CEU: Rehab Concepts: Superset - 201

Hey, this is Sandy. And Randy? And we're here on AT Corner. Being an Athi trainer comes with ups and downs, and we're here to showcase it all. Join us as we share our world in sports medicine. Welcome back to another episode of AT Corner. For this week's episode, we have another Rehab Concepts Education episode, and today we'll be talking about Super Setting.

It's been a while since we've had a rehab concept, so I'm super excited to dive into this and I feel like super setting is probably something that athletic trainers do, but not something that we actively think about. Say consciously do right, right When I first think of like super setting, I feel like it's like my first thought is like, this is a really cool late stage rehab kind of concept. I mean, I, I guess you could

probably do it whenever. That's just what comes to mind for me. That's actually really funny that you say that because I feel like I do it a lot earlier than late phase, yeah. It would be funny is or would it be cool is if, because I didn't see anything like this, if they actually had more kind of super setting for rehab, that'd be actually pretty cool to see. So anyway, this is ACU episode.

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this? Yeah. So we're going to describe what super setting is and kind of what the goal of using this kind of technique is or then we're going to discuss the physiological response to super setting and then we're going to discuss the applications of super setting as it relates to rehab. So if you're wondering what is super setting we?

Just kind of jumped in and kept talking. Then you have come to the right place. Basically it's a programming style designed to create a lifting session that is time efficient and what it basically consists of is performing two or more exercises which I didn't know the OR more part, I always kind of knew it as just like 2. But yeah, honestly, I, I kind of picture two, yeah, like when I'm doing rehab. But yeah, I mean, I guess you could do more than two, I would say.

Technically you can I There actually was one study that did do what's kind of termed Tri setting, which is basically super setting with three OK exercises. But essentially these exercises are done in succession with minimal to no rest, right? So you're basically jumping from one exercise to the next with really no rest period in like in between those. So there are three different types, which again, I didn't know that either. I kind of only knew the the first one which is agonist and

antagonist. That's what I think of. Yeah. So this is basically you're exercising The Agonist muscle and then you jump to a set of the antagonist muscle. So for an example, this would be like a bicep curl. And then you start doing like tricep extensions. The next type is is called alternate peripheral, which is basically do an upper extremity exercise and then do a lower extremity exercise. Yeah, I didn't know that. Yeah, I I wouldn't have thought

of that either. And other than like, I feel like here here's I feel like maybe some of us have been doing this on accident because like you do an upper extremity exercise and you're like, Oh well, you don't need to rest before you like go into a lower extremity, you know? Yeah, actually really fast before we move on to for The Agonist antagonist, just a a short plug for neurokinetic therapy. If you guys have not heard of it. It's a basically a I don't even

know how to explain. It's like a technique. It's like a it's like a different take on manual muscle testing. To help with your evaluation, like with manual muscle testing that really dives into agonist antagonist relationships. Yeah. So if you are more interested in that and want to dive a little bit deeper in The Agonist antagonist, neurokinetic therapy would be a really great place to start. Yeah, for sure. I wish there was more research on that because that'd be cool to read.

And then the final type of super setting is biomechanically similar. So this is basically the same muscle or action, which is kind of maybe like a slight difference in the type of exercise. So this is like possibly doing like bench press and then going into like like flies or doing like a barbell bench and then jump into a dumbbell bench, right? So it's a slight variation, but you're basically doing the same

motion. Oh, OK. So again, the goal of super setting is, hey, we're trying to make a time efficient way of lifting. So does it actually do that? And the evidence does say it is

actually very good at doing that. Oh, that's awesome, yes. So when it's compared to traditional lifting. So this is like completing one set of exercises and then resting and then you progress to the next and then resting in between those sets. So like doing your squat, one set, rest squat, one set, rest, squat, and then move on. It's actually like around 60% faster than doing traditional lifting. So one of the studies that looked at it was like a traditional lift lasted about an hour.

Super setting cut it down to 35 minutes. That's kind of cool. Yeah. So it actually you actually do get a really good workout out of this. And what's crazy is a lot of those studies also found that the perceived exertion super setting was harder than traditional set like traditional lifting. I mean, it makes sense. You're kind of being in that more fatigued state, not allowing your body to be fully rest, which I think is so

beneficial. When you think of like sport, you don't always have like that A1 minute rest or like that two-minute. Yeah, that's true. I didn't think of it that way, but that's very true. Like you don't really have a lot of time to rest. Right. I mean, depends on the sport also, and I keep going back to this, but I feel like this is also something that maybe we can be doing more intentionally because I feel like this is something that happens anyway.

