Practical Guide to Hip and Knee Strengthening

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Top Contributors - Wanda van Niekerk and Jess Bell  

Progressive Overload for Strength Development

General principles to consider with progressive overload:

• Remember TWO things when dealing with a patient who requires strengthening:
  • Establish the level of load they can currently cope with
  • Keep reassessing the situation as patient progresses
• Progressively expose an individual to load at a tissue and system level
• Maximum tolerated loads are necessary to generate supraphysiological stress and low level of micro failure to create adaptation
• Allow sufficient recovery time to enable adaptation
• Application of the appropriate load to drive the required adaptation
• Specific Adaptation to Imposed Demand (SAID) principle
  • Adaptations produced by training are highly specific to the nature of the stimulus or overload applied
  • Adaptations are specific to strength, power, endurance, functional activity, joint angle, sequence of muscle activations, energy systems and virtually all other variables present
  • SAID principle is impacted by:
    • Position or length of the muscle (length-tension relationship)
    • Speed of contraction (force - velocity relationship)
    • Muscle contraction type (isometric, concentric, eccentric)
    • Percentage (%) repetition maximum
      • Training as a percentage of repetition maximum (RM)
        • e.g. 80% 1RM
      • Repetitions to failure
        • e.g. 80% 1RM = 7 - 10 repetitions to failure

Modified Daily Adjustable Progressive Resistance Exercise (DAPRE) System

• System introduced by Knight (ref)
• 5 RM TO 7 RM 4-set system
• System allows patients to train at fullest potential while still accounting for variations in strength levels
• Sets 1 and 2 are warm-up sets, sets 3 and 4 are maximum effort sets
• Sets are designed around a "working weight"
• The working weight is the weight used in set 3
• Weights used for sets 1 and 2 is a percentage of the working weight (set 1 uses 50% of the working weight, set 2 uses 75% of working weight, set 3 uses the full working weight)
• maximum repetitions performed in set 3 determines the weight to be used in set 4
• number of repetitions performed in set 4 is used to determine the working weight for the next training session
• this system is ideal for rehabilitation, regardless of the degree of the patient's strength or deconditioning
• Recommended article to read: The Daily Adjustable Progressive Resistance Exercise System: Getting Reacquainted With an Old Friend

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