Therapeutic Exercise

True/False. Power can ONLY represent single burst of high intense energy

False. Can represent a single burst of less intense activity and Can represent a single burst of high-intense activity

True/False. If muscle performance is to improve, the load must equal the metabolic capacity of the muscle being trained

False. If muscle performance is to improve, the load must EXCEED the metabolic capacity of the muscle being trained

Many motor tasks are somewhat ballistic movements that involve both stretch and speed. Muscle strength is necessary foundation here Can be gained either increasing the work for a muscle must perform during a specific amount of time or period or reducing the amount of time required to produce the work The greater the intensity of the exercise and the shorter time period taken to generate force, the greater the muscle power

Muscle Power

What does SAID stand for?

Specific Adaptation to Imposed Demands

has been linked to durations of a single stretch cycle ranging from as few as 5 seconds to 5 minutes per repetition when either a manual stretch or self-stretching procedure is employed

Static Stretching

Power =

Time X Distance

True/False. Force output from greatest to least - eccentric, isometric, concentric muscle contraction

True

True/False. Muscle produces greatest tension when it is near or at the physiological resting length at the time of contraction.

True

Arise directly from the health condition Ex: Neck pain from a pinched nerve

primary impairments

results from preexisting impairment Ex: postural abnormalities

secondary impairments

Both ______ & __________ have been shown to improve flexibility equally, ballistic stretching is thought to cause greater trauma to stretched tissues and greater residual muscle soreness than static stretching

static stretching and ballistic stretching

focuses on the progressive loading of muscle by manipulating, for example, the intensity or volume of exercise. Intensity of resistance exercise refers to how much weight (resistance) is imposed on the muscle, whereas volume encompasses variables such as repetitions, sets, or frequency of exercise, any one or more of which can be gradually adjusted to increase the demands on the muscle.

Overload principle

movement of a segment within the unrestricted ROM that is produced entirely by an external force; there is little to no voluntary muscle contraction

PROM

Indications: -In regions where there is acute, inflamed tissues -When a pt is not able to or not supposed to actively move a segment(s) of the body, as when comatose, paralyzed or on a complete bed rest, movement is provided by a external force -After an surgical repair of contractile tissue when active motion would compromise the repaired tissue

PROM indications

Also known as PROM, is the degree to which a body segment can be passively moved through the available ROM and is dependent on the extensibility of muscles and connective tissues that cross and surround a joint. is a prerequisite for—but does not ensure— dynamic flexibility.

Passive flexibility

Physical practice. The movements of an exercise or functional task are actually performed. Mental practice. A cognitive rehearsal of how a motor task is to be performed occurs prior to actually executing the task; the terms visualization and motor imagery practice are used synonymously with mental practice.

Physical vs mental practice

used interchangeably with static or dynamic balance

Postural control

Muscle spasm or guarding and pain may also cause a ________________ contracture. In both situations, the involved muscles appear to be in a constant state of contraction, giving rise to excessive resistance to passive stretch

Pseudomyostatic

Indications for Use of Stretching

ROM is limited because soft tissues have lost their extensibility as the result of adhesions, contractures, and scar tissue formation, causing activity limitations (functional limitations) or participation restrictions (disabilities) Restricted motion my lead to structural deformities that are otherwise preventable Muscle weakness and shortening of opposing tissue have led to limited ROM May be a component of a total fitness or sport-specific conditioning program deigned to prevent or reduce the risk of musculoskeletal injuries May be used prior to and after vigorous exercise to potentially reduce post-exercise muscle soreness

Slight variations of the same task are carried out in an unpredictable order; for example, a patient could practice stepping to and from platforms of different heights or practice standing up from chairs of different heights or styles in a random order; therefore, the task changes with each repetition.

Random-order practice

Variations of the same task are performed in random order, but each variation of the task is performed more than once; for example, the patient rises from a particular height or style chair, and then repeats the same task a second time before moving on to a different height or style chair.

Random/blocked-order practice

Adaptive changes in the body's systems, such as increased strength or endurance, in response to a resistance exercise program are transient unless training-induced improvements are regularly used for functional activities or unless an individual participates in a maintenance program of resistance exercises

Reversibility Principle

A framework of specificity is a necessary foundation on which exercise programs should be built Whenever possible, exercises incorporated in a program should mimic the anticipated function

SAID program

Is a type of stretching procedure done independently by the pt after careful instruction and supervised practice

Self-stretching

A series of discrete tasks performed in a certain order Ex: wheelchair transfer. Position the wheelchair -> lock the wheels -> remove armrest -> scoot forward -> etc.

