Therapeutic Exercise Exam 2

precautions for isometric exercise

-Apply and release the contractions gradually -Breath-holding is common with this type of exercise, encourage exhalation with contraction -Blood Pressure -you have to be very cautious - something to not have them do at home 54

Precautions for resistance exercise

-Avoid Valsalva-holding breath and they start to turn red -Watch for and avoid substitute motions -Be cautious not to overtrain, or overwork the patient -Be aware of Exercise-Induced muscle soreness

Integration of function

-Balance of strength, power, and endurance -Task-specific Movement Patterns during resistance -the purpose of us doing strength training is to get the patient to be more functional

Reversibility principle

-Changes made through strength/endurance training are short-lived unless training-induced changes are used regularly for functional activities or unless individuals participate in a maintenance program of resistance exercise -Detraining begins within a week or two after stopping a resistance exercise program -If you don't use it, you lose it!!!!

Endurance training

-Characterized by having a muscle contract and lift or lower a light load for many repetitions or sustain a muscle contraction for an extended period of time. -For many patients with impaired muscle performance, this training has a more positive impact on improving function than strength training.

Power Training

-Muscle strength is a necessary foundation for developing muscle power. -The greater the intensity of exercise and the shorter the time period taken to generate force, the greater the muscle power

Frequency

-Number of exercise sessions per day or week -Dependent on intensity and volume

Circuit Weight Training

-Pre-established sequence of continuous exercises performed in succession for total body conditioning -Typically repetitions are higher and intensity lower than with other weight training programs -Usually 8-12 reps at 90-100% of 10RM with short rests between sets and stations (15-20 seconds) -higher reps and lower intensity

Resistance Exercise

Any form of active exercise in which dynamic or static muscle contraction is resisted by an outside force applied manually or mechanically. -static-muscle length doesn't change -dynamic-muscle length is changing -manually-applied from human -mechanically-applied from a machine or bands or other thing besides human

progressive loading; intensity; volume

Application of Overload Principle -Focus on the _______________________________ of the muscle -Done by manipulation of intensity or volume of exercise -______________________- how much weight is imposed on the muscle -______________________- encompasses variables such as repetitions, sets, or frequency of exercise

Pseudomyostatic Contracture

a) May be result of central nervous system lesion -Examples: spasticity, rigidity b) Muscle guarding and muscle spasms may also cause this kind of contracture c) If neuromuscular inhibition procedures to reduce muscle tension are temporarily applied, full, passive elongation of the apparently shortened muscle is then possible

Fibrotic contracture and irreversible contracture

a)Due to fibrous changes in connective tissue of muscle and periarticular structures -Examples include fibrotic adhesions, scar tissue, or heterotopic bone b)Permanent loss of soft tissue extensibility c)Typically requires surgical intervention d)Can occur from: -Long periods of immobiliazation of tissues in shortened state -Tissue trauma and subsequent inflammatory response -very significant and irreversible -many times need surgical intervention -common with total knee replacement - that's why its so important to get knee moving after e)The longer this kind of contracture exists the more difficult it becomes to regain optimal mobility

flexibility

ability to rotate a single joint or series of joints smoothly and easily through an unrestricted, pain-free, range of motion

Passive flexibility (passive ROM) (if the joint cannot go past a certain degree in passive flexibility it will not go there or farther with dynamic flexibility)

basically PROM - Pre-requisite, but does not ensure, dynamic

protecting the surgical site

in post-operative patients there is nothing more important than?

6-10 ; 4-6

isometric exercise -Intensity-varies, still need to consider overload -Duration- ___________ seconds -Repetitions- good for increasing effectiveness -Joint Angle and Mode specificity- gains in muscle strength occur at or very near training angle, _____________ points in ROM is recommended, increases static strength only

manual and mechanical stretching

passive and assisted stretching -more hands on (manual) -done by a machine (mechanical)

stress strain curve: elastic limit

point at which tissue does not return to it's original shape or size

watershed zone

post rotator cuff surgery there is an abduction pillow because it the arm is abducted it helps with blood flow -so when you do ER exercises abducting to assure optimal blood flow

stress-strain curve: elastic range

region where there is direct proportional ability of the tissues to resist the force of the load (will go to original state) -stretching someone in this range will probably not be effective and will lead to no changes

self stretching

stretching done by the patient AFTER instruction and supervision by therapist

tissue resistance

stretching goes into?

