A Quick Review on 3 Strengthening Regimens

Recently I was reviewing a care plan I had on a patient, when I asked myself what the end game was and why we were implementing specific exercises.  I was forced to review some basic strength training principles I feel all therapists could use a review on every once and a while.

1.      The Delorme technique:

This is the basic technique we are probably most familiar with.  This technique advocates for three sets of ten resistive repetitions progressively increasing the weight with each set.  More specifically the first repetition is generally 50% of the patient’s ten repetition maximum, the second, 75%, and then finally 100%.  The object here is to progressively load the muscle to reach the maximum there in fatiguing it maximally by the end of the last set.

2.      The Oxford technique:

In reverse of the Delorme, the Oxford maximally loads the muscle at the first set and progressively lightens the load as the muscle fatigues.  To date, there as been no significant evidence to advocate for one technique over the other.  Maintaining a range around 10 reps for three sets, and staying within these percentages for the 10 repetition maximum is repeatedly shown to be advantageous in strengthening programs.

3.      The DAPRE method:

This method affords us the ability to know when and how much to increase weight whereas the others tend to be less accurate and efficient.  In this regimen, a working weight for a 6 repetition maximum is calculated. Then based on the working weight the patient performs at least 3 sets, preferably 4 at 50%, 75%, and then as many as possible at 100% of the 6 repetition maximum.  Then, based on the max possible in set 3, the weight is adjusted up and down and a 4^th performed to the maximum.  This technique allows the therapist to precisely change the weight up/down specific pounds to best fit the patient.

These principles are based on strength training a healthy patient/muscle with no additional factors.  As you well know, in a rehab sense a maximum cannot be always attained for safety issues.  Use of thera-band and other resistive techniques at lighter weights can be used to target fatiguing the muscle.  I often stick with the principle of having a patient perform 50 repetitions with no fatigue, mild “muscle-burning”, and report of ease, before upgrading the resistance.  This high repetition number with no c/o adverse pain is designed for muscle endurance and efficiency over power and intensity. However, once the endurance is available and the patient can safely perform the exercises, adding weight for power and intensity can be safely initiated.

Reference: Kisner C and Colby LA. Therapeutic Exercise Foundations and Techniques. 5^th ed. 2007. pp 206-208.