Serial

In general, the ___________ duration of a single stretch cycle, the ________ the number of repetitions applied during the stretch cycle.

Shorter Greater

The ability of the neuromuscular system through synergistic muscle actions to hold a proximal or distal body segment in a stationary position or to control a stable base during superimposed movement. Joint stability is the maintence or proper alignment of bony partners of a joint by means of passive and dynamic components being able to do what you want to do without falling over

Stability

To maintain appropriate alignment, ensure the correct muscle action and movement pattern, and avoid unwanted substitute motions during resistance exercise,

Stabilization

For an effective stretch to occur, it is important to _________ (fixate) either the proximal or distal attachment site of the muscle-tendon unit being elongated

Stabilize

Is a broad term that refers to the extent that the contractile elements of muscle produce force Implicit in this definition is the idea that with adequate strength, the contractile tissue generates enough force to meet the physical and functional demands placed on the systems.

Strength

The greatest measurable force that is exerted by a muscle or muscle group to overcome resistance during a single maximum effort

Strength

What are the three elements of muscle performance?

Strength Power endurance

The development of muscle strength is an integral component of most rehabilitation or coordinating programs for individuals of all ages and abilities The systemic practice of using muscle force to raise, lower, or control heavy external loads for relatively low number of reps. over a short period of time

Strength training

Changes in the body structures (anatomically) -These domains occur at the cellular, tissue, or body system level

Structures

In contrast to the SAID principle, carryover of training effects from one variation of exercise or task to another also has been reported. Has been reported to occur on a very limited basis with respect to the velocity of training

This phenomenon is called transfer of training, overflow, or a cross-training effect.

T/F low-intensity, slowly applied, continuous, end-range static stretch does not appear to cause significant neuromuscular activation (evidence of increased EMG activity) of the stretched muscle.However, the assertion that static stretching contributes to neuromuscular relaxation (inhibition) of the stretched muscle, as the result of activation of the GTO, is not supported by experimental evidence in human research studies.

True

T/F. Short fibers with pinnate and multipinnate design in high force-producing muscles. Long, parallel design in muscles with high rate of shortening but less force production.

True

The pt must be taught to perform stretching procedures correctly and safely in order to make sure the self-stretching is be done effectively

True

True/False. Concentric contraction: increases speed which decreases tension.

True

True/False. Despite numerous studies over the decade, the "ideal" combination of the duration of a single stretch cycle has yet to be determined.

True

The "average," untrained adult, when exercising with a load that is equivalent to 75% of the 1-RM, is able to complete approximately 10 repetitions before needing to rest. At 60% intensity about 15 repetitions are possible, and at 90% intensity only 4 or 5 repetitions are usually possible.

Volume

The entire task is performed from beginning to end and is not practiced in separate segments.

Whole practice

When is high velocity stretching recommended?

Young, active patient in the final phase of rehabilitation, who wishes to return to high demand recreational or sport activities after a musculoskeletal injury, may need to perform carefully progressed, high-velocity stretching activities prior to beginning plyometric training or simulated, sport-specific exercises or drills

If pt assists in moving the joint through greater range

active stretching

the execution of a task or action by an individual

activity

Occurs when a person has trouble or unable to perform a task or ADLs

activity limitations

difficulties an individual may have in executing actions, tasks, and activities,

activity limitations

Patient makes infrequent errors Focus on the most consistent and efficient movements Patient explores variation and modifications of movement strategies More variability can be added to the environment at this time

associative stage

Sensory cues from an external source that are supplemental to intrinsic feedback and that are not inherent in the execution of the task -may arise from a mechanical source or from another person

augmented (extrinsic) feedback

movements are automatic The pt does not have to pay attention to the specific tasks and thus can do multiple tasks simultaneously

autonomous stage

At puberty, as hormonal levels change, there is rapid acceleration in the development of muscle strength, especially in

boys

Apply an very low-intensity stretch of force over a prolonged period of time to create relatively permanent lengthening of soft tissues, presumbley due to plastic deformation Ex: Cuff weight or weight-pulley system, adjustable orthodic devices or automated stretching devices These devices provide either a constant load with variable displacement or constant displacement with variable loads.

