Hey, this is Sandy. And Randy?
And we're here on AT Corner. Being an Athi trainer comes with
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Join us as we share our world in sports medicine.
Welcome back to another episode of AT Corner.
For this week's episode, we have another Rehab Concepts Education
episode, and today we'll be talking about Super Setting.
It's been a while since we've had a rehab concept, so I'm
super excited to dive into this and I feel like super setting is
probably something that athletic trainers do, but not something
that we actively think about. Say consciously do right, right
When I first think of like super setting, I feel like it's like
my first thought is like, this is a really cool late stage
rehab kind of concept. I mean, I, I guess you could
probably do it whenever. That's just what comes to mind
for me. That's actually really funny
that you say that because I feel like I do it a lot earlier than
late phase, yeah. It would be funny is or would it
be cool is if, because I didn't see anything like this, if they
actually had more kind of super setting for rehab, that'd be
actually pretty cool to see. So anyway, this is ACU episode.
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Randy will have those up for you.
And why don't we talk about what what the objectives are for
this? Yeah.
So we're going to describe what super setting is and kind of
what the goal of using this kind of technique is or then we're
going to discuss the physiological response to super
setting and then we're going to discuss the applications of
super setting as it relates to rehab.
So if you're wondering what is super setting we?
Just kind of jumped in and kept talking.
Then you have come to the right place.
Basically it's a programming style designed to create a
lifting session that is time efficient and what it basically
consists of is performing two or more exercises which I didn't
know the OR more part, I always kind of knew it as just like 2.
But yeah, honestly, I, I kind of picture two, yeah, like when I'm
doing rehab. But yeah, I mean, I guess you
could do more than two, I would say.
Technically you can I There actually was one study that did
do what's kind of termed Tri setting, which is basically
super setting with three OK exercises.
But essentially these exercises are done in succession with
minimal to no rest, right? So you're basically jumping from
one exercise to the next with really no rest period in like in
between those. So there are three different
types, which again, I didn't know that either.
I kind of only knew the the first one which is agonist and
antagonist. That's what I think of.
Yeah. So this is basically you're
exercising The Agonist muscle and then you jump to a set of
the antagonist muscle. So for an example, this would be
like a bicep curl. And then you start doing like
tricep extensions. The next type is is called
alternate peripheral, which is basically do an upper extremity
exercise and then do a lower extremity exercise.
Yeah, I didn't know that. Yeah, I I wouldn't have thought
of that either. And other than like, I feel like
here here's I feel like maybe some of us have been doing this
on accident because like you do an upper extremity exercise and
you're like, Oh well, you don't need to rest before you like go
into a lower extremity, you know?
Yeah, actually really fast before we move on to for The
Agonist antagonist, just a a short plug for neurokinetic
therapy. If you guys have not heard of
it. It's a basically a I don't even
know how to explain. It's like a technique.
It's like a it's like a different take on manual muscle
testing. To help with your evaluation,
like with manual muscle testing that really dives into agonist
antagonist relationships. Yeah.
So if you are more interested in that and want to dive a little
bit deeper in The Agonist antagonist, neurokinetic therapy
would be a really great place to start.
Yeah, for sure. I wish there was more research
on that because that'd be cool to read.
And then the final type of super setting is biomechanically
similar. So this is basically the same
muscle or action, which is kind of maybe like a slight
difference in the type of exercise.
So this is like possibly doing like bench press and then going
into like like flies or doing like a barbell bench and then
jump into a dumbbell bench, right?
So it's a slight variation, but you're basically doing the same
motion. Oh, OK.
So again, the goal of super setting is, hey, we're trying to
make a time efficient way of lifting.
So does it actually do that? And the evidence does say it is
actually very good at doing that.
Oh, that's awesome, yes. So when it's compared to
traditional lifting. So this is like completing one
set of exercises and then resting and then you progress to
the next and then resting in between those sets.
