Therapeutic Exercise

What exercises can be done during the chronic stage? what are the goals?

-Increase tensile quality of scar: progressive strengthening and endurance exercises -Endurance consists of high rep, low weight, or more exercise -This is the stage where we promote functional activities. Based on what they were doing before they got injured, get them back to independence. -Develop functional independence: functional exercises, and specificity drills

Poor Knee Proprioception

Strength-lunge matrix (go in every direction) strengthening and working on proprioception Flexibility: yoga, lengthening, half moon (standing on one leg and flexing the trunk) Endurance- side step with band, remember to add time Speed of contraction: jump rope, hopping, kicking a ball, anything requiring you to move quickly Function: walking on the beach

Increased Lumbar Lordosis

Strength-yoga bridge, crunch(transverse abdominis breathing) Endurance-plank (timed) Flexibility-child's pose, hip flexion stretch Speed of contraction-sitting pelvic tilt, high knees, swinging a bat, throwing a ball, move the trunk quickly

Weak hip extensors

Strength: bridges, leg extensors Endurance: pushing off hard with a time Flexibility: hip flexors Speed of contraction: slow-squat and then jumping Function: up the stairs

SAID principle

The SAID principle(specific adaptation to imposed demands) suggests that a framework of specificity is a necessary foundation in which exercise programs should be built. This principle applies to all body systems and is an extension of Wolff's law (body systems adapt over time to the stresses placed.)

Isokinetic exercise

The term isokinetic refers to movement that occurs at an equal (constant) velocity.

Closed chain exercise

These exercises involve motions in which the body moves on a distal segment that is fixed or stabilized on a support surface.

Open Chain exercise

These exercises involve motions in which the distal segment (hand or foot) is free to move in space, without necessarily causing simultaneous motions at adjacent joints.

Overload Principle

This means stressing the body or parts of the body to levels beyond those normally experienced.

T/F closed chain exercises are performed in a weight bearing position.

True

Endurance

a broad term that refers to the ability to perform low-intensity, repetitive, or sustained activities over a prolonged period of time

Strength

broad term that refers to the ability of contractile tissue to produce tension and a resultant force based on the demands placed on the muscle

Power

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)

Eccentric contraction

lengthening of a muscle contraction

Concentric contraction

shortening of a muscle contraction

What are some parameters besides intensity, frequency and duration of exercise?

-% Body Weight: you can use full weight bearing or full weight bearing with weights -Base of Support: wide to narrow, bilateral, unilateral, fixed on support surface to sliding on support surface -Support surface: unstable/moving, rigid to sift, height-ground level increasing height (foam?) -Balance: with external support or no external support (tandem is going to be harder) You can start taking away visual and balance goes down. As we age, elderly people use their vision to help them balance. When you go to the bathroom at night turn on the light. -Exclusion of limb movement: small to large ranges of motion, short arc to full arc Increase the difficulty by limiting or increasing ROM. -Plane or direction of movement: uniplanar to multiplanar, anterior to posterior to diagonal -Speed of movement or directional changes (slow or fast) For example calf raises

What exercises can be done during the subacute stage? what are the goals?

-Develop mobile scar: selective stretching, mobilization/manipulation of restrictions -You can use ROM exercises, have them moving - Limited joint mobilization: Actively tell them to move it. - You will get more ROM when you let the patient move due to reciprocal inhibition. The inhibition inhibits the antagonist. - Inflammatory action that creates edema puts an inhibition to the nerve endings to give motor actions. We have not lost muscle fibers. It is the nervous system. We are talking about the ability for the nervous system to send motor signals to muscle. -Pain and fear can also turn off the NS. - Promote healing: non-destructive active, resistive, open and closed chain stabilization, muscular endurance, and cardiopulmonary endurance exercises, carefully progressed in intensity and range - Gait training normalizing the gait, teaching how to push off, swing phase, heel strike -This is where we begin strengthening as well. The pain is going down and now we can do harder exercises.

What exercises can be done during the cumulative trauma stage? what are the goals?

-Patient never gets out of chronic responses. For example, a carpenter who continues to injure himself. Every time he comes he has an inflammatory reaction. o Thickened tissue o Fibroblasts o Cross fibers grow and become less extensible and do not take the trauma they did before. o These are career killers -Educate the patient in ergonomics counseling in ways to prevent recurrence, home instruction in safe progression of stretching and strengthening exercises, instruction on signs of too much stress -Develop strong mobile scar: friction massage, STM -Develop a balance in length and strength of the muscles: correct cause of faulty muscles and joint mechanics with appropriately graded stretching and strengthening exercises -Progress functional independence: "Train muscles to function according to demand" provide alternatives for support if they cannot, train coordination and timing, develop endurance -Analyze job/activity: adapt home, work, and sport/environment/tools.

What exercises can be done during the acute stage? what are the goals?

-Vascular changes, exudation of cells and chemicals, clot formation, phagocytosis, neutralization of irritants, early fibroblastic activity -Inflammation, pain before tissue resistance -Control the effects of inflammation: selective test, ice compression, elevation -Prevent deleterious effects at rest: nondestructive movement, passive range of motion, massage, and muscle setting (is low intensity isometric exercise performed against little to no resistance.) with caution. o Isometric exercise, gentle AROM(only without pathology). o Muscle Pump -Reduce pain and swelling -Patient education: knowing what is going to happen vs the unknown will affect the outcome about what will happen.

Plyometric exercise

A program of high-intensity, high velocity exercises. It not only improves muscle strength but also develops power output, quick neuromuscular reactions, and coordination.

Active ROM

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

Active Assistive ROM

Active-assistive ROM is a type of AROM in which assistance is provided manually or mechanically by an outside force because the prime mover muscles need assistance to complete the motion

What are the stages of healing?

Acute, subacute, Chronic, and cumulative trauma

Isotonic exercise

Exercise that has equal tension. The load (weight) does not change, the torque imposed by the weight and the tension generated by the muscle both change throughout the range of movement.

Isometric exercise

Is a static form of exercise in which a muscle contracts and produces a force without an appreciable change in the length of the muscle and without visible joint motion.

Resistive Exercise

It is any form of active exercise in which dynamic or static muscle contraction is resisted by an outside force applied manually or mechanically.

Passive ROM

It is the active range of motion of a segment within the unrestricted ROM that is produced entirely by an external force. There is little to no voluntary muscle contraction. The external force may be from gravity, a machine, another individual, or another part of the individual's own body. PROM and passive stretching are not synonymous.