High Repetition, Low Intensity Interventions

The other day my boss and I were discussing the usage of aerobic machines (total gym, bike, UBE) in our treatment sessions. Prior to attending the Harris Health Residency and my manual therapy fellowship, I viewed these machines as “fillers” in patient care. The machines were an easy place to stick a patient when I was busy. Ironically, after going through these advanced training courses, I use these machines more than ever BUT for different reasons.

Collagen is the principle component of most connective tissue (ligaments, tendons, fascia, joint capsules). After an injury, the normal collagen matrix is disrupted. Evidence shows that this collagen is remodeled by continuous motion, blood supply and oxygen, vitamin C, and protein intake. For example, the inner 2/3’s of the meniscus has poor blood supply. To heal a meniscal lesion, those collagen fibers need 1000’s of repetitions. The leg bike or total gym (on a low level) are the best ways to target those fibers. The same principle applies to the glenoid labrum and the upper extremity ergometer. These tissues needed to be trained at ~15% of 1 RM to allow for proper fluid exchange and healing to occur. 

Sometimes the warm-up seems meaningless for our patients, but with the proper education and instruction, we can teach them the importance of these long duration interventions. 

-Jim 

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