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244 | Why Junk Volume Is Holding Back Your ACL Progress · The ACL Athlete Podcast

• 0:18
  SPEAKER_00: Welcome everyone to the ACL Athlete Podcast.
• 0:22
  SPEAKER_00: This is the podcast where we talk about everything related to the ACL, whether that's the injury itself, the rehab process, return to sport, and more.
• 0:31
  SPEAKER_00: I'm your host, Dr.
• 0:32
  SPEAKER_00: Ravi Patel, performance physical therapist and coach.
• 0:36
  SPEAKER_00: Between myself and fellow guests and experts, you'll learn through the lens of the patient, the healthcare professional, and the coach.
• 0:43
  SPEAKER_00: The goal of this podcast is to equip you, the athlete, with the education to make the best informed decision about your care and your ACL journey.
• 0:54
  SPEAKER_00: Thanks for joining.
• 0:55
  SPEAKER_00: Now let's dive into today's episode.
• 1:01
  SPEAKER_00: What is up, team, and welcome back to another episode on the ACL Athlete podcast.
• 1:07
  SPEAKER_00: So, first, I just want to say thank you for the messages and the conversations for those of you who have listened to the OR series, which was the past three episodes, on being inside the operating room, observing some ACL surgeries, pulling some nuances out that we can carry over to our ACL rehab and some practical takeaways.
• 1:29
  SPEAKER_00: So if you haven't caught that, go check out those episodes, put a lot into them, and maybe it will highlight a few things that have been on your brain about your process and maybe trying to kind of vet essentially some ideas within this process.
• 1:45
  SPEAKER_00: So check that out if you haven't.
• 1:47
  SPEAKER_00: Otherwise, digging into today's podcast episode, which is focused on why junk volume is holding back your ACL rehab and your progress.
• 2:01
  SPEAKER_00: So with working with hundreds of ACLers all over the world, observing hundreds of different protocols at this point, research papers, auditing tons of physical therapists programs, strength and conditioning coaches programs via our mentees, via the mentorship, people sending me programs.
• 2:20
  SPEAKER_00: I get to see a lot in this space.
• 2:23
  SPEAKER_00: And this is all that I focus on.
• 2:25
  SPEAKER_00: This is my world, this is what I'm obsessed with.
• 2:27
  SPEAKER_00: As you guys know at this point, if I've done 243 episodes at this point, you can say I am a little weird about the ACL rehab space.
• 2:38
  SPEAKER_00: But it's because this is very personal to me.
• 2:41
  SPEAKER_00: And I think that this is just a place where there is just in need of help for the ACL or for the clinician, for the coach, for the entire community as a whole.
• 2:52
  SPEAKER_00: As we know, injury rates are increasing, and there are more complexities with this process, and return to sport rates are not really great, they continue to decrease.
• 3:04
  SPEAKER_00: And so I am just really obsessed with this space, and I want to just share my thoughts in terms of something that I do notice.
• 3:14
  SPEAKER_00: Obviously, this whole podcast is based on that.
• 3:17
  SPEAKER_00: But one thing about this that just being able to observe, especially talking with the ACLers and auditing a ton of these PT programs that we see from our mentees, there's one thing that I consistently see, and that is junk volume.
• 3:34
  SPEAKER_00: And so junk volume is something that we use as a team, and this is basically doing excessive training volume.
• 3:42
  SPEAKER_00: So think more exercises, more sets, more reps.
• 3:46
  SPEAKER_00: That does not drive meaningful adaptations.
• 3:49
  SPEAKER_00: And at the end of the day, in ACL rehab, that is all that we care about.
• 3:54
  SPEAKER_00: Are we moving the needle forward with the stimulus and the adaptation that we need to be able to get back to do the thing?
• 4:02
  SPEAKER_00: Right.
• 4:03
  SPEAKER_00: None of you guys are here because you enjoy ACL rehab, unless you are a physical therapist or coach helping other people, right?
• 4:09
  SPEAKER_00: You are here because this rehab has taken away something that you want to do, whether it is your physical activity, whether it is particular sports, activities that you love to do, whether it is just being able to move and use your body, whether it is to engage in a group setting, whether it is just for you to be able to play with your kids or to be able to just be yourself, right?
• 4:31
  SPEAKER_00: It is very meaningful to be able to move.
• 4:34
  SPEAKER_00: And so then therefore, this injury and this rehab and this surgery, if you had it, is standing in the way of something that you really care about.
• 4:44
  SPEAKER_00: And so all we care about doing is getting you back to that thing.
• 4:47
  SPEAKER_00: That's all you really care about at the end of the day.
• 4:50
  SPEAKER_00: So all we are trying to do is design something very strategic that is going to give you the adaptations, those changes that we need structurally, physically, and also mentally to be able to get you back to doing those things.
• 5:05
  SPEAKER_00: And so, commonly in ACL rehab, people are doing eight plus exercises, 10 plus exercises, 12 plus exercises in a session.
• 5:15
  SPEAKER_00: Random circuits might be happening.
• 5:17
  SPEAKER_00: They might be copying stuff from Instagram or YouTube to add to their rehab.
• 5:23
  SPEAKER_00: And while I don't fault some of you guys who maybe feel like there is some incompleteness to your rehab, I know that this is probably the biggest challenge is that you just feel like you're not getting enough, which I will touch on here in a second.
• 5:36
  SPEAKER_00: But with that said, like I get it.
• 5:38
  SPEAKER_00: And so you're someone who's struggling with extension.
• 5:41
  SPEAKER_00: You might be someone who is struggling to activate your quads or getting quad strength to develop.
• 5:46
  SPEAKER_00: I know these things all exist.
• 5:48
  SPEAKER_00: So you're trying to essentially explore all the depths of the world and trying to figure out what's going on.
• 5:54
  SPEAKER_00: And usually what happens is that you're like, oh, this won't hurt.