low; changes

Creep Based on time there is changes that occur within the tissue -__________ load over extended period of time -load never ________________

Rest interval

Critical element, necessary to allow time for the body to recuperate from the acute effects of exercise associated with muscle fatigue or to offset adverse responses such as muscle soreness

immobilization, sedentary lifestyle, poor postural alignment, impaired muscle performance, tissue trauma resulting in inflammation and pain, and congenital or acquired deformities

what are the factors that lead to hypomobility? (hint: pretty much the same factors that lead to decreased range of motion)

tension, compression, bending, shear, torsion, and combined loading torsion-compression

what are the types of tissue stresses/loads?

stabilize proximal and move distal

when you are stretching or doing rom where do you want to stabilize and move?

neuromuscular facilitation and inhibition techniques

Founded on concept of reflexively decreasing tension prior to stretch Example: PNF Stretching Autogenic Inhibition: Relaxation of a muscle following development of tension - ex. contracting biceps and then when biceps relaxes elongate elbow Reciprocal Inhibition: Relaxation of antagonistic muscle group with activation of agnostic muscles - My arms bent and I want to straighten arm - utilize and contract triceps there will be antagonist muscles that allow me to move

atrophy; neuromuscular; movement; points

Isometric Exercise: Rationale and Indications -To prevent or minimize muscle _______________ when joint movement is not possible -To activate muscles to begin to re-establish ___________________________ control when movement is contraindicated -To develop postural and joint stability -To improve muscle strength when ______________________ could cause pain or compromise joint integrity -To develop static muscle strength at particular ______________ in ROM needed for specific task

work

Muscle performance is the capacity of muscles to do what?

PROM; above and below

Protection Phase (Think more acute phase) -Maintain soft tissue and joint integrity and mobility of surrounding segments ideally the segments we are working with -Gentle ______________ -Maintain integrity and function of associated areas -Working the joints ________________________

impairments; impairments; re-gained; function

SHOULDER PAIN -With any condition you must be mindful of "chasing pain". - we don't chase pain -Pain, despite being an impairment, is often functionally the result of ______________________. Common goals of treatment for most conditions: -Reduce ________________________ -Improve neuromuscular strength throughout range of motion, specially within ________________ ranges -Restore ____________________

local shoulder; refer pain into the shoulder; thoracic spine; posture

Shoulder pain is multi-factorial and much is to be considered -Consider the _________________________ anatomy -Consider the areas that can _____________________________________ such as the cervical and thoracic spine -Consider the impact of the _______________________ in attaining full upper extremity elevation -Consider __________________ and how it relates to joint space and joint motion

energy stores, fatigue, recovery from exercise, age, gender, and cognitive status

Skeletal Muscle Adaptation -Factors such as _____________________________________________________________ _________________________________ and many more can affect the muscle's ability to develop and sustain tension -The Therapist must recognize these and that they can affect a patient's performance and outcomes with exercise

stress strain curve: failure point

Stress or load being placed on tissue is too much. Complete tissue failure (rupture, fx, etc.)

soft tissue extensibility; flexibility and ROM

Stretching is any therapeutic maneuver designed to increase ________________________________ and subsequently improve _______________________________ by elongating structures that have adaptively shortened and have become hypomobile

labrum, rotator cuff, joint capsule

Subacromial space and bursa -sore there you have muscles that attach there, a bursa -3 main structures that increase stability of shoulder: ____________________, _______________________(keep head of humerus centered and compressed in the glenoid), and _______________________ (blended with the rotator cuff).

Strength training

Systematic procedure of a muscle or muscle group lifting, lowering, or controlling heavy loads for a relatively low number of repetitions or over a short period of time.

Duration

The total number of weeks or months during which a resistance exercise program is carried out

Alignment and Stabilization

To strengthen a specific muscle effectively and avoid substitute motions, appropriate positioning of the body and limb is essential

examination and evaluation of the patient, preparation for stretching, and application of manual stretching procedures

What are the Procedural Guidelines for Application of Stretching Interventions?

relaxation training, pilates, yoga, and tai chi, heat, cold, massage, biofeedback, and joint traction or oscillation

What are the adjunct interventions to stretching?

manual stretching, self stretching, and mechanical stretching

What are the different modes of stretching?

progressive resistance exercise, circuit weight training, and plyometric training

What are the different types of training regimens?

pathology, severity of impairments, other deficits, stage of healing, age and overall fitness, and ability to cooperate and learn

What are the factors that influence how appropriate, effective, or safe resistance exercise is and how the exercises are designed, implemented and progressed?

overload principle, SAID principle, and reversibility principle

What are the guiding principles to resistance exercise?

