October 6, 2024 • 24 mins
Can muscle growth be the missing link in your rehabilitation journey? Discover how focusing on hypertrophy can revolutionize your recovery process on this episode of the Hercules Performance and Physical Therapy Podcast. Join Dr. Alec, as he unveils the often-overlooked power of muscle growth in physical therapy. Learn why building muscle mass is not just for athletes but essential for anyone recovering from injury or surgery. Through the lens of ACL recovery, we illustrate how early muscle regrowth is crucial for joint stabilization, pain protection, and accelerated return to normal activities.
We dive deep into the science of hypertrophy, shedding light on innovative techniques like blood flow restriction training that can stimulate muscle growth without overburdening injured areas. Understand the pivotal role of nutrition, particularly protein intake, in muscle repair and growth. Beyond rehabilitation, we explore how maintaining muscle mass benefits long-term health, from regulating blood sugar to combating age-related muscle loss. This episode is packed with vital insights and practical advice aimed at educating patients on why strength building is key to effective rehabilitation. Reach out with your questions and let us support you in transforming your rehab journey through the power of hypertrophy.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr Alec (00:01):
What's up everyone?
Welcome back to the HerculesPerformance and Physical Therapy
Podcast.
I'm your host, dr Alec, andtoday we're talking about a
topic that's a total gamechanger when it comes to rehab.
It's also one of my favoritetopics to chat about.
It's hypertrophy, it's musclegrowth, and it's why it's
crucial for anyone recoveringfrom an injury, whether you're
(00:24):
dealing with a surgery, chronicpain or you're just getting back
to your favorite activities.
Muscle growth isn't just forour athletes, it's for anyone
trying to improve their qualityof life.
Now, I know that when peoplethink of physical therapy, they
usually think of lacrosse balls.
They think of mobility.
(00:45):
They might think of littletherapy.
They usually think of lacrosseballs.
They think of mobility.
They might think of littlecorrective exercises.
They think of, possibly, painrelief and dry needling, but
muscle growth, hypertrophy issomething we must focus on in
rehab, and I believe it's one ofthe most missed components of
the physical therapy process.
So today we're going to breakdown why that is what the
(01:07):
process looks like and howfocusing on getting stronger can
get you back to doing what youlove faster, and also, if you're
not focusing on this in therehab process, why you may not
be getting the results you wantor back to the activity you want
as fast as you should be.
But let's jump right in.
What even is hypertrophy?
(01:28):
Hypertrophy is essentially theprocess of increasing the size
of your muscle.
When you stress those muscles,they break down.
So think workouts, trainingsessions, rehab those are all
forms of breaking down muscle.
It's a strength stimulus andwith proper recovery they
(01:48):
rebuild bigger and stronger.
But here's the thing In thephysical therapy world rehab,
training, hypertrophy isn'talways about getting jacked.
I think a lot of people hearmuscle mass and they think these
big bodybuilders, and I cantell you from a personal
(02:11):
standpoint the amount of effortand work it would take to build
muscle mass at that degree is ona different level.
It's a full-time job.
What I'm talking about here isfunctionality Muscle mass that
you should have to be able to dothe activities you want.
Functionality muscle mass thatyou should have to be able to do
the activities you want.
Whether it's being a footballplayer, who may require more
(02:32):
muscle mass, or someone whoparticipates in functional
fitness classes just forlongevity, there's a degree of
muscle mass that must be had inorder to stabilize your joints,
to protect yourself from pain,to improve your overall movement
in general, especially after aninjury or surgery, it's likely
that hypertrophy needs to bediscussed, because after those
(02:54):
particular events, meaning aninjury or surgery, there's this
phenomenon called muscle atrophythat might occur.
And it's essentially when youboil down atrophy.
It's muscle loss, because whenyou're not using those muscles
for a period of time and it canbe as little as seven days we
start to lose strength, we startto become inactive and that
(03:18):
starts to shrink the size of themuscle.
Because your body's reallysmart.
If it senses we don't needsomething, it gets rid of it
really quickly.
And muscle is super energy,expensive.
It costs a lot to upkeep it.
It costs a lot from anutritional standpoint as well.
Your body likes to be lazy attimes.
It will shut off the signalthere and start to create that
(03:40):
change if we're not using it.
So, for example, your shouldermight have been immobilized in a
sling, or maybe you'rerecovering from an ACL surgery
and the process of atrophystarts.
With that atrophy, muscle lossquickly comes a weaker muscle, a
weaker movement.
So now there's weaker areas andless support.
(04:03):
No wonder there's pain beinggenerated.
Our joints start to become achy.
All these things start tospiral when we lose muscle mass.
And this is exactly whyfocusing on hypertrophy muscle
growth is so critical in rehab.
So let's break down why that'ssuch a big idea.
(04:24):
When you're dealing with aninjury or you're recovering from
pain or surgery, your musclesaren't just weaker, their entire
musculoskeletal system is outof alignment.
Weak muscles mean poor jointstability.
Let's take a common example,one I've touched on already an
ACL tear.