• 5:57
  SPEAKER_00: Like, this looks like a cool exercise.
• 5:59
  SPEAKER_00: Let me add this in.
• 6:00
  SPEAKER_00: Or maybe your physical therapist is giving you a ton of exercises.
• 6:04
  SPEAKER_00: And this can be essentially what happens, especially post op, because there are so many different things you might be doing daily.
• 6:11
  SPEAKER_00: So then you start to have this accumulated list.
• 6:14
  SPEAKER_00: Often you'll start off with, you know, six to eight exercises.
• 6:18
  SPEAKER_00: And then what happens is that you'll keep those and then there'll be more added.
• 6:22
  SPEAKER_00: And then you'll keep those and there'll be more added.
• 6:24
  SPEAKER_00: And it just depends on the physical therapist or training, how intentional they are.
• 6:28
  SPEAKER_00: And so these are things that we typically see in this process.
• 6:33
  SPEAKER_00: And while, yes, in some sessions you could do eight exercises, but the thing is, is like it just really depends on where you are in this process and the intention behind each exercise and the structure.
• 6:45
  SPEAKER_00: Now, if you're doing like three easy warm-up movements, for example, just to get you prepped, sure, that could be a part of that.
• 6:52
  SPEAKER_00: And then maybe you're doing maybe five additional movements.
• 6:55
  SPEAKER_00: Now, the specific number itself doesn't matter nearly as much as the structuring and the why behind it all, right?
• 7:04
  SPEAKER_00: There are sessions where you may end up doing more exercises, but the thing is that I see it's just constantly just more exercises or maybe just more stuff being done in your sessions or each and every single day.
• 7:18
  SPEAKER_00: And so with this kind of junk volume terminology or too much training volume, they end up doing too much moderate output.
• 7:27
  SPEAKER_00: That's essentially what we're looking at, right?
• 7:29
  SPEAKER_00: These ACLers, when they're doing this, there's too much moderate output that doesn't have much intent.
• 7:35
  SPEAKER_00: It doesn't have a ton of strategy or structure around it, and it also doesn't have a ton of built-in recovery that's intentional.
• 7:43
  SPEAKER_00: And so what happens is that leads to stalled progress, some lingering symptoms you might be dealing with, maybe some confusion around what's going on.
• 7:52
  SPEAKER_00: And then the thing that I wanted to bridge this into was essentially having multiple calls with athletes where this thought just started to stir up more and more.
• 8:03
  SPEAKER_00: And as we talk about it as a team, I was just like, you know what, let's do a podcast episode on this.
• 8:08
  SPEAKER_00: And so I want to share some of these calls that I literally had this past week with people in terms of where they are.
• 8:16
  SPEAKER_00: One athlete was training legs six days a week.
• 8:19
  SPEAKER_00: Six days, y'all.
• 8:21
  SPEAKER_00: And while there can be certain structures, don't get me wrong, that you can do legs six days a week, three of those days might be super light days, right?
• 8:32
  SPEAKER_00: You might be doing some isometrics, you might be doing some mobility work, but y'all, no one is training legs six days a week.
• 8:38
  SPEAKER_00: I promise you, especially if you are hitting it hard with the movements, the sets, reps, intensity, you shouldn't be able to do six days a week.
• 8:46
  SPEAKER_00: That's just not good strength and conditioning, it's not good rehab.
• 8:49
  SPEAKER_00: Six days a week is going to dig you a deep hole that you're not gonna be able to come out of.
• 8:53
  SPEAKER_00: But that was one ACL.
• 8:55
  SPEAKER_00: Another ACLer, she was doing four hours of rehab work a day, and there were fresh post-op.
• 9:02
  SPEAKER_00: Four hours of rehab work a day, and they were literally fresh post-op.
• 9:06
  SPEAKER_00: It just doesn't really add up here, like why she's doing so much work every single day.
• 9:11
  SPEAKER_00: Yes, you are doing some stuff more frequently post-op, but with that said, four hours of work, you might be almost doing too much, right?
• 9:20
  SPEAKER_00: I had one ACLer who said she literally had 20 exercises, and for all of these exercises, she had to do three sets to do almost every day, y'all.
• 9:31
  SPEAKER_00: 20 exercises, seven of those were aiming to accomplish the exact same thing.
• 9:37
  SPEAKER_00: So basically, it was all focused on knee extension, and seven of those were doing the exact same thing, but yet they were doing three sets of all seven of those exercises.
• 9:46
  SPEAKER_00: Why?
• 9:47
  SPEAKER_00: Why why are we doing this?
• 9:49
  SPEAKER_00: Why it just doesn't make sense.
• 9:51
  SPEAKER_00: Another one was sneaking in exercises on days where they weren't scheduled, thinking it wouldn't hurt anything.
• 9:57
  SPEAKER_00: Now, this is almost a little bit more to that athlete themselves, but with that said, like we tend to see that with some people where they're trying to sneak in other exercises thinking it won't hurt.
• 10:08
  SPEAKER_00: And so then, therefore, they just end up doing too much every single day, right?
• 10:13
  SPEAKER_00: And the consistent theme with all these people when talking with them, there's a lack of progress, they feel stalled, there is knee swelling and pain, sometimes stiffness with this, there's a lack of structure and direction in general, and then they feel burned out.
• 10:31
  SPEAKER_00: And I would feel burned out too if I was doing 20 exercises every single day for my rehab.
• 10:36
  SPEAKER_00: This is all essentially a load management issue.
• 10:41
  SPEAKER_00: The distribution of stress and load on the body is not being managed well, and honestly, mentally too.
• 10:46
  SPEAKER_00: I think that gets overlooked, but especially as you get further in this process of ACL rehab, you just feel like you're in this rehab purgatory where you're just constantly doing stuff, right?
• 10:56
  SPEAKER_00: But eventually, after you get out of those early phases, it should transition more into a strength and conditioning type program, right?
