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Appropriate rep/set quantity when rehabilitating serious myogenic nerve entrapments 

MSK Neurology
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Finding an appropriate rep/set quantity is often difficult in issues where there is severe muscular impairment, and especially with serious polyneuropathies such as thoracic outlet syndrome or lumbosacral plexus entrapment syndrome.
The reason for this, is that for something like this to develop, the impairment of the muscle is so severe that its work capacity is close to zero. Excess stimulus will result in overloading and inhibited progress, demotivation and inevitable failure.
The more generalized a strengthening protocol is, the more a muscle can handle. This, because the "isolation" is very poor, and compensation great. WIth properly executed, specialized exercises (as in my channel), however, the impaired muscle will be stimulated very directly. This is necessary, but also comes with pitfalls, especially with regards to the great likelihood of overburdening. For serious muscle impairments, anything between 1-15 reps, one set, twice per week is usually adequate. Generally, for TOS or LPES, around 5 reps will be adequate, although it may sound absurd at first. If this isn't heavy or cause any pain the day after, you are likely not getting it right, or the diagnosis is wrong. Usually the first-mentioned.
By properly regulating the work intensity, a great and linear progression may be achieved.

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11 фев 2019

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Комментарии : 55   
@ImpulsoCreativo9322
@ImpulsoCreativo9322 4 года назад
This was so needed and so well done.
@Stoffendous
@Stoffendous 2 года назад
Youre such a BOSS Kjetil. Thanks for these great videos!
@crippen479
@crippen479 5 лет назад
Thanks A LOT for this. For me this made perfect sense, and I also feel the rush of the ego. I was actually glad that it takes so much time, cause that is my experience, but not my expectation. Now both my experience and expectations are in sync. Cheers for your amazing work.
@melodyebuskin5490
@melodyebuskin5490 Год назад
I’m combining a few of your exercises in rotation throughout the week ie two or three videos every other day. Thank you for all the work your do to help others. Your videos have answered so many questions I’ve had for along time.
@gpmaher
@gpmaher 5 лет назад
Thank you for this posting
@khabibthebear-whisperer4740
@khabibthebear-whisperer4740 5 лет назад
Thank you for uploading new videos! Look forward to seeing more from this channel👍
@bakercorps
@bakercorps 5 лет назад
U can't box
@martingibbins6621
@martingibbins6621 3 года назад
Definately needed this video. I've clearly been overtraining my scalenes and piriformis by working them too often. It's difficult being patient when you're in such agony.
@MSKNeurology
@MSKNeurology 3 года назад
Common problem. Less is more when it comes to rehab.
@michaelmelvin7045
@michaelmelvin7045 5 лет назад
You sir are awesome... The ego check or "realism" is a big one for me. After dealing with TOS for over a year and finding your info.. I just want to jump right in and do a million reps and be better.. sure enough it doesn't work like that. I did probably 2x10 (probably cheated) a couple days in a row for the scalenes and man, my symptoms definitely flared up. I kind of wanted to cry when you just said it's okay. Take it as slow as you need.. that we need to keep ourselves in check. I really appreciate you and the info you share and also your passion for the work you do. Thank you.
@MSKNeurology
@MSKNeurology 4 года назад
Good job bro
@screambluemurder101
@screambluemurder101 4 года назад
Michael Melvin how is it now?
@melodyebuskin5490
@melodyebuskin5490 Год назад
At 6:10 onwards: Five reps, one time, twice a week…it can take a year. Makes sense.
@mementomori6526
@mementomori6526 5 лет назад
Great video.Could you do a video for restoring the normal curvature of the cervical spine ?
@MSKNeurology
@MSKNeurology 5 лет назад
Already done. Search my channel
@chrisarmstrong6304
@chrisarmstrong6304 5 лет назад
Thanks for your channel and blog - they've been super helpful to me after being fed years of template rehab advice. How do you differentiate between mild, moderate and significant exacerbation of symptoms? For example, I did 2 x 10 for medius and anterior scalenes earlier today, and now I'm feeling tight and tingly around the region. Would that be classed as mild or significant? Thanks again.