After that surgery, your quadsand hamstrings become very weak,
(04:46):
they start to atrophy and theweaker those muscles are, the
more pressure that might put onyour joints, ligaments and
tendons, as I discussed.
Basically, you're asking yourbody to do a lot with a lot less
support.
That's why we are fans ofemphasizing muscle regrowth as
early as possible.
We're not talking aboutthrowing you under heavy squats,
(05:08):
heavy deadlifts.
Obviously we've got to respectthat healing timeline and we've
got to understand and meet youwhere you're at.
But we start small.
With the right exercises, evenat low loads, we can start
working on hypertrophy to regainthat lost muscle mass.
The stronger your musclebecomes, the better protected
(05:30):
your joints will be and the lesslikely you will experience a
re-injury.
The less likelihood that we'regoing to have problems down the
line and the more likelihoodwe're going to get the things
back to these activities fasterdown the line and the more
likelihood we're going to getthe things back to these
activities faster.
And whenever we hear strongermuscles again, let's start
associating that with biggermuscle.
(05:54):
So let's go through a quick caseexample on an ACL.
For any of you that have dealtwith it or know someone that
deals with this, this might shedsome light on what's going on.
Studies have shown that afterjust one week of immobilization
(06:15):
from after the surgery, you canlose anywhere from 1 to 10% of
muscle mass.
That is huge and remember,muscle loss equals strength loss
.
The longer you wait to startaddressing this, the harder it
does become to regain that lostmuscle.
We're not just talking aboutthe knee being weak in this case
.
We're talking about thedownstream effects of your
(06:37):
ability to walk, run, jump andeven just stabilize your
self-standing.
That's why the sooner we canstart working hypertrophy, the
sooner we can build back thatstrength.
And building muscle isn't justabout returning to that full
function.
It's about preventing futureinjuries as well.
If your muscles are weak andyour body compensates in ways
(06:59):
that put more stress on otherareas, it makes you vulnerable
to the possible forces that canlead to another ACL tear down
the line.
Injury prevention is a hot topicin general and that's a whole
other podcast.
So the purpose and the way I'mgoing to describe this is a
(07:19):
decreased risk of injury downthe line, and I'm just going to
use the term injury preventionfor ease of conversation here.
But when we're looking atre-injury you can start to see
that these people that came outof ACL rehab came out of these
long rehab processes and theydidn't quite get their muscle
mass back, their strength back.
(07:40):
There can be a correlation tothese increased re-tears that
are often seen with more of apoor therapy bout.
So let's be real.
For a second, building muscle,especially in the rehab setting
where we have so manyrestrictions on us early on,
(08:01):
especially out of something likean ACL surgery, building muscle
is slow.
I wish I could tell you thattwo weeks of working out will
get you back to 100%.
I will never advertise that.
I will never tell people,because that's just flat out
wrong.
On average, you're looking atabout 0.5% to 1% muscle growth
(08:22):
per week and we're talking aboutoptimizing muscle growth here.
So yeah, it's slow, but thatdoesn't mean it's not happening
and this is why a lot of peopleget discouraged and drop out of
therapy programs too, becausethis process of building muscle
is slow.
But when you put it into thecontext of just a general
fitness program, think about howlong it takes to truly lose
(08:45):
body fat, build muscle.
How many years body buildersspend building up their frames?
Those people don't look likethat in a year up their frames.
Those people don't look likethat in a year.
That's 10 years, 15 years,sometimes, maybe even longer.
Maybe it even started in theirearly teens, where they just
started getting to the gym andworking out and they already
(09:06):
came in with a base Point beingis it is slow and you got to
stick with it.
A lot of people do getfrustrated because it is so
massively slow, but the truth ishypertrophy does take time and
it takes consistency.
Every session is progress, evenif it doesn't feel like it at
first.
Your muscles need time to breakdown and rebuild.
(09:27):
The important thing here is tostay consistent and trust the
process.
So here are some keys to howyou, how we, how anyone can
start to build muscle.
Growth muscle can start to buildmuscle more efficiently.
The magic lies in somethingcalled progressive overload.
(09:51):
So, simply put, progressiveoverload means gradually
increasing the demand on yourmuscles over time.
This can be done through a fewdifferent methods.
Think adding weight to thebarbell, adding weight to a
dumbbell, increasing the repsthat you do want to set, or even
alternating, creating somevariety in the exercises you use
.
These are all different toolsto increase the stimulus that
(10:16):
can eventually lead to morehypertrophy, more muscle mass.
When you're in rehab, sometimeswe can't load you with heavy
weights, so, taking a quick stepback, there's a bunch of
different ways to increasemuscle mass, increase strength.
One of the classic ways wethink about building muscle is
(10:38):
through heavy weights, musculartension.
There's two other ways inparticular that are commonly
discussed.
One is metabolite, whichbasically means that buildup of
waste products when you do a bigset of something.
So let's think a bicep curl,you've got a lightweight and
you're doing 30 reps and you getthat big bicep pump and burn.