• 11:04
  SPEAKER_00: And so then, therefore, we are balancing days where you are in the gym training, and then maybe the next day is a low-key recovery day.
• 11:12
  SPEAKER_00: Maybe it's an off day, right?
• 11:13
  SPEAKER_00: It just depends on what are the priorities at that point.
• 11:16
  SPEAKER_00: But with that said, we want to manage the load.
• 11:20
  SPEAKER_00: And that is going to be so important of all the stress on the knee, on the body, and that's going to help us also mentally to avoid burnout.
• 11:29
  SPEAKER_00: I see this as a very key problem with burnout, is that people are just going hard for so, so long.
• 11:35
  SPEAKER_00: They're not given intentional rest.
• 11:37
  SPEAKER_00: Their provider doesn't necessarily pick up on cues whenever they're burning out or running their bodies down into the ground or lack of progress, right?
• 11:45
  SPEAKER_00: And I think this is very, very important for us to pick up on because of just the length of how long this process is, right?
• 11:53
  SPEAKER_00: And so the other thing that I wanted to share was just another athlete who joined us.
• 11:59
  SPEAKER_00: She was working with a reputable ACL PT who was doing two and a half hours in the gym.
• 12:05
  SPEAKER_00: So she would see this PT, and then other days she would have structured four different days, and she was spending two and a half hours in the gym on her own and was not making progress.
• 14:21
  SPEAKER_00: She felt stuck.
• 14:22
  SPEAKER_00: We audited her program.
• 14:24
  SPEAKER_00: We're just like, okay, so let's just kind of look and see like what are the things that you are struggling with via testing, and then also let's just kind of audit and see what's going on.
• 14:33
  SPEAKER_00: And it was just so much volume.
• 14:36
  SPEAKER_00: And so we reduced it down and got more surgical based on her testing, and she was able to move forward with only three days a week, one hour workouts each week.
• 14:46
  SPEAKER_00: So that's the thing that can be done.
• 14:49
  SPEAKER_00: Like we don't need 10 hours of work every single week for ACL rehab.
• 14:54
  SPEAKER_00: We really don't.
• 14:55
  SPEAKER_00: And of course, different phases will require different amounts of commitment, whether you're working on range of motion and strength, you know, versus if you are through the range of motion purgatory, if you will, where you're not working on it as much daily, then therefore you are going to be able to allow a little bit more balance to your plate because you're just focused on more strength and conditioning focused work, which requires days where you are just not really focused on the legs.
• 15:22
  SPEAKER_00: You can't focus on it every single day.
• 15:24
  SPEAKER_00: And so that is something that is going to be really important here because I think in this process, we see a lot of ACLers get really stuck.
• 15:33
  SPEAKER_00: And don't get me wrong, early on, I was guilty of some of this too.
• 15:37
  SPEAKER_00: Like, you know, I'd get excited about certain specific exercises or not wanting to leave any gaps in the day.
• 15:43
  SPEAKER_00: But over the years, I have embraced a less is more mentality.
• 15:47
  SPEAKER_00: And it has not failed me, it has not failed our team in terms of the ACLers we work with because as we work with more, we are always trying to audit things.
• 15:57
  SPEAKER_00: Like every single week as a team, we are always talking through programs, we are talking through programming audits, we're talking through cases, and we're like, okay, here are the hard cases, here are the ones that we seem to be having a little bit more straightforward process.
• 16:13
  SPEAKER_00: And then we're also talking about what we can do differently to improve these types of situations for our ACLers based on the context of their lives.
• 16:21
  SPEAKER_00: And so this is so important for us to make sure that we audit and making sure that we aren't just giving our athletes just a ton of, you know, exercises just because, you know, that's what you do, right?
• 16:33
  SPEAKER_00: Like we want to make sure we have a why for every single thing that is put into the program.
• 16:39
  SPEAKER_00: And that is one of the essential pillars of our team and when we program for our athletes and guide them, is that anytime you're doing an exercise, there is a why behind everything.
• 16:49
  SPEAKER_00: I promise you that.
• 16:50
  SPEAKER_00: And that is something that got drilled so heavily into me when I was doing my strength conditioning internship, because if I didn't, it's got to get out.
• 16:59
  SPEAKER_00: You got to be able to explain why and a rhyme and a reason as to why you're implementing that for your particular athlete, and especially in this case for ACL rehab.
• 17:09
  SPEAKER_00: So this is something that I wanted to also share a caveat for is the double-edged sword of this feel of needing to do more as an ACLer.
• 17:19
  SPEAKER_00: For some with bad rehab, you know, they're just not getting enough, or more so it's just like they're doing stuff, but it's not really challenging, right?
• 17:29
  SPEAKER_00: And it might just be more of doing exercises that are actually challenging you exactly where you're at, right?
• 17:37
  SPEAKER_00: That's the big thing here.
• 17:39
  SPEAKER_00: So I get that from if you're not getting the right rehab with where you are.
• 17:43
  SPEAKER_00: And then there's those people who compare themselves to who they are pre-injury, they're high energy, big exercise people who can't sit still, impatient.
• 17:53
  SPEAKER_00: So they feel the urge to do more.
• 17:56
  SPEAKER_00: And I think this is something where it's going to be really important to work with someone who knows ACLs, can individualize things, is so key.
• 18:05
  SPEAKER_00: Also be able to make sure it meets you where you are.
• 18:08
  SPEAKER_00: And also, you know, be able to check your athletes if they are doing too much, right?
• 18:12
  SPEAKER_00: I've had to have a lot of hard conversations with people.
• 18:15
  SPEAKER_00: We tend to work with a lot of dedicated, high exercise functioning people.
• 18:19
  SPEAKER_00: And with that said, you know, sometimes we have to have that honest conversation.
• 18:23
  SPEAKER_00: Look, you don't need to go on this walk right now.
• 18:25
  SPEAKER_00: Your knee is swollen.