What is wrong with me? Why did it happen? What are you the PT going to do about it? What am I as the patient going to do about it? How long will it take? How much will it cost?

What are the things patients want to know?

protection phase, controlled motion phase, and return to function phase

What are the three stages of healing? (Think of them on a continuum-a lot of time you are going to be between the two)

serratus anterior

What muscle is often neglected but plays a big role in scapular control?

microfailure; permanent; adequate healing time

What occurs during a stretch? •________________________ of soft tissue comes prior to complete failure -Microfailure needed for ________________________ change •Healing and remodeling time between bouts MUST be allowed -Failure to allow __________________________________ will result in tissue failure •Tissue failure will often lead to things such as adhesions and scar formation -Adhesions and scar formation could lead to contracture and decreased range of motion

before; no effect or decrease; >90; >90

•Dynamic stretching is more effective ______________ vigorous exercise •Static stretching found to either have _______________________________ performance immediately following stretch session ▫Decrements are greatest with stretches held _________ seconds •Dynamic stretching found to enhance performance, especially with stretches _________ seconds

Stress-Relaxation

•Force applied to stretch a material decreases as the tissue strain reaches a specific dimension •Occurs when material is strained to a given dimension and maintained at that strain •Clinical Example: Serial casting -Serial casting - used to increase rom-cast at 80 degrees tissues respond, recast at 90 degrees, recast as tissue adapts -as it adapts that strain decreases

AROM; functional

•Integration of function into stretching ▫If the patient is able, ALWAYS retrain using ______________ into the newly gained range of motion ▫Have patient perform ______________________ activities post isolated stretching or find ways to stretch utilizing functional activities

mobilization/manipulation; prior

•Per the textbook, manual stretching and joint _____________________________________ may be most effective early in the rehab process ▫Progression to self stretching exercises •If normal arthrokinematics of a joint are not occurring, the stretch is more likely to be painful •Joint mobilization/manipulation, if needed, is often best done ______________ to stretching -Joint work first -followed by stretching -followed by strengthening

stress strain curve: plastic range

•Permanent changes in the shape or size of the tissue. For long lasting change you push into this range

Because you can have both active and passive contractile units controlling

Why can eccentric hold more loads?

parameters and progression of closed-chain exercises

-% Body weight: partial to full weight bearing, modified to full, full weight bearing to adding weights -Base of support: wide to narrow, bilateral to unilateral, fixed on support surface to sliding on support surface -support surface: stable to unstable/moving, rigid to soft, low step and then increasing height to higher step -Balance: with external support to no external support, eyes open to eyes closed -Excursion of limb movement: small to large ranges, short arc to full arc -Plane or direction of movement: uniplanar to multiplanar, anterior-->posterior-->diagonal -Speed of movement: slow to fast

Mechanical Resistance

-A form of active-resistive exercise in which resistance is applied through the use equipment or mechanical apparatus -Useful when resistance necessary is greater than what Therapist can apply manually

isokinetic exercise

-A form of dynamic exercise in which the velocity of muscle shortening or lengthening and angular limb velocity is predetermined and held constant by a rate-limiting device know as an isokinetic dynamometer -Carry-over to function is questionable -a machine that that's resistance is exactly the same throughout range of motion

Isometric Exercise (static exercise)

-A static form of exercise in which a muscle contracts and produces force without noticeable change in length of muscle and without visible joint motion. -Includes holding against a force applied manually, holding a weight in a particular position, pushing or pulling an immoveable object -length of the muscle is not going to change -using this for stabilization

Manual Resistance

-A type of active-resistive exercise in which resistance is provided by a therapist. -Useful in early stages of exercise program

endurance

-Ability to perform low-intensity, repetitive, or sustained activities over a prolonged period of time -Although strength and muscle endurance are associated they do not always correlate well with each other

recovery

-Adequate time for ______________________ from exercise is a must with every resistance program -Light exercise may aid in recovery, most likely due to neural and circulatory influence -Precaution: long-term improvement in muscle performance is only achieved if the patient is allowed adequate time to recover from fatigue

