Exercise Prescription - Resistance Training

I compiled information from the ACSM guidelines to exercise prescription, the NSCA essentials of strength and conditioning, as well as the IJSPT article regarding exercise dosing for PTs into a nice 1 page summary.

Included in this sheet is a plan I wrote for s/p ACL reconstruction in a 18 yo M soccer player. Notice how everything is on a continuum but as future PTs we combine our knowledge of tissue healing timeframes and expertise in movement to create a progressive but safe plan for return to sport.

There are a lot of right answers and as a perpetual overthinker that can be really annoying because we want the perfect answer. Don''t strive for perfection, but let your foundational understanding of which energy systems work when training different variables, the key differences between strength vs power, and a strong understanding of common orthopedic PT diagnoses guide you to selecting a correct answer. There are a lot of right answers but there are also a lot of clear wrong answers.

Ex's of clearly wrong answers off the top of my brain:

1. Week 10 s/p ACL reconstruction a PT prescribes 3x20 bodyweight squats to target strength. (This targets hypertrophy/endurance, not strength. This volume is inappropriate at this point in care and may fatigue the pt more than 72 hrs. Why are we doing this? There is really no good reason as our goals at this stage should be progressing strength training, working on side-to-side leg strength differences, and introducing low level power exercises as appropriate.
2. 70 yo F w/Hx of osteoporosis presents to PT w/ LBP and PT prescribes 3x1minute dead bugs. (This targets endurance, which, eh, this is where the PT knowledge comes in of assessing the pt...which of the 3 TBC does this pt fit into? Is there a DP? Is it movement coordination, etc. In this case, the reps/time of the exercise is inappropriate as this would likely fatigue the pt and have soreness lasting >72 hrs.

Key takeaways:

• Know the tissue healing timeframe, in the case of an ACL (ligament) we do not start true strengthening until about week 8 and the weeks before that are PROM, AAROM, AROM because the ligament is still healing. Re-gaining full strength can anywhere from 6+ months.
• Understand the physiology of energy systems as it relates to different resistance training goals.
  
  • Strength: 2-6setsx0-6repsx85-100% 1RM, but why? To develop true strength you have to lift heavy weights based off the %1RM chart.
    
    • Ex: Powerlifter that needs really high 1RM squat for a competition, during the highest loads of their training they are doing low rep sets (5x3) at high intensity or high weight to target strength.
  • Power: 3-5setsx1-5 repsx75-80% 1RM, however, the key part of power is, speed.
    
    • Ex: Olympic weightlifter that does a power clean is a very explosive movement and they are moving the bar at a high velocity which means the intensity or the resistance on the bar has to be less and the reps has to be less because we are focusing on speed and form not strength development.
  • Hypertrophy: 3-6setsx6-12repsx67-85% 1RM. Increasing size of muscle does correlate with increasing strength especially for beginners, so there is some overlap. However, because we increase rep to develop size of musculature, we decrease intensity so that we can perform more reps.
    
    • Ex: Biceps curl 3x12 w/DB for general bicep size growth.
  • Endurance: 2-3setsx12-20+repsx<67% 1 RM.
    
    • Ex: Walking lunges, burning out the muscles and focusing on endurance over a longer period of time/reps but at the lower intensity.
  • Generally, as PTs, depending on the setting, we are likely going to train all of these variables in any given population at some point, but the key is we have other tools and knowledge from exercise science backgrounds and medically that we can address more of those early phases of healing/rehab and ensure that we are dosing properly as move up toward strengthening and eventually plyometrics, speed, and agility.

Aerobic endurance/training is not addressed in this review necessarily as it follows different but similar programming. The main thing that will change is instead of % 1RM, we use % VO2max, HR training zones, etc.