Periodization Concepts for the Orthopedic Patient

1. Periodization Concepts for the Orthopedic Patient

2. Objectives • Understand what a periodized program is • To be able to manipulate the training variables to achieve the desired muscular conditioning effect (ex: endurance, strength, power, etc) • Aware of the adaptations that occur when performing a strength training program • Distinguish the differences between the spectrum of strength / power and mm endurance • How to progress a resistance training program based on client goals and previous training status

3. What is strength? • Strength / fitness: • Has different meaning for different people depending on: • Age • ADL’s and IADL’s • Occupation • Severity and type of injury • Healing capacity

4. What is strength?What is power?

5. Physics Definitions • Force: mass x acceleration • Strength is defined as the maximal amount of force that a muscle or muscle group can generate at a specific velocity • Work: force x distance • Power: strength x speed (work/time)

6. Periodization Concepts • What is periodization? • Periodization is a method of planning periods or cycles in which training specificity, intensity, and volume changes within an overall training program (Baechle and Earle 2000) • Manipulation of key strength training variables that includes number of sets, reps, intensity, repetition speed, rest periods, frequency or order of exercises

7. For intermediate to advanced training, it is recommended that individuals use a wider loading range, from 1–12 RM in a periodized fashion… For loading, it is recommended that loads corresponding to 1–12 RM be used in periodized fashion…

8. Periodization Concepts • Why periodize your training programs? • Prevent overtraining • Decrease the onset of staleness • Promote the development of specific physical performance parameters • Allows for “peaking” of key performance variables that are specific to an individuals function

9. Periodization Concepts • Why should a physical therapist understand the concepts of periodization • Three sets of 10 will only get you so far!! • You must have an understanding of what the goals of exercise are for your patients based on the type of tissue involved, the stage of healing and the co-morbid conditions that your patients may have that influence their ability to train successfully

10. Periodization Concepts • Physiological basis for periodization • Based on the concepts of: • Endocrinology • Biomechanics • Neurology • Muscle physiology • Metabolism

11. Review of Muscle Physiology • Types of Muscle Fibers:Fast & Slow Twitch Fibers:Not really just two types but a continuum between the two.Both are present in varying mixture in most muscles. Classically divided into: Type I Type IIA Type IIB

12. Review of Muscle Physiology • Types of Muscle FibersType I: Characteristics • Slow acting myosin isoform • Contract more slowly with less force • Rely primarily on oxidative metabolism • Many mitochondria • Myoglobin • Highly vascularized • Contain little glycogen • Small diameter • Resistant to fatigue

13. Review of Muscle Physiology • Type IIA: Characteristics • Fast acting myosin isoform • Contract rapidly with greater force • Have high oxidative capacity • Highly vascularized • Many mitochondria • Have myoglobin • Intermediate amounts of glycogen and anaerobic capacity • Intermediate size • Not very common in most people : Class switching

14. Review of Muscle Physiology • Type IIB: Characteristics • Fast acting myosin isoform • Contract rapidly with greater force • Rely on anaerobic metabolism • Few mitochondria • Less well vascularized • Lack myoglobin • High glycogen content • Large diameter

15. Review of Muscle Physiology • IIb IIab IIa IIac IIc • Strength training converts the IIb mm fibers to the more oxidative IIa mm fiber type by as much as 93%

16. Review of Bioenergetics

17. Review of Bioenergetics • Muscle Energetics: Energy (ATP) Requirements for Muscular Contraction • Movement of myosin head chain: Requires ATP hydrolysis for each stroke; majority of energy requirements are here • Mobilization of Calcium stores: Calcium must be pumped back into the SR at the end of each contractile pulse. Calcium pumps on SR require ATP. • Reestablishment of membrane potential: Contractile stimulation requires an action potential, so the Na/K pump must be used which requires ATP.

