“Wait, what? How many did you say?”
Usually, this comment is accompanied by a raised brow and a surprised look. “Yup. That’s right. You’re going to be doing a x reps...but over y-z number of sets.”
That’s the answer that usually follows. The reason this is so surprising for some people is that x is usually somewhere in the range of 75-100 and y-z is anywhere from 3-5. That’s a lot you say? Well, after reading this, it may make a little more sense.
Coming to physical therapy usually means there is some sort of injury, movement, or posture that needs to be addressed or corrected. For the most part, this is concurrent with having a strength deficit, a muscular imbalance, a decrease in endurance, or even compensation for pain with a certain movement pattern. To address these issues, we, as physical therapists, have to develop treatments for 1) increasing endurance, 2) pumping up strength and building muscle, and 3) reteaching proper neuromuscular movement patterns.
Each therapist has his or her own bag of tricks to cater to each and every one of these needs, because there are hundreds of different exercises/activities to reach these goals. However, there are only a handful of parameters that are the most efficient to achieve them.
For the most part, research has shown that performing high repetitions with low weights is a great way to increase endurance. It helps to increase circulation for healing purposes and also begins to push away the inflammatory chemicals produced by recently injured tissues. Repetitions range from 15-25 reps, with the amount of weight dependent on the body part being exercised. The amount of repetitions should be set so that one is pain free and able to complete them without being totally spent after a set. The number of sets ranges from 3-5 sets, depending on endurance and intensity. Rest breaks are on the shorter end, around 15-30 seconds.
Building strength moves towards the other end of the spectrum - lower reps, higher weights. With great strength comes great responsibility...wait...that's Spider-Man. What I meant to say was that building strength comes a with greater exercise intensity. Here, weight and load are increased, and repetition ranges from 8-15. To build more strength and muscle, more load has to be moved. Since the weight is higher, the number of sets are lower, around 3-4. It also comes with a longer recovery period between sets, around 30-45 seconds.
Reeducation of a compensated movement pattern runs a similar gauntlet as endurance training - just beat it up with high repetition. A compensation happens if a certain motion is painful. The body is very efficient in moving itself in the most pain free way, even if it is not the most efficient way. The way to overcome this is to teach the body that it has to move back into its normal movement pattern. This can only occur if we are able to work a client in a pain free/decreased pain range of that certain motion. Once that is achieved, just getting the body to perform that movement over and over, repetition upon repetition, is the way to go. It is essentially telling the body, “Hey, this is a better and more efficient way to do this.” When this is figured out, the body will automatically adopt that pattern.
So that’s why you have to do 100. There is a pretty good foundation of for doing all of those repetitions. I’m not just trying to be mean...usually
;-)
Let me know what you guys think! This is a pretty generalized overview of these topics. To really get a good individualized plan for you, give us a shout. You can email me at sancho@jointventurespt.com or if you live out of town, you can contact your doctor or local therapist!