@MSKNeurology
@MSKNeurology 5 лет назад
Sounds like it's mild. If it passes within a few days. 2x10 is excessive, but the more wrongly you perform the exercises the "more you'll get away with". All in all just follow the advice given in this video.
@naimismail7768
@naimismail7768 3 года назад
Hi Dr, Great video. I suspect that I have TOS, do you have any video's on how to train weak/rigid scalenes? thanks
@mapex311
@mapex311 3 года назад
Yeah search his videos for scalenus
@steverogers7869
@steverogers7869 3 года назад
When you say 'heavy' what does that mean exactly? If doing trap shoulder shrugs, I assume that means a lot of weight with proper form. But what about strengthening longissimus colli or SCM? Does heavy not apply here?
@gemini456
@gemini456 2 года назад
Hi Dr.Larsen. Thanks for all your videos and information. What do I do if one rep once per week gives exacerbation for many days. In my case in piriformis syndrome.
@MSKNeurology
@MSKNeurology 2 года назад
Then you're looking at years of rehab. I don't recommend surgical resection for this problem. Do one rep per week. Try to increase to 2 after six months. If it makes you much worse, do 3-6 months more at 1 rep and try again. Also be sure to wath my videos on muscle bracing and clenching.
@jackprot351
@jackprot351 Год назад
@@MSKNeurology Have you had patients with this level of weakness recover and ameliorate their symptoms over the course of years, or are you extrapolating your theory in this instance? I am in a similar state as Gemini, but regarding my JOS; when I hold my head in proper positioning for any longer than about 30 minutes per day, I get severe exacerbation of symptoms(fatigue, brainfog, heavy head) for a week.
@brendanschroeder1862
@brendanschroeder1862 Год назад
Dr. Larson, I’ve enjoyed your writing on muscle thickness regarding atrophy and fatty infiltration. My question to you is, is there a way at home or a simple test to determine whether a muscle is thick due to strength or fibrose?
@MSKNeurology
@MSKNeurology Год назад
No, expertise is needed
@zuraiashvili8647
@zuraiashvili8647 4 года назад
Dr. Larsen, first of all thank you for sharing all these invaluable information. I have question regarding muscle thickness that you mentioned, I have done ultrasound study which indicates that scalenes on the right side where i have TOS are 1.1cm thicker than the ones on the left side. What i have been told is that these muscles are overly strong and active and that's why they are thick so i need to relax and stretch scales, you are saying that muscles can be weak and thick please explain how does this work? please?
@MSKNeurology
@MSKNeurology 4 года назад
Read my tos article
@zuraiashvili8647
@zuraiashvili8647 4 года назад
@@MSKNeurology Dear Larsen, i must have read it at least 10 times by now, but i dont understand whether muscle thickness means hypertrophy(which you say in article) or weakness, there is no one here who can do muscle test, they just looked at these muscles on ultrasound and right anterior scalene is 1.1cm thicker than left one and middle scalene is 0.6 mm thicker. I also lose some of the blood flow in the scalene triangle and complete loss of pulse below clavicle when i extend my hand and rotate head. I just dont understand how should i identify whether i need to strengthen these muscles when they are already thick. I am not doctor so maybe i missed something in your article or i did not understand it.
