What is SuperSlow Rehabilitation?

SUPERSLOW REHAB®
HIGH INTENSITY STRENGTH CONDITIONING’S APPLICATION TO MEDICAL CONDITIONS
by Gary H. Lindahl, Physical Therapist and SuperSlow® Master

High Intensity Strength Training Background

Arthur Jones, inventor of the Nautilus exercise equipment, popularized his philosophy of brief, intense workouts through bodybuilding magazine articles in the early 1970’s. Jones’s Nautilus Principles eventually became known as high intensity training, a term coined by Nautilus’s director of research, Ellington Darden, PhD. It was Ken Hutchins’s involvement with Nautilus as a surgery technician and photographer, athletic trainer, physical therapist, speaker, and his eventual involvement with the largest clinical study ever conducted on exercise and osteoporosis that led him to develop the SuperSlow exercise protocol.

SuperSlow Strength Training

The SuperSlow ® strength training protocol was developed and introduced in the 80’s by Ken Hutchins through an osteoporosis study at the University of Florida. SuperSlow Level I certification for high intensity strengthening was developed for the general exerciser but I could see that it contains all the safe guards to train more fragile individuals with complicated diagnoses. 

A typical SuperSlow workout involves a SuperSlow Instructor supervising a client on four to six weight machines, each targeting a specific muscle group.  Weights are slowly raised for 10 seconds and lowered for 10 seconds non-stop until the targeted muscles reach momentary muscular failure. The turning point comes when you try to push beyond muscular failure for an extra 10 seconds.

When a muscle is pushed past momentary muscular failure, the body responds by increasing the size of that muscle if it is allowed adequate time for recovery and adaptation between workouts. Rest between workouts is physiologically essential for building lean muscle. 

SuperSlow is a system that requires several components to be effective:

• a certified SuperSlow Instructor
• SuperSlow strength training equipment
• an ideal exercise environment
• a client/patient who is willing to learn the protocol, be coached, show up consistently and apply effor

The ideal exercise environment:

• Is private or semi-private
• Is cool, with a temperature of approximately 68 degrees and fans positioned near machines
• Has no mirrors, noise, unnecessary decoration, or other distractions

A typical work out takes about twenty minutes, one-to-two times a week. Health benefits to the SuperSlow lifestyle can be:

• Increased cardiovascular efficiency
• Increased metabolism
• Increased bone density
• Improved energy and endurance

If you want to learn more about the fundamentals of SuperSlow strength training, read about this at the end of this article at Learn More About SuperSlow.

SuperSlow Rehab

I became a SuperSlow Master and then developed the SuperSlow protocol for 14 medical diagnosis and health conditions. This is called SuperSlow Rehab. This form of exercise rehab is not taught in the schools of physical therapy or medical schools. SuperSlow protocol has fewer repetitions, slow movement, and no unloading of the targeted muscles to complete muscle fatigue. The results show greater strength in less time.

A key principle of SuperSlow Rehab is to achieve functionality for which the patient’s prescription has been written and strengthen the entire body (i.e. targeting the specific area including upper and lower extremities, core musculature, and low back).

1. Only recently has this form of strengthening for individuals with or without medical problems, been targeted for functional strength. This has come about because of two primary reasons:
2. The introduction of exercise equipment in the 90’s that allows full range of motion, variable resistance, minimal friction, and adjustments for proper and safe positioning and alignment Prior to the 90’s most all exercise in the gym was with ”free weights”. Some equipment existed, but with high friction, minimal settings for alignment, and poor stabilization of the trunk. The development of a protocol for training that incorporates total control of the person being exercised. Specifically, the SuperSlow ® protocol, previously described.

I stumbled on the SuperSlow protocol by accident in the fall of 1998. I was intrigued enough to go back to Orlando, Florida and talk with Mr. Hutchins, liked what I saw in the protocol, and proceeded to complete the Level I and II certification and was appointed a Master.

Having been a physical therapist for 35 years, I was very aware of the fact that in many instances we in physical medicine were not aggressive in our rehabilitation, especially with post surgery back patients. It appeared to me that this protocol was the safest avenue to introduce high intensity strengthening into the medical arena. It has proven to be true.

SuperSlow Rehab Study Group

Since February 1999, I have specialized in “aggressive rehabilitation” using SuperSlow Rehab based on SuperSlow high intensity strengthening protocol. My study group has consisted of personally evaluating 1625 individuals to qualify them for the program. With the help of three certified SuperSlow Level I Instructors, these individuals have accumulated 40,501 sessions of SuperSlow Rehab on 14 different strength training machines. The diagnosis pool included degenerative discs, herniations, degenerative joints, Multiple Sclerosis, Parkinson’s Syndrome, Rheumatoid Arthritis, cancer, Fibromyalgia, Diabetes, cardiac issues, hypertension, etc.

Post surgery strengthening includes low back fusions, laminectomies, total hips, knees, and shoulders.

One particular diagnosis that I feel this program is too aggressive for is Chronic Fatigue Syndrome. I’ve had two individuals with this syndrome, and I was not able to formulate an exercise plan that did not result in exacerbating symptoms.

One criteria is required of all candidates for SuperSlow Rehab. They must be stabilized in their condition, including medication. Additional considerations are no joint swelling, acute pain, nor muscle spasm.

Can SuperSlow Rehab be dangerous? It certainly can if not used properly. However, each physical therapist, physical therapy assistant and or PT Tech/SuperSlow Instructor goes through SuperSlow Level I certification and completes with SuperSlow Rehab, courseware and hands on training for 14 medical diagnosis and health conditions. Knowledge of the equipment and its proper adjustments, and an understanding of the SuperSlow protocol and SuperSlow Rehab keeps this form of strength training-based rehab safe and highly effective.