Like, you know, you know how many times you write a rehab plan for an athlete and you kind of just let them go and you know, they've been coming in and, and doing their own thing and like, you didn't tell them how much to rest in between. Like they might just be doing REST or not be doing REST. I would say or even if you did that, probably just. Did more just jump into the next thing? That or took too long to rest 'cause they start talking to

somebody. Right, I think that the last time that we we sat down and timed the rest in between someone sets is BFR. Probably that's yeah, 'cause there's AI feel like there is a lot more to that, you know, with the machine and 'cause the machine has programmed rest right? You just have to do the 30 and then 32nd rest and then 15 and then 32nd rest and then 15, yeah. Yeah. So yeah, you're right. I don't, I don't can't even

think of a time. Last time I actually sat there like OK we're resting for 30 seconds, timer on. Right. So now that we know it actually at least achieves its goal of being a time efficient kind of programming style, now it's time to understand what why is it different? Is it the same?

What is it exactly doing? And it really kind of depends on the type that you use. So if you're kind of using the more biomechanically similar method, right, you're going to you're choosing a method that's going to be more fatiguing. All right? So you're going to try and choose something that's going to probably go towards more the endurance side of it. And I wouldn't say necessarily it's an endurance exercise. It's kind of like that strength

endurance kind of idea. But compared to like agonist antagonist, like this is the more kind of fatiguing method. I mean that agonist antagonist would still be fatigued but. I mean, it makes sense you're just targeting the same. Muscle, and this is kind of seen by the evidence that shows that throughout the lift, as you go through the sets, you see a lower velocity of the lift. Power also starts to decrease. So you can see they're starting to get fatigued.

Also there are increases in blood lactate levels, right, which can also lead to fatigue if it's from the increased acidity from the lactate. And then it can also possibly lead to more damage, right, 'cause the acidic environment cells don't really like that and then start to also become damaged as well. And then again, you can also see increases in creatine kinase, which is usually used as a sign

for DOMS. So it kind of a sign of, hey, you're increasing more damage, you're going to get some more soreness out of this. But most athletes really just, and maybe most clinicians kind of care about the OK, well, do we get strength out of it right? And what I found found to be

very interesting was the results really tended to be very similar to traditional lifting. Oh, that's really interesting. Like the strength gains were actually very similar. So it takes less time to build the same amount of strength. Yes. And probably more quote UN quote painful because you have to work through a little bit more fatigue. Yeah, for sure. Some results have shown like in some categories that there's like a slight non statistical increase compared to traditional

as well. But again, technically non statistical, but something to note. I think it's very interesting. So yes, it does kind of lend more to that efficiency part. Next kind of looking at power

and honestly the results are the same as strength, right? It tends to be very similar to traditional lifting. But what I thought was interesting is the studies that kind of looked at this or like anything that I saw didn't really look at power specific exercise. All right. So they still compare just traditional lifting, which is more kind of strength based. They didn't look at like, oh, compare it to a plyometric program or like, you know, actual kind of power lifts.

The programming is specifically powered powered for power. I feel like when I think of super setting I would not pair this with power. Neither would I. I feel like, so for example, one of the ones that I do is a single leg RDL with a kickstand with a dumbbell or a kettlebell. And so I do that and then I move into a split squat and and

that's like very standard. You can watch their form like I feel with with power, it's like I worry about their form with fatigue, which I mean, there's also the argument that you should be working kind of through fatigue to make sure that they are able to get there. But I, I don't know, I feel like you kind of have to make a judgement call now and power is

not really one that. Yeah. That's why I think if you looked at it probably to power specific programming, it probably wouldn't hold up because this is just compared to traditional lifts, right. So I agree. And then next is now kind of looking at hypertrophy and I, I feel like this one's very

interesting. I didn't really see anything that really labeled results for hypertrophy. So actually looking at change in the muscle size. So with hypertrophy, the one thing that is really difficult for for us to kind of do with hypertrophy, especially if like the athletes fairly healthy. I mean, obviously if we're rehabbing them, they're slightly injured, but like in general, right, they're kind of in a healthy state. It's not like post op. Post op is something different.

Don't have huge, obvious deficits. Yeah. But for hypertrophy, you tend to need really high loads at very high intensities, right? Like I think, I think technically the hypertrophy window is like 8 to 12 reps at like I think it's over percent over over percent, over 80% one Rep Max on on an exercise. So this it's, it's a very intense thing and super setting. Like some of the studies didn't really go that far, like didn't

use that kind of intensity. But it is interesting because some superset studies actually showed you lifted more total load compared to traditional lifting. So theoretically there could be the avenue for that. But then also others showed that it was actually less load compared to traditional lifting. So what you're saying is it depends. I say it depends. It's. A very athletic training thing to do. Yeah, I think it's really dependent on the type of kind of super set program you do.

