Can muscle growth be the missing link in your rehabilitation journey? Discover how focusing on hypertrophy can revolutionize your recovery process on this episode of the Hercules Performance and Physical Therapy Podcast. Join Dr. Alec, as he unveils the often-overlooked power of muscle growth in physical therapy. Learn why building muscle mass is not just for athletes but essential for anyone recovering from injury or surgery. Through the lens of ACL recovery, we illustrate how early muscle regrowth is crucial for joint stabilization, pain protection, and accelerated return to normal activities.

We dive deep into the science of hypertrophy, shedding light on innovative techniques like blood flow restriction training that can stimulate muscle growth without overburdening injured areas. Understand the pivotal role of nutrition, particularly protein intake, in muscle repair and growth. Beyond rehabilitation, we explore how maintaining muscle mass benefits long-term health, from regulating blood sugar to combating age-related muscle loss. This episode is packed with vital insights and practical advice aimed at educating patients on why strength building is key to effective rehabilitation. Reach out with your questions and let us support you in transforming your rehab journey through the power of hypertrophy.

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Transcript

Dr Alec : 0:01

What's up everyone? Welcome back to the Hercules Performance and Physical Therapy Podcast. I'm your host, dr Alec, and today we're talking about a topic that's a total game changer when it comes to rehab. It's also one of my favorite topics to chat about. It's hypertrophy, it's muscle growth, and it's why it's crucial for anyone recovering from an injury, whether you're dealing with a surgery, chronic pain or you're just getting back to your favorite activities. Muscle growth isn't just for our athletes, it's for anyone trying to improve their quality of life.

0:37

Now, I know that when people think of physical therapy, they usually think of lacrosse balls. They think of mobility. They might think of little therapy. They usually think of lacrosse balls. They think of mobility. They might think of little corrective exercises. They think of, possibly, pain relief and dry needling, but muscle growth, hypertrophy is something we must focus on in rehab, and I believe it's one of the most missed components of the physical therapy process. So today we're going to break down why that is what the process looks like and how focusing on getting stronger can get you back to doing what you love faster, and also, if you're not focusing on this in the rehab process, why you may not be getting the results you want or back to the activity you want as fast as you should be.

1:25

But let's jump right in. What even is hypertrophy? Hypertrophy is essentially the process of increasing the size of your muscle. When you stress those muscles, they break down. So think workouts, training sessions, rehab those are all forms of breaking down muscle. It's a strength stimulus and with proper recovery they rebuild bigger and stronger. But here's the thing In the physical therapy world rehab, training, hypertrophy isn't always about getting jacked. I think a lot of people hear muscle mass and they think these big bodybuilders, and I can tell you from a personal standpoint the amount of effort and work it would take to build muscle mass at that degree is on a different level. It's a full-time job. What I'm talking about here is functionality Muscle mass that you should have to be able to do the activities you want. Functionality muscle mass that you should have to be able to do the activities you want.

2:31

Whether it's being a football player, who may require more muscle mass, or someone who participates in functional fitness classes just for longevity, there's a degree of muscle mass that must be had in order to stabilize your joints, to protect yourself from pain, to improve your overall movement in general, especially after an injury or surgery, it's likely that hypertrophy needs to be discussed, because after those particular events, meaning an injury or surgery, there's this phenomenon called muscle atrophy that might occur. And it's essentially when you boil down atrophy. It's muscle loss, because when you're not using those muscles for a period of time and it can be as little as seven days we start to lose strength, we start to become inactive and that starts to shrink the size of the muscle. Because your body's really smart. If it senses we don't need something, it gets rid of it really quickly. And muscle is super energy, expensive. It costs a lot to upkeep it. It costs a lot from a nutritional standpoint as well. Your body likes to be lazy at times. It will shut off the signal there and start to create that change if we're not using it.

3:43

So, for example, your shoulder might have been immobilized in a sling, or maybe you're recovering from an ACL surgery and the process of atrophy starts. With that atrophy, muscle loss quickly comes a weaker muscle, a weaker movement. So now there's weaker areas and less support. No wonder there's pain being generated. Our joints start to become achy. All these things start to spiral when we lose muscle mass. And this is exactly why focusing on hypertrophy muscle growth is so critical in rehab. So let's break down why that's such a big idea.

4:24

When you're dealing with an injury or you're recovering from pain or surgery, your muscles aren't just weaker, their entire musculoskeletal system is out of alignment. Weak muscles mean poor joint stability. Let's take a common example, one I've touched on already an ACL tear. After that surgery, your quads and hamstrings become very weak, they start to atrophy and the weaker those muscles are, the more pressure that might put on your joints, ligaments and tendons, as I discussed. Basically, you're asking your body to do a lot with a lot less support.