@MSKNeurology
@MSKNeurology 4 года назад
@@zuraiashvili8647 Damanged muscles fibrose and become thicker. The thickness is due to damage, not hyperactivity. You may appreciate the text from my LPES paper: PATHOGENESIS Lumbosacral plexus entrapment syndrome is caused by entrapment of the lumbar plexus, lumbosacral trunk and proximal sciatic nerves within the psoas major and piriformis muscles, when these are impaired. The cause, and even definition of impairment, however, is a controversial topic. Again, some jumping between issues is necessary to provide citations which may illuminate the question at hand. A commonly accepted notion is that TOS and piriformis syndrome (PS) are caused by overuse and hypertrophy of the scalenus anticus and piriformis muscles.55,56,57,58,21,59,60,61,62,63 However, if this was the sole cause, then one would expect daily stretching, massaging, or at least surgical resection of the hypertrophic tissue to resolve the problem. This, however, has not turned out to be the case. Contrarily, Hopayian et al. state, in their systematic review,21 regarding piriformis syndrome, that this problem has been described for the last 70 years, yet it remains controversial, as it could be argued that there is no value in diagnosing a problem which has no proven treatment. Regarding conservative treatment of TOS, Vanti et al. state, in their review,59 that there is no consensus with regards conservative treatment of TOS, e.g. as to what should be stretched and what should be strengthened. It is also well known that long-term outcomes out surgical intervention for TOS have variable outcomes at best.64,65,66,67,68 Could it be that the lack of consensus, as well as beneficial treatment outcomes are a result of fundamental Page 4 4 pathophysiological misconceptions? Is it likely, based on both the evidence as well as empirical data, that “overactive” and “overly strong” muscles cause nerve entrapments? Inevitably, a misconceived etiological perspective would negatively affect both diagnostic criteria as well as treatment outcomes. Digging deeper, research has shown that painful areas may develop myofascial hypertrophy with fatty infiltration (atrophy),71,72,73,74,79,78 implying that these thickened muscles, in reality, may be injured and tremendously weak. Elliott74 showed that whiplash patients tend to develop hypertrophy with concomitant atrophy of the cervical muscles. Langevin71 showed that low back pain sufferers might develop up to 25% thicker thoracodorsal fascia than controls, despite the well-known prevalence of paraspinal erector atrophy in LBP patients.75 Stecco76,77 showed that the degree of thickness correlated with pain levels and that the affected muscle’s fascia rigidizes due to a buildup of hyaluronic acid. Massoud78 demonstrated that hypertrophied gluteus maximus muscles in sacroiliac joint dysfunction (SIJD) were hypertrophied upon inspection, yet proven very weak upon strength testing. Similarly, Mooney79 demonstrated gluteal EMG hyperactivity of the gluteus maximus on the symptomatic side of SIJD, however, and interestingly, after improving gluteal strength, its excess EMG signal output normalized (i.e. reduced), indicating that EMG overactivity may be a sign of muscle inadequacy and not necessarily a sign of domination, as it is generally considered. Thus, increased muscle thickness & activity in the co-presence of pain may indicate underlying weakness and injury of that structure. Certainly, a thickened structure with high EMG output, but later proven weak, is very counterintuitive. But, these findings may aid in explaining why many seemingly logical approaches to disengage (massages, stretching, needling etc.) “over-active” culprit muscles, e.g. the piriformis muscle, repeatedly fail in providing long-term relief in the treatment of entrapment neuropathies. Moreover, MR imaging of the culprit muscle’s tendons may frequently reveal tendinous hypointensity consistent with chronic degeneration as opposed to dominance, as will be discussed in detail in the “Imaging” section. Therefore, with regards to the mechanism of pathology, impaired muscular structures such as the psoas major, piriformis, or similar may develop fascial fibrosis and subsequent rigidity as a result of chronic inadequacy and overburdening, irritating its intimately traversing nerves, resulting in entrapment neuropathy. The notion that weak muscles, rather than overly strong and dominant muscles are the culprit, carries a greater sense of logic. Why would strength be a liability? Then, rather than performing never-ending myofascial release (MFR) in the hope of disengaging the “fiendish muscle”, a strategy which has repeatedly proven not to be an effective long-term intervention for entrapment neuropathies, a simple and inexpensive approach of muscle strengthening may be carried out instead. (3) (PDF) Lumbosacral entrapment syndrome, a little-known but common cause of chronic pelvic and lower extremity pain. Available from: www.researchgate.net/publication/329177824_Lumbosacral_entrapment_syndrome_a_little-known_but_common_cause_of_chronic_pelvic_and_lower_extremity_pain [accessed Jul 17 2020].