(11:01):
That is what we refer to asthat metabolite buildup and it's
another way that we can getmore hypertrophy.
It's another way that we buildmuscle, but it's not necessarily
, according to research, thenumber one way.
When we think about musclegrowth in general, we think
about muscular tension beingmaybe the more effective tool.
(11:25):
We think metabolite, that burnsensation and we also think
something along the lines of thenervous system.
So just the fact that youpractice the skill of something
like a squat and going throughthe reps, the more activation
from your brain to your legmuscles and doing that skill can
(11:45):
actually start to develop themuscle there, because your body
knows it needs to lay down moremuscle tissue to support that
activity.
You're training yourself to doyou to support that activity.
You're training yourself to doso.
Taking a step back there, weknow in some rehab protocols,
like coming off an ACL, that wecan't use heavy weights.
Maybe we can't even stand on aleg at the beginning.
(12:06):
So we have to use some of thedifferent mechanisms I described
to get that muscle growth, evenif it's not 100% optimal, like
a bodybuilder would use whenthey're peaking for a show.
So with that low load exercises, especially off of a surgery,
we can provide some progressivechallenge to the muscle.
(12:27):
As you get stronger, we'llgradually then start to add load
and more reps, especially as wemove along in the timeline of
healing.
The body's smart you don'tchallenge it, it won't grow.
And I think that's theunderlying concept to all of
hypertrophy.
You got to continue tochallenge the muscle.
By adding a little bit moreeach time, you're basically
(12:50):
forcing your muscles to adaptand grow.
And, like I've mentioned,there's better ways of doing
that at certain times in yourrehab process, at certain times
in your fitness journey.
And that brings us right into areally unique tool that can be
used to help you grow somemuscle, especially when we can't
use heavy loads early on.
(13:11):
And this first tool that I'mgoing to discuss is blood flow
restriction.
Now I will say this is a reallytrendy tool and it's one that
has kind of a unique origin aswell, and I'll get into that.
But this is a tool for peoplewho can't tolerate heavy lifting
you during injury or coming offa surgery.
With BFR blood flow restriction, we restrict blood flow to the
(13:35):
muscle during light exercisesomewhere around that 30% of
your one rep max.
That, in other words, meansreally light compared to what
your strength was in the past.
This creates a similar effectto lifting heavy weights by
essentially, in simple terms,tricking your muscle into
(13:56):
thinking it's under more stressthan it really is.
But it goes right back to one ofthe mechanisms of muscle growth
I talked about, which is thatmetabolite building.
It's that burn sensation, burnsensation.
So what it looks like is youbasically put a cuff looking
tourniquet around let's call ityour leg, if you're trying to
(14:17):
build your legs up after an ACLand we have a special tool that
will allow us to accuratelyconstrict how much blood comes
in and out.
And then we go through a seriesof exercises with it under
light load to again protect thejoint, the muscle, whatever it
is we need to work on, and thisallows us to get a really good
(14:39):
stimulus to the muscle withoutirritating those things we can't
really irritate at that moment.
And this allows us to takethose initial steps in the rehab
process to building muscle mass, to again building strength,
because if we're building musclemass, we're building strength
and let me tell you it works.
We've seen amazing results withthis technique for people
(15:01):
recovering from ACL, tears,rotator cuff repairs, even
chronic pain conditions where itis just very sensitive to get
into certain movements like asquat or a deadlift.
We can start to bridge that toour activities by starting a
little lighter, but it gives usthe advantage of still getting a
really good challenge.
(15:21):
That is needed to build themuscle to support that movement
we need, and in the past we usedto be a little limited.
Yeah, we could unique our wayaround stuff, but it's always
nice to work that movement youwant and if it's very much
dependent on the load when yourpain starts, it's nice that we
(15:42):
can scale back the weight a bitand still give you a good
stimulus for your body.
The second tool I would say formuscle growth, especially in an
early on physical therapy rehabsetting, is nutrition, and
that's probably not one youthought we would say, but your
(16:03):
body needs the right fuel torecover and grow strong.
You think about this all thetime in the fitness world.
Think of your muscles like acar engine.
You're not giving it the rightfuel, it's not going to run
optimally.
And when it comes tohypertrophy, protein is king.
You need sufficient protein torepair and build your muscle
fibers.
A lot of experts recommend inthat 0.8 to 1 gram of protein
(16:27):
per pound of body weight,especially when you're in
recovery mode.
So you weigh 150 pounds, youshould aim for at least 120 to
150 grams of protein.
Beyond protein you also need toconsider your overall caloric
intake, so the actual amount offood you're taking in.
If you're not eating enough,your body won't have the energy
(16:49):
it needs to actually repair thatmuscle tissue that we broke
down in our session, in ourtraining yes, let's not forget
about carbs and fats.
That's going down some deeprabbit holes with nutrition.
Bottom line is most people comeout of a surgery and totally
just blow off their nutrition,thinking they're not as active,
(17:10):
and that is the total wrongthing to do.