• 18:26
  SPEAKER_00: Stop doing an extra workout on your off day because you're not giving yourself a break, right?
• 18:32
  SPEAKER_00: Of course, we are trying to make this more tactical and to be able to communicate with these athletes to make sure we want to have them along in this process.
• 18:41
  SPEAKER_00: So understand what are the goals for them in the short term and long term, and also how this all plays together in the structure and the way that we've built this out together.
• 18:49
  SPEAKER_00: And if we need to make changes or adapt it, we're here to make that happen, right?
• 18:53
  SPEAKER_00: If they need more of a stimulus of something, we can always add or adjust things.
• 18:59
  SPEAKER_00: It's just making sure we're communicating based on that, right?
• 19:02
  SPEAKER_00: But today we break down why less is more, how to use the high low principle, the 8020.
• 19:10
  SPEAKER_00: Some of these things you have heard me talk about, and also what the research says about volume and strength and hypertrophy, because I think that's going to be important as we consider volume and training in general, especially in this rehab process.
• 19:25
  SPEAKER_00: And so, one of the things that I wanted to share with this is two different analogies I'll keep super short.
• 19:32
  SPEAKER_00: So, one is that think about our energy and output as a battery.
• 19:37
  SPEAKER_00: Let's say we start the day and the workout with a full battery, it will eventually run out and we need to recover, aka recharge the battery.
• 19:46
  SPEAKER_00: In order to give our next lift our best, think about if you just keep doing stuff each and every single day, right?
• 19:55
  SPEAKER_00: You keep emptying, emptying the battery and you don't give it enough time to recharge.
• 20:00
  SPEAKER_00: You don't give it enough time to be able to recover and eventually going into each day with a half full battery, or even sometimes it's feeling depleted.
• 20:09
  SPEAKER_00: And while that can be layered into bigger topics of nutrition, stress, sleep, just overall recovery.
• 20:17
  SPEAKER_00: Those obviously all play into this, but we're talking about rehab specifically.
• 20:21
  SPEAKER_00: If we're just going hard every single day, that battery is going to keep getting drained and we're not going to be able to allow it to fully recharge and recover.
• 20:29
  SPEAKER_00: The other analogy I want to share here is just thinking about training in rehab sessions as digging a hole.
• 20:35
  SPEAKER_00: When you're working on your quad and your knee, especially through a true strength and conditioning session where you're really pushing weight, you're digging a hole.
• 20:44
  SPEAKER_00: You're stressing that knee, you're stressing your body, and that hole is being dug, right?
• 20:47
  SPEAKER_00: You're just digging, pulling out dirt.
• 20:50
  SPEAKER_00: When you recover, it's like you're allowing yourself to fill that hole back up with the dirt, right?
• 20:56
  SPEAKER_00: You're trying to get it back to where it was.
• 20:58
  SPEAKER_00: And side note, this is actually where the adaptations and the muscle strength and growth actually happen, is not when you're actually working them out, it's actually when you allow it to recover, which often gets missed.
• 21:11
  SPEAKER_00: If you don't allow yourself to recover, then it's like you put some dirt back in the hole, but then you just dig a deeper hole.
• 21:20
  SPEAKER_00: And if you repeat it, it's less dirt in, more dirt out, leading to a deeper and deeper hole.
• 21:27
  SPEAKER_00: So, what's my point here?
• 21:29
  SPEAKER_00: We need to avoid junk volume in rehab and really want to make sure we train and rehab with purpose.
• 21:37
  SPEAKER_00: That is going to be really, really key here.
• 21:39
  SPEAKER_00: And that's where the programming and structure is going to be so key in this as well.
• 21:43
  SPEAKER_00: And so, this is where rehab and SNC principles, strength and conditioning principles really do come into play.
• 21:50
  SPEAKER_00: But first, I want to provide some understanding around what I mean by volume, so then that way we can kind of lay the foundation a little bit more as we go into some of these topics.
• 22:01
  SPEAKER_00: So, some common methods of measuring training volume, including counting the number of sets to failure, the volume load, it could be sets times reps times weight, distance, number of sprints, etc.
• 22:14
  SPEAKER_00: Right?
• 22:15
  SPEAKER_00: There are different ways to calculate volume.
• 22:18
  SPEAKER_00: And I am not too crazy about needing to calculate every single thing to a T.
• 22:24
  SPEAKER_00: But of course, if we have these measurable numbers, and that's great to track over weeks and over time, just to see if there's any big jumps, even something as simple as like step count, right?
• 22:36
  SPEAKER_00: Like, does that really spike up and jump?
• 22:38
  SPEAKER_00: Those are going to be things that we want to factor in, right?
• 22:41
  SPEAKER_00: But with that said, volume could be this kind of catch-all term.
• 22:45
  SPEAKER_00: So I want to break this terminology down a little bit from a training standpoint.
• 22:50
  SPEAKER_00: So there's something called maintenance volume, which is how much volume you need to maintain your gains.
• 22:56
  SPEAKER_00: There's something called minimum effective dose, MED.
• 23:01
  SPEAKER_00: That is the smallest amount of stimulus needed to drive positive adaptations.
• 23:06
  SPEAKER_00: If we are below this, then there will be no adaptations.
• 23:10
  SPEAKER_00: Basically, you're just doing easy stuff.
• 23:12
  SPEAKER_00: You will not have any positive adaptations from it.
• 23:15
  SPEAKER_00: So minimum effective dose is the minimum needed dosage to be able to make some sort of positive adaptation.
• 23:23
  SPEAKER_00: Maximum adaptive volume.
• 23:26
  SPEAKER_00: This is where we are training at our optimal range of volume that we can adapt to and recover appropriately to drive quote unquote optimal performance.
• 23:35
  SPEAKER_00: Now, this is a moving target, y'all.
• 23:37
  SPEAKER_00: And so this is something that will vary based on a number of factors in terms of just your nutrition, recovery, uh, what the focus is.
