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Jim Rivard completed his Bachelors in Physical Therapy in 1988 from the University of Puget Sound. He later received a Masters in Orthopedic Manual Therapy (1991) and a Doctor of Manual Therapy from The Ola Grimsby Institute (2008). He is the co-owner of MTI Physical Therapy, the Chief Academic Officer of The Ola Grimsby Institute and President of the American Academy of Orthopedic Manual Physical Therapists. He is the co-editor of a 3 volume textbook set on STEP (Scientific Therapeutic Exercise Progressions), as well as teaching Residencies, Fellowships and seminars in over 12 countries.


No specific evidence exist pertaining to which parameters are best suited to improve local vascular perfusion to a set of muscles to provide a means of nutrition, removal of metabolic exudates, recovery from tissue ischemia and normalization of neurologic based tone. Specificity in exercise dosage, emphasized in the Nordic training programs as Medical Exercise Therapy (MET), traditionally referenced training at 60% of 1RM to emphasize local circulation. This has been further emphasized in the STEP (Scientific Therapeutic Exercise Progressions) curriculum in the United States. The 60% 1RM range is used to increase local circulation, providing oxygen to repairing tissues. A comparison of 40%, 60% and 80% of 1RM for the purpose of improving local circulation to the infraspinatus, confirmed with Doppler testing, will be presented. Exercise design concepts for shoulder rehabilitation, as it relates to tissue impact and motor control as it relates to dose or load, time under tension, concentric versus eccentric resistance, line of pull and rest periods must also be integrated into these basic dosage concepts.

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