Like if you're doing the biomechanically similar, well, you're probably not going to get through as much 'cause you're going to fatigue, right? Whereas maybe agonist antagonist, right, you might be able to get through more 'cause the muscles aren't necessarily fatiguing at a faster rate. Also, there is some linture that has shown maybe a slight increase in testosterone after a superset. This was really small and the study that kind of looked at it

used a lower intensity anyway. So it's kind of like how helpful is that? And did the study even, could this study achieved more if they did higher intensity? It's a little question mark. So I think for hypertrophy, it's still kind of up in the air, but still a possibility for strength and power. OK. Did they say anything about fatigue or like endurance? I didn't see anything. Is I feel like this would be great for that for endurance. Yeah, I didn't see anything on

endurance specific exercise. I'm trying to think off the top of my head like if they were able to do more reps over time. Yeah, I didn't see anything that looked at like true endurance because I would assume this would help with endurance. And honestly I feel like it would help with the strength endurance. So it'd be interesting to see a study that looked at as you fatigue, do you maintain your

strength longer? See, that's like when I do this, I'm mostly doing it when like in the later stages. OK, So I know I said earlier that I do like earlier stages. I think earlier stages I just kind of group the exercises together. But like when I'm trying to target endurance, like later stages, I kind of do more like less rest and more grouping of exercises to target that fatigue and work through that fatigue. For sure. So yeah, now taking it into that kind of practice approach and

like, like you said, I think it really depends on what your goal is for your rehab and what kind of your super setting you kind of want to do. Like I said, I think it's really great, especially like if you're looking more late stage rehab, like really strengthen durance, right 'cause you know you're, you can increase some strength and you can also increase some endurance. So being able to maintain the strength as you start to fatigue.

I think it's very important, especially if you go with more of that that biomechanically similar style that's going to be a little bit more intense towards the endurance side of things. So I think that's definitely a good consideration if you're kind of looking and of course for strength and power, right. The normal like we've already presented like that is going to be just like traditional lifting just cutting down almost half the time.

But if you're looking for something hypertrophy, I mean, it might still be possible. I think you just really have to make sure that you are doing those higher intensities and maintaining higher loads. Again, I feel like as athletic trainers like going for high hypertrophy that necessitates those higher loads. It's really hard for us to do

just time wise. That's almost kind of like you're hoping your strength coaches are doing that if you have access to one, but still a possibility if you do have time and you're in that possibility and you are doing a late stage rehab that needs still focus on hypertrophy. I thought what was interesting, some of the studies did kind of differ on OK, how many reps did they do within the set?

Did they go to like failure, muscle failure or do they just do a normal set range and going to failure can still help with hypertrophy. There are some studies out there that show that going to volitional failure can actually increase hypertrophy. But again, I don't think you could really compromise the load component. You do need a higher load to actually induce hypertrophy. And like I said, right strength, a great technique for this.

I think the really nice thing about this technique is just the time efficient component. And I think the word time, time efficiency makes any AT happy because yeah, I I think it's a nice way of especially again, if you have someone late stage and you're like, dude, I just don't have enough time to dedicate like taking someone over to the weight room because you know, you have all these other things, right? This might make it a little bit more feasible, right?

You're cutting down to 30 minutes ish, right? That's not bad. You know, that's a lot easier to find in our time than an hour plus. Honestly, I think it is just being more intentional with it. Like and here here's I don't know how you guys do your rehab plans, but usually like I'll I'll write my exercises out by by like what I'm trying to target. And the reason why I do that is because like let's say I am targeting a hamstring strain and I'm trying to target, right.

I'm trying to do hamstring eccentric, I'm trying to do hamstring concentric, I'm trying to do a glute, I'm trying to do core. You know, I'm trying to maybe some calves like. So I'm trying to target all these things, right? And I'm going in and I'm riding in my exercise sheet like hamstring, hamstring, glute, glute, like whatever. And I target them by a group because then I, I actually work with athlete and say, Hey, like

I'm giving you all of these. But on, on one day I want you to like pick like 2 hamstring exercises or pick like 1 glute exercise and then pick like 2 core exercises. So then they have a little bit of variety within their rehab plan, but they're still targeting the same group of muscles. I think if. For me, like because I because I like categorize it that way in

my rehab plans. If it is this, this actually might be easier to target with the supersets because I can just be like, oh, do this and then like no rest. And when you go into like this next. But I was also thinking something that I do for hamstrings, some manual resistance, just having them prone. Usually I'll start them with an eccentric manual resistance of that hamstring where they're just prone in just knee extension or knee flexion into knee extension. So I'm resisting and I'll do

that and then no rest. I move into that concentric phase and the concentric phase is so much harder after that eccentric. But I like to do the eccentric first, especially because muscle recruitment and we're and it's harder and I like to target that eccentric later. I end up doing it when they're more fatigued like later stages. But I like to start closer to that and I do superset that one, yeah. Nice. That's interesting. That's really cool.