Plyometric training

-Also called stretch-shortening drills -High intensity and high velocity exercises that emphasize the development of muscular power and coordination -Incorporated into advanced phases of rehabilitation -Used to train quick movements for starting and stopping Stretch-shortening-eccentric loading stretch to an explosive movement -this is end game phases of rehab

Controlled Motion Phase (Sub-Acute)

-Control pain, edema, and joint effusion-there could be inflammation still occurring in this phase -Functional Activities - slow progression daily if previously immobilized -ROM-making sure that ROM is maintained and also increasing that ROM -Progressively increase joint and soft tissue mobility -Joint mobilization Gr III and IV (grades 3 and 4 are into tissue resistance with the goal of restoring arthrokinematics motion at that joint) -Self or Manual stretching -Inhibit muscle spasm and correct faulty mechanics -Joint mobilization Gr I and II -Protected weight bearing as indicated -Movement retraining -Improve arthrokinematics -Improve muscle performance-strength, endurance, power -Improve range of motion

Progressive Resistance Exercise: DAPRE Regimen

-Daily Adjustable Progressive Resistance Exercise -A program to help with knowing how to increase resistance for the overload principle. -See tables 6.11 and 6.12 on pages 227 -Based on 6RM -4 sets, resistance for 4th set and next session based on number of reps that were able to be performed during 3rd set.

Power

-Defined as work produced by a muscle per unit of time (force x distance/ time) -Rate of performing work -The relationship of force and velocity are factors that affect muscle power.

muscle energy techniques

-Designed to lengthen muscle and fascia, as well as mobilize joints -Voluntary contractions by patient against counterforce by practitioner

open chain exercises

-Distal segment moves in space -Independent joint movement -Movement of body segments only distal to the moving joint -Muscle activation occurs predominantly in the prime mover -Typically performed in NWB positions -Resistance is applied to the moving distal segment

closed chain exercises

-Distal segment remain in contact with support surface -Interdependent joint movements -Movement of body segments may occur distal and/or proximal to the moving joint -Muscle activation occurs in multiple muscle groups -Typically performed in WB positions -Resistance applied to multiple moving segments -Uses axial loading if in WB

Benefits of resistance training

-Enhanced muscle performance -Increased strength of connective tissues -Greater bone mineral density -Decreased stress on joints -Reduced risk of soft tissue injury -Improvement in capacity to repair and heal -Improvement in Balance -Improvement with performance of ADL's -Changes in body composition -Enhance feeling of well-being -Improvement in perception of disability and quality of life

contraindications for isometric exercise

-High intensity isometrics exercises may be contraindicated for patients with a history of cardiac or vascular disorder

overload principle

-If muscle performance is to improve, the muscle must be challenged to perform at a level greater than that to which it is accustomed -If the demand remains constant after the muscle has adapted, the level of muscle performance can be maintained but not increased.

speed of stretch

-Importance of a slowly applied stretch in most cases -Ballistic stretching -High-velocity stretching in conditioning programs and advanced-phase rehabilitation -ballistic stretching can be good -be able to withstand rapid change - more used for athletes -but for most patients we will not use it

strength; time

-In a _________________ program, the amount of resistance applied to the muscle is incrementally and progressively increased -For endurance training, more emphasis is place on increasing the ____________ a muscle contraction is sustained or the number of repetitions performed rather than on increasing resistance.-more emphasis on volume

soft tissue mobilization/manipulation

-Involves application of sustained manual pressure or slow, deep stroking -IASTM - Instrument assisted soft tissue mobilization -Examples: Friction massage, myofascial release, acupressure, and trigger point therapy, dry needling

Muscle Setting Isometrics

-Low intensity contraction (sub-maximal) -No appreciable resistance -Beginning of isometric continuum -Used to decrease pain and spasm, promote relaxation and circulation after injury to soft tissue during acute stages of healing -Does not improve strength except in very weak muscles -Can slow down atrophy and maintain mobility of muscle fibers -A lot of time used early on after post-op -Will not improve strength - unless the muscle is very very weak - however in most cases it will not improve strength

Determinants of resistance exercise

-Many elements determine if a resistance program is appropriate, effective, and safe. -Alignment, stabilization, dosage (intensity, volume, frequency, duration, and rest interval), mode, velocity, periodization, and integration of exercise