4:59

That's why we are fans of emphasizing muscle regrowth as early as possible. We're not talking about throwing you under heavy squats, heavy deadlifts. Obviously we've got to respect that healing timeline and we've got to understand and meet you where you're at. But we start small. With the right exercises, even at low loads, we can start working on hypertrophy to regain that lost muscle mass. The stronger your muscle becomes, the better protected your joints will be and the less likely you will experience a re-injury. The less likelihood that we're going to have problems down the line and the more likelihood we're going to get the things back to these activities faster down the line and the more likelihood we're going to get the things back to these activities faster. And whenever we hear stronger muscles again, let's start associating that with bigger muscle.

5:54

So let's go through a quick case example on an ACL. For any of you that have dealt with it or know someone that deals with this, this might shed some light on what's going on. Studies have shown that after just one week of immobilization from after the surgery, you can lose anywhere from 1 to 10% of muscle mass. That is huge and remember, muscle loss equals strength loss. The longer you wait to start addressing this, the harder it does become to regain that lost muscle. We're not just talking about the knee being weak in this case. We're talking about the downstream effects of your ability to walk, run, jump and even just stabilize your self-standing. That's why the sooner we can start working hypertrophy, the sooner we can build back that strength. And building muscle isn't just about returning to that full function. It's about preventing future injuries as well. If your muscles are weak and your body compensates in ways that put more stress on other areas, it makes you vulnerable to the possible forces that can lead to another ACL tear down the line.

7:09

Injury prevention is a hot topic in general and that's a whole other podcast. So the purpose and the way I'm going to describe this is a decreased risk of injury down the line, and I'm just going to use the term injury prevention for ease of conversation here. But when we're looking at re-injury you can start to see that these people that came out of ACL rehab came out of these long rehab processes and they didn't quite get their muscle mass back, their strength back. There can be a correlation to these increased re-tears that are often seen with more of a poor therapy bout. So let's be real.

7:53

For a second, building muscle, especially in the rehab setting where we have so many restrictions on us early on, especially out of something like an ACL surgery, building muscle is slow. I wish I could tell you that two weeks of working out will get you back to 100%. I will never advertise that. I will never tell people, because that's just flat out wrong. On average, you're looking at about 0.5% to 1% muscle growth per week and we're talking about optimizing muscle growth here. So yeah, it's slow, but that doesn't mean it's not happening and this is why a lot of people get discouraged and drop out of therapy programs too, because this process of building muscle is slow.

8:39

But when you put it into the context of just a general fitness program, think about how long it takes to truly lose body fat, build muscle. How many years body builders spend building up their frames? Those people don't look like that in a year up their frames. Those people don't look like that in a year. That's 10 years, 15 years, sometimes, maybe even longer. Maybe it even started in their early teens, where they just started getting to the gym and working out and they already came in with a base Point being is it is slow and you got to stick with it. A lot of people do get frustrated because it is so massively slow, but the truth is hypertrophy does take time and it takes consistency. Every session is progress, even if it doesn't feel like it at first. Your muscles need time to break down and rebuild. The important thing here is to stay consistent and trust the process. So here are some keys to how you, how we, how anyone can start to build muscle.

9:41

Growth muscle can start to build muscle more efficiently. The magic lies in something called progressive overload. So, simply put, progressive overload means gradually increasing the demand on your muscles over time. This can be done through a few different methods. Think adding weight to the barbell, adding weight to a dumbbell, increasing the reps that you do want to set, or even alternating, creating some variety in the exercises you use. These are all different tools to increase the stimulus that can eventually lead to more hypertrophy, more muscle mass.

10:22

When you're in rehab, sometimes we can't load you with heavy weights, so, taking a quick step back, there's a bunch of different ways to increase muscle mass, increase strength. One of the classic ways we think about building muscle is through heavy weights, muscular tension. There's two other ways in particular that are commonly discussed. One is metabolite, which basically means that buildup of waste products when you do a big set of something. So let's think a bicep curl, you've got a lightweight and you're doing 30 reps and you get that big bicep pump and burn. That is what we refer to as that metabolite buildup and it's another way that we can get more hypertrophy. It's another way that we build muscle, but it's not necessarily, according to research, the number one way.

