Hypertrophy: I Got Over it

Hypertrophy.

Pursuit of mass looms large in performance -- for dudes. Gets to be obsessive sometimes in knee rehab. Girth is easy to measure. Feel the burn, see some results. But do those numbers reflect improvement in function?

Size matters. But is it the priority, especially at the start of the process?

Now patients can do some pretty functional (and slick!) e-stim at home with their own Power Dot or Compex units. These things can be helpful. We don't have to waste precious time during an in-person session now.

Then there is BFR. I'll be brutally honest: I don't like it and I don't bother. I think it is a major distraction from the real work that needs to be done in rehab. Why are physios so drawn to gadgets? Why aren't we more concerned with management of gravity and ground reaction forces? Connect the brain to the leg to the ground and move. Focus on coordination and control throughout the full ROM before anything else. Girth before capacity and joint integrity seems foolish.

The hypertrophy will come when you have full function and command of the system. Give it some time. Support it with the best nutrition possible.

I've not personally taken a medically-oriented course on the topic, but I have tried the Kaatsu stuff. I found the shit-storm of numbness and burn to be disconcerting. How in the world could anyone really focus on moving well and connecting things?

A set of force plates and some software seems like a much better investment. Spend your time building neuromuscular foundations. Yes, we track girth, but it is a secondary variable, not a primary focus. Play the long game.

On the athletic development side of things, I learned to bypass the whole "hypertrophy" training block -- and the whole scheme of traditional yearly periodization -- with my tall high school volleyball and basketball guys. They were all lacking in mass. But it was clear to me that my priorities were to arm them with good habits and good movement while they played too many games, all year round. I didn't have time to waste and we didn't have any mirrors to distract us; but we did have a scale to track the general trajectory of weight gain. This was the time to build body awareness and lower extremity mobility so they were ready for the collegiate system. My job was to keep their knees and shoulders healthy; keep their hearts joyful and make sure they were still loving the game.

From L to R: 6' 6", 6' 10", 6' 9", 6' 7", 6' 2". High school juniors and seniors.

I chose to support long-term health and physical literacy versus short term aesthetics -- periodize the long-term needs of the developing athlete, not the competition year. Taught them to eat and fuel better during this period of peak height velocity and peak sport madness. We cannot rush Mother Nature. We are much better off if we use our time with them to "build in" and not worry too much about the "build on." Most of these young men won't get to their full adult weights until their mid-twenties. So do what is necessary now and arm them with good habits and decision making. Yes, we can have fun and throw in some bodybuilding work now and then. But don't lose sight of what is most important.

If you can let go of hypertrophy, you will free yourself and your athletes up for the more important work. You will see that good programming and progression can support the development of both. Connect things first, don't isolate. Build in, then you can build on via a more authentic process of maturation.