@MSKNeurology
@MSKNeurology 4 года назад
@@zuraiashvili8647 The quick answer to your question is to do what I recommend in my article and stop wasting your time on bullshit
@martingibbins6621
@martingibbins6621 3 года назад
@@MSKNeurology phenomenal info there. Thank you.
@brendanschroeder1862
@brendanschroeder1862 Год назад
Dr.Larson, I watched a seminar on CCI today. One of the main points was with instability, the joints “turn off” and the muscles “turn on”. With this, the muscles being constantly on degenerate. Do you agree with this?
@MSKNeurology
@MSKNeurology Год назад
Not even close
@user-nm8kq5qu8m
@user-nm8kq5qu8m 5 месяцев назад
If you find a rep amount that provokes non-pain related symptoms, like anxiety, nausea, dizziness for the longus capitis to a moderate degree, but do not provoke pain of the muscle at all, does that indicate that it is too much or too little? If I push to the point of even mild pain (8 reps), my dizziness and other symptoms get pretty bad the following day, so I've been doing fewer reps (5 reps)
@user-sh3kn9ov8v
@user-sh3kn9ov8v 9 месяцев назад
Would you say that small support muscles recover faster than big stronger muscles? Therefore one could train those muscles more often?
@MSKNeurology
@MSKNeurology 8 месяцев назад
In my experience it has more to do with degree of deterioration. A big or small very deteriorated muscle will take way longer to recover, and vice versa.
@rubsydos
@rubsydos 3 года назад
i really need u...but i cant ..i have tried lot of different doctorss ,,chiropractors,accupunture,allopathy ..all kind of ..but in vain.😭😭😭😭lost my balance..now i am jobless everyday pain cant work ..i can't
@HN-Anonymous
@HN-Anonymous 3 месяца назад
Here you say twice a week but in the articles you say every day or every other day for exercises like Sub-occipital and deep neck flexors, can you clarify? So depending on the individual, it’s ok for some patients to do the neck exercises every other day even? Thanks a million!
@MSKNeurology
@MSKNeurology 3 месяца назад
Which article? Must be many years old; more than 6 year old. Let me know. Edit: I think I found it. Will amend.
@HN-Anonymous
@HN-Anonymous 3 месяца назад
@@MSKNeurology for some reason I can’t paste the link looks like, but in the article titled “Multifactorial causes and solutions to chronic neck pain “ it says: “But, what I usually tell the client is that they do their exercises either every day, or every other day, one or two sets until mild fatigue.”
@karibohning6909
@karibohning6909 2 года назад
Just my arms are heavy. I feel the fatigue and weakness just sitting here. What do I Do? You said heavy weight> That seems counterintuitive. I had a meeting with you a while ago. Arms are bad- biceps are weak- going into forearms.
@MSKNeurology
@MSKNeurology 2 года назад
I did not say heavy weights. Sounds like you are not following the protocol at all.
@RobertLongM
@RobertLongM 3 года назад
What's a Rep? What's in a Rep?
@bellaburda8597
@bellaburda8597 3 года назад
Hey Robert, how was your recovery going?
@RobertLongM
@RobertLongM 3 года назад
@@bellaburda8597 seems doing Curalistic.org is much more affective working on trigger points / fibrosis than working a muscle
@Steuben1978
@Steuben1978 5 лет назад
Ok i have enough of the Doctors. in Berlin! Regarding the treatment and diagnostics of upper cervical spine problems its a wasteland! My next to do list! 1. Check the days of vacation time from my employer 2. Improving my english pronounciation and vocabulary! 3. Maybe another upright MRI of my upper cervical area 4. Book an appointment for a consulatation over skype (first need to get a camera) and if that went well ....an appointment in Norway!
@MSKNeurology
@MSKNeurology 4 года назад
Sounds like your English is plentifull. Welcome.
@cecetolove
@cecetolove 4 года назад
Trainingandrehabilitation I wrote you in another post so pardon my eagerness. How can I get in touch with you for steps to move fwd.
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