I can remember right off myhead two specific incidences
where people recovering from anacl surgery pilato told me my
nutrition doesn't matter, I'mnot doing as much as I need to,
and I just kind of put my hand,my head, in my hands because the
(17:30):
way we recover from a surgerygrow back all that tissue and
muscle and all that fascia thatthat surgeon went through to
correct the problem that neededto be corrected.
The only way that's gonna growback and recover is if you give
it the nutrients it needs.
You you eat food, your bodydigests that and it sends those
(17:51):
nutrients to heal that area.
If you're now, let's say,post-surgery and you decide, eh,
my nutrition's not as importantand you stop eating the protein
you need, you stop eating allthe good nutrients, you're not
doing yourself a service.
If anything, you're slowingdown your healing process.
The time you need to focus onnutrition even more so than you
(18:12):
normally do, and I should sayyou should focus on nutrition
all the time is out of surgery.
So if you're serious aboutrehabbing your injury and
actually growing the muscle toget stronger and improving how
fast you get there, don't ignorenutrition.
So let's move out of the rehabspace for a bit.
(18:33):
Let's just talk abouthypertrophy for longevity and
health, and there's a huge groupof people advocating for this
now.
A lot of doctors are a lot of.
Our fitness industry is as well.
Hypertrophy isn't just aboutgetting back to your sport or
activity.
There's a component of justoverall well-being.
(18:55):
It plays such a huge role inoverall health.
I don't know if you knew this,but more muscle can actually
help to regulate blood sugar.
Muscle acts as a sink, in asense, for glucose, which means
that building muscle canactually help prevent or manage
conditions like diabetes, andthat's just one implication of
(19:16):
the longevity that muscle masscan provide to someone if you
have more of it.
Also, as we age, we naturallylose a lot of muscle mass, a
process known as sarcopenia.
If you're not actively workingon building or maintaining that
muscle, you're really puttingyourself at a risk for decreased
(19:36):
mobility, balance, strengthfalls, fractures all the things
that we associate as we getolder, and what we're starting
to see is that it's becausewe're losing muscle mass and
strength that these things occur, not because we're getting
older per se.
So if you really wanna doyourself some justice, start
(19:57):
building muscle mass now,because I will say, it's always
easier to build muscle mass whenyou're younger and you have
more time on your hands, versuslater in life, where now we're
playing the catch-up game andit's actually harder to do some
of the tasks we need to buildthat muscle mass.
So if we're talking aboutinjuries, we're talking about
long-term health.
Hypertrophy should be involved.
(20:20):
So, wrapping this up, some ofmy final thoughts on hypertrophy
and just the core of how itshould be implemented into a
rehab.
As such, hypertrophy isn'toptional.
It's essential for strength,stabilizing your joints and
(20:44):
protecting yourself in thefuture.
It's your body's armor andthat's how I describe it to
people in the clinic is viewmuscle as that protective coat
that you're going to put on yourbody's armor and that's how I
describe it to people in theclinic is view muscle as that
protective coat that you can puton your body In general.
If you have more of it, it'sgoing to help you.
There's very rarely a timewhere I'll say you have too much
strength, this is a problem.
(21:05):
We get to that point.
We'll have a differentconversation.
We're doing something veryright.
From a muscle hypertrophystandpoint, I very rarely have
to say that.
I've never said that.
Let's be honest Build moremuscle.
You will not look like abodybuilder if you don't want to
.
Most people who arebodybuilders even say to
themselves they can't buildenough muscle mass for what they
(21:25):
want.
It's very hard to do that.
Don't worry about that.
Build it for longevity's sake.
And plus, having more musclemass in your frame just helps
with a lot of different thingslike I discussed, like diabetes,
glucose regulation etc.
And just remember muscle massbuilding hypertrophy is slow and
(21:47):
steady process.
It does.
It takes time, consistency andthe right approach, the right
mechanism for what you need todo to get that muscle to grow.
If you're feeling stuck, ifyou're unsure what the current
plan is, go back to the basics.
Start with a basic strength andconditioning routine.
(22:08):
Then think about progressivelyoverloading, adding a little bit
more weight, more reps Ingeneral, sticking to your
general three to four sets ofeight to twelve.
It's a really good startingspot for hypertrophy.
No, it's not the end-all be-allthere, but in general, if you
(22:28):
take yourself pretty close tofailure and you use a heavy-ish
weight somewhere in that 70 to80% range, you're going to do
yourself really good service andyou're going to put really good
results, not only from alongevity standpoint, but in a
rehab standpoint, where you'retrying to recover from an injury
and you're trying to makesomething stronger.
(22:59):
You got to build the muscle mass.
It's not talked about, but itmust be done.
Thanks for letting me chat yourear off about hypertrophy.
Like I said, it's a subject I'mvery passionate about because
it's something that's not oftenassociated with the rehab
(23:20):
process, yet it's an underlyingmechanism of how we get stronger
.
It's a huge component of whatI'm going to say.
My physical therapy fieldpreaches, but we don't do a
really good job of educatingthat.
That's what's going on, and Ithink it makes a lot of sense to
people when you explain we needto make you stronger for X, y
(23:41):
and Z.