• 23:45
  SPEAKER_00: I would say this is also a little bit more applicable to someone who has been training versus someone who's going through something like a rehab process.
• 23:54
  SPEAKER_00: And then the last point that I want to bring up or the term is maximum recoverable volume.
• 24:00
  SPEAKER_00: This is the absolute maximum volume that your body can hinge.
• 24:04
  SPEAKER_00: Handle and recover from.
• 24:06
  SPEAKER_00: Sometimes it's necessary to pass this threshold from time to time.
• 24:09
  SPEAKER_00: Sometimes it's called overreaching in more strength and conditioning terminology.
• 24:14
  SPEAKER_00: But this allows us to elicit greater adaptations.
• 24:17
  SPEAKER_00: But the important point with this is to make sure it is not often, and usually with stuff like this, there are quote unquote deloads that allow for that higher accumulation of volume and then allow for that supercompensation, which is where basically you work, work, work, um, and then there's that point of overreaching where you really stress your body to get the training effect you want, and then you supercompensate.
• 24:44
  SPEAKER_00: So basically, this is for us to get that adaptation based on the strain we have put on our body, right?
• 24:51
  SPEAKER_00: But when it's not monitored well or we're constantly overreached without recovering well, you do open the door for a potential injury or for some things to start bugging out.
• 25:04
  SPEAKER_00: And so while I would say in most situations, max recoverable volume is not something that we are striving for in majority of ACL rehab.
• 25:15
  SPEAKER_00: While we are pushing some thresholds, it is just a little different with ACL rehab because in this space with the rehab process, most of our training lives with minimal effective dose.
• 25:29
  SPEAKER_00: And I would say this is where most people probably live.
• 25:33
  SPEAKER_00: Not a lot of people, unless you are so to a T doing max recoverable volume and hitting that upper threshold consistently, unless you are like an Olympian, you are someone who is so strategically focused on like very high-level competitive events, and it's going to be something where you are also having like such a rigid strength and conditioning program with a coach who is dialing this in day after day, week after week, very specifically, right?
• 26:01
  SPEAKER_00: And we're assuming this without there being as much of an injury to deal with.
• 26:08
  SPEAKER_00: So ACL rehab and most training lives in the minimum effective dose.
• 26:13
  SPEAKER_00: What is the minimum necessary to move the needle?
• 26:16
  SPEAKER_00: And especially when we are dealing with much more limited bandwidth for the knee, more volatility, and also sensitivity, given it is a joint recovering from a major surgery, versus someone, like I said, who is just training to increase their performance, uh, whether that be like a bench press or they're running a half marathon or some sort of other competitive endeavor, right?
• 26:41
  SPEAKER_00: So it's gonna be a little different in terms of the way that you we are progressing in rehab, especially, versus fully someone who is uninjured and fully performance-based, right?
• 26:52
  SPEAKER_00: This all comes back to just being load management.
• 26:56
  SPEAKER_00: And it's even more highly sensitive for ACL rehab, as I'm sure you guys have taken away from this episode at this point, which means we have to be more strategic and much more surgical in the approach of what we do.
• 27:11
  SPEAKER_00: There are basically two things we're looking for: maximize the positive effects and minimize the negative effects, right?
• 27:18
  SPEAKER_00: And that is going to be something we need to make sure we understand how to do practically.
• 27:23
  SPEAKER_00: So let's dive into that.
• 27:24
  SPEAKER_00: Number one, you've heard me talk about a high-low approach.
• 27:27
  SPEAKER_00: I've done an episode exactly on this, so go catch that if you haven't caught it.
• 27:31
  SPEAKER_00: This is a concept originated by Charlie Francis in sprint training, and essentially it's been adapted into the strength and conditioning rehab realm.
• 27:40
  SPEAKER_00: But the concept is you have high stress days and low stress days.
• 27:44
  SPEAKER_00: High means it's just like high demand on your central nervous system, on your body.
• 27:49
  SPEAKER_00: It's typically like heavier lifts, power-based workouts, you know, a lot of the dynamic stuff you might do on a field that has high effort outputs, those are high days.
• 27:59
  SPEAKER_00: So usually your gym focused days are going to be high days.
• 28:04
  SPEAKER_00: And then you have low days.
• 28:06
  SPEAKER_00: These are more recovery-based days.
• 28:07
  SPEAKER_00: It might be mobility focused, you might be doing isometrics, you might even be doing some steady stay aerobic work or control work.
• 28:15
  SPEAKER_00: It's stuff that if you really needed to do every day, you could do every day because the intensity is so low that it's not really going to do too much on your body, right?
• 28:26
  SPEAKER_00: And so that's where high low comes from is balancing these things.
• 28:31
  SPEAKER_00: And so one thing that happens is that ACLers tend to live in that medium or moderate zone.
• 28:37
  SPEAKER_00: So then therefore they're doing too much every single day, and then therefore they don't allow themselves to recover.
• 28:43
  SPEAKER_00: And then they also don't allow themselves to have really, really high output days.
• 28:47
  SPEAKER_00: And some of this might come down to not being pushed with their provider.
• 28:52
  SPEAKER_00: But it's also something that I think just by nature of if things are spread across day to day today, you're just gonna kind of hit it at a moderate intensity.
• 29:03
  SPEAKER_00: Just because also hitting higher intensity, most people are just not as comfortable doing it because it requires more and it demands more.
• 29:10
  SPEAKER_00: But this is truly where the value of adaptation is sit.
• 29:14
  SPEAKER_00: And so if you're always in this moderate range, you're not doing enough to be able to truly get the adaptations you want, and then you're almost doing too much to where you don't really recover either.
• 29:27
  SPEAKER_00: So high low day, you can always think as alternating of like high, low, high, low.
• 29:32
  SPEAKER_00: And that allows for this undulating pattern.