characteristics of mechanical stretching

Patient needs to activiely think about each component and the sequencing of the skilled movement Because of the focus on the task, distracting or busy environments may interfere with the learning or increase errors Learners often need frequent feedback of performance

cognitive stage

A mix of primary and secondary impairments Ex: a patient with knee pain from osteoarthritis may exhibit decreased cardiovascular enduranace from lack of activity due to pain

composite impairments

Occurs during the performance of a task; also known as "real-time" feedback

concurrent feedback

Occurs on a regularly recurring, continuous basis during practice of a motor task

constant feedback

Repetitive uninterrupted movements with no discrete start or finish Ex: ambulation

continuous

Information that is given after a short interval or time has elapsed, allowing time for the learner to reflect on how well or poorly an task was executed

delayed feedback

A task with a clear start and stop Ex: performing a quad set

discrete

True/False. The greater the number and synchronization of motor units firing, the least the force production

false. The greater the force production

The ability to move freely, without restriction, used interchangeably with mobility

flexibility

Relates to the ability of the neuromuscular systems to produce the appropriate amount of the force, during functional activities in a smooth and coordinated manner

functional strength

Information that is given directly after a task is completed

immediate feedback

The loss of integrity of the physiological, anatomical, and/or physiological functions of the body and are a partial reflection of a person's health status

impairments

Sensory cues that are inherent in the execution of a motor task -arises directly from performing or attempting to perform the task -may immediately follow completion of a task or may occur even before a task has been completed -most often involves proprioceptive, kinesthetic, tactile, visual, or auditory cues

intrinsic feedback

Immediate, post-talk augmented feedback about the outcome of a motor task

knowledge of results

It is generally agreed that _____ load long duration stretching is more effective than _____intensity or ballistic stretching.

low high

In some situations the use of mechanical stretching devices is indicated, particuarly when ______ therapies have been ineffective.

manual

The ability of structures or segments of the body to move or be moved in order to allow the occurence of range of motion for functional activites

mobility

capacity of muscle to produce tension and do physical work Encompasses: strength, power and muscular endurance

muscle performance

A task is broken down into separate dimensions. Individual and usually the more difficult components of the task are practiced. After mastery of the individual segments, they are combined in sequence so the whole task can be practiced.

part practice

Involve some degree of social interaction. Encompasses a person's ability to participate in what they deem meaningful to their life

participation

the involvement of the individual in a life situation

participation

problems an individual may experience in involvement in life situations, involving difficulties participating with self-care, responsibilities within the home, workplace, or community, and recreational, lesiure and social activities

participation restricions

When pt is relaxed as possible during the stretch

passive stretching

occurs after completing or attempting to complete a motor task

postresponse feedback

Is related to the strength and speed of movement and is defined as the work (force x distance) produced by a muscle per unit of time (force X distance/time) The rate of performing work The rate at which muscle produces a force and the relationship between the force and velocity are key factors

power

Information that is given about the average performance of several repetitions of motor skills

summary feedback

Is the systematic, planned performance of bodily movements, postures, or physical activities intended to provide a patient/client with means to remediate or prevent impairments, improve, restore, or enhance physical function, prevent or reduce health-related risk factors, and optimize overall health status, fitness, or sense of well-being

therapeutic exercise

Occurs irregularly, randomly during practice of a motor task

variable (intermittent) feedback

Strength reaches a maximal level earlier in _______ than ______-, with women reaching a peak during the second decade and in most men by age 30. Strength then declines approximately 1% per year, or 8% per decade.

women then men

In young adult and middle adulthood strength declines approximately

1% per year or 8% per decade

The greatest amount of weight a subject can move through the available ROM just one time.