Patients with hypermobility

-Mobility of a joint beyond normal limits -With increased mobility comes decreased stability -Common examples: -Dislocation -Subluxation -Profound strength deficits such as large rotator cuff tears -Some Central Nervous System Lesions -Peripheral Nerve Lesions

Progressive Resistance Exercise: Oxford Regimen

-Much like Delorme -Uses 3 sets of 10 RM with regressive loading -Diminishes the resistance as muscle fatigues -Rest intervals between sets -Incrementally increases resistance over time -Has been shown to increase strength gains over time -in terms of PT you are starting high but you would want to be very cautious and do really good warm up

Progressive Resistance Exercise (PRE)

-Program that uses constant external resistance applied to the contracting muscle by some mechanical means and incrementally increased. -The repetition maximum is used for determining and progressing resistance. -follows progressive overload principle -when doing weight start low and build -monitor patient -go up a little bit each time - this will have a profound effect -if they are doing 3x10 for three weeks they probably aren't getting stronger -start 3x10 and go up 1 rep every other day

Return to function phase

-Progressively increase flexibility and neuromuscular strength -Emphasize correct mechanics, safe progressions, and exercise strategies for return to function -Prepare for functional demands -Try to mimic possible job situations the patient may encounter With strength we are ideally starting to work toward function -strength early on will start with open chain -activity specific as possible

Modes of Exercise

-Refers to the form of exercise, type of contraction, and manner it's carried out. -Should mimic desired functional activity

Multi-Angle Isometrics

-Resistance is applied manually or mechanically -At multiple angles within available ROM -Used when the goal is increased strength throughout range when joint ROM is permissible but dynamic exercise is painful or inadvisable -You are only going to get stronger to the specific angle that you are doing -SAID principle

contraindications to resistance exercise

-Resistance training is most often during acute inflammation, or some acute diseases.-do passive instead -Careful selection of mode of exercise and keeping intensity low, adverse effects can be avoided. -Pain: if a patient has pain with AROM, resistance should not be applied -Acute inflammation: dynamic resistance exercises must be performed with caution and often may not yet be indicated Light muscle setting may be better option -Severe Cardiopulmonary Disease is a contraindication also. Resistance training should be postponed for at least 5 weeks after Myocardial Infarction, open-heart surgery, or until clearance by Cardiologist or supervising physician.

neural tissue mobilization

-Restores nerve mobility -Nerve glides - nerves need blood, space, and movement

joint mobilization/manipulation

-Skilled manual therapy interventions -Used to modulate pain and treat joint impairments

SAID principle

-Specific Adaptations to Imposed Demands -Extension of Wolff's Law-Body systems adapt over time to stresses placed on them -Helps the therapist determine the exercise prescription and which parameters of exercise should be selected to create specific training effects that best meet specific functional needs -Specificity of Training -Adaptive effects of training are highly specific to the training method employed -Should be considered relative to mode and velocity of exercise as well as patient or limb position and movement pattern during exercise -Task specific practice must always be emphasized

Velocity of Exercise

-Speed at which the muscle contracts -Affects muscle tension which affects muscular strength and endurance

Intensity

-The amount of resistance imposed on the contracting muscle during each repetition of an exercise -It should never be so great as to cause pain!

Muscle Fatigue

-The diminished response of muscle to a repeated stimulus and reflected in the progressive decrease in the muscle's ability to fire. -Signs include: discomfort or pain, tremors in contracting muscle, jerky active movements, inability to complete the movement, use of substitution motions, and decline in peak torque with isokinetic testing

Exercise Order

-The order of exercises during a session can have an impact on muscle fatigue -Large muscle groups, before small. Multi joint to single joint. --Higher intensity before lower intensity. -This is a general guideline

myostatic contracture

-Type of contracture -No specific muscle pathology -Resolve in short period of time - related more to immobilities

Progressive Resistance Exercise: Delorme Regimen

-Uses 3 sets of 10 RM with progressive loading -Warm-up built into protocol -Rest intervals between sets -Incrementally increases resistance over time -Has been shown to increase strength gains over time

open; open; closed; closed; closed; closed

-_____________-chain exercises are better at improving muscle performance of a specific muscle or group -In early phases of rehab the choice of ____________-chain exercises allow for more control than ______________-chain -______________-chain exercises are thought to promote dynamic stability -_______________-chain is better for instabilities (generally speaking) -_______________-chain is best for improved balance and postural control -close chain will promote any kind of stability -open chain is a way to get you to be able to do closed chain -in most cases but not all cases closed chain will be better functionally for the patient

concentric; eccentric; eccentric; concentric; eccentric

-_________________________ Exercise- recruits a larger number of muscle units to control the same load as compared to an ___________________ contraction -________________________ Exercise- larger loads can be used with this training; however at the end of a exercise program the strength gains appear to be similar to ______________________. -__________________________ also tends to cause greater delayed-onset muscle soreness -However, if a patient is too weak to lift a segment against gravity, they may be able to lower that segment against gravity, due to muscular demands and recruitment of motor units to control the same load

