Why do we need periodization?
Today’s topic is all about the concept of periodization and how it may or may not fit into your rehabilitation process.
Naturally, the first question we have to ask is, “what exactly is periodization and when is it needed?”
In a nutshell, periodization offers a guide to re-introduce and accumulate graded exposures to specific demands. The concept is extremely versatile and should be taken into consideration in almost all reconditioning situations. Periodization most commonly uses consistent methods (exercises) with gradually increasing volume and/or intensity over the course of multiple weeks and months. The goal being to increase the amount of physical work the athlete can perform and recover from over a given period of time.
Periodization principles can provide a tremendous overarching framework for reconditioning and rehabilitation that hold the coach, clinician, and athlete accountable to progressive change over time while minimizing the risk of doing too much too soon.
As with all theories, there can be inherent limitations and pitfalls when relying exclusively on periodization principles and implementation.
When discussing the topic of periodization, it can be very useful to first take a step back and appreciate what our end goals of reconditioning or training are?
Is our goal to get an individual back to soccer after a recent ACL repair?
Is our goal to return to work as a nanny following an acute low back injury?
Is our goal to get back to a 500lb squat after a knee injury?
Is our goal to run a marathon PR after a chronic achilles tendinopathy?
All of these cases would likely be handled in very different ways because of variations in length of recovery, the tissues involved, the unique activity demands, and the client’s desired level of future activity.
Assuming we know where we need to get to in the future, we can then seek to reverse engineer the process. By having a specific end-goal in mind, we can work backwards from the end in order to make logical regressions until we reach the client’s current level of abilities. This allows for sequential and graded improvements over multiple exposures and a sufficient period of time.
An example could be when working with the runner dealing with an achilles tendinopathy who plans to run a marathon. Assuming the time frame is feasible, we can reverse engineer the date of the marathon to present day. In doing so, we can work backwards and start with the end goal of being able to run 26.2 miles as fast as possible. From there, we progressively work backward in time to ensure we do not rapidly increase running mileage or volume too much per week.
Assuming the marathon is in a few months, we can utilize this logic to progressively accommodate the individual to elevating levels of both mileage and speed of running over the course of numerous weeks. The beauty of this example is that it is easily quantifiable and should follow relatively linear trends over time to minimize the risk of over-training compared to established capabilities.
Guess what? Strength training, reconditioning, and return to sport is really no different!
If we are faced with a situation in which an athlete is severely deficient in strength, power, endurance, or really any performance quality, we can apply the same thinking to “work backwards” from their end goal to their current abilities.
Instead of modifying the mileage, we may adjust the overall tonnage lifted per session, per week, or per month. Alternatively, we may adjust the volume of exercise performed at a given intensity (say performing >10 repetitions of squat at >80% 1 rep max or the goal of accumulating >10,000lbs of work in a single squat session).
The dials that can be adjusted remain very similar:
- Intensity (“how hard are they working? What is their level of exertion?”)
- Dosage (“how many reps are they performing per set?”)
- Volume (“how much total physical work are they doing?)
Periodization in its most basic sense is seeking to titrate the dose of physical stress we are placing on our clients.
The better we can titrate the physical load over the course of days, weeks, and months, the fewer set-backs we will likely experience along the way due to lack of preparedness and the subsequent need for additional recovery days.
More volume and load equates to greater physical stress on the system. If we do a poor job of accumulating tolerance to chronic loading (overreaching extends into the realm of overtraining), we may be faced with impaired recovery time and reduced performance outcomes.
In the coming weeks we will dive more into the details of the nuts and bolts of applying periodization principles and methods.
-Mike Reinhardt, PT, DPT
This article takes an extensive look at the potential pain contributions associated with tendinopathy. The authors discuss the potential central and peripheral mediated pain mechanisms while also acknowledging the remaining gaps in understanding. There are a plethora of potential contributors to tendon pain, and the search for these should consider sources beyond solely local tendon damage.
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