Posts tagged strength training
What Are The Best Treatments For Patellofemoral Pain?

Patellofemoral pain syndrome or pain under the knee cap is the most common diagnosis in the knee and a frequent reason patients seek out the care of their primary care physician or Physical Therapist. Patient’s with this condition often experience aching or sharp pain under or around the knee cap (patella) during squatting, running, jumping, stair climbing, hiking, and prolonged sitting. Pain results from abnormal contact between the knee cap and thigh (femur). Prior thoughts on this condition believed the knee cap was responsible for the abnormal contact and interventions were designed to target the patella.

Outdated theories including balance between the outer and inner quadriceps muscle have been replaced by better research indicating the hip may play a more significant role in the condition. The hip musculature including the gluts contribute significantly to the alignment of the thigh under the knee cap. As the alignment improves a greater portion of the joint surface area is able to distribute the forces across the knee reducing joint pressure and pain. The quadriceps function to dissipate the forces across the knee and should be targeted along with the hip musculature in this condition.

The Journal of Orthopedic Sports Physical Therapy recently published their clinical practice guidelines including the best available medical evidence and expert opinion on how to effectively diagnosis and treat this condition (Willy et al. 2019). Authors reviewed 4500 scientific articles on this condition between 1960 and present day. They selected 271 articles for the review and broke down their findings into the most supported risk factors, examination tests, diagnosis, treatments, and prognostic factors. Authors found most individuals with this condition improve with Physical Therapy interventions including activity modification and strength training. Patients may also benefit from short term (< 6 weeks) utilization of foot orthotics and taping for pain relief. Authors reported manual therapy and dry needling were not shown to be useful for this condition.

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Which Lower Body Exercise Is Best For Hip and Leg Activation?

Strength training is an essential part of any workout program. Participants should aim for 2 to 3 workouts per week targeting major muscle groups of the upper and lower body. Multi joint movements such as the squat or deadlift provide a more effective and efficient workout compared to single joint exercises (ex. leg extension machine). The exercise prescription (sets, repetitions, and intensity) is more important than a specific exercise when developing muscle strength, but exercise selection remains important for addressing individual needs (weakness, tightness) and when working with a Physical Therapist after returning from injury. A recent research study determined which exercises are best for lower extremity muscle activation.

Delgado and colleagues in the Journal of Strength and Conditioning Research examined the muscle activation levels of the back squat, romanian deadlift, and barbell hip thrust (2019). Researchers captured the activation levels (EMG) of the quadriceps, hamstring, and gluteus maximus muscles during each exercise in a group of trained (> 1 year experience) men. EMG data was collected under two conditions: a 60 kg weight and at the participants one repetition max.

Similar to a previous study, authors found greater gluteus maximus recruitment in the hip thrust compared to the back squat. Interestingly, the hip thrust’s gluteus maximus recruitment was not statistically different than the romanian deadlift. As expected, quadriceps recruitment was greatest in the back squat and this exercise effectively targeted the knee and hip extensors. Conversely, hamstring recruitment was greatest in the romanian deadlift. This study highlights the ability of multi joint exercises to target multiple muscle groups throughout the lower extremity improving effectiveness and efficiency in your workouts.

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Should Women with Osteoporosis Engage in High Intensity Resistance and Impact Training?

Despite the fact that bones respond favorably to high impact exercise and high-intensity resistance training these types of exercise are typically avoided in women with osteoporosis due to concerns that heavy loading of ‘fragile’ bone may result in increased risk of fracture. The LIFTMOR trial (Watson et al 2017, J Bone Mineral Research) calls into question this traditional belief that osteoporotic females should not lift heavy weights.

 This high-quality trial investigated the effects of an 8-month, 2x/week high intensity, progressive resistance and impact weight-bearing training (>80-85% of 1 rep max) in women with osteoporosis compared to women participating in low-resistance (<60% 1 rep max) exercise targeting mobility and balance. The high-intensity exercisers gained bone mass where their low-intensity counterparts lost bone mass. The high intensity group also had significant improvements in measures linked to fall risk as well as height.