We're dealing with this injury,so now it's time to grow your
muscle and this is why it'staking so long.
This is why you got to put inthe time and the effort.
It doesn't just happenovernight.
Just like building muscle foryour fitness routine for
longevity takes time andconsistency, so does this
process for the rehab setting.
(24:01):
Thank you again, guys.
If you have any questions inyour rehab journey anything on
hypertrophy, anything on fitnessgive us a shout-out and we'll
be more than willing to help you.
Have a good rest of your night,guys.
See you soon.
What's up everyone?
Welcome back to the HerculesPerformance and Physical Therapy
Podcast.
I'm your host, dr Alec, andtoday we're talking about a
topic that's a total gamechanger when it comes to rehab.
It's also one of my favoritetopics to chat about.
It's hypertrophy, it's musclegrowth, and it's why it's
crucial for anyone recoveringfrom an injury, whether you're
(00:24):
dealing with a surgery, chronicpain or you're just getting back
to your favorite activities.
Muscle growth isn't just forour athletes, it's for anyone
trying to improve their qualityof life.
Now, I know that when peoplethink of physical therapy, they
usually think of lacrosse balls.
They think of mobility.
(00:45):
They might think of littletherapy.
They usually think of lacrosseballs.
They think of mobility.
They might think of littlecorrective exercises.
They think of, possibly, painrelief and dry needling, but
muscle growth, hypertrophy issomething we must focus on in
rehab, and I believe it's one ofthe most missed components of
the physical therapy process.
So today we're going to breakdown why that is what the
(01:07):
process looks like and howfocusing on getting stronger can
get you back to doing what youlove faster, and also, if you're
not focusing on this in therehab process, why you may not
be getting the results you wantor back to the activity you want
as fast as you should be.
But let's jump right in.
What even is hypertrophy?
(01:28):
Hypertrophy is essentially theprocess of increasing the size
of your muscle.
When you stress those muscles,they break down.
So think workouts, trainingsessions, rehab those are all
forms of breaking down muscle.
It's a strength stimulus andwith proper recovery they
(01:48):
rebuild bigger and stronger.
But here's the thing In thephysical therapy world rehab,
training, hypertrophy isn'talways about getting jacked.
I think a lot of people hearmuscle mass and they think these
big bodybuilders, and I cantell you from a personal
(02:11):
standpoint the amount of effortand work it would take to build
muscle mass at that degree is ona different level.
It's a full-time job.
What I'm talking about here isfunctionality Muscle mass that
you should have to be able to dothe activities you want.
Functionality muscle mass thatyou should have to be able to do
the activities you want.
Whether it's being a footballplayer, who may require more
(02:32):
muscle mass, or someone whoparticipates in functional
fitness classes just forlongevity, there's a degree of
muscle mass that must be had inorder to stabilize your joints,
to protect yourself from pain,to improve your overall movement
in general, especially after aninjury or surgery, it's likely
that hypertrophy needs to bediscussed, because after those
(02:54):
particular events, meaning aninjury or surgery, there's this
phenomenon called muscle atrophythat might occur.
And it's essentially when youboil down atrophy.
It's muscle loss, because whenyou're not using those muscles
for a period of time and it canbe as little as seven days we
start to lose strength, we startto become inactive and that
(03:18):
starts to shrink the size of themuscle.
Because your body's reallysmart.
If it senses we don't needsomething, it gets rid of it
really quickly.
And muscle is super energy,expensive.
It costs a lot to upkeep it.
It costs a lot from anutritional standpoint as well.
Your body likes to be lazy attimes.
It will shut off the signalthere and start to create that
(03:40):
change if we're not using it.
So, for example, your shouldermight have been immobilized in a
sling, or maybe you'rerecovering from an ACL surgery
and the process of atrophystarts.
With that atrophy, muscle lossquickly comes a weaker muscle, a
weaker movement.
So now there's weaker areas andless support.
(04:03):
No wonder there's pain beinggenerated.
Our joints start to become achy.
All these things start tospiral when we lose muscle mass.
And this is exactly whyfocusing on hypertrophy muscle
growth is so critical in rehab.
So let's break down why that'ssuch a big idea.
(04:24):
When you're dealing with aninjury or you're recovering from
pain or surgery, your musclesaren't just weaker, their entire
musculoskeletal system is outof alignment.
Weak muscles mean poor jointstability.
Let's take a common example,one I've touched on already an
ACL tear.
After that surgery, your quadsand hamstrings become very weak,
(04:46):
they start to atrophy and theweaker those muscles are, the
more pressure that might put onyour joints, ligaments and
tendons, as I discussed.
Basically, you're asking yourbody to do a lot with a lot less
support.
That's why we are fans ofemphasizing muscle regrowth as
early as possible.
We're not talking aboutthrowing you under heavy squats,
(05:08):
heavy deadlifts.
Obviously we've got to respectthat healing timeline and we've
got to understand and meet youwhere you're at.
But we start small.