11:17

When we think about muscle growth in general, we think about muscular tension being maybe the more effective tool. We think metabolite, that burn sensation and we also think something along the lines of the nervous system. So just the fact that you practice the skill of something like a squat and going through the reps, the more activation from your brain to your leg muscles and doing that skill can actually start to develop the muscle there, because your body knows it needs to lay down more muscle tissue to support that activity. You're training yourself to do you to support that activity. You're training yourself to do so.

11:57

Taking a step back there, we know in some rehab protocols, like coming off an ACL, that we can't use heavy weights. Maybe we can't even stand on a leg at the beginning. So we have to use some of the different mechanisms I described to get that muscle growth, even if it's not 100% optimal, like a bodybuilder would use when they're peaking for a show. So with that low load exercises, especially off of a surgery, we can provide some progressive challenge to the muscle. As you get stronger, we'll gradually then start to add load and more reps, especially as we move along in the timeline of healing. The body's smart you don't challenge it, it won't grow. And I think that's the underlying concept to all of hypertrophy. You got to continue to challenge the muscle. By adding a little bit more each time, you're basically forcing your muscles to adapt and grow. And, like I've mentioned, there's better ways of doing that at certain times in your rehab process, at certain times in your fitness journey. And that brings us right into a really unique tool that can be used to help you grow some muscle, especially when we can't use heavy loads early on.

13:11

And this first tool that I'm going to discuss is blood flow restriction. Now I will say this is a really trendy tool and it's one that has kind of a unique origin as well, and I'll get into that. But this is a tool for people who can't tolerate heavy lifting you during injury or coming off a surgery. With BFR blood flow restriction, we restrict blood flow to the muscle during light exercise somewhere around that 30% of your one rep max. That, in other words, means really light compared to what your strength was in the past. This creates a similar effect to lifting heavy weights by essentially, in simple terms, tricking your muscle into thinking it's under more stress than it really is.

13:59

But it goes right back to one of the mechanisms of muscle growth I talked about, which is that metabolite building. It's that burn sensation, burn sensation. So what it looks like is you basically put a cuff looking tourniquet around let's call it your leg, if you're trying to build your legs up after an ACL and we have a special tool that will allow us to accurately constrict how much blood comes in and out. And then we go through a series of exercises with it under light load to again protect the joint, the muscle, whatever it is we need to work on, and this allows us to get a really good stimulus to the muscle without irritating those things we can't really irritate at that moment. And this allows us to take those initial steps in the rehab process to building muscle mass, to again building strength, because if we're building muscle mass, we're building strength and let me tell you it works. We've seen amazing results with this technique for people recovering from ACL, tears, rotator cuff repairs, even chronic pain conditions where it is just very sensitive to get into certain movements like a squat or a deadlift. We can start to bridge that to our activities by starting a little lighter, but it gives us the advantage of still getting a really good challenge. That is needed to build the muscle to support that movement we need, and in the past we used to be a little limited. Yeah, we could unique our way around stuff, but it's always nice to work that movement you want and if it's very much dependent on the load when your pain starts, it's nice that we can scale back the weight a bit and still give you a good stimulus for your body.

15:48

The second tool I would say for muscle growth, especially in an early on physical therapy rehab setting, is nutrition, and that's probably not one you thought we would say, but your body needs the right fuel to recover and grow strong. You think about this all the time in the fitness world. Think of your muscles like a car engine. You're not giving it the right fuel, it's not going to run optimally. And when it comes to hypertrophy, protein is king. You need sufficient protein to repair and build your muscle fibers. A lot of experts recommend in that 0.8 to 1 gram of protein per pound of body weight, especially when you're in recovery mode. So you weigh 150 pounds, you should aim for at least 120 to 150 grams of protein. Beyond protein you also need to consider your overall caloric intake, so the actual amount of food you're taking in. If you're not eating enough, your body won't have the energy it needs to actually repair that muscle tissue that we broke down in our session, in our training yes, let's not forget about carbs and fats. That's going down some deep rabbit holes with nutrition.

17:02

Bottom line is most people come out of a surgery and totally just blow off their nutrition, thinking they're not as active, and that is the total wrong thing to do. I can remember right off my head two specific incidences where people recovering from an acl surgery pilato told me my nutrition doesn't matter, I'm not doing as much as I need to, and I just kind of put my hand, my head, in my hands because the way we recover from a surgery grow back all that tissue and muscle and all that fascia that that surgeon went through to correct the problem that needed to be corrected. The only way that's gonna grow back and recover is if you give it the nutrients it needs. You you eat food, your body digests that and it sends those nutrients to heal that area. If you're now, let's say, post-surgery and you decide, eh, my nutrition's not as important and you stop eating the protein you need, you stop eating all the good nutrients, you're not doing yourself a service. If anything, you're slowing down your healing process. The time you need to focus on nutrition even more so than you normally do, and I should say you should focus on nutrition all the time is out of surgery. So if you're serious about rehabbing your injury and actually growing the muscle to get stronger and improving how fast you get there, don't ignore nutrition. So let's move out of the rehab space for a bit.

