By Mitch Hauschildt, MA, ATC, CSCS
I have said many times that so much of what we do in the strength and conditioning/fitness/rehab world is a simple form of evolution. We basically give the body stimulus and watch it react. If we give it the correct stimulus, we get the product that we want. If we miss the mark and provide the wrong load, volume, movements, or other stimulus, we get something that we don’t want.
This is all due to the brain’s constant desire to feel safe. The brain is always looking to survive and we have illustrated that in a number of different ways and posts in the past. The basic premise is that the brain is always adapting to become more efficient, so if we can harness the power of adaptation and use it to our advantage, we get stronger, more resilient people.
I have written in the past about periodization is completely underutilized, especially in the clinical and fitness world. We tend to see a lot of exercises and sets, reps and loads thrown out without much of an overall plan which leads to stagnation, injuries and poor performance. There are a ton of options for periodization models out there, including linear, block, undulating, and conjugate. If you aren’t currently using a periodization model, I’m not sure that it matters all that much which model you decide to use initially. Rather, it’s more important that you actually use one and begin to look at a systematic process for how you vary your loads, volumes and intensities.
With all of that being said, the model that really peaked my interest a few years ago was created by Cal Dietz at the University of Minnesota. Cal’s Triphasic training approach is based on the premise that athletes need to be proficient in Isometric, Concentric and Eccentric phases of all movement (thus the name Triphasic training). Most of us focus on the Concentric phase of movements and don’t spend a lot of time in the other two areas. This stunts overall performance (especially for speed and power individuals) and makes us less resilient overall. I highly recommend that you read his book and really understand the science behind it and how he programs for his collegiate athletes.
I believe that there is a huge application in the clinical world for the Triphasic methodology and it dovetails nicely with how we should be approaching our rehabs. First is the isometric phase of exercise. Triphasic training suggests that we should start our training with isometric training and do it through pause reps where we stop mid movement for 3-6 seconds and focus on control during the pause.
In the rehab world, it is also smart to begin with isometrics and many of us do this already, especially with our post-surgical patients with isometric holds when a joint isn’t ready to move through a range of motion. Where I think that most of us fall short is that we train isometrically initially, but never revisit this phase with our movements later.
The next phase to be trained is eccentric motion. Triphasic training suggests that we do this by slowing down our eccentric phase of a movement, taking 3-6 seconds to descend into a squat, for example, really focusing on control during the lengthening phase of the movement. Again, this is a natural second step for many of our rehab patients. Performing eccentric movements can be a great way to train a movement pattern early on because it does tend to take a little bit less strength and control and aids in motor learning of a new pattern.
Finally, after training isometrically and eccentrically, we get to concentric movements where our focus should turn to how our clients shorten and ascend out of the bottom of a movement. This is where most of us spend all of our time in training, which isn’t all bad, but I think we can do better.
So, how does the Triphasic Methodology apply to the clinical setting?
The application can be a bit challenging because there are a ton of variables in play in the clinical world. When using the program with healthy athletes in a traditional strength and conditioning program, the phases are designed to be performed in specific blocks consisting of 3-6 weeks each within a larger macrocycle of training and ultimately ending in a training peak for a specific championship event or season. For most of us in the rehab world, we are focused on returning to activity so they can participate in programs such as this. And, oftentimes we have a much smaller amount of time to work with our patients.
My suggestion for implementing the Triphasic methodology into a clinical setting are as follows:
- Always start with our patient’s strength programs by working through the 3 phases of movement in the order of Isometric, Eccentric and Concentric. This is sort of a “pretraining” phase. The goal of this phase is to use the methodology to teach proper movement patterns, motor control, protect to the injured body part if needed, and prepare them for future training. In a long-term rehab scenario, such as a post-operative ACL reconstruction, this pretraining phase make take several weeks to move through. Or, in the case of a shorter-term program such as patella femoral knee pain where you only get a few weeks’ worth of visits with your patient and they are high functioning, you may move through this phase in a couple of sessions. The major goal is to make sure that they have at least some control in each of the 3 phases and to get them ready to move to more complex programing.
- Where you go next really depends on how much time you have with your patient. Longer term rehab programs have a lot more room for a more traditional approach to programming than short term programs have. Here are ways to integrate Triphasic programming into each scenario:
- Long Term Rehab (3-6 months): These individuals have significant injuries and lots of room in their program for changes in volumes and intensities. I recommend that you work through the pretraining phase and spend a lot of time there. Once they can perform their activities of daily living (ADLs) efficiently, then move onto Isometric training, performing pause reps, for 2-4 weeks and then the same duration for eccentric and concentric training. If you do things in this sequence, you will lay a strong foundation for a lot of training later in the rehab program. And, you will find that you feel more comfortable performing complex exercises earlier than you may have before because these exercises become self-limiting. Meaning, when you have someone who is fairly early in their ACL rehab program performing pause squats, you will find that they aren’t interested in increasing the load too quickly which can lead to poor movement patterns, soft tissue pain, or risk of re-injury. It will force them to be very stable very early because you are putting the body under a small, but significant load because of the duration. It’s amazing what this tempo change does for these individuals. This also works very well for filling in the gap between weeks 2 and 10. That is an area that a lot of individuals get bored with their programs. If we do our job correctly, they are moving well after a couple of weeks, but not ready to do things like jumping and running drills until closer to the 10-12 week mark. This variation in their training programs helps keep them engaged and excited to train every day.
- Short Term Rehab (2-4 weeks): As we discussed earlier, short term rehabs are a bit more of a challenge for implementing Triphasic training. My suggestion is that you work quickly through the pretraining phase as more of an introduction to the training philosophy. From there, you don’t have enough time to fully immerse them into a full training program. I suggest that you implement a bit of a conjugate flare to the program by focusing on a different training method each day. So, you might work on isometric work on Monday, eccentric work on Wednesday and concentric training on Friday. This allows you to work all areas of their abilities, but in a condensed manner. You will have to manage any soreness carefully and because of the short training window, I view this as both training and education for their future training programs after they have been released from my care.
There are a ton of ways to skin a cat and no specific methodology will work in all situations and solve all problems, but I do see a lot of potential in a marriage between the clinical world and Triphasic training. For the record, I have not met Cal Dietz, nor do I have any financial gain for selling his book. But, I do see a great potential in his training programs for populations that are outside of the normal strength and conditioning setting. Do yourself a favor and pick up his book and think outside the box and make some headway with your patients.
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