With the right exercises, evenat low loads, we can start
working on hypertrophy to regainthat lost muscle mass.
The stronger your musclebecomes, the better protected
(05:30):
your joints will be and the lesslikely you will experience a
re-injury.
The less likelihood that we'regoing to have problems down the
line and the more likelihoodwe're going to get the things
back to these activities fasterdown the line and the more
likelihood we're going to getthe things back to these
activities faster.
And whenever we hear strongermuscles again, let's start
associating that with biggermuscle.
(05:54):
So let's go through a quick caseexample on an ACL.
For any of you that have dealtwith it or know someone that
deals with this, this might shedsome light on what's going on.
Studies have shown that afterjust one week of immobilization
(06:15):
from after the surgery, you canlose anywhere from 1 to 10% of
muscle mass.
That is huge and remember,muscle loss equals strength loss
.
The longer you wait to startaddressing this, the harder it
does become to regain that lostmuscle.
We're not just talking aboutthe knee being weak in this case
.
We're talking about thedownstream effects of your
(06:37):
ability to walk, run, jump andeven just stabilize your
self-standing.
That's why the sooner we canstart working hypertrophy, the
sooner we can build back thatstrength.
And building muscle isn't justabout returning to that full
function.
It's about preventing futureinjuries as well.
If your muscles are weak andyour body compensates in ways
(06:59):
that put more stress on otherareas, it makes you vulnerable
to the possible forces that canlead to another ACL tear down
the line.
Injury prevention is a hot topicin general and that's a whole
other podcast.
So the purpose and the way I'mgoing to describe this is a
(07:19):
decreased risk of injury downthe line, and I'm just going to
use the term injury preventionfor ease of conversation here.
But when we're looking atre-injury you can start to see
that these people that came outof ACL rehab came out of these
long rehab processes and theydidn't quite get their muscle
mass back, their strength back.
(07:40):
There can be a correlation tothese increased re-tears that
are often seen with more of apoor therapy bout.
So let's be real.
For a second, building muscle,especially in the rehab setting
where we have so manyrestrictions on us early on,
(08:01):
especially out of something likean ACL surgery, building muscle
is slow.
I wish I could tell you thattwo weeks of working out will
get you back to 100%.
I will never advertise that.
I will never tell people,because that's just flat out
wrong.
On average, you're looking atabout 0.5% to 1% muscle growth
(08:22):
per week and we're talking aboutoptimizing muscle growth here.
So yeah, it's slow, but thatdoesn't mean it's not happening
and this is why a lot of peopleget discouraged and drop out of
therapy programs too, becausethis process of building muscle
is slow.
But when you put it into thecontext of just a general
fitness program, think about howlong it takes to truly lose
(08:45):
body fat, build muscle.
How many years body buildersspend building up their frames?
Those people don't look likethat in a year up their frames.
Those people don't look likethat in a year.
That's 10 years, 15 years,sometimes, maybe even longer.
Maybe it even started in theirearly teens, where they just
started getting to the gym andworking out and they already
(09:06):
came in with a base Point beingis it is slow and you got to
stick with it.
A lot of people do getfrustrated because it is so
massively slow, but the truth ishypertrophy does take time and
it takes consistency.
Every session is progress, evenif it doesn't feel like it at
first.
Your muscles need time to breakdown and rebuild.
(09:27):
The important thing here is tostay consistent and trust the
process.
So here are some keys to howyou, how we, how anyone can
start to build muscle.
Growth muscle can start to buildmuscle more efficiently.
The magic lies in somethingcalled progressive overload.
(09:51):
So, simply put, progressiveoverload means gradually
increasing the demand on yourmuscles over time.
This can be done through a fewdifferent methods.
Think adding weight to thebarbell, adding weight to a
dumbbell, increasing the repsthat you do want to set, or even
alternating, creating somevariety in the exercises you use
.
These are all different toolsto increase the stimulus that
(10:16):
can eventually lead to morehypertrophy, more muscle mass.
When you're in rehab, sometimeswe can't load you with heavy
weights, so, taking a quick stepback, there's a bunch of
different ways to increasemuscle mass, increase strength.
One of the classic ways wethink about building muscle is
(10:38):
through heavy weights, musculartension.
There's two other ways inparticular that are commonly
discussed.
One is metabolite, whichbasically means that buildup of
waste products when you do a bigset of something.
So let's think a bicep curl,you've got a lightweight and
you're doing 30 reps and you getthat big bicep pump and burn.
(11:01):
That is what we refer to asthat metabolite buildup and it's
another way that we can getmore hypertrophy.
It's another way that we buildmuscle, but it's not necessarily
, according to research, thenumber one way.
When we think about musclegrowth in general, we think
about muscular tension beingmaybe the more effective tool.
(11:25):
We think metabolite, that burnsensation and we also think
something along the lines of thenervous system.
So just the fact that youpractice the skill of something
like a squat and going throughthe reps, the more activation
from your brain to your legmuscles and doing that skill can
(11:45):
actually start to develop themuscle there, because your body
knows it needs to lay down moremuscle tissue to support that
activity.
