The Doctor Briefing for The Threshold Protocol

For the clinician. Handed to you by your patient. Two sides.

Patient name
Date
Most recent DEXA, date
Sites scanned and T-scores
Scanning facility
Bone medication, current or past

Your patient is considering a twelve-week progressive resistance and low-impact loading program called The Threshold Protocol. She was asked to bring you this page before she starts, or before she moves past light load if she has already begun. I designed the program. I am not her clinician, and this is not a treatment recommendation. It is a plain description of exactly what she would be doing, so that you can tell her whether she should.

What she would be doing

Two sessions a week, twelve weeks, twenty-four sessions, thirty to forty minutes each. Free weights and bodyweight. No machines. Nine movements in total: hip hinge, squat, overhead press, bent row, hip thrust, split squat, suitcase carry, heel drop, low hop.

Weeks 1 to 4, Foundation. Hinge, squat, overhead press and row only. Three sets of eight, RPE 5 to 6 out of 10. This block is for motor competence. It is not intended to be an osteogenic stimulus and the copy tells her so.

Weeks 5 to 10, loading block. Hinge, squat and overhead press at five sets of five, plus one horizontal pull. Target RPE 7 to 8, reaching 8 around week 9. Load is self-selected against that rating, then progressed by a fixed rule: two consecutive sessions completed at RPE 8 or below adds 5 lb upper body or 10 lb lower body. Any set at RPE 9.5 or above holds. Missed reps in two consecutive sessions cuts load by 10 percent.

Impact, introduced week 7. Heel drops, five sets of five, progressing to low hops. Impact is delayed further or permanently withheld under the screening rules below.

Weeks 11 to 12. Two heavy sessions, one deload, one assessment.

Prohibited for the full twelve weeks: loaded spinal flexion, loaded trunk rotation, and the standing or seated toe touch. Flexion under load concentrates compressive force on the anterior vertebral body, which is where osteoporotic vertebrae wedge and fail. Sinaki and Mikkelsen reported considerably more vertebral fractures in postmenopausal women doing flexion exercise than in those doing extension exercise (1984).

The evidence, and the one place we depart from it

Frost's mechanostat holds that bone adds material only when strain exceeds a threshold, and resorbs below it (Frost HM, 1987). The program is built on that premise: load has to be heavy enough to matter, or it is only exercise.

Watson SL, Weeks BK, Weis LJ, Harding AT, Horan SA, Beck BR. High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. J Bone Miner Res. 2018. That trial ran five sets of five above 85 percent of one-repetition maximum plus impact loading, twice weekly, thirty minutes, for eight months, and reported gains in lumbar spine and femoral neck BMD against a low-intensity control.

LIFTMOR was supervised. This program is not. Every session in that trial had a trained supervisor standing next to the participant. Your patient will be alone in a garage or a commercial gym with a phone. Those are not the same conditions, nothing in the product implies they are, and the adaptations below exist because of the difference.

That single difference is why the program uses a four-week technique ramp before any real load, RPE-based loading rather than a percentage of a tested one-rep maximum (she never tests a 1RM), a filmed self-check that gates entry to the loading block, and the screening below.

Screening already applied

She completed an eight-question intake before any training content opened. Any one of the following locks the program entirely, shows her a clinical pathway page, and gives her the address to write to for a full refund, which is granted:

• A clinician has already restricted her exercise
• Any vertebral fracture, clinical or morphometric, ever
• Any fracture in the past two years
• T-score of -3.0 or below at any site
• Spinal stenosis
• Spondylolisthesis
• Uncontrolled hypertension
• Surgery within six months
• Pregnancy
• T-score between -2.5 and -2.9 together with kyphosis or scoliosis

Any one of the following extends Foundation from four weeks to six, delays impact, and puts this page in front of her with a recommendation to see you first: T-score between -2.5 and -2.9; kyphosis or scoliosis alone; inability to rise from the floor without pushing off furniture. A reported balance disorder does all of that and removes impact work permanently.

This page travels with her either way: a woman the screen cleared brings it to you before she loads past light weight, and a woman the screen refused brings it so the conversation about what stopped the sale starts specific. The screen runs before payment, so a refused woman has paid nothing.

Three questions, if you have a minute

1. Is there anything in her imaging or fracture history, including an incidental morphometric vertebral deformity she may not know about, that should keep her out of axial loading?

2. Given her T-score, medication status and fall risk, is progression to five sets of five at RPE 8 appropriate for her, or should she hold at Foundation loads?

3. When is her next DEXA due, and can it be booked at the same facility on the same scanner as the last one?

Clinician name
Signature
Date
Restrictions or modifications

If your answer is that she should not do this, she should tell us. If she has bought, the program locks and she is refunded in full, on a request nobody here argues with. If the checkout already stopped her, there is nothing to unwind: no money moved.

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Written by A DPT with twenty-two years in orthopaedic and bone health rehabilitation. A team of physical therapists, in orthopaedic and bone health rehabilitation.

Questions about the protocol, the loading, or anything on this page: support@latticehealth.online. A named human answers, and if the question is clinical it reaches the physical therapist who wrote it rather than a support queue.