So like doing your squat, one set, rest squat, one set, rest,
squat, and then move on. It's actually like around 60%
faster than doing traditional lifting.
So one of the studies that looked at it was like a
traditional lift lasted about an hour.
Super setting cut it down to 35 minutes.
That's kind of cool. Yeah.
So it actually you actually do get a really good workout out of
this. And what's crazy is a lot of
those studies also found that the perceived exertion super
setting was harder than traditional set like traditional
lifting. I mean, it makes sense.
You're kind of being in that more fatigued state, not
allowing your body to be fully rest, which I think is so
beneficial. When you think of like sport,
you don't always have like that A1 minute rest or like that
two-minute. Yeah, that's true.
I didn't think of it that way, but that's very true.
Like you don't really have a lot of time to rest.
Right. I mean, depends on the sport
also, and I keep going back to this, but I feel like this is
also something that maybe we can be doing more intentionally
because I feel like this is something that happens anyway.
Like, you know, you know how many times you write a rehab
plan for an athlete and you kind of just let them go and you
know, they've been coming in and, and doing their own thing
and like, you didn't tell them how much to rest in between.
Like they might just be doing REST or not be doing REST.
I would say or even if you did that, probably just.
Did more just jump into the next thing?
That or took too long to rest 'cause they start talking to
somebody. Right, I think that the last
time that we we sat down and timed the rest in between
someone sets is BFR. Probably that's yeah, 'cause
there's AI feel like there is a lot more to that, you know, with
the machine and 'cause the machine has programmed rest
right? You just have to do the 30 and
then 32nd rest and then 15 and then 32nd rest and then 15,
yeah. Yeah.
So yeah, you're right. I don't, I don't can't even
think of a time. Last time I actually sat there
like OK we're resting for 30 seconds, timer on.
Right. So now that we know it actually
at least achieves its goal of being a time efficient kind of
programming style, now it's time to understand what why is it
different? Is it the same?
What is it exactly doing? And it really kind of depends on
the type that you use. So if you're kind of using the
more biomechanically similar method, right, you're going to
you're choosing a method that's going to be more fatiguing.
All right? So you're going to try and
choose something that's going to probably go towards more the
endurance side of it. And I wouldn't say necessarily
it's an endurance exercise. It's kind of like that strength
endurance kind of idea. But compared to like agonist
antagonist, like this is the more kind of fatiguing method.
I mean that agonist antagonist would still be fatigued but.
I mean, it makes sense you're just targeting the same.
Muscle, and this is kind of seen by the evidence that shows that
throughout the lift, as you go through the sets, you see a
lower velocity of the lift. Power also starts to decrease.
So you can see they're starting to get fatigued.
Also there are increases in blood lactate levels, right,
which can also lead to fatigue if it's from the increased
acidity from the lactate. And then it can also possibly
lead to more damage, right, 'cause the acidic environment
cells don't really like that and then start to also become
damaged as well. And then again, you can also see
increases in creatine kinase, which is usually used as a sign
for DOMS. So it kind of a sign of, hey,
you're increasing more damage, you're going to get some more
soreness out of this. But most athletes really just,
and maybe most clinicians kind of care about the OK, well, do
we get strength out of it right? And what I found found to be
very interesting was the results really tended to be very similar
to traditional lifting. Oh, that's really interesting.
Like the strength gains were actually very similar.
So it takes less time to build the same amount of strength.
Yes. And probably more quote UN quote
painful because you have to work through a little bit more
fatigue. Yeah, for sure.
Some results have shown like in some categories that there's
like a slight non statistical increase compared to traditional
as well. But again, technically non
statistical, but something to note.
I think it's very interesting. So yes, it does kind of lend
more to that efficiency part. Next kind of looking at power
and honestly the results are the same as strength, right?
It tends to be very similar to traditional lifting.
But what I thought was interesting is the studies that
kind of looked at this or like anything that I saw didn't
really look at power specific exercise.