You're training yourself to doyou to support that activity.
You're training yourself to doso.
Taking a step back there, weknow in some rehab protocols,
like coming off an ACL, that wecan't use heavy weights.
Maybe we can't even stand on aleg at the beginning.
(12:06):
So we have to use some of thedifferent mechanisms I described
to get that muscle growth, evenif it's not 100% optimal, like
a bodybuilder would use whenthey're peaking for a show.
So with that low load exercises, especially off of a surgery,
we can provide some progressivechallenge to the muscle.
(12:27):
As you get stronger, we'llgradually then start to add load
and more reps, especially as wemove along in the timeline of
healing.
The body's smart you don'tchallenge it, it won't grow.
And I think that's theunderlying concept to all of
hypertrophy.
You got to continue tochallenge the muscle.
By adding a little bit moreeach time, you're basically
(12:50):
forcing your muscles to adaptand grow.
And, like I've mentioned,there's better ways of doing
that at certain times in yourrehab process, at certain times
in your fitness journey.
And that brings us right into areally unique tool that can be
used to help you grow somemuscle, especially when we can't
use heavy loads early on.
(13:11):
And this first tool that I'mgoing to discuss is blood flow
restriction.
Now I will say this is a reallytrendy tool and it's one that
has kind of a unique origin aswell, and I'll get into that.
But this is a tool for peoplewho can't tolerate heavy lifting
you during injury or coming offa surgery.
With BFR blood flow restriction, we restrict blood flow to the
(13:35):
muscle during light exercisesomewhere around that 30% of
your one rep max.
That, in other words, meansreally light compared to what
your strength was in the past.
This creates a similar effectto lifting heavy weights by
essentially, in simple terms,tricking your muscle into
(13:56):
thinking it's under more stressthan it really is.
But it goes right back to one ofthe mechanisms of muscle growth
I talked about, which is thatmetabolite building.
It's that burn sensation, burnsensation.
So what it looks like is youbasically put a cuff looking
tourniquet around let's call ityour leg, if you're trying to
(14:17):
build your legs up after an ACLand we have a special tool that
will allow us to accuratelyconstrict how much blood comes
in and out.
And then we go through a seriesof exercises with it under
light load to again protect thejoint, the muscle, whatever it
is we need to work on, and thisallows us to get a really good
(14:39):
stimulus to the muscle withoutirritating those things we can't
really irritate at that moment.
And this allows us to takethose initial steps in the rehab
process to building muscle mass, to again building strength,
because if we're building musclemass, we're building strength
and let me tell you it works.
We've seen amazing results withthis technique for people
(15:01):
recovering from ACL, tears,rotator cuff repairs, even
chronic pain conditions where itis just very sensitive to get
into certain movements like asquat or a deadlift.
We can start to bridge that toour activities by starting a
little lighter, but it gives usthe advantage of still getting a
really good challenge.
(15:21):
That is needed to build themuscle to support that movement
we need, and in the past we usedto be a little limited.
Yeah, we could unique our wayaround stuff, but it's always
nice to work that movement youwant and if it's very much
dependent on the load when yourpain starts, it's nice that we
(15:42):
can scale back the weight a bitand still give you a good
stimulus for your body.
The second tool I would say formuscle growth, especially in an
early on physical therapy rehabsetting, is nutrition, and
that's probably not one youthought we would say, but your
(16:03):
body needs the right fuel torecover and grow strong.
You think about this all thetime in the fitness world.
Think of your muscles like acar engine.
You're not giving it the rightfuel, it's not going to run
optimally.
And when it comes tohypertrophy, protein is king.
You need sufficient protein torepair and build your muscle
fibers.
A lot of experts recommend inthat 0.8 to 1 gram of protein
(16:27):
per pound of body weight,especially when you're in
recovery mode.
So you weigh 150 pounds, youshould aim for at least 120 to
150 grams of protein.
Beyond protein you also need toconsider your overall caloric
intake, so the actual amount offood you're taking in.
If you're not eating enough,your body won't have the energy
(16:49):
it needs to actually repair thatmuscle tissue that we broke
down in our session, in ourtraining yes, let's not forget
about carbs and fats.
That's going down some deeprabbit holes with nutrition.
Bottom line is most people comeout of a surgery and totally
just blow off their nutrition,thinking they're not as active,
(17:10):
and that is the total wrongthing to do.
I can remember right off myhead two specific incidences
where people recovering from anacl surgery pilato told me my
nutrition doesn't matter, I'mnot doing as much as I need to,
and I just kind of put my hand,my head, in my hands because the
(17:30):
way we recover from a surgerygrow back all that tissue and
muscle and all that fascia thatthat surgeon went through to
correct the problem that neededto be corrected.
The only way that's gonna growback and recover is if you give
it the nutrients it needs.
You you eat food, your bodydigests that and it sends those
(17:51):
nutrients to heal that area.
If you're now, let's say,post-surgery and you decide, eh,
my nutrition's not as importantand you stop eating the protein
you need, you stop eating allthe good nutrients, you're not
doing yourself a service.