18. Review of Bioenergetics • Hydrolysis of ATP stores: • allows for ~1-2 seconds sustained contraction • Phosphocreatine:High energy phosphate to quickly rephosphorylate ADP. • 5-8 seconds sustained contraction • Glycogen and glycolysis:Muscular store of glycogen undergoes glycolytic cycle to yield ATP, lactic acid and 2 molecules of pyruvate. Glycolysis also yields such molecules as NADH and FADH2 to be used to generate ATP or used in later reactions such as the Krebs cycle. Rapid, does not require oxygen. • One minute sustained contraction

19. Review of Bioenergetics • Muscle Energetics • Oxidative metabolism:In the mitochondria. Slow, but capable of supplying a large amount of energy.. Electrons are transported from NADH, FADH2 molecules down a transport chain to the terminal electron receptor O2. The end product is a large amount of ATP (larger than any other metabolic process) and H2O • > Three minutes sustained contraction

20. Periodization: Theory

21. Periodization: Theory • Hans Selye: Canadian Endocrinologist described the physiological basis of why periodization is effective based on three stages General Adaptation Syndrome:

22. Periodization: Cycles • Periodization programs are divided into smaller cycles of training with each cycle of training devoted to a particular performance variable • Microcycle: smallest period of time in the model usually one week long • Mesocycle: intermediate period in the training cycle that consists of multiple microcycles usually from 3 weeks to 12 weeks (6-8 weeks common) • Macrocycle: long term program that last for several months to a year. This cycle represents the entire training cycle towards the overall goal

23. Periodization: Reduction of Fatigue • Periodization may minimize the various forms of neuromuscular fatigue • Central: fatigue occurs proximal to the motor units at the brain and / or spinal level • Occurs due to prolonged duration exercises, with decreased intensity and high volume • Need CNS activation to activate the motor units

24. Periodization: Reduction of Fatigue • Peripheral fatigue: • Present at the motor neuron, NMJ or mm fibers • Occurs with more high intensity, short duration activities • Glycolytic metabolism produces fatigue due to: • Increase metabolites such as lactate, H+, AMP, phosphate • Decrease substrates such as creatine, ATP and glycogen

25. Periodization: Reduction of Fatigue and Improved Performance • Because of the varying nature of intensity and volume, periodization allows for reduced tendency towards fatigue by both mechanisms • Allows for preservation of anabolic stimulating hormones such as testosterone while maintaining cortisol levels • Utilization of the SAID principle to allow for specific training of mm fibers towards their use for functional activities

26. Goals of a Periodized Resistance Exercise Program

27. Goals of a Periodized Resistance Exercise Program • Supercompensation refers to the desired, beneficial training effect that occurs in direct response to the applied training stress, and following a recovery period • Supercompensation is the return of the performance level from a point of reduced capacity that follows a training episode, beyond the pre-training level and to a new, higher performance baseline

28. Goals of a Periodized Resistance Exercise Program Positive Adaptation Negative Adaptation Figure 1 - note that the training effect brings the performance capacity back to a higher level Figure 2 - note the inadequate recovery stage and its’ effect on adaptation

29. Periodization Models • Linear: progressive systematic decrease in volume while increasing intensity between each mesocycle specific time intervals to focus on a particular physical attribute • Undulating / non linear: the volume and intensity vary within each micro or mesocycle. To be discussed later

30. Linear Periodization • Stages of periodization • Preparation • Muscle endurance • Hypertrophy • Transition period 1 • Basic Strength • Power • Competition (Peaking period) • Transition period 2 (Active Rest)

32. Linear Periodization • Preparation Stage: • Muscle endurance: • 2 – 3 sets of 20 – 25 reps, rest periods 30 – 60 seconds, frequency 2 – 3 days per week • Hypertrophy: • increased volume, (3-6 sets of 10-20 reps) per muscle group, rest periods 60-90 seconds, frequency 3-4 days per week, 50% to 75% 1RM • Muscle fiber conversion of type IIB to type IIAB / IIA • Due to increased / stable concentrations of testosterone, growth hormone, IGF to allow for mm fiber hypertrophy

33. Adaptations to Early Phase I Training • Increased Type I fiber recruitment • Increased capillary density • Increased utilization of Free Fatty Acids • Increased skeletal mm mitochondria • Reduced capacity for Type II fiber recruitment • Strength gains are due to combination of Type I fiber hypertrophy and increased neural recruitment

34. Adaptations to Late Phase I Training • Increased Type II A activation • Conversion shift from Type IIB to Type II A • Increased reliance on glycolytic metabolism • Increased lactic acid production • Improved buffering of lactic acid via production of lactate • Increase myofilament production • Increase satellite cell proliferation / mitosis • Strength gains are due to increased CSA • Takes 8 – 12 weeks to occur

