Written by Tim McGonigle, PT
Priority #1 – Safety
Priority #2 – Bone cell production
Temporary conditions that perhaps were not present when your individual program was designed can cause weakened connective tissues creating increased fracture risk. These include illnesses, especially those related to viruses, systemic inflammatory conditions or infection, and the use of antibiotics or steroids. We recommend stopping the cell signaling aspect of the program for perhaps 3 weeks after the illness or consumption of the antibiotics or steroids has passed. Other temporary conditions that produce a general weakened state, such as a spike in stress, periods of poor sleep, excessive consumption of alcohol/recreational drugs, or a poor diet may also warrant a break from the cell signaling exercises for a few weeks until improved health conditions have been restored. If you are on a long-term steroid regime, please be sure your therapist is aware as more caution will be warranted when performing the impact exercises.
Please consult your physician regarding the safety of resuming the impact exercise program if there is any question regarding a temporary change in your general or bone health.
Allow for an Initial Tissue Toughening Period
For many, impact forces will be new to their tissues. Foundational remodeling for most tissues in healthy individuals takes 6 to 8 weeks. It is reasonable to assume it will take even longer if other musculoskeletal or health issues are present.
If you have not subjected your tissues to impact stresses for quite some time, or if you have other musculoskeletal or health issues, please allow for an initial tissue toughening period by gradually building up to full participation of your assigned program. For example, performing only 5 or 10 reps of each assigned impact exercise at 50% of a productive vigor for the first 3-4 weeks, gradually building up to the perceived productive vigor by week 8. We are finding that this gradual build-up is particularly important for the plantar tissues on the bottom of the feet and for degenerative joints/discs. We encourage initial participation with athletic shoes on to provide a little extra buffer against the jolt of the impact exercises during the initial toughening period.
Research on Impact Dosage
Research indicates that 40 impacts per exercise every eight hours produces the maximal number of new bone cells. However, this dose may not be necessary for improved bone health. While the impact does have to be enough to deform bones before their cells produce the signal to multiply, there is evidence that as few as six effective impacts three times a week is enough to stimulate new bone cell formation. It is your responsibility to adjust the application of the program to fit your current presentation (intensity, number of reps per session, number of sessions per week). It is far more productive to do a little too little over time than producing an injury that forces a disruption in the program.
Orthopedic Implants and Surgery
Orthopedic implants (plates, screws, rods, joint replacements) require a modification to the program. Any surgery temporarily weakens the local tissues. Please check with your therapist if you have any surgery prior to resuming the program.
Thank you for focusing on your safe participation in the program.
The Folsom Physical Therapy Staff