Conclusion

I am completely aware that what has been accomplished in my exercise studio over the past five years could not be classified as a “study” as it relates to academia.

What I have accomplished is taking the knowledge I accrued over 40 years of private physical therapy practice and introduced the concept of high intensity strengthening, SuperSlow Rehab, into my practice in 1999. I had no idea as to what the outcome would be.

Thanks to a few physicians who trusted me in this vision, I was able to specialize in this form of “rehabilitation” while foregoing 90% of traditional physical therapy. After 5.5 years, the results have exceeded what I suspected, and the referring physicians have been equally awed. Speed of results and safety of the SuperSlow Rehab protocol were beyond expectations.

Additionally, the ‘pay-for-service’ SuperSlow strength training program is ideal for the general public, who like to work out a medical-based facility, and it is exceptional for bridging rehab patients to become strength training clients. I am a ‘two-door’ business model meaning that I have SuperSlow Rehab (door one) and SuperSlow for general exerciser (door two) in one training area at the same time. This translates into sustainability of rehab results, increased referrals (friends and family), and a much needed infusion of cash as physical therapists battle the downward death spiral of insurance reimbursement.

Medicine has advanced considerably over the past 10 years and it is vital that physical therapists, physicians, and others in the physical medicine field stay abreast of the changes. Continued use of SuperSlow Rehab can be a vital aspect of a treatment plan when applied appropriately and with adequate knowledge of the protocol.

Learn More About SuperSlow Strength Training

SuperSlow is a method of high intensity strength training which involves performing each repetition of an exercise at a very slow speed. Repetitions are started in a slow and controlled manner, followed by a 10 second lifting phase, a smooth reversal of direction, and a 10 second lowering phase before slowing down and starting the cycle over. Like the traditional Nautilus high intensity strength training method it evolved from, SuperSlow involves brief, infrequent workouts, consisting of one set per exercise, and only a few exercises addressing all of the body’s major muscle groups. A typical SuperSlow workout may involve between 4 and 6 exercises performed once or twice weekly.

The slow repetition speed makes SuperSlow both safer and more effective than traditional strength training protocols. Slower repetitions involve lower acceleration, resulting in lower force and less momentum. Lower force means less risk of injury, and less momentum means the muscles are worked more effectively over a full range of motion. Research by Westcott et al has shown that SuperSlow produces 50% greater increases in muscular strength than the traditional Nautilus training using a 2 second lifting and 4 second lowering movement.1

During SuperSlow exercise, the muscles are worked against a level of resistance challenging enough to produce a deep level of fatigue within a short period of time. Once the muscles have been fatigued to the point where further movement is impossible, the resistance is contracted against for up to 10 more seconds before slowly returning to the starting position. When it is possible to perform an exercise for 2 minutes or longer before achieving this deep level of fatigue, the resistance is increased for the next workout to continue to challenge the muscles. Progressively exposing the muscles to a greater load than they are accustomed to working against ensures continuous stimulation for greater improvement.

I prefer time as the quantitative measure of exercise performance as it is more precise than counting repetitions, and easier to determine when to add, subtract, or maintain the weight lifted. Accordingly, all of the criteria for resistance progression will be determined by the time under load required to achieve momentary muscular failure. Increase weight the next session if time is over 2 minutes under load. Decrease the weight if unable to reach 1 minute 20 seconds. Maintain the same weight if between 1:20 and 1:59. Stop the exercise if the time exceeds 2:20.

Range of motion of each repetition should be as great as possible. As you begin to fatigue, range of motion will decrease. In fact, at the very end of the exercise the range will be short as you reach momentary fatigue. This is acceptable.

Speed of movement should be slow, steady and continuous throughout the movement. The motion should be under control at all times. This will minimize the momentum involved resulting in more efficient muscular loading over the full range of the exercise. The concentric (positive) and eccentric (negative) movements should be performed in approximately 10 seconds each, for a total of 20 seconds per repetition cycle. Reversal of direction between eccentric and concentric movements at the start point of the exercise (lower turnaround) should be smooth and continuous, without pausing or resting, and without bouncing or heaving out of the start. Reversal of direction between concentric and eccentric movements at the end point of the exercise (upper turnaround) should occur prior to full extension or “lockout” on compound pushing exercises. On single joint and compound pulling exercises, pause briefly in the most contracted position before reversing direction starting with the third or fourth repetition.

SuperSlow requires rest between workout sessions. Muscles inroaded to the point of momentary muscular failure require time for repair and growth. If you train a muscle again too soon, you interrupt the recovery process and prevent the body from producing the adaptations stimulated during the previous workout. Minimum time between workouts is 72 hours, allowing a frequency of no more than 2 sessions per week. This gives the muscles time to heal and grow.

Machines versus free weights? Selectorized (weight-stack) machines which can be precisely adjusted to provide proper body positioning and/or alignment and stabilization during exercise are better adapted to working with individuals with various medical problems. To this end, Nautilus provides a line of equipment for SuperSlow exercise and for a medical settings. This equipment has reduced friction and the ability to restrict range of motion at either end of a movement, small incremental resistance selection, and the highest quality manufacturing. This equipment provides safer, more efficient exercise than free weights, bands, or other modalities.

1 Westcott WL, Winett RA, Anderson ES, Wojcik JR, Loud RL, Cleggett E, Glover S. Effects of regular and slow speed resistance training on muscle strength. Journal of Sports Medicine and Physical Fitness. 2001 Jun;41(2):154-8