Muscles need to be pushed to grow and become healthy. One overlying principle that there is in my world view is that Type II muscle selectively atrophies. Another way to say that is "use it or lose it". The reason a 40 year old man looks so different than an 18 year old is that the 18 year old engages in activities that stimulate the production of Type II muscle (fast twitch fibers) whereas the 40 year old typically engages in activities that are more endurance oriented, and which only stimulate Type I muscles, the endurance fibers. Another aspect to this consideration is that Type I fibers adapt to exercise levels, implying that at a steady state, the Type I fibers no longer mature and grow.
In a nutshell, what this means to me is that first of all, for rehabilitation to be complete, both Type I and Type II muscles need to be stimulated. So exercise needs to include short bout high intensity activities for that specific purpose.
Now that said, given that I believe that PT is a three tier process, Phase 1. Get you out of trouble, Phase 2. Make you strong and durable, and Phase 3. Make you bulletproof, the short bout high intensity component of the rehabilitation process is best timed to coincide with late Phase 2 and all of Phase 3 activities. In fact we use the ability of a patient to execute short bout high intensity activities to signify the end of their rehabilitation and the start of their return to training. In the case of athletes, they can return to practice at this point, and still yet increase their match fitness to be able to return to competition safely.
We keep statistics in our office, and our data shows us that our average number of visits in our center is 9 per patient. We see people 2x per week, and so we usually see people for about 6 weeks, more or less. Now this is just an average and of course we see people longer and more often if the situation calls for it. For example, our Work Conditioning Program participants are in our facility daily for 6-8 weeks, and we often see athletes who need just one or two visits. But if you figure that we see people over about an 8 week period, it is in that time frame that we move from Phase 1 to Phase 3, and if that is to be the case, then PT needs to be aggressive.
This means that as a patient you would need to work pretty hard to resolve your issues in that short time frame.
That means we have to have you working on restoring your foundational movement patterns, building your functional (especially core) strength, and rebuilding your lost Type II muscle mass in that brief period of time.
The only way that happens in that time frame is with sweat and post exercise muscle soreness. Post exercise muscle soreness in this case is NOT pain (ie, irritated joints, tendons, discs etc).
In the event that you are interested in reading more, you can visit our website where I go into more detail about PT at Sports Reaction Center.
Posts
