Periodization Concepts for the Orthopedic Patient

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
 How to progress a resistance training program
based on client goals and previous training
Strength / fitness:
 Has different meaning
for different people
depending on:
ADL’s and IADL’s
Severity and type of injury
Healing capacity
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)
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
For intermediate to advanced training, it is
recommended that individuals use a wider
loading range, from 1–12 RM in a periodized
For loading, it is recommended that loads
corresponding to 1–12 RM be used in
periodized fashion…
Why periodize your
training programs?
 Prevent overtraining
 Decrease the onset of
 Promote the development
of specific physical
performance parameters
 Allows for “peaking” of key
performance variables that
are specific to an
individuals function
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
Physiological basis for periodization
 Based on the concepts of:
▪ Endocrinology
▪ Biomechanics
▪ Neurology
▪ Muscle physiology
▪ Metabolism
Types of Muscle Fibers:
Fast & Slow Twitch Fibers:
Not really just two types but a continuum between the
Both are present in varying mixture in most muscles.
Classically divided into:
Type I
Type IIA
Type IIB
Types of Muscle
Type I: Characteristics
Slow acting myosin isoform
Contract more slowly with less
Rely primarily on oxidative
Many mitochondria
Highly vascularized
Contain little glycogen
Small diameter
Resistant to fatigue
Type IIA:
Fast acting myosin isoform
Contract rapidly with greater
Have high oxidative capacity
Highly vascularized
Many mitochondria
Have myoglobin
Intermediate amounts of
glycogen and anaerobic
Intermediate size
Not very common in most
people : Class switching
Type IIB:
Fast acting myosin isoform
Contract rapidly with
greater force
 Rely on anaerobic
 Few mitochondria
 Less well vascularized
 Lack myoglobin
 High glycogen content
 Large diameter
IIb IIab IIa IIac IIc
Strength training
converts the IIb mm
fibers to the more
oxidative IIa mm fiber
type by as much as
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.
 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
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
Hans Selye: Canadian
described the
physiological basis of
why periodization is
effective based on
three stages General
Adaptation Syndrome:
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
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
Peripheral fatigue:
 Present at the motor
neuron, NMJ or mm
 Occurs with more high
intensity, short duration
 Glycolytic metabolism
produces fatigue due to:
▪ Increase metabolites such
as lactate, H+, AMP,
▪ Decrease substrates such
as creatine, ATP and
Because of the varying nature of intensity
and volume, periodization allows for reduced
tendency towards fatigue by both
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
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
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
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
Stages of periodization
 Preparation
▪ Muscle endurance
▪ Hypertrophy
 Transition period 1
▪ Basic Strength
▪ Power
 Competition (Peaking period)
 Transition period 2 (Active Rest)
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
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
Increased Type II A activation
Conversion shift from Type IIB to
Type II A
Increased reliance on glycolytic
Increased lactic acid production
Improved buffering of lactic acid
via production of lactate
Increase myofilament
Increase satellite cell
proliferation / mitosis
Strength gains are due to
increased CSA
Takes 8 – 12 weeks to occur
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
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
 Muscle fiber emphasis are IIB fibers
 Anaerobic glycolysis to creatine phosphokinase
 Primary response to training is enhanced neuromuscular
Strength training can have a profound effect on
the hormonal, nervous, and immune systems
Hormonal adaptations
 What type of strength program increases
Large mm group exercises
Heavy loads > 85% 1RM
Moderate to high volume: multiple sets and / or exercises
Short rest 30 – 60 seconds
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 cortisol production
excessive production can result in mm catabolism,
and adverse immune responses
What kind of training program increases Growth
high volume (10RM) for multiple sets (3) with short
rest periods (1 minute) that promotes mm
soreness (lactic acid)
Closed chain
movements done first:
Compound Strength
 Neuromuscular / balance
 Bench press
 Power
 Military press
 Strength exercises
 Rows
 Open chain exercises
 Lat pulldown
 Endurance activities
 Squat
 Lunges
 Deadlift
Increased recruitment
of Type IIB muscle
 Improved mm
recruitment via
myotatic stretch reflex
 Improved mm
recruitment via length
– tension relationship
 Motor learning effects
Power exercises
 Powerclean:
 Push press:
Transition Period:
 Volume is decreased dramatically while intensity
 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)
Transition Period:
 Creatine phosphokinase
metabolism is primary
 Goal is to increase
components of strength
and power
▪ Increase recruitment of
larger motor units
▪ Increase motor unit firing
▪ Increase motor unit
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
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
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
1-2 week
3-4 week
5-7 week
1-4 reps
1-2 sets
4-8 reps
3-4 sets
4-6 sets
5-7 sets
Depends on the
training intensity /
 Previous exercise
status of the patient
 Other physical
 Job
 Sport
 Recreational pursuits
Beginner: (< 2 months of strength training): 2
times per week
Intermediate: (2 to 6 months): 3 – 4 times per
Advanced: (> 1 year): 4 - 6 times per week
Candow, D.G., and D.G. Burke.
Effect of short-term equal-volume resistance training with
different workout frequency on muscle mass and strength
in untrained men and women. J. Strength Cond. Res. 21(1)
RCT of 29 untrained volunteers (27–58 years; 23 W, 6 M )
 group 1: 2X /wk @ 3 sets of 10 RM for 9 ex
 group 2: 3X/Wk @ 2 sets of 10 RM for 9 ex
Outcome measures:
 lean mass whole body DEXA
 strength (1 rep max squat and bench press)
Both groups increased lean tissue mass (2.2%), squat
strength (28%), and bench press strength (22–30%) with
training (p 0.05), with no other differences.
Classic strength/power periodized training superior
for increasing:
maximal strength (e.g., 1 RM squat)
cycling power
motor performance
jumping ability.
Short term training has shown similar performance
improvements between periodized and multiple-set
nonperiodized models
 Periodic variation in training variables is necessary for
long term resistance training.
 ACSM Position Stand : Progression Models in
Resistance Training for Healthy Adults - 2002
Vary the intensity and volume within the
Daily Undulating Periodization
 Vary volume and intensity each workout day
 Example:
▪ Monday: Heavy: 85-90% 1RM
▪ Wednesday: Medium: 70-75% 1RM
▪ Friday: Light: 60-65% 1RM
Weekly Undulating Periodization
 Vary volume and intensity each workout week
 Example:
▪ Week 1: Heavy: 85-90% 1RM
▪ Week 2: Medium: 70-75% 1RM
▪ Week 3: Light: 60-65% 1RM
Patient / Task
% of maximum
power to
Time to complete the
Energy System
63 y/o sedentary
female with hx of
diabetes who has a
BMI of 40 who has
difficulty with sit to
7 seconds
37 y/o fireman with 80%
a one year hx of a
quadricep tendon
repair c/o weakness
in the quads after
climbing 3 flights of
25 seconds
16 y/o male with
BMI of 38, 40% BF
desires a program
Patient / Task
% of maximum
Time to complete
power to complete the task
Energy System
14 year old female 70%
800m runner c/o
right hip abductor
weakness with a
3month hx of left
LBP and changes in
her running gait at
the last 100m of
the race
2min and 20 sec
50 year old male
long distance
cyclist with c/o
muscular fatigue in
his lumbar
paraspinals while
15 minutes
Thank You!