Protection Phase (Think more acute phase)

-a lot of signs of inflammation -protect the tissues - tissues have been damaged and they need time to heal -Patient education -educate on RICE -What to expect -Activity modification -Control Pain, Edema, Muscle Guarding -Gentle PROM -Joint mobilization Gr I and II (not going into tissue resistance) -Modalities? -Muscle setting? -muscle setting can help with muscle spasm, -quad sets getting brain to fire that muscle -no strengthening

Dynamic Constant External Resistance Exercise (DCER) we use the term isotonic

-a mainstay of resistance programs -A form of resistance training where a limb moves through a ROM against a constant external load, provided by free weights, weight machines, or pulley systems. -requires both concentric and eccentric contractions to control the load -Limitation is that the muscle is challenged maximally at only one point in the ROM

patients with hypomobility; focus should be on restoring mobility

-conditions that have limited joint mobility and range of motion -Primarily a mobility restriction versus strength deficit; however, when mobility is restricted a secondary strength deficit is likely -Chronic strength deficits could also lead to this On this case what should our focus be?

Dynamic Exercise; concentric; eccentric

-muscle contraction causes joint movement and excursion of a body segment as the muscle contracts and shortens or lengthens under tension -______________________ contraction- physical shortening of the muscle against a force -______________________ contraction- physical lengthening of the muscle as it attempts to control a load

DOMS (delayed onset muscle soreness)

-muscle soreness and aching beginning 12 to 24 hours after exercise and peaking at 48 to 72 hours, and subsiding 2 to 3 days later -tenderness with palpation -be mindful of this with patients -adjust accordingly to what patients say -follow up questions are important - how long were they sore for?

scapula, humerus, and clavicle; clavicle; scapulothoracic; parascapular; ball and socket; high; low

-shoulder is made up of ______________________________________________. -shoulder connected to body through one bone the ___________________ -foundation of shoulder really occurs in the ___________________________ joint - but that is a functional joint -general strengthening for shoulder - start with _____________________ musculars -strengthening rotator cuff with poor control of scapula will be very limited -the shoulder is a _________________________ joint -significance: ___________ mobility _________ stability

Dynamic flexibility (active ROM)

AROM but how much flexibility do you have

strength

Ability of a contractile tissue to produce tension and a resultant force based on the demands placed on the muscle

functional strength

Ability of the neuromuscular system to produce, reduce, or control forces, contemplated or imposed, during functional activities, in a smooth, coordinated manner

Contracture

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 limited range of motion

Periodization

Builds systematic variations in exercise intensity and repetitions, sets, or frequency at regular intervals over a specified period of time

elbow flexion contracture; extension contracture

Contracture-more permanent but not always permanent decreased rom because of shortening of muscle tendon -if you cant straighten arm -bicep contracture - that would be called an ______________________________________. -arm stuck straight would be an __________________________________. -most contractures tend to be more flexion based

time; managing the load

Cyclical Loading and Connective Tissue Fatigue •This occurs on a continuum •Principle of cyclical loading may allow for improved function but pathology may result -Negative Example: runner increasing weekly mileage suffers a stress fracture. •Overuse syndromes in general -Positive Example: athlete working out in the weight room with high intensity training increases strength •_____________ must be allowed between bouts of cyclic loading for remodeling and healing How do we ensure its positive? Making sure there is proper rest - key is _____________________________. -stress on the tissues is good - the key is the amount of stress and how often we are stressing them

hypomobility

Decreased mobility or restricted motion at a single joint or series of joints

examination; resistance; distal; stabilization; intensity; volume; verbal or written instructions; watch; rhythmic unresisted

