Heavy lifting is critical for connective tissue health. And often as we inevitably develop tendinopathies (nagging pain in joints and connective tissue) we instinctively abstain from the heavy lifting or body movements, load up on anti-inflammatories, ice down, or even stop activity altogether. Perhaps some replace the heavy weights with an alleged therapeutic dose of light weight and high reps. All of these therapies have a time and place, but for optimizing recovery and protecting the body from injury, these modes may be less helpful than intended and perhaps even provide contraindication.
As we age and miles build up, the incidence rates of tendinopathies increase. With this ever present risk, we must have a strategy for recovery and pre-hab that will safeguard as much as possible from the forces of entropy. HSR (Heavy Slow Reps) & isometric work can be some of the most effective ways of ensuring connective tissue health and healing while engendering longevity.
WHY WE DEVELOP TENDINOPATHY:
If collagen does not have the proper nutrition, hydration, or most importantly, adequate rest and recovery between workout or injury, connective tissues will heal poorly resulting in non optimum collagen cross linkages and potentially ill fated scar tissue that leave your body well prepared for flare ups and catastrophic injury. Without proper recovery or periodization of work, collagen formations structure in parallel patterns that are weak and potentially painful. But lets assume that these conditions may have been sufficient, but non-the less, tendinopathy develops. Below we outline a couple of science based remedies that can be instituted and included in weekly work as prophylaxis.
WHAT IS HSR (HEAVY SLOW RESISTANCE)?
Heavy Slow Resistance work sounds exactly as it is. Its lifting heavy weights slowly in the eccentric and concentric portions of movement. According to Scot Morrison (2022), HSR load is defined as >70% 1RM and at a tempo of 30 reps per minute being ideal. Although I find this rate a bit too fast, and follow a protocol more aligned with a micro set structure: 3 reps (8 s/rep), 3 sets, 15 sec rest in between each set, and with an intensity of >85% (Sakamoto & Sinclair, 2006).
Connective tissue adapts differently than muscular tissue and is most responsive to heavy stimulation, and long strain durations. One of the main purposes of connective tissue is to transfer force while providing a safe and pliable medium for safe landings. Cross linking of the fibers (optimal formation) are often increased with power, speed, and resistance training. Although, HSR & isometric work focuses on structure and recovery, all types of training can be periodized for best connective tissue health and resilience.
MECHANISM BEHIND HSR:
Fibril morphology is abnormal in tendinopathy. Improvements from HSR are due to changes in fibril morphology more towards normal fibril density and area and production of new fibrils through catalyzed collagen turnover. Fast and explosive movement tenses up connective tissue into a more organized unit (great for keeping joint functionality). Moving slowly, the connective tissue acts more like individual fibers and further activates collagen remodeling; building more robust structures. The focusing on the eccentric portion of movement optimizes collagen formation within connective tissue. HSR is considered more suitable for long term pain reduction and improvement in function.
WHAT IS ISOMETRIC TRAINING?
Isometric based training uses muscle contraction or tension without the movement of load; muscle length is fixed, and pressure increases in the muscle and joint capsule. This leads to an improvement of tolerance from stress the tissues can withstand before breakdown. Isometric based training not only increases mobility strength, (by +33%) and pain relief (which could be due to stimulating a reduction in inflammation cytokines (Anwer, S., & alghadir, A. (2014). In summary, isometrics provide a way to stimulate muscles without aggravating tendinopathy while appearing more effective during competitive environments for short term relief.
Kongsgaard M, Qvortrup K, Larsen J, Aagaard P, Doessing S, Hansen P, Kjaer M, Magnusson SP. Fibril morphology and tendon mechanical properties in patellar tendinopathy: effects of heavy slow resistance training. Am J Sports Med. 2010 Apr;38(4):749-56. doi: 10.1177/0363546509350915. Epub 2010 Feb 12. PMID: 20154324.
Anwer, S., & alghadir, A. (2014) Effect of isometric quadriceps exercise on muscle strenghth, pain, and function in patients with knee osteroarthritis: A randomized called study. Journal o Physical therapy science, 26(5), 745-748, https//doi.org/101589/jpts.26745
Morrison S, Cook J. Putting “Heavy” into Heavy Slow Resistance. Sports Med. 2022 Jun;52(6):1219-1222. doi: 10.1007/s40279-022-01641-y. Epub 2022 Jan 27. PMID: 35084703; PMCID: PMC9124646.
Lim HY, Wong SH. Effects of isometric, eccentric, or heavy slow resistance exercises on pain and function in individuals with patellar tendinopathy: A systematic review. Physiother Res Int. 2018 Oct;23(4):e1721. doi: 10.1002/pri.1721. Epub 2018 Jul 4. PMID: 29972281.
Sakamoto A, Sinclair, PJ. Effect of movement velocity on the relationship between training load and the number of repetitions of bench press. J Strength Conditioning Res. 2006;20:523-527 [Pubmed] [Brave]