And that would be more of that bio mechanically similar. Similar. Yeah, for sure. Nice. That's cool. I feel like most of the ones that I do are bio mechanically similar. I mean, that's very cool. You're stressing the muscle put into a very fatigued state. Right. What are some of your super sets that you've done? Do you have any like?

See that thing is, I don't think I've ever consciously actually done it. That's why I was interested in reading this 'cause I do kind of want want to start applying it a little bit more. I feel like I would like to do The Agonist antagonist more. But now I'm very intrigued based on what you said about that biomechanically similar kind of way of applying it. I feel like the reason why I like target this is because of fatigue.

I don't, I didn't, I didn't really think of it because of hypertrophy or because of like any of these other things that we talked about. Like it makes it makes sense. But I feel like it's so much easier to think about it as especially the the biomechanically similar ones, the ones that are you're, you're already working that muscle and then you're going to keep working that muscle.

And again, remember with super setting, it is back-to-back exercises, minimal rest in like in between those sets, but like there is a rest component be like before you start it up again, Right, Right, right. But yeah, so just keep that in mind that it is supposed to be stressful like that. It is back-to-back like, OK, we go to this exercise. All right, moving to the next. Nope, stop stalling. No, no conversation. Let's go.

I also like to do The Agonist antagonist back-to-back if I've noticed that they are targeting and not targeting, if they are recruiting. You know, sometimes when you get injured, you recruit the antagonist. Yeah, I, I like to do that so that we can the kind of fatigue, quote UN quote fatigue, right, the whatever antagonist. And then when we move into the opposite, then we can try and

get that knot to fire. And I was going to say, there's actually evidence behind that as far as it increases neural drive to The Agonist muscle when that happens. Nice, yeah. So you are increasing that kind of neural drive to actually get The Agonist to fire more. And ideally that should get the antagonist to like, not fire. Yeah, correct. Ideally, that's kind of like my. Perfect world, right? I'm.

Trying to think of an example of when I do this, I feel like it's, it's just like I see it and then I'm like, oh, let's just let's just target the opposite muscle. It's hard for me to like sit here and think in a perfect example. But yeah, I actually, I do pair my my calf raises with my tib raises. Nice. Like against like I'll do like calf raises, like usually I'll do like sets of 15 'cause like that, that's pretty for sure tiring.

And then and then I'll get them back against the wall and then do tib raises like straight into those. But other than that, like, off the top of my head, I, it's hard for me to think of a perfect example. Yeah. Yeah, I can't think of actually consciously programming it this way. Oh sorry I hip flexors. Hip flexors love to Hip flexors are so tricky. Sometimes I feel like the hip flexor glute like that hip flexion glute or hip extension like pairing. I feel like that's a really good

pairing too. Yeah, yeah, for sure. Yeah, OK. You were going to say sorry? No, I was just thinking. I just don't consciously think that I've meant to do that. I feel like I've done it. That's what I think is like when, when you were talking about this, like I, I really think that this is something that we do in rehab. I think that we can we have so much power with knowledge to make this more intentional because it is super beneficial. It is even just from a time

efficiency component, right? Right. You can cut down time, which again most a TS wish they had more of right? So being able to actually have something that can achieve the same goals is just lifting is very beneficial. What is your action item for this? I would say super setting is very similar to traditional lifting as outcomes, so I think it's something that you can feel pretty confident to try and implement into your practice. How?

By programming an exercise after an exercise with minimal to no rest, being a little more intentional about how you organize it. And then just really knowing what what your goal is for that rehab. I mean, we already do a pretty good job of what coming up with our goals for rehab. So I think that might be an easy transition to be able to like, Oh well, I want this to be a more fatiguing day and I'm going to use this technique to do so.

Honestly, I think this will also help with setting the intention and setting, setting up a little bit better of a rehab program because and I see this like when athletes come from, you know, some other places or even clinics that they go see other clinicians, sometimes they are just given really basic exercises that don't challenge them.

I feel like this can also add a level of challenge for sure that even with the same exercises, I think can target a little bit different, different intention and really get us a little bit closer to our goal of getting them back. For sure. So with that, again, if you're interested in this CEU, go ahead and Scroll down to the show

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