General Principles of Manual or Mechanical Resistance Training -Perform a thorough _______________________ to determine what types of resistance to use and what exercises to perform -Warm-up: use light repetitive movement without ____________________ to the specific area to be worked. -Resistance: usually placed at the ______________ end of the segment being strengthened -_______________________: necessary to avoid unwanted, substitute motions-can be external or internal -________________: initially have patient practice the pattern without resistance, resistance should not be more than the patient can control in a smooth manner using proper form. -________________: typically most adults can perform an exercise 8-12 reps, but this is very patient specific. -_______________________________________: use lay terms when describing an exercise and give specific instruction and clear illustration for home exercise programs -Monitoring the Patient: always _____________ and assess the patient's response to the exercises given -Cool Down: use _________________________________ movement to cool down

we go into plastic range but we are very careful about how far we go in and we give ample time to heal in between

How do we get microfailure without rupture of material?

isometric; DCER-isotonics; stabilization exercises; functional exercise; plyometric and sport specific

Hypomobility - Exercise Mode Progression -_____________________________ -Can be used when muscle activation is not contraindicated, but motion may still be -Most often this scenario relates to post-operative -Can be used when you want to begin to facilitate neuromuscular control, proprioceptive feedback, and improve circulation when you are still under strict ROM restrictions -Usually earlier stages of rehab, early on with ROM restrictions, this would look like muscle setting with sub-maximal contraction. -______________________________-Minimal to no resistance at first -Multiple tool options to perform exercises -Consider concentric and eccentric type exercises -Usually begins slowly during controlled motions phase if there are no restrictions from surgery -start in controlled mobility phase -__________________________- exercises that result in co-contraction of muscles around a joint, thus providing stabilization of the joint. -In hypomobility cases, stability is not generally a concern as the problem is too little mobility versus too much. -If a joint is hypomobile, surrounding joints may need to work on stabilization. -______________________________-Started in controlled motion or return to function stages of rehab -Start as early as able given symptoms, potential restrictions, etc. -Always need to consider the functional goals of the patient. -_____________________________________-Not started until later stages of rehab, once ROM is fully re-gained and good quality muscular control achieved -HIGH stress through the tissues -If patient does not have good muscular control they are NOT ready

UE and LE; trunk; pushing and pulling; larger; smaller; multi-joint; isolation

In circuit weight training exercise order is important -Should alternate _________________ and ____________ exercises-generally speaking -Should alternate between ___________________________ muscle groups -_________________ muscle groups before _________________ muscle groups -__________________ exercises before ____________________ exercises

c3-c5; upper trapezius; heart; gallbladder; kehr's sign; elbow; impingement

It's important when Examining a patient with shoulder pain to consider all sources of pain for the shoulder region.-this information could save someone's life -Cervical Spine refers to the shoulder typically _____________ problems -Diaphragm - perceived in ________________________ region -______________: perceived in left axilla, pectoral region, or jaw -______________________ - perceived at tip of shoulder and parascapular region -Other systemic origins can be sources of shoulder pain as well -Spleen - ___________________ is classical sign of ruptured spleen -The shoulder itself can refer pain to the upper arm, but usually not past the _________________ -Along lateral upper humerus is a common presentation for ___________________________. -we could detect cancer and save someones life and be a huge game changer -if ROM is normal, strength is normal, everything looks normal but there is pain these could play a factor

progression; functional; impairment

KEY POINTS -Most patients after the early stages begin to follow a similar __________________________. -Therapeutic exercise should be very specific to the Patient's __________________________ goals in all situations -Even though the pathologies for a given area will have similarities, not all patients with a given pathology will have the same _________________________. -that's why its so important to treat the impairment not the pathology

uncontrolled blood sugars; initial onset of symptoms, freezing, frozen, thawing

Patients with Hypomobility Examples of Diagnoses or Pathology -Immobility after immobilization -Adhesive Capsulitis (frozen shoulder)-most common in people with __________________________________. -Decreased ROM in a capsular pattern -Idiopathic or Insidious -4 stages of frozen shoulder : _______________________________________ ____________________________________ -Many Rotator Cuff Pathologies -Hypomobility in this case is likely a protective response from the body -RA and OA (degenerative arthritis) -Traumatic Arthritis -Post injury/trauma

joint mobilization; stretching to regain full range of motion; strengthening throughout range of motion; utilization of new range of motion with function

Patients with Hypomobility Generalized treatment progression: 1. ___________________________ 2.___________________________________________________ 3.________________________________________________________________ 4._______________________________________________________________________ -Pain education and modalities done throughout as indicated -Other forms of treatment such as dry needling, myofascial treatment, etc. may be indicated -With these treatments you must be able to determine "why am I doing this treatment? What is the goal?"

