Putting “Heavy” into Heavy Slow Resistance

Scot Morrison,Jill Cook

doi:10.1007/s40279-022-01641-y

Scot Morrison, Jill Cook

Open Access

https://doi.org/10.1007/s40279-022-01641-y

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Abstract

The body of literature on tendinopathy management has come a long way in the last few decades and a variety of changes in the clinical approach have emerged from this research. One particular approach that shows promise has been called “heavy slow resistance” (HSR), and this has been the subject of investigation in a number of randomized controlled trials. While the premise for this approach is defensible, a critical examination of the implementation of these HSR protocols results in some concerns when compared to basic exercise science principles. This article lays out some considerations that will help future investigators to improve their exercise prescription approaches in this area.

Highlights

1 IntroductionThe management of tendon pain via progressive loading is well documented and appears to be one of the best interventions currently available
Heavy slow resistance (HSR) is commonly used when managing tendinopathies since tendon strain sufficient for adaptation is generally more likely at a higher percentage (> 70%) of maximum, but the Relative submaximal lifting capacity (RSLC) will limit total repetitions possible at that load (< 6)
There are some fundamental programming principles that appear to be missed in the heavy slow resistance” (HSR) literature that require clarification in order to make exercise prescription match the idea contained in the title “HSR.”

Summary

Key Points

Relative submaximal lifting capacity (RSLC) will dictate repetitions at a set load and slower tempos compound this effect. Heavy slow resistance (HSR) is commonly used when managing tendinopathies since tendon strain sufficient for adaptation is generally more likely at a higher percentage (> 70%) of maximum, but the RSLC will limit total repetitions possible at that load (< 6). This means that volume must derive from something other than increasing repetitions per set if %RM and tempo are maintained. There are some fundamental programming principles that appear to be missed in the HSR literature that require clarification in order to make exercise prescription match the idea contained in the title “HSR.”

Introduction

Relative Submaximal Lifting Capacity

Time Under Tension and Relative Submaximal

Findings

Discussion and Conclusion