BraceLab Clinical Clues

July 2021 No. 22

Why Ask Patients to Lift Heavy Weights?

Jerry Ditz, DPT, Dip. Osteopractic, Cert. SMT, Cert. DN

Figure 1: Farmer’s walk

In Clinical Clue 16, why did I recommend using heavy weights when describing Farmer’s Walk (Figure 1)?

The answer is simple: patients performing exercises at higher resistance levels impact their nervous system more than doing the same exercise at lower resistance levels. The nervous system responds to heavier weights by showing improved neural drive (1) as well as an increase in the number of motor neurons available to perform a muscle contraction. Jenkins et.al. noted not only greater strength gains at higher resistance levels, but also more efficient muscle contraction/s. (2)

How do you calculate the desirable exercise weight? The best method is to base the exercise weight on the calculation of the one repetition maximum weight the patient can lift. The detailed explanation below using the overhead reach (military press) explains the repetition assessment method formula. See Figures 2 & 3. This approach can be used with a variety of strengthening exercises or functional activities including, but not limited to, the sit to stand, farmers walk, dead lift, or bench press.

Figure 2: Military lift starts at shoulder
Figure 3: Full lift should be achieved before returning to shoulder height

First, inform the patient that the goal of the test is to create a reference point against which to measure progress. If any time during testing their resting pain level increases, the testing stops. Additionally, if improper body or grip mechanics are observed, the test may be stopped.

START WITH A WARMUP SEQUENCE:

  1. Patient completes five minutes of upper body cycling on an ergometer at low resistance.
  2. Ask the patient to raise their hand up and down ten times from their shoulder to full overhead extension without lifting a weight.
  3. Allow patient to rest one minute; monitor resting pain level.
  4. If pain did not increase, ask the patient what weight of hand dumbbells they think they can lift up and down from their shoulder to fully overhead ten times. This weight is the perceived ten repetition maximum (3).
  5. Choose 50% of the perceived ten repetition maximum weight and ask the patient to lift this weight up and down from their shoulder to fully overhead ten times.
  6. Allow patient to rest one minute: monitor resting pain level.
  7. If pain did not increase, ask the patient to lift the weight up and down from their shoulder five times while holding 75% of their perceived ten repetition max.
  8. Allow patient to rest one minute; monitor resting pain level.

IF PAIN DID NOT INCREASE, BEGIN TESTING:

  1. Ask the patient if he/she feels they can still lift their perceived ten repetition maximum weight up and down from their shoulder ten times. Tell the patient the goal is to complete at least eight repetitions, but not more than 13. (The test is successful if they complete eight to 13 repetitions; the weight is then used to calculate their one repetition maximum.)
  2. Decrease the weight if the patient is uncomfortable or increase if the patient finds it too easy. Continue until the patient completes between eight and 13 repetitions.
    • If the patient completes 13 repetitions, ask them to rest two minutes while monitoring resting pain level and if the pain does not increase, repeat the exercise with more weight. For the upper extremity increase or decrease the weight in five-to-ten-pound increments and for the lower extremity, increase or decrease the weight in ten-to-20-pound increments.
    • If the patient was unable to complete at least eight repetitions, ask them to rest two minutes, and if pain did not increase, repeat the exercise with less weight.
  3. Once the patient can lift the weight up and down from shoulder level between eight and 13 times, their one repetition max is determined using this formula:

While most patients do not have increased pain after this testing, it is important to advise patients they may experience delayed normal onset muscle soreness in the ensuing 24 to 48 hours.

Having calculated the one repetition maximum, use that weight to determine the weight for the patient’s clinical or home exercise. A good starting point is about 60-to-80% of the one repetition maximum weight, completing between six-to-ten repetitions and a total of three-to-six sets. Accurately determining a patient’s weight/resistance for exercise is valuable. If the weight is not heavy enough your patients could be missing out on strength gains and improved muscle contraction efficiency.

 

1. Farina D, Negro F, & Dideriksen JL. The effective neural drive to muscles is the common synaptic input to motor neurons. J Physiol. 2014 Aug 15; 592(Pt 16): 3427-3441. Published online 2014 Jun 10. doi: 10.1113/jphysiol.2014.273581

2. Jenkins ND, Miramonti AA, Hill EC, Smith, CM, Cochrane-Snyman KC, Housh TJ, & Cramer JT. Greater neural adaptations following high-vs. low-load resistance training. Front Physiol. 2017 May 29. doi.org/10.3389/fphys.2017.00331

3. National Strength and Conditioning Association. Exercise Technique Manual for Resistance Training. 3rd ed. Champaign, IL: Human Kinetics. 2016.

 

Download Clinical Clues No.22, Why Ask Patients to Lift Heavy Weights?; July 2021

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Disclaimer: BraceLab Clinical Clues are intended to be an informal sharing of practical clinical ideas; not formal evidence-based conclusions of fact.

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