eccentric; concentric; inflamation, pain, or significant joint instability; slowly

Plyometric training -Rapid ______________________ contraction followed by rapid reversal of movement with ______________________ contraction -Plyometrics should not be used if __________________________________ ________________________________ is present -When initiating Plyometric training progress _______________ with speed, intensity, reps and frequency

Arthrogenic and periarticular contracture

Type of contracture a)Develops when tissues that cross or attach to a joint or joint capsule lose mobility, restricting normal arthrokinematic motion b)Examples includes adhesions, synovial proliferation, joint effusion irregularities in articular cartilage, or osteophyte formation -more of the joint itself and what crosses the joint - joint capsule, synovial membrane, related to cartilage -osteophyte-bone spur or thickening of the bone - common on osteoarthritis

Stabilization Isometrics

Used to develop a sustained level of co-contraction to improve posture or dynamic stability of a joint by means of mid-range contractions against resistance in antigravity and WB positions when allowed -goal is that you want a cocontraction

exercise volume; training volume

Volume -_____________________________ = reps x sets x resistance -_____________________________ = summation of exercise volumes

manual and mechanical stretching, self stretching, neuromuscular facilitation and inhibition techniques, muscle energy techniques, joint mobilization/manipulation, soft tissue mobilization/manipulation, and neural tissue mobilization

What are interventions to increase mobility of soft tissues?

muscle setting, stabilization, and multi-angle isometrics

What are the 3 categories that isometrics can be divided into?

strength, power, and endurance (Most resistance training programs seek to achieve a balance between the 3 to meet the goals of the patient)

What are the 3 key elements of muscle performance?

Eccentric, concentric, and isometric

What are the 3 types of muscle contractions?

Strain

change in size and shape of material/tissue; deformation (Leveau).

radicular pain

pain along a nerve root distribution-not peripheral nerve

stress

•force per unit area -Technically it is the reaction within the material/tissue from the load •Internal reaction/resistance

Creep

•permanent deformation due to low load applied over extended period •The load does not change when material begins to deform •Clinical Example: Night splints/dynamic splint -example is a night splint/dynamic splint : elbow flexion contracture - I need to stretch elbow flexors - lets say I have a brace that's pulling and allows increased extension - as it changes that brace adjusts and allows elbow to go in different positions

Cyclical loading

•repeated stress placed through a tissue •produces heat and may cause failure below tissues typical failure point •The greater the load, the fewer number of cycles needed for failure •Minimal load required •Principle can be used for stretching -Example is contracted post-op patient who increases weekly visits for more aggressive stretching when cleared by physician

stress-strain curve: Toe region

•taking up slack in the tissue -ADL's occur in this region -no resistance

indications for stretching

▫Adhesions, contractures, or scar tissue limit ROM ▫Potential for structural deformity due to limited ROM ▫Shortening of muscles ▫Part of a total fitness program ▫Pre and post vigorous exercise

Determinants of stretching

▫Alignment and stabilization ▫Direction of stretch ▫Intensity of stretch ▫Duration of stretch ▫Frequency of stretch ▫Cyclic (intermittent) stretching ▫Tissue temperature

contraindications for stretching

▫Bony block - ex. elbow extension ▫Nonunion fracture - bones are not healing together - problem with stretching is you could disrupt any possible healing ▫Acute inflammation or infection ▫Sharp or acute pain with elongation ▫Hematoma (pooling of blood) or tissue trauma ▫Hypermobility ▫Hypomobility provides stability or control

Potential benefits and outcomes of stretching

▫Increased flexibility and ROM ▫General fitness ▫Other potential benefits: -Injury prevention - research is fairly poor -Reduced post-exercise muscle soreness - also poor research -Enhanced performance - depends on who you are and what you do

Selective stretching

▫Typically occurs in patients with paralysis -picking something that you want to stretch therapeutically - avoid stretching some areas to help them functionally ▫Example: Spinal cord injury - tenodesis for grip, selective stretching of hamstrings while simultaneously allowing trunk extensors to tighten

overstretching

▫is a stretch well beyond normal muscle length ▫May be beneficial for some populations (example: gymnasts) ▫Must be careful as this can lead to instability ▫Increased importance of dynamic muscular control