1-RM

As with prepubescent children, resistance training during puberty also results in significant strength gains. During puberty, these gains average _______ above that which is expected as the result of normal growth and maturation

30-40%

Contraindications to stretching

A bony block limits joint motion There was a recent fracture, and bony union is incomplete There is evidence of an acute inflammatory or infectious process (heat and swelling) or soft tissue healing could be disrupted in the restricted tissues and surrounding region There is sharp, acute pain with joint movement or muscle elongation A hematoma or other indication of tissue trauma is observed Hypermobility already exists Shortened soft tissues provide necessary joint stability in lieu of normal structural or neuromuscular control Shortened soft tissues enable a pt with paralysis or severe muscle weakness to perform specific functional skills otherwise not possible

A type of AROM in which assitance is provided manually or mechanically by an outside force because the prime mover muscles need assitance to complete the motion

AAROM

Indications: -when a pt has weak musculature and is unable to move a joint through desired range (usually against gravity) This ROM is used to provide assistance to the muscles in a carefully controlled manner so the muscle can function at maximal level and be progressively strengthened Once pt gains control on their ROM, they are progressed manual or mechanical resistance exercises to improve muscles performace for a return to functional activities

AAROM

Indications: -When pt is able to contract the muscles actively move a segment with or without assistance -When a segment of the body is immobilized for a period of time, AROM is used on regions above and below the immobilized segment to maintain the areas in as normal condition as possible and to prepare for new activities, such as walking with crutches -Can be used for aerobic conditioning programs and is used to relieve stress from sustained postures

AROM

Movements of a segment within the unrestricted ROM that is produced by active contraction of the muscles crossing that joint

AROM

is determined by the direction of muscle fibers and the line of pull of the muscle to be strengthened. The patient or limb should be positioned so the muscle being strengthened acts against the resistance of gravity and the weight. This, of course, is contingent on the comfort and mobility of the patient

Alignment

Influences the amount of tension present in soft tissue and then affects the ROM available in all joints

Alignment Alignment of the muscles and joints to be stretched as well as the alignment of the trunk and adjacent joint must be considered.

It is often the responsibility of a therapist to recommend the type of stretching device that is most suitable to the pt and to teach them how to safely use and monitor the equipment in the home setting Stretch force applied with a cuff weight as a fe pounds. Devices such as the joint active systems adjustable orthrosis allow a pt to control and adjust the stretch force during a session Orthotics with a preset that remain constant while the orthotic is in place Involves a substantially longer overall duration of stretch than is practical with manual or self stretching exercises. Duration is anywhere from 15-30 mins and 8-10 hrs sessions or continuous throughout the day except for times of hygiene exercises.

Application mechanical stretching

is the result of intra-articular pathology. These changes may include adhesions, synovial proliferation, joint effusion, irregularities in articular cartilage, or osteophyte formation

Arthrogenic and periarticular

The ability to align body segments against gravity to maintain or move the body (center of mass) within the available base of support without falling; the ability to move the body in equilibrium with gravity via interaction of the sensory and motor systems.

Balance

A rapid, forceful intermittent stretch—that is, a high-speed and high-intensity stretch Not recommended for elderly and/or fragile individuals

Ballistic Stretching

The same task or series of exercises or tasks is performed repeatedly under the same conditions and in a predictable order; for example, the patient may consistently practice walking in the same environment, stepping to and from the same height platform, standing up from the same height chair, or lifting containers or equal size or weight; therefore, the task does not change from one repetition to the next.

Blocked-order-practice

This type of fatigue is the diminished response of an individual (the entire body) as the result of prolonged physical activity, such as walking, jogging, cycling, or repetitive lifting or digging. It is related to the body's ability to use oxygen efficiently

Cardiopulmonary Fatigue

Ability to perform moderate-intensity, repetitive, total body movements, over an extended period of time. Ex: walking, jogging, cycling, swimming, etc.

Cardiopulmonary Fitness (AKA Endurance)

-Enables the pt to maintain or increase the extensibility gained as the result of direct intervention and supervised practice. Often an integral component of an home exercise program and is necessary for long-term self-management of many musculoskeletal and neuromuscular disorders

Characteristics of Self-Stretching

adaptive shortening of the muscle-tendon unit and other soft tissues that cross or surround a joint resulting in significant resistance to passive or active stretch and limitation of ROM, which may compromise functional abilities.1

Contracture

The correct timing and sequencing of muscle firing combined with the appropriate intensity of muscular contraction leading to the effective initiation, guiding, and grading of movement Is the basis of smooth, accurate, efficient movement and occurs at a consious or automatic level

Coordination

A relatively short-duration stretch force that is repeatedly but gradually applied, released, and then reapplied is described as a the end-range stretch force is applied at a slow velocity, in a controlled manner, and at relatively low-intensity

Cyclic (intermittent) stretch

What are some benefits of cardiopulmonary fatigue?