 Importantly, in the over 2600 high-intensity training sessions, only 1 mild adverse event was noted and that participant returned to high intensity training to complete the study without concerns.

 High-intensity exercises included (*all exercise sessions supervised by a physical therapist):

Dead lift

Overhead press

Back squat

Jumping chin-ups with drop landings


Contact your exercise experts at Mend to get started on improving your bone health now.

Skipping Breakfast Impairs Subsequent Resistance Training Workouts

The basics of sleep, hydration, and nutrition are the low hanging fruits of performance. Easy to access, albeit hard to change at times, but extremely impactful on our overall health and wellbeing. The cognitive and physical benefits of breakfast are well established and the timing and contents of the meal has been shown to influence future athletic performance. A previous blog discussed the importance of pre and post workout protein intake and a new article further supports the utilization of pre workout meal.

Authors in the Journal Of Strength And Conditioning Research studied the impact of a pre workout meal on resistance trained men (Naharudin et al. 2019). Participants were included if they performed strength training at least 3 days per week and ate routinely ate breakfast prior to their workouts. In the study, each participant’s 10 rep max was found during a back squat and bench press exercise. They were then randomized to either a breakfast containing 1.5 grams of carbohydrate per kg of body weight or water only. 2 hours post meal each participant performed 4 sets at 90% of their 10 rep max on each of the 2 exercises. As expected, total work performed and performance was significantly lower in the group who skipped breakfast.

No Strength Gain Differences Found Between Low and High Load Exercise IF Reps Are Taken To Failure

In our previous blogs we have discussed the errors most exercise participants make when selecting intensity (amount of weight) while at the gym. Humans are often poor estimators and when it comes to strength training they often select weights below the intensity required to promote optimal strength and muscle gains. Trying to base a weight off a one repetitions maximum is time consuming, impractical, and possibly contraindicated for some weight training participants. Conversely, research articles continued to support using fatigue as an alternative to the 1 repetition maximum weight selections. Fatigue takes the guesstimation out of exercise weight selection and can be very effective at promoting optimal strength gains.

Dinyer and colleagues in The Journal Of Strength And Conditioning Research randomized untrained women to either a low or high intensity weight training program (2019). All of the women underwent clinical and body mass (% fat free mass) testing before and after the 12 week training program. Each group was assigned to a weight equaling a low (30% of 1 rep max) or high (80% of 1 rep max) intensity for 2-3 sets during 4 exercises (lat pulldown, military press, leg extension, and leg curl). Both groups took their workout sets to fatigue. Authors reported while both groups improved their maximum strength at the end of the 12 weeks there were no differences between the low or high intensity groups. In addition no changes in fat free mass were noted in the groups.

This study highlights the importance of working with a sub maximal weight and lifting it a maximum number of times for optimal strength gains. We recommend selecting a repetition range first (ex. 8-12 reps) then selecting a weight, but adjusting this weight higher if you can perform more repetitions than your established rep range.

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No Differences Found Between Surgery Or Physical Therapy For Tendon Injury

Overuse tendon injuries can present as an acute inflammatory response (Tendinitis) or a chronic degeneration condition (tendinopathy).   These injuries result when an individual’s volume of activity (type, duration, frequency, and intensity) exceeds the strength and integrity of the tendon.  At MEND, we commonly see these injuries in the tendons of the rotator cuff, knee, ankle or elbow.  Recent studies summarized in our previous blog posts have highlighted the importance of a Physical Therapy exercise program.  Optimal, progressive loading of these injuries is critical to the healing process (remodeling) resulting in decreased pain and improved function.  Despite overwhelming evidence supporting exercise interventions patients may still be provided with a surgical treatment.

A recent study from the British Medical Journal reviewed the available medical evidence to determine the effectiveness of Physical Therapy compared to surgery or no treatment in patients with tendinopathy (Challoumas et al. 2019).  Authors included 12 studies of over 1000 patients to determine the impact of these treatments on a patient’s pain, function, range of motion, strength and quality of life.  Authors reported Physical Therapy was as effective as surgery in both the mid and long term for improving pain, function, and quality of life.  Authors report surgery should be reserved for patients who do not improve with 12 months of a loading program.