• 29:35
  SPEAKER_00: But of course, like there are always strategies around this, given there are seven days in the week.
• 29:40
  SPEAKER_00: So we can structure this a number of different ways.
• 29:42
  SPEAKER_00: But with that said, the general principle stays the same.
• 29:45
  SPEAKER_00: We don't want a bunch of high, high, high days back to back because then therefore you don't give yourself enough time to recover, right?
• 29:53
  SPEAKER_00: Undercook versus overcook.
• 29:54
  SPEAKER_00: I did something on this recently, but I'm such a big fan of undercooking as we start.
• 29:59
  SPEAKER_00: I think that is so valuable in this ACLRIA process because it allows us to create a safe entry point into movement and into training, especially if they're new.
• 30:09
  SPEAKER_00: And we can always observe the dose response to it and then add more versus having to take things away and being reactive when the knee flares up, or it's just too much to accomplish.
• 30:21
  SPEAKER_00: The next point I want to bring up is about strength and hypertrophy principles.
• 30:25
  SPEAKER_00: So for hypertrophy, there is plenty of research at this point.
• 30:28
  SPEAKER_00: Brad Schoenfield leads the field in hypertrophy.
• 30:31
  SPEAKER_00: So if you want to learn anything hypertrophy-wise, the man has really done a lot of research on this stuff and with a lot of smart people.
• 30:39
  SPEAKER_00: But basically, he's shown that you know, if you hit 10 hard sets per muscle group per week, usually that is like the minimum effective dose for maximizing growth.
• 30:51
  SPEAKER_00: So hard sets meaning it could be within one to three reps of failure.
• 30:55
  SPEAKER_00: And that's probably the biggest thing that I see people struggle with is that they don't truly get themselves close to failure.
• 31:03
  SPEAKER_00: Now, if you have a very painful, swollen, sensitive knee, you don't need to be pushing these rep ranges as much.
• 31:11
  SPEAKER_00: But as soon as it's calmed down and you have the ability to do that, then that is something we want to work towards.
• 31:16
  SPEAKER_00: And our athletes work towards that in this process.
• 31:19
  SPEAKER_00: And I think that's very important to be able to do because otherwise you are just kind of doing junk volume again.
• 31:25
  SPEAKER_00: You feel like you are essentially doing work, but you're kind of like in a rocking horse.
• 31:30
  SPEAKER_00: You're not necessarily moving, but you're just kind of rocking.
• 31:34
  SPEAKER_00: You're move, there's movement, but there's no progress, right?
• 31:37
  SPEAKER_00: So this is something that I think is very important with the hypertrophy research because we want to make sure this muscle can gain some size here.
• 31:44
  SPEAKER_00: And so uh sometimes people are like, oh, well, I'll do a ton of different exercises, but they've also shown that basically once you hit 20 sets per week, there's diminishing returns.
• 31:53
  SPEAKER_00: And so then that leads to also potentially overtraining and then less recovery.
• 31:58
  SPEAKER_00: And so that becomes an issue in and of itself.
• 32:01
  SPEAKER_00: But when we're talking about minimum effective dose, if you can hit 10 hard sets per muscle group per week and you hit that close to failure, you're gonna be in such a good spot to see the muscle grow and to recover well as well.
• 32:14
  SPEAKER_00: You don't need a ton of work to be able to get there.
• 32:18
  SPEAKER_00: Now, people are on a spectrum, but the research is very, very clear on this.
• 32:23
  SPEAKER_00: And while there are more ideal hypertrophy ranges, um, yes, you could say like anywhere from like six to twelve, for example, you'll see different ranges for repetitions.
• 32:35
  SPEAKER_00: With that said, they've also shown that you can get hypertrophy with different ranges.
• 32:40
  SPEAKER_00: It could be three or five, it could be 10 reps, it could be 20 reps.
• 32:44
  SPEAKER_00: There still tends to be a sweet spot in that middle, I would say, but the most important thing is proximity to failure.
• 32:51
  SPEAKER_00: The other piece that I also want to share here that has been researched pretty heavily is being able from a strength standpoint to hit three to five sets per lift, two to three times per week.
• 33:02
  SPEAKER_00: Um, and of course, the lift can kind of vary here, but the intensity is what's gonna be really important, especially with a strength standpoint.
• 33:09
  SPEAKER_00: When you're talking about true specific peak strength that you're trying force output that you're trying to improve, you're likely doing less volume and higher intensity.
• 33:18
  SPEAKER_00: So we're putting more weight and we're decreasing the reps.
• 33:21
  SPEAKER_00: And so that's gonna be something that is going to be very much driven by the intensity and specificity versus just pure volume of doing exercise for a certain muscle group, right?
• 33:33
  SPEAKER_00: And so that's gonna be specific for strength.
• 33:36
  SPEAKER_00: So the main concept around this is it's not about how many exercises or sets, it's about how many effective near failure sets per muscle group you're accumulating weekly.
• 33:48
  SPEAKER_00: Let me repeat that again.
• 33:49
  SPEAKER_00: It's not about how many exercises or sets, it's about how many effective near failure sets per muscle group you're accumulating weekly.
• 34:00
  SPEAKER_00: The next point I want to share is the 80-20 principle.
• 34:03
  SPEAKER_00: This is something that we do as a just a pure audit that I would encourage you to do.
• 34:08
  SPEAKER_00: Um, if you're an ACL or if you're a clinician or coach listening, we make all of our mentees go through this process, but it's the 80-20 principle where you essentially look at your program and you cut out 80% of it and you keep 20%.
• 34:23
  SPEAKER_00: What is that 20% that you're gonna keep there?
• 34:26
  SPEAKER_00: And that is gonna be important from an auditing standpoint because then it's going to help you cut through a lot of that junk volume and be able to be like, okay, well, these are my main movements, and then you need to be able to answer why.
• 34:37
  SPEAKER_00: You need to be like, okay, well, right now I have a deficit in extension, so I'm doing this particular knee extension movement to help get that hyperextension.