Decrease in blood sugar (glucose) levels. Decrease in glycogen stores in muscle and liver. Depletion of potassium, especially in the elderly patient

Period of time a stretch force is being applied and shortened tissues are held in a lengthened position

Duration of a stretch

What are characteristics for manual stretching?

During manual stretching, the clinician or caregiver applies an external force that lengthens the targeted tissue resistance The therapist manually controls the site of stabilization and the direction, rate of application, intensity, and duration of stretch. can be performed passively, with assistance from the pt, or even independently by the pt Manual stretching typically employs a controlled, static stretch applied at an intensity consistent with the pt's comfort level Held 15-60s and repeated intensity is often increased as tolerated for subsequent reps. in an effort to achieve progressive lengthening

Also known as AROM, is the degree to which an active muscle contraction moves a body segment through the available ROM of a joint. It is dependent on the degree to which a joint can be moved by a muscle contraction and the amount of tissue resistance met during the active movement.

Dynamic Flexibility

When is manual stretching and joint mobilization/intervention most appropriate?

Early on in the rehabilitation process, which involves hands-on intervention by a practitioner

Despite widespread use of manual stretching by clinicians, its effectiveness of increasing tissue extensibility is debatable Some investigators report that manual stretching increases muscle length ROM in non-impaired subjects, others have reported a negligble effect from manual stretching, especially in the presence of long-standing contractures associated with tissue pathology.

Effectiveness of Manual stretching

-Studies base their effectiveness on the short-term soft tissues properties of either creep or stress-relaxation and on the long-term effects of plastic deformation Be cautious when interpreting studies or product information reporting "permanent" lengthening through the use of stretching devices. The term permanent may mean that length increases were maintained as little as a few days or a week after discontinuing use of a stretch device, while long-term follow-up may indicate that tissues have returned to their normal state.

Effectiveness of Mechanical stretching

A broad term that refers to the ability to perform repetitive or sustained activities over a prolonged period of time

Endurance

True/False contractile soft tissues are known to yield to a low-intensity, continuously applied stretch force, as used in static stretching.

False NONcontractile soft tissues

T/F. Cyclic stretches are single repetitions

False. Are multiple repetitions per cycle

True/False. Eccentric contraction decreases speed which increases tension.

False. Increases speed which increases tension

True/False. High percentage type I fibers - low production, slow rate of maximum force development, will fatigue

False. Is resistant to fatigue

T/F. High percentage of type IIA and IIB fibers -rapid high force production; slow fatigue

False. RAPID fatigue

T/F. The greater the muscle diameter, the less its tension-producing capacity.

False. The MORE its tension-producing capactiy

True/False. The lower the frequency of firing the greater the tension.

False. The greater the frequency of firing the greater the tension

Fibrous changes in the connective tissue of muscle and periarticular structures can cause adherence of these tissues and subsequent development of a fibrotic contracture.

Fibrotic and Irreversible

Changes in the body functions (physiological) -These domains occur at the cellular, tissue, or body system level

Function

Refers to decreased ROM. This decreased ROM can be caused by variety of pathological factors including muscle length, capsular restriction, etc.

Hypomobility

This model does not focus on disability or on disease, but is intended to classify and code different health and health-related states experienced by everyone

ICF model

Either intrinsic feedback sensed during a task or immediate, post-task, augmented feedback (usually verbal) about the nature or quality of the performance of a motor task

Knowledge of perfromance

the diminished response of muscle to a repeated stimulus—is reflected in a progressive decrement in the amplitude of motor unit potentials. This occurs during exercise when a muscle repeatedly contracts statically or dynamically against an imposed load This acute physiological response to exercise is normal and reversible

Muscle Fatigue

What are the six components of function?

Muscle performance Cardiopulmonary endurance mobility/flexibility Neuromuscular control/coordination stability balance/Postural equilibrium

Types of impairments:

Musculoskeletal Neuromuscular Cardiovascular/Pulmonary Integumentary

Although the musculotendinous unit has adaptively shortened and there is a significant loss of ROM, there is no specific muscle pathology present

Myostatic

interaction of the sensory and motor systems that enables synergists, agonists, and antagonists as well as stabilizers and neutralizers to anticipate or respond to proprioceptive and kinesthetic information and subsequently to work in correct sequence to create coordinated movement. All of our sensory and motor system working together for our bodies to function

Neuromuscular Control