All right. So they still compare just
traditional lifting, which is more kind of strength based.
They didn't look at like, oh, compare it to a plyometric
program or like, you know, actual kind of power lifts.
The programming is specifically powered powered for power.
I feel like when I think of super setting I would not pair
this with power. Neither would I.
I feel like, so for example, one of the ones that I do is a
single leg RDL with a kickstand with a dumbbell or a kettlebell.
And so I do that and then I move into a split squat and and
that's like very standard. You can watch their form like I
feel with with power, it's like I worry about their form with
fatigue, which I mean, there's also the argument that you
should be working kind of through fatigue to make sure
that they are able to get there. But I, I don't know, I feel like
you kind of have to make a judgement call now and power is
not really one that. Yeah.
That's why I think if you looked at it probably to power specific
programming, it probably wouldn't hold up because this is
just compared to traditional lifts, right.
So I agree. And then next is now kind of
looking at hypertrophy and I, I feel like this one's very
interesting. I didn't really see anything
that really labeled results for hypertrophy.
So actually looking at change in the muscle size.
So with hypertrophy, the one thing that is really difficult
for for us to kind of do with hypertrophy, especially if like
the athletes fairly healthy. I mean, obviously if we're
rehabbing them, they're slightly injured, but like in general,
right, they're kind of in a healthy state.
It's not like post op. Post op is something different.
Don't have huge, obvious deficits.
Yeah. But for hypertrophy, you tend to
need really high loads at very high intensities, right?
Like I think, I think technically the hypertrophy
window is like 8 to 12 reps at like I think it's over percent
over over percent, over 80% one Rep Max on on an exercise.
So this it's, it's a very intense thing and super setting.
Like some of the studies didn't really go that far, like didn't
use that kind of intensity. But it is interesting because
some superset studies actually showed you lifted more total
load compared to traditional lifting.
So theoretically there could be the avenue for that.
But then also others showed that it was actually less load
compared to traditional lifting. So what you're saying is it
depends. I say it depends.
It's. A very athletic training thing
to do. Yeah, I think it's really
dependent on the type of kind of super set program you do.
Like if you're doing the biomechanically similar, well,
you're probably not going to get through as much 'cause you're
going to fatigue, right? Whereas maybe agonist
antagonist, right, you might be able to get through more 'cause
the muscles aren't necessarily fatiguing at a faster rate.
Also, there is some linture that has shown maybe a slight
increase in testosterone after a superset.
This was really small and the study that kind of looked at it
used a lower intensity anyway. So it's kind of like how helpful
is that? And did the study even, could
this study achieved more if they did higher intensity?
It's a little question mark. So I think for hypertrophy, it's
still kind of up in the air, but still a possibility for strength
and power. OK.
Did they say anything about fatigue or like endurance?
I didn't see anything. Is I feel like this would be
great for that for endurance. Yeah, I didn't see anything on
endurance specific exercise. I'm trying to think off the top
of my head like if they were able to do more reps over time.
Yeah, I didn't see anything that looked at like true endurance
because I would assume this would help with endurance.
And honestly I feel like it would help with the strength
endurance. So it'd be interesting to see a
study that looked at as you fatigue, do you maintain your
strength longer? See, that's like when I do this,
I'm mostly doing it when like in the later stages.
OK, So I know I said earlier that I do like earlier stages.
I think earlier stages I just kind of group the exercises
together. But like when I'm trying to
target endurance, like later stages, I kind of do more like
less rest and more grouping of exercises to target that fatigue
and work through that fatigue. For sure.
So yeah, now taking it into that kind of practice approach and
like, like you said, I think it really depends on what your goal
is for your rehab and what kind of your super setting you kind
of want to do. Like I said, I think it's really
great, especially like if you're looking more late stage rehab,
like really strengthen durance, right 'cause you know you're,
you can increase some strength and you can also increase some
endurance. So being able to maintain the
strength as you start to fatigue.
