals participating in resistance training. If I want to keep an individual lifting within the constraints of evidence, utilizing tempo can be useful.
Dr. Miles,
Thanks for your reply. I get what you’re saying that it’s a generic example and that there is no absolute correct dosage for all symptomatic individuals, especially given that this is an inexact science. I’ll be the first to acknowledge that I will often try to oversimplify things to “black and white” to make it easier to comprehend, and I am probably making that mistake here.
With that said, if there is no correct absolute dosage for all individuals, why not incorporate a mix of all the different techniques into the template? If we’re not sure what technique works, doesn’t it make sense to try and incorporate all of them instead of specific ones?
The typical approach would be an attempt to not mix too many variables. If I’m adding in a little bit of everything, it is much harder to discern from where the response is coming from. This gets to the point in the most recent piece regarding finding a place from which to start. The variability typically lies much more in the individual we are addressing in terms of training history, symptoms, expectations, etc so we tend to favor a more streamlined approach so that we do not have variability coming from both the individual, and the interventions we are providing. The does make it somewhat probabilistic thinking as I would posit we get the right approach entirely laid out correctly from the start 60% of the time. Hence the typical advocacy for individual follow-ups as there often are changes that need to be made. Even in the Kongsgaard and Beyer papers, not everyone was a responder.
Still, if we can find the proper starting point and begin attaining the small wins alluded to in the piece, then we can start layering back in variability. I will often advocate for athletes to perform sets through tolerable range (in this instance a pin squat would be the typical example) for working sets, then place drop sets afterward working to one lower pin. This gives two means with which to seek those wins either with increasing weight through the tolerable range, or increasing the range through which an individual is working. I know we revert to the utilization of nuanced quite often, but it is because items like the template will get most athletes most of the way there. A large part of the rehab process for many of these individuals is peeling through programming and external stress looking for contributors, essentially eliminating the variables in the discussion that could be contributing or at least attempting to control for them. Sometimes we do need to pick that one trick and work there, then we add a second, and a third, until we’re back to normal programming.
I also wanted to add that in the template, weeks 2-13 do have a 3-0-3 tempo (Look at the Introduction Tab on the template). Just FYI!
Having a general system/approach to find the entry point is far more important than whatever the actual starting programming looks like. There are a million ways to get to the destination, but you have to find a place to start.
If the template I sketched out is too little stimulus for someone, within a few sessions of progression it should become appropriate. Alternatively, if the knee rehab template starts out being too much stimulus for someone, there are multiple ways of regressing it to get some initial desensitization (as discussed in the template, I believe) to find an appropriate starting stimulus.