PhysioPraxis

Be very clear on whether you’re trying to perform or train.

Performance is maximal and looking to achieve a clear external goal. It generally isn’t healthy and it flirts the edges of risk. It’s also going to be relatively acute.

Training is chronic and is directly targeting the specific adaptation desired. Occasionally it will have outputs at the level of performance (eg Sprint interval training) but volume and frequency are very controlled.

A common training mistake is to assume the metric you’re tracking is informing you about whatever system is being overloaded. This is putting too much onto one specific metric.

A good example would be heart rate. This is a great proxy for estimating the cardiovascular response to what is being done (not perfect since HR response can change without changing the exercise eg beta blockers, anxiety, POTS syndrome etc) However, if you start running, cycling, and rucking aiming for the same HR zones without also tracking the musculoskeletal loads that occur you may find that your cardiovascular system is able to tolerate a dosage that your musculoskeletal system cannot.

I tend to find this concept is frequently novel to people I’m working with and since it’s also often revealed in their subjective narrative it’s a good place for some education. It’s also important for us to remember when designing programs. Things like HR and RPE are great but we need to be very aware of how valid our implementation of these metrics are for the individual we’re working with.

We can view the imposition of exercise stress as information being given to our target tissue/systems about the demands they will face in the future. Our body is always adjusting to be prepared for future events which it anticipates from a best guess derived from available information.

So our job with ExRx is to closely mimic the challenges that will be faced in “the real world” in a progressive manner. This allows us to “lead” our adaptations to the place where the body is prepared for the task demands. And this is done with a good needs analysis and then matching those needs with our metabolic/mechanical/morphological specific interventions.

I frequently think of this quote when I see an overly complicated narrative for a rehab approach. Being brilliant at the basics will always get you to your destination (hat tip to & who have been teaching this longer than I’ve been alive) - overly complicated lines of reasoning just increase the likelihood that your narrative is a product of telling a story to fit what happened (resulting).

Assessment of the stage of healing, clearing full and pain free ROM, loading the relevant systems/tissues till sufficient adaptation occurred to handle the necessary forces and reintegration into the task while staying within the envelope of function will always be the bedrock for a program. Many times this is more about removing extras than it is adding something special.

Building on the Envelope of Function idea when someone is dealing with a post op (or conservative management) injury my general advice involves a description of MED vs MTD and the hormetic zone between them where we want to stay.

Then we go over “the rules” :

Don’t be stupid: Don’t do things you know will cause a problem or put you at high risk. If you would get injured doing something and describe what you were doing when it happened as “stupid” then don’t do that thing. This is based on an expectation of risk prior to the event which is different from an accident.

Don’t be stubborn: Listen to your body, use the soreness rules, effusion tests, load test etc. Stubborn isn’t going to bring on an acute injury but it will stall progress and create issues. Stubborn is getting feedback from your body and ignoring it over time.

Don’t be lazy: Some MED is necessary at a body level to address global fitness and at the level of the injury to drive healing. So avoiding activities while you heal is also a bad idea.

This paper by Lambrianides et al takes an interesting look at the role different training stimuli have on strength over time. The image above only touches on a few topics this paper covers so it would be worth a read if this interests you.

Two points it reinforces - there’s a wide range of testing time frames used in practice whereas adaptations can occur rather rapidly. By the 8-12 week mark most strength increases have stalled when programs don’t update to reflect those changes (auto regulation anyone?) So it’s important to test frequently enough to capture those changes in time to adjust as needed.