If anything, you're slowingdown your healing process.
The time you need to focus onnutrition even more so than you
(18:12):
normally do, and I should sayyou should focus on nutrition
all the time is out of surgery.
So if you're serious aboutrehabbing your injury and
actually growing the muscle toget stronger and improving how
fast you get there, don't ignorenutrition.
So let's move out of the rehabspace for a bit.
(18:33):
Let's just talk abouthypertrophy for longevity and
health, and there's a huge groupof people advocating for this
now.
A lot of doctors are a lot of.
Our fitness industry is as well.
Hypertrophy isn't just aboutgetting back to your sport or
activity.
There's a component of justoverall well-being.
(18:55):
It plays such a huge role inoverall health.
I don't know if you knew this,but more muscle can actually
help to regulate blood sugar.
Muscle acts as a sink, in asense, for glucose, which means
that building muscle canactually help prevent or manage
conditions like diabetes, andthat's just one implication of
(19:16):
the longevity that muscle masscan provide to someone if you
have more of it.
Also, as we age, we naturallylose a lot of muscle mass, a
process known as sarcopenia.
If you're not actively workingon building or maintaining that
muscle, you're really puttingyourself at a risk for decreased
(19:36):
mobility, balance, strengthfalls, fractures all the things
that we associate as we getolder, and what we're starting
to see is that it's becausewe're losing muscle mass and
strength that these things occur, not because we're getting
older per se.
So if you really wanna doyourself some justice, start
(19:57):
building muscle mass now,because I will say, it's always
easier to build muscle mass whenyou're younger and you have
more time on your hands, versuslater in life, where now we're
playing the catch-up game andit's actually harder to do some
of the tasks we need to buildthat muscle mass.
So if we're talking aboutinjuries, we're talking about
long-term health.
Hypertrophy should be involved.
(20:20):
So, wrapping this up, some ofmy final thoughts on hypertrophy
and just the core of how itshould be implemented into a
rehab.
As such, hypertrophy isn'toptional.
It's essential for strength,stabilizing your joints and
(20:44):
protecting yourself in thefuture.
It's your body's armor andthat's how I describe it to
people in the clinic is viewmuscle as that protective coat
that you're going to put on yourbody's armor and that's how I
describe it to people in theclinic is view muscle as that
protective coat that you can puton your body In general.
If you have more of it, it'sgoing to help you.
There's very rarely a timewhere I'll say you have too much
strength, this is a problem.
(21:05):
We get to that point.
We'll have a differentconversation.
We're doing something veryright.
From a muscle hypertrophystandpoint, I very rarely have
to say that.
I've never said that.
Let's be honest Build moremuscle.
You will not look like abodybuilder if you don't want to
.
Most people who arebodybuilders even say to
themselves they can't buildenough muscle mass for what they
(21:25):
want.
It's very hard to do that.
Don't worry about that.
Build it for longevity's sake.
And plus, having more musclemass in your frame just helps
with a lot of different thingslike I discussed, like diabetes,
glucose regulation etc.
And just remember muscle massbuilding hypertrophy is slow and
(21:47):
steady process.
It does.
It takes time, consistency andthe right approach, the right
mechanism for what you need todo to get that muscle to grow.
If you're feeling stuck, ifyou're unsure what the current
plan is, go back to the basics.
Start with a basic strength andconditioning routine.
(22:08):
Then think about progressivelyoverloading, adding a little bit
more weight, more reps Ingeneral, sticking to your
general three to four sets ofeight to twelve.
It's a really good startingspot for hypertrophy.
No, it's not the end-all be-allthere, but in general, if you
(22:28):
take yourself pretty close tofailure and you use a heavy-ish
weight somewhere in that 70 to80% range, you're going to do
yourself really good service andyou're going to put really good
results, not only from alongevity standpoint, but in a
rehab standpoint, where you'retrying to recover from an injury
and you're trying to makesomething stronger.
(22:59):
You got to build the muscle mass.
It's not talked about, but itmust be done.
Thanks for letting me chat yourear off about hypertrophy.
Like I said, it's a subject I'mvery passionate about because
it's something that's not oftenassociated with the rehab
(23:20):
process, yet it's an underlyingmechanism of how we get stronger
.
It's a huge component of whatI'm going to say.
My physical therapy fieldpreaches, but we don't do a
really good job of educatingthat.
That's what's going on, and Ithink it makes a lot of sense to
people when you explain we needto make you stronger for X, y
(23:41):
and Z.
We're dealing with this injury,so now it's time to grow your
muscle and this is why it'staking so long.
This is why you got to put inthe time and the effort.
It doesn't just happenovernight.
Just like building muscle foryour fitness routine for
longevity takes time andconsistency, so does this
process for the rehab setting.
(24:01):
Thank you again, guys.
If you have any questions inyour rehab journey anything on
hypertrophy, anything on fitnessgive us a shout-out and we'll
be more than willing to help you.
Have a good rest of your night,guys.
See you soon.
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