35. Linear Periodization: Preparation Phase • Preparatory stage: • Technique is not emphasized due to the high volume of training • Goal is to build a base through increased mm / strength endurance • Must be cautious to avoid overtraining with increased cortisol production

36. Linear Periodization: Transition Period • Transition Period 1 : • Basic Strength: volume decreases from the hypertrophy phase, intensity increases (3-5 sets of 4-6 reps at 80-90% 1 RM), frequency is 3-5 days per week, rest periods are 2-3 minutes • Muscle fiber emphasis are IIB fibers • Anaerobic glycolysis to creatine phosphokinase metabolism • Primary response to training is enhanced neuromuscular efficiency

37. Linear Periodization: Endocrine System Considerations • Strength training can have a profound effect on the hormonal, nervous, and immune systems • Hormonal adaptations • What type of strength program increases Testosterone? • Large mm group exercises • Heavy loads > 85% 1RM • Moderate to high volume: multiple sets and / or exercises • Short rest 30 – 60 seconds

38. Linear Periodization: Endocrine System Considerations What is Cortisol?: stress hormone produced from the adrenal cortex assists in remodeling of connective tissue acute exercise that involved high volume, large mm groups increased cortisolproduction excessive production can result in mm catabolism, and adverse immune responses What kind of training program increases Growth Hormone?: high volume (10RM) for multiple sets (3) with short rest periods (1 minute) that promotes mm soreness (lactic acid)

39. Linear Periodization: Transition Period I Exercises • Closed chain movements done first: • Neuromuscular / balance • Power • Strength exercises • Open chain exercises • Endurance activities • Compound Strength Exercises: • Bench press • Military press • Rows • Lat pulldown • Squat • Lunges • Deadlift

40. Adaptations to Late Phase I Training • Increased recruitment of Type IIB muscle fibers • Improved mm recruitment via myotatic stretch reflex • Improved mm recruitment via length – tension relationship • Motor learning effects

41. Linear Periodization: Late Transition Period I Exercises • Power exercises • Powerclean: http://media.crossfit.com/cf-video/cfj-nov-05/hang-power-clean.wmv • Push press: http://media.crossfit.com/cf-video/SPPPPJ155.wmv Snatch: http://media.crossfit.com/cf-video/cfj-nov-05/power-snatch.wmv

43. Linear Periodization: Late Transition Period I • Transition Period: • Volume is decreased dramatically while intensity increases • Technique and functional development is emphasized • Power and explosive compound movements are the basis of this stage • Variables: 3-5 sets, 2-5 reps, 3-5 days/week, rest periods 3 minutes • 85-95% of 1RM (strength) • 80-90% 1 RM (power) 1 – 2 reps (single events) • 75-85% 1 RM (power) 3 – 5 reps (multiple events)

44. Linear Periodization: Late Transition Period I • Transition Period: • Creatine phosphokinase metabolism is primary • Goal is to increase neuromuscular components of strength and power • Increase recruitment of larger motor units • Increase motor unit firing • Increase motor unit summation

45. Linear Periodization: Late Transition Period I • Transition Period: • Modifications for the orthopedic patient • For power development, safer to use lighter loads with emphasis on speed of the contraction for the development of power (~50% of 1RM) for 12-15 reps

46. Linear Periodization: Competition / Peak Phase • Competition / Peaking Phase • Emphasis is on preparing for the event • Maximizing technique • Volume is low to prevent injury and fatigue • Variables are: 1-3 sets of 1-3 reps, 90-95% of 1RM, 1-5 days per week, rest periods 3-5 minutes • Done for usually one week to prevent fatigue, overtraining and injury

48. Linear Periodization: Transition Period II: • Transition Period 2 (Active Rest) • Variables are 80-85% of 1RM, 2-3 sets of 6-8 reps, 2 days per week • Client pursues other fitness interests Cross training (cycling, swimming, rowing, inline -skating, etc) This period is continued until approximately 3 – 4 months before the start of the next season or event, then cycles repeat

49. Resistance Exercise Prescription

50. Resistance Exercise Prescription • Depends on the training intensity / volume • Previous exercise status of the patient • Other physical demands: • Job • Sport • Recreational pursuits