What’s Your Minimum Effective Exercise Dose

The minimum effective dose (MED) is almost a universal concept.
See how it can impact on your ability to solve your shoulder pain problem fast.

In this episode:

00:25 – MED explained
00:45 – Get real world examples of MED at work
01:20 – How MED relates to shoulder rehabilitation
01:35 – Getting the physiological tissue loading balance right
02:20 – The biggest shoulder rehabilitation mistake most physiotherapist and personal trainers make
03:00 – Start small but think big
03:20 – The best way I know to consistently find your MED window
03:55 – Overloading is a sure fire way to a shoulder pain nightmare
04:20 – Your MED moves with you

See the power of MED at play >Get Super Fast Shoulders!

Hi, and welcome to theshoulderguy.com, my name is Luke, and I’m The Shoulder Guy.

What’s your MED?

That’s today’s Shoulder Guy News broadcast. Now this is what we’re trying to do when we’re doing shoulder physiotherapy on someone, especially when they’ve got a painful and reactive shoulder.

MED stands for minimum effective dose. That’s all we’re trying to do.

And what the minimum effective dose actually means is: what’s the smallest amount that I can put into the system to get the outcome that I want?

An example of MED is when you’re boiling water. Water only takes 100° Celsius or 212° Fahrenheit to bring it to boil. Anything over and above that temperature is a waste of time and energy, because the water is already boiling. Another example is: don’t get a three-ton truck to do a one-ton truck job. The extra two ton of load capacity is a waste of time and energy and could be utilized doing another job somewhere else. There are plenty of examples out there in the real world around about this MED-type philosophy, and the concept of MED.

What we’re trying to do with your shoulder, especially when we’re trying to rehabilitate it, and this message really is for physiotherapists out there and personal trainers, exercise physiologists, but also for you at home. You only try to do the smallest amount to get the outcome that you want. When we’re looking at the shoulder, what we’re trying not to do is to underload the shoulder. The less we do, the less that we are actually active with our shoulder and our whole body, we can become underloaded. Our bodies need physiological loading naturally to maintain the health of the cells. Especially the rotator cuff tendon cells around about the shoulder. If we underload the system, we potentially are going to get an imbalance in the system. Potentially it can become a little bit more on the catabolic side of things, as opposed to a nice balance between anabolic and catabolic, from a cellular point of view.

Then if we come up the other end and do what most people do, which is go ahead and overload the shoulder. They go ahead and go too aggressive with their shoulder rehabilitation. They start to load the shoulder up aggressively, lots of external rotation, lots of loading onto potentially an already overloaded system altogether. This is also something that’s going to tip the balance towards potentially a catabolic state, where something is now being broken down. There should be a nice balance between things that are being repaired, and things that are being broken down. We get a nice, even (anabolic/catabolic) balance.

This MED window, which is where you want to start to work your shoulder from initially, is going to be somewhere in the middle. A nice little red window here. This is the window for loading. This is the window for dosage. That could mean, what’s the intensity of exercise? How many days a week am I exercising? How many sets and reps of this particular exercise am I going to do? In my experience, it’s very, very light. We don’t want to do too much initially, especially for a reactive shoulder. We’re trying to get the loading and the dosage correct. The best way to do it is to start out with the minimum dose possible.

The way that you’re going to check whether that dose was correct or not is purely by your 24 hour response. You want to bring your patient back in, or if you’re sitting at home, you want to check how you feel tomorrow and the next day. If we load the system up today, we’re going to potentially get a reaction if it is too much.

Underloading the system is a little bit more sinister. That tends to creep in over time. We’re less aware of that. Certainly if we do too much, we’re going to find out about it 24-48 hours later. Potentially we’re going to have some reaction in the shoulder. We might get some excess shoulder pain. We might now have some stiffness within that shoulder. There’s some of the signs that you might pick up to say, what I did two days or what I did yesterday was too much. It was potentially outside my minimum effective dose window.

What we know is as the shoulder improves and as your body accommodates to exercise and we get a training effect then, this window will start to move. It’s going to start to move up as you move up, as your (shoulder) muscles, (tendons) and your nervous system start to accommodate to the loading that you’re putting on it. Your MED window will gradually move up to a better training state.

At each stage, we need to doublecheck what our MED window is. We’re always checking our 24 hour response. That’s the best way to doublecheck in my opinion. It’s an easy thing to do. It works well. You can write it down. You get a nice feeling. You can be quite subjective and objective about how you feel two or three days later after you performed the exercises.

The concept of MED is so important to grasp. It’s essential for starting out your shoulder physiotherapy program. For you at home, it’s essential for you not to overload your shoulder when you’re trying to rehabilitate it. It’s essential that you don’t overload your shoulder after you have a shoulder injury.

These are some really important points, and I hope that you find them useful.

My name’s Luke, and I’m The Shoulder Guy, and I’ll see you again in another episode of Shoulder Guy TV. Bye for now.

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