• 34:46
  SPEAKER_00: You might be like, okay, well, I'm having my donor side as a limiter, rate limiter for me.
• 34:53
  SPEAKER_00: So therefore, I'm doing some specific isometrics to help that area be able to improve from a sensitivity standpoint and tolerance.
• 35:01
  SPEAKER_00: And then it might be quad strength.
• 35:02
  SPEAKER_00: So then, therefore, you might have one to two particular movements that you're really pushing hard on a particular training day that you are trying to really move the needle with.
• 35:11
  SPEAKER_00: And that's your 80-20 right there.
• 35:13
  SPEAKER_00: The rest of that stuff's probably junk.
• 35:15
  SPEAKER_00: So then, therefore, if you walk into the gym and only have 10 minutes to do something, there you go.
• 35:19
  SPEAKER_00: That allows you to understand what are our priorities and goals we're working towards, and also what movements are gonna help facilitate that adaptation.
• 35:28
  SPEAKER_00: The last point I'm gonna bring up is less is more or the addition by subtraction principle.
• 35:34
  SPEAKER_00: To me, these kind of look the same, but basically you're trying to get more out of doing less or addition by subtraction.
• 35:41
  SPEAKER_00: So you're cutting something away and you're actually adding to what you're doing.
• 35:45
  SPEAKER_00: So think about reducing it down to three to five key movements and hitting those super hard versus 10 at a moderate intensity.
• 35:56
  SPEAKER_00: Think about doing that.
• 35:58
  SPEAKER_00: You're like, oh wow, okay, there's like a breath of fresh air because you actually are doing less.
• 36:02
  SPEAKER_00: You don't have to go through 10 different movements, and you're also putting so much intent behind those three to five movements versus all 10 of those movements at moderate intensity.
• 36:12
  SPEAKER_00: You'll have better mentality around this going into the gym and knocking that out, knowing you have five things versus 10 things to do.
• 36:20
  SPEAKER_00: And with that, you'll cut the 10 things short if you do the 10 things, because it's 10 things.
• 36:26
  SPEAKER_00: So then that is just going to be something that you're like, well, I need to get through all this, so let me get through all of it.
• 36:32
  SPEAKER_00: So this is really, in my opinion, just not great programming in most cases, especially if the goal is power, strength, or hypertrophy, right?
• 36:40
  SPEAKER_00: We need to reduce this down to get more out of it.
• 36:44
  SPEAKER_00: And so people think that more is better, but it's not always the case.
• 36:48
  SPEAKER_00: And I've seen so many ACLers move the needle with doing a lot less.
• 36:53
  SPEAKER_00: We've had people who have been in phases where they could only do two days a week, and they really go hard on those two days a week with what we have set, and they move the needle.
• 37:04
  SPEAKER_00: And we've seen people who have gone six to seven days a week and have been stuck for months and months.
• 37:10
  SPEAKER_00: And so this is something that you would never expect, and they also are very much like, there's no way I feel like I'm not doing a lot.
• 37:17
  SPEAKER_00: And then we retest and we look at things and they've improved.
• 37:21
  SPEAKER_00: How is that the case?
• 37:23
  SPEAKER_00: It's because we're sticking to scientific research, we're sticking to principles of rehab and strength and conditioning, and that is so key in this process.
• 37:32
  SPEAKER_00: Last additional point I'm gonna add here.
• 37:34
  SPEAKER_00: I know this episode is so long, but stick with me here because I promise you, a lot of you probably listening are like, this is me.
• 37:42
  SPEAKER_00: This is it.
• 37:43
  SPEAKER_00: This is a lot of what is going on, and I feel this, but I want to share this one last point.
• 37:49
  SPEAKER_00: People want to constantly change exercises, and I think that's just the nature of human beings.
• 37:55
  SPEAKER_00: You want novelty, especially with the way that workout classes are, especially boot camp style classes, it's always a new workout, different workouts, and there's no harm in that, don't get me wrong.
• 38:07
  SPEAKER_00: It just depends on what you like, what you like for movement, and what you want.
• 38:12
  SPEAKER_00: But with that said, at some time points, yes, this can be done in the ACL rehab process.
• 38:19
  SPEAKER_00: But any good ACL and strength and conditioning block is going to have at least three to six weeks worth of a specific set targets, but then also certain movements.
• 38:33
  SPEAKER_00: So we're not gonna change up the program every single week.
• 38:37
  SPEAKER_00: And we're not gonna change that up just for the sake of changing, especially if someone is making progress week to week.
• 38:43
  SPEAKER_00: We change because the goals may have changed based on testing, maybe, maybe something's come up in their lives.
• 38:50
  SPEAKER_00: Or sure, yeah, there are times where it's monotony.
• 38:53
  SPEAKER_00: You don't want to do the same thing for 12 to 16 weeks, right?
• 38:57
  SPEAKER_00: That's just not, you're gonna get bored.
• 39:00
  SPEAKER_00: But with that said, when we think about true physiological adaptations, usually we're looking at six-ish weeks.
• 39:09
  SPEAKER_00: It could be four weeks, let's just say from the four to eight week window.
• 39:12
  SPEAKER_00: When we're like, okay, if we're doing said movements, where does the adaptation start to occur?
• 39:17
  SPEAKER_00: And we start to see those adaptations start to occur after the four-week window, up until like the six-week window and beyond.
• 39:24
  SPEAKER_00: It just depends on what you're working on.
• 39:27
  SPEAKER_00: But with that said, that is just basic human physiology from a training standpoint.
• 39:33
  SPEAKER_00: And if you change it each week, you won't know if you're really improving, especially for heavy strength lifts.
• 39:42
  SPEAKER_00: So that's why we typically work in four to six week blocks, still progressing things like the movement variations.
