Using HSR + Reconditioning for full outcomes
Aug 22, 2022
Tendon pain is one of my favorite things to manage remotely. Why? Because there’s not much you can truly do to make changes to the cellular structure of the tendon besides load it. That means, it can be managed purely with a Prescriptive Exercise Program.
About 5 years ago, I had a client who I worked with in a purely remote fashion. He had anterior knee pain for about 2 years at this point and was convinced that he would never squat, run, or jump again. After hearing the story of how he got to this point (running multiple 20 rep squat cycles) - not to judge or discourage, just to provide some perspective - we outlined the plan.
Me: “Alright… I am going to have you lunge twice per week and squat once. We are going to use a lot of tempo work and train at an RPE of 8/10… meaning it’s going to be HEAVY”
Him: “But I haven’t squatted in YEARS”
Me: “I know, and that’s part of the problem. We need to make the parameters ideal for you to get that tendon back in prime shape”
Him: “I trust you and I’m all in”
Now the fun starts.
If you’ve followed me for a while, you have probably heard me reference the Heavy Slow Resistance (HSR) Protocol from the research group Beyer, et al. If you’re new to this concept, let me quickly outline it: for degenerative tendon issues (chronic), mechanical load is necessary! The HSR protocol is a 12-week cycle with a loading frequency of 3x per week (hence the 2 days of lunging and 1 day of squatting), combined with some nasty tempo work of 3 seconds up/down, and an ideal RPE of 8/10 (unless pain goes above 5/10, then we decrease the load). It’s important to control other variables along the way such as depth and potential aggravating factors (cyclic loading - running, jumping, fast body weight movements).
After about 4 weeks of using the protocol, my client was amazing.
“My knees aren’t hurting”
But the job was only 1/4th of the way done. I say 1/4th because even though we still have 8 weeks left of the HSR work, we still must recondition the tissues - aka “Return to Sport”.
At about 8 weeks into the HSR cycle, we started to layer in cyclic loading drills - think light plyometrics such as wall running drills, jumping to a small box - which then progressed to jogging… running... sprinting… rebounding box jumps…performing CrossFit workouts again… hitting Olympic lift PRs… It was amazing to see.
The total timeline for this client to hit these goals was about 10 months total. This is important to understand because often our clients think the job is done when the symptoms are gone! The job is done when we have reconditioned the tissues to have a protective workload against the weekly and daily stress (7-day average) we are putting them through!
This is why I consistently mention pitching the entire journey to your client which in turn increases the lifetime value (LTV) while also getting a complete outcome!
If you are working with performance or athletic populations, having a remote management process installed guarantees this! Think of it like this:
Symptom resolution (maybe in person, maybe remote) > Training Reintegration (remote) > Reconditioning (remote) > Maintenance (remote)
Look at how much of that journey can take place external to your facility and without your presence, but still with access to all your knowledge!
If you’re ready to break free from the traditional brick and mortar model, we should chat.
Interested in learning how to apply this to your clients?