18:33

Let's just talk about hypertrophy for longevity and health, and there's a huge group of people advocating for this now. A lot of doctors are a lot of. Our fitness industry is as well. Hypertrophy isn't just about getting back to your sport or activity. There's a component of just overall well-being. It plays such a huge role in overall health. I don't know if you knew this, but more muscle can actually help to regulate blood sugar. Muscle acts as a sink, in a sense, for glucose, which means that building muscle can actually help prevent or manage conditions like diabetes, and that's just one implication of the longevity that muscle mass can provide to someone if you have more of it.

19:22

Also, as we age, we naturally lose a lot of muscle mass, a process known as sarcopenia. If you're not actively working on building or maintaining that muscle, you're really putting yourself at a risk for decreased mobility, balance, strength falls, fractures all the things that we associate as we get older, and what we're starting to see is that it's because we're losing muscle mass and strength that these things occur, not because we're getting older per se. So if you really wanna do yourself some justice, start building muscle mass now, because I will say, it's always easier to build muscle mass when you're younger and you have more time on your hands, versus later in life, where now we're playing the catch-up game and it's actually harder to do some of the tasks we need to build that muscle mass. So if we're talking about injuries, we're talking about long-term health. Hypertrophy should be involved. So, wrapping this up, some of my final thoughts on hypertrophy and just the core of how it should be implemented into a rehab.

20:34

As such, hypertrophy isn't optional. It's essential for strength, stabilizing your joints and protecting yourself in the future. It's your body's armor and that's how I describe it to people in the clinic is view muscle as that protective coat that you're going to put on your body's armor and that's how I describe it to people in the clinic is view muscle as that protective coat that you can put on your body In general. If you have more of it, it's going to help you. There's very rarely a time where I'll say you have too much strength, this is a problem. We get to that point. We'll have a different conversation. We're doing something very right.

21:10

From a muscle hypertrophy standpoint, I very rarely have to say that. I've never said that. Let's be honest Build more muscle. You will not look like a bodybuilder if you don't want to. Most people who are bodybuilders even say to themselves they can't build enough muscle mass for what they want. It's very hard to do that. Don't worry about that. Build it for longevity's sake. And plus, having more muscle mass in your frame just helps with a lot of different things like I discussed, like diabetes, glucose regulation etc. And just remember muscle mass building hypertrophy is slow and steady process. It does. It takes time, consistency and the right approach, the right mechanism for what you need to do to get that muscle to grow.

21:59

If you're feeling stuck, if you're unsure what the current plan is, go back to the basics. Start with a basic strength and conditioning routine. Then think about progressively overloading, adding a little bit more weight, more reps In general, sticking to your general three to four sets of eight to twelve. It's a really good starting spot for hypertrophy. No, it's not the end-all be-all there, but in general, if you take yourself pretty close to failure and you use a heavy-ish weight somewhere in that 70 to 80% range, you're going to do yourself really good service and you're going to put really good results, not only from a longevity standpoint, but in a rehab standpoint, where you're trying to recover from an injury and you're trying to make something stronger.

22:59

You got to build the muscle mass. It's not talked about, but it must be done. Thanks for letting me chat your ear off about hypertrophy. Like I said, it's a subject I'm very passionate about because it's something that's not often associated with the rehab process, yet it's an underlying mechanism of how we get stronger. It's a huge component of what I'm going to say.

23:28

My physical therapy field preaches, but we don't do a really good job of educating that. That's what's going on, and I think it makes a lot of sense to people when you explain we need to make you stronger for X, y and Z. We're dealing with this injury, so now it's time to grow your muscle and this is why it's taking so long. This is why you got to put in the time and the effort. It doesn't just happen overnight. Just like building muscle for your fitness routine for longevity takes time and consistency, so does this process for the rehab setting. Thank you again, guys. If you have any questions in your rehab journey anything on hypertrophy, anything on fitness give us a shout-out and we'll be more than willing to help you. Have a good rest of your night, guys. See you soon.