I think it's very important, especially if you go with more
of that that biomechanically similar style that's going to be
a little bit more intense towards the endurance side of
things. So I think that's definitely a
good consideration if you're kind of looking and of course
for strength and power, right. The normal like we've already
presented like that is going to be just like traditional lifting
just cutting down almost half the time.
But if you're looking for something hypertrophy, I mean,
it might still be possible. I think you just really have to
make sure that you are doing those higher intensities and
maintaining higher loads. Again, I feel like as athletic
trainers like going for high hypertrophy that necessitates
those higher loads. It's really hard for us to do
just time wise. That's almost kind of like
you're hoping your strength coaches are doing that if you
have access to one, but still a possibility if you do have time
and you're in that possibility and you are doing a late stage
rehab that needs still focus on hypertrophy.
I thought what was interesting, some of the studies did kind of
differ on OK, how many reps did they do within the set?
Did they go to like failure, muscle failure or do they just
do a normal set range and going to failure can still help with
hypertrophy. There are some studies out there
that show that going to volitional failure can actually
increase hypertrophy. But again, I don't think you
could really compromise the load component.
You do need a higher load to actually induce hypertrophy.
And like I said, right strength, a great technique for this.
I think the really nice thing about this technique is just the
time efficient component. And I think the word time, time
efficiency makes any AT happy because yeah, I I think it's a
nice way of especially again, if you have someone late stage and
you're like, dude, I just don't have enough time to dedicate
like taking someone over to the weight room because you know,
you have all these other things, right?
This might make it a little bit more feasible, right?
You're cutting down to 30 minutes ish, right?
That's not bad. You know, that's a lot easier to
find in our time than an hour plus.
Honestly, I think it is just being more intentional with it.
Like and here here's I don't know how you guys do your rehab
plans, but usually like I'll I'll write my exercises out by
by like what I'm trying to target.
And the reason why I do that is because like let's say I am
targeting a hamstring strain and I'm trying to target, right.
I'm trying to do hamstring eccentric, I'm trying to do
hamstring concentric, I'm trying to do a glute, I'm trying to do
core. You know, I'm trying to maybe
some calves like. So I'm trying to target all
these things, right? And I'm going in and I'm riding
in my exercise sheet like hamstring, hamstring, glute,
glute, like whatever. And I target them by a group
because then I, I actually work with athlete and say, Hey, like
I'm giving you all of these. But on, on one day I want you to
like pick like 2 hamstring exercises or pick like 1 glute
exercise and then pick like 2 core exercises.
So then they have a little bit of variety within their rehab
plan, but they're still targeting the same group of
muscles. I think if.
For me, like because I because I like categorize it that way in
my rehab plans. If it is this, this actually
might be easier to target with the supersets because I can just
be like, oh, do this and then like no rest.
And when you go into like this next.
But I was also thinking something that I do for
hamstrings, some manual resistance, just having them
prone. Usually I'll start them with an
eccentric manual resistance of that hamstring where they're
just prone in just knee extension or knee flexion into
knee extension. So I'm resisting and I'll do
that and then no rest. I move into that concentric
phase and the concentric phase is so much harder after that
eccentric. But I like to do the eccentric
first, especially because muscle recruitment and we're and it's
harder and I like to target that eccentric later.
I end up doing it when they're more fatigued like later stages.
But I like to start closer to that and I do superset that one,
yeah. Nice.
That's interesting. That's really cool.
And that would be more of that bio mechanically similar.
Similar. Yeah, for sure.
Nice. That's cool.
I feel like most of the ones that I do are bio mechanically
similar. I mean, that's very cool.
You're stressing the muscle put into a very fatigued state.
Right. What are some of your super sets
that you've done? Do you have any like?
See that thing is, I don't think I've ever consciously actually
done it. That's why I was interested in
reading this 'cause I do kind of want want to start applying it a
little bit more. I feel like I would like to do
The Agonist antagonist more. But now I'm very intrigued based
on what you said about that biomechanically similar kind of
way of applying it. I feel like the reason why I
like target this is because of fatigue.