• 39:48
  SPEAKER_00: You might have something that challenges it a little bit more, like let's say you're doing a drop jump, and then next you're gonna do a single leg drop jump.
• 39:55
  SPEAKER_00: Yeah, but if you're doing a certain squat variation or split squat variation, we may make it harder by different ways of increasing the variation of it, the sets, reps, intensity, the velocity, or the speed of it.
• 40:09
  SPEAKER_00: But that's just a side note here, as I think it's important to mention.
• 40:13
  SPEAKER_00: Um, I'm sure I'll do an episode on this at some point.
• 40:16
  SPEAKER_00: But this is something that I think is super key and can be super helpful in this process because a lot of times people want things to change very, very regularly, maybe once a week or every two weeks.
• 40:29
  SPEAKER_00: And the thing is with ACL, especially when you truly get into like the gym training, we don't want to change too much too often because then that's going to create a lot of moving pieces, which makes it harder to track progress.
• 40:45
  SPEAKER_00: But then also if something flares up, for example, if you're constantly changing the variables, you're also not going to know what flared it up, right?
• 40:54
  SPEAKER_00: If I have the same program from week three to week four, and all I've done is maybe improved the or increased the RPE or the intensity of it, or maybe added like a few reps to it or one more set, it's very unlikely the knee is going to respond negatively to that because it's such a small increase, but we're still getting an output from it.
• 41:15
  SPEAKER_00: So then if the person goes and their knee flares up, we can track and be like, oh, maybe this was because you went and walked 10,000 steps and you've only walked up until 4,000 steps the week before, right?
• 41:28
  SPEAKER_00: So we can start tracking these things and be able to be a bit more detective-like, but then also keep the ship moving along in the right direction.
• 41:37
  SPEAKER_00: So, in summary, this has been way too long of an episode on this.
• 41:41
  SPEAKER_00: I'm so sorry.
• 41:42
  SPEAKER_00: I did not expect it to go this long, but you know what?
• 41:46
  SPEAKER_00: I just wanted to talk about this principle.
• 41:49
  SPEAKER_00: I see it so much with in the ACL space and something I am not going to say I've never been guilty for, but at the same time, once you learn, you make updates and you change.
• 42:00
  SPEAKER_00: And so we always make sure to find the sweet spot for our ACLers of what we're looking for, adaptation-wise, time-wise, and making sure they're not doing a bunch of junk volume.
• 42:11
  SPEAKER_00: And so that's the summary.
• 42:14
  SPEAKER_00: I look at junk volume as someone having the emergency brake on while you are driving.
• 42:20
  SPEAKER_00: It's just slowing down your progress, slowing down you on this journey.
• 42:24
  SPEAKER_00: I'd rather you have do three exercises really, really well with high intention output and intensity than 10 exercises moderately well.
• 42:34
  SPEAKER_00: We want to eliminate the junk volume by anchoring two principles.
• 42:38
  SPEAKER_00: I promise, as much as you think you can outsmart it, you will not.
• 42:42
  SPEAKER_00: It's the reason why these principles have stood the test of time.
• 42:46
  SPEAKER_00: We cannot outsmart the human body, unfortunately.
• 42:50
  SPEAKER_00: And this is where I think having an audit of your ACL program, the structure and the movements, the reps and sets, intensity, all that matters so much within each phase of this process.
• 43:01
  SPEAKER_00: Auditing it just to make sure is this meeting what I need from a minimum effective dose standpoint, or am I going to, you know, the max unrecoverable volume where you're just like hitting such an end where you're like, this is not even allowing me to progress.
• 43:19
  SPEAKER_00: And so that's something that I think is important to audit as time goes on in ACL rehab.
• 43:24
  SPEAKER_00: So I hope that this was helpful, y'all.
• 43:26
  SPEAKER_00: Get rid of your junk volume, be more strategic.
• 43:30
  SPEAKER_00: And I would almost encourage you that if you're working on exercises, if you try to do five of them really well with high intention, proximity to failure, getting closer to failure and fatiguing that muscle and that movement, versus doing 10 where you just do a bunch of reps and then you're like, all right, cool, I'm done.
• 43:50
  SPEAKER_00: You're kind of checking the box.
• 43:52
  SPEAKER_00: And in reality, exercises are just a vehicle for adaptations.
• 43:57
  SPEAKER_00: There's no perfect exercise.
• 43:58
  SPEAKER_00: There's not one bulletproof exercise, although knee extension is probably close to it.
• 44:03
  SPEAKER_00: But with that said, exercises, the rep sets, tempos, it's all just a proxy of putting stress on your body.
• 44:11
  SPEAKER_00: That it's just been built into a system of exercise prescription where you do sets, tempo, reps, certain intensities, and hoping for a specific output, right?
• 44:21
  SPEAKER_00: But at the end of the day, your body doesn't know any different, whether it is a split squat or a squat.
• 44:26
  SPEAKER_00: It just knows that it is doing this movement.
• 44:28
  SPEAKER_00: So then, therefore, we need to lean into this stuff and do the movements well, do them very intentionally at high outputs when it's needed, and also make sure we're not doing too much, also not too little, right?
• 44:41
  SPEAKER_00: But especially not too much, where it is very much limiting your ability to recover and also be able to progress forward.
• 44:50
  SPEAKER_00: So I hope that this is helpful, y'all.
• 44:52
  SPEAKER_00: If you have any questions about this, if you feel like you're a junk volumer and you're worried about it, send us a message.
• 44:59
  SPEAKER_00: I audit people's programs, I give feedback for that stuff.
• 45:02
  SPEAKER_00: So I'm happy to take a look.
• 45:04
  SPEAKER_00: Our team is happy to take a look.
• 45:06
  SPEAKER_00: So you can reach out via email, via Instagram, wherever that might be.
• 45:11
  SPEAKER_00: But other than that, I will catch you guys next week.
• 45:14
  SPEAKER_00: This is your host, Robbie Patel, signing off.