I don't, I didn't, I didn't really think of it because of
hypertrophy or because of like any of these other things that
we talked about. Like it makes it makes sense.
But I feel like it's so much easier to think about it as
especially the the biomechanically similar ones,
the ones that are you're, you're already working that muscle and
then you're going to keep working that muscle.
And again, remember with super setting, it is back-to-back
exercises, minimal rest in like in between those sets, but like
there is a rest component be like before you start it up
again, Right, Right, right. But yeah, so just keep that in
mind that it is supposed to be stressful like that.
It is back-to-back like, OK, we go to this exercise.
All right, moving to the next. Nope, stop stalling.
No, no conversation. Let's go.
I also like to do The Agonist antagonist back-to-back if I've
noticed that they are targeting and not targeting, if they are
recruiting. You know, sometimes when you get
injured, you recruit the antagonist.
Yeah, I, I like to do that so that we can the kind of fatigue,
quote UN quote fatigue, right, the whatever antagonist.
And then when we move into the opposite, then we can try and
get that knot to fire. And I was going to say, there's
actually evidence behind that as far as it increases neural drive
to The Agonist muscle when that happens.
Nice, yeah. So you are increasing that kind
of neural drive to actually get The Agonist to fire more.
And ideally that should get the antagonist to like, not fire.
Yeah, correct. Ideally, that's kind of like my.
Perfect world, right? I'm.
Trying to think of an example of when I do this, I feel like
it's, it's just like I see it and then I'm like, oh, let's
just let's just target the opposite muscle.
It's hard for me to like sit here and think in a perfect
example. But yeah, I actually, I do pair
my my calf raises with my tib raises.
Nice. Like against like I'll do like
calf raises, like usually I'll do like sets of 15 'cause like
that, that's pretty for sure tiring.
And then and then I'll get them back against the wall and then
do tib raises like straight into those.
But other than that, like, off the top of my head, I, it's hard
for me to think of a perfect example.
Yeah. Yeah, I can't think of actually
consciously programming it this way.
Oh sorry I hip flexors. Hip flexors love to Hip flexors
are so tricky. Sometimes I feel like the hip
flexor glute like that hip flexion glute or hip extension
like pairing. I feel like that's a really good
pairing too. Yeah, yeah, for sure.
Yeah, OK. You were going to say sorry?
No, I was just thinking. I just don't consciously think
that I've meant to do that. I feel like I've done it.
That's what I think is like when, when you were talking
about this, like I, I really think that this is something
that we do in rehab. I think that we can we have so
much power with knowledge to make this more intentional
because it is super beneficial. It is even just from a time
efficiency component, right? Right.
You can cut down time, which again most a TS wish they had
more of right? So being able to actually have
something that can achieve the same goals is just lifting is
very beneficial. What is your action item for
this? I would say super setting is
very similar to traditional lifting as outcomes, so I think
it's something that you can feel pretty confident to try and
implement into your practice. How?
By programming an exercise after an exercise with minimal to no
rest, being a little more intentional about how you
organize it. And then just really knowing
what what your goal is for that rehab.
I mean, we already do a pretty good job of what coming up with
our goals for rehab. So I think that might be an easy
transition to be able to like, Oh well, I want this to be a
more fatiguing day and I'm going to use this technique to do so.
Honestly, I think this will also help with setting the intention
and setting, setting up a little bit better of a rehab program
because and I see this like when athletes come from, you know,
some other places or even clinics that they go see other
clinicians, sometimes they are just given really basic
exercises that don't challenge them.
I feel like this can also add a level of challenge for sure that
even with the same exercises, I think can target a little bit
different, different intention and really get us a little bit
closer to our goal of getting them back.
For sure. So with that, again, if you're
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that's all. Yeah.
Thank you for helping us showcase athlete training behind
the tape. Bye.