Therapuetic-Exam 2

diagonal patterns

- patterns of movement associated with PNF are composed of multijoint, multiplanar, diagonal, and rotational movements of the extremities, trunk, and neck -multiple muscle groups contract simultaneously - two pairs of diagonal patterns for the upper and lower extremities

maximal resistance

- the amount of resistance applied during dynamic concentric muscle contractions is the greatest amount possible that still allows the patient to move smoothly and without pain through the available ROM

indications for near-maximal or maximal loading

- when the goal of exercise is to increase muscle strength and power and possibly increase muscle size - for otherwise healthy adults in the advanced phase of a rehab program after a musculoskeletal injury - in conditioning program for individuals with no know pathology - for individuals training for competitive weight lifting or body building

progression of balance for closed-chain exercise

- with external support --> no external support - eyes open --> eyes closed

number of reps, sets, and rest intervals

-8-12 reps - decrease resistance if patient can't complete 8-12 reps - after a brief rest, do more reps -for progressive overloading, initially increase number of reps or sets; at a later point in the exercise program, gradually increase resistance

progressive resistance exercise

-PRE is a system of dynamic resistance training in which a constant external load is applied to the contracting muscle by some mechanical means (free weight or weight machine) and incrementally increased

sources of resistance for isometric exercise

-band, wall -hold weight while doing this

influence of the speed of muscle contraction (force-velocity relationship)

-concentric contraction: increase speed --> decrease in tension - eccentric contraction: increase in speed --> increase in tension

direction of resistance

-during concentric exercise resistance is applied in the direction opposite to the desired motion, whereas during eccentric exercise resistance is applied in the same direction as the desired motion

how many sets/reps do you do to improve muscle endurance

-low resistance - fatigue with 40-50 reps - 4-5 sets

contradictions to resistance exercise

-pain -inflammation -severe cardiopulmonary disease

examination and evaluation leading up to resistance training

a comprehensive examination and evaluation is the cornerstone of an individualized resistance training program

sets

a predetermined number of consecutive repetitions grouped together

2 on muscle strength scale

able to move through full ROM gravity eliminated

position and movement of the therapist

along the diagonal

energy systems for exercise

anaerobic (high intensity) aerobic (lower intensity)

placement of resistance

as distal as you can without crossing the next joint - generates most amount of external torque with the least amount of manual or mechanical resistance (load)

proprioception

awareness of body position

wolff's law

body systems adapt over time to the stresses placed on them

advantage of manual resistance exercise

can dictate the resistance given to patient - have more control + engagement

verbal or written instructions

don't use medical terminology or jargon

what type of contraction is the strongest

eccentric

what type of contraction is most efficient

eccentric is more efficient, fewer motor units are needed for the same load when compared to concentric, less tension in the muscle is created when eccentrically controlling a consistent load

integration of rest into exercise

for moderate-intensity resistance training, a 2-3 minute rest period after each set is recommended

influence of type of muscle contraction

force output from greatest to least- eccentric, isometric, concentric muscle contraction

3 on muscle strength scale

holds test position against gravity

endurance training

is characterized by having a muscle contract and life or lower a light load for many repetitions or sustain a muscle contraction for an extended period of time

volume

is the summation of the total number of repetitions and sets of a particular exercise during a single exercise session times the intensity of the exercise

4 types of muscle contractions

isometric, concentric, eccentric, isokinetic

adaptations of connective tissues (tendons, ligaments, and connective tissue in muscle)

it is believed that tendon and ligament tensile strength increases in response to resistance training to support the adaptive strength and size changes in muscle

if you can do the move concentrically than

its too easy eccentrically

kinesthetic awareness

know where your body is while its moving

what type of contraction has more tension

less tension when working eccentrically when load is consistent

motor unit

motor neuron and the skeletal muscle fiber's innervated by that motor nueron's axonal terminals

endurance

muscle endurance is the ability of a muscle to contract repeatedly against a load (resistance), generate and sustain tension, and resist fatigue over an extended period of time

power

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 - power= (force x distance)/ time

influence of length-tension relationship of muscle at time of contraction

muscle produces greatest tension when it is near or at the physiological resting length at the time of contraction

strength

muscle strength is the greatest measurable force that can be exerted by a muscle or muscle group to overcome resistance during a single maximum effort

repetitions

number of muscle contractions performed to move the limb through a series of continuous and complete excursions against a specific exercise load

velocity

of exercise

power training

power can be enhanced by either increasing the work a muscle must perform during a specified period of time or reducing the amount of time required to produce a given force

influence of muscle architecture- fiber arrangement and fiber length

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

isometric exercise

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

strength training

systematic procedure of a muscle or muscle group lifting, lowering, or controlling heavy loads (resistance) for a relatively low number of repetitions or over a short period of time

specificity of training

the adaptive effects of training, such as improvement of strength, power, and endurance, are highly specific to the training method and employed *exercises incorporated in a program should mimic the anticipated function

intensity

the amount of resistance (weight) imposed on the contracting muscle during each repetition of an exercise

influence of recruitment of motor units

the greater the number and synchronization of motor units firing, the greater the force production

influence of frequency of firing of motor units

the higher the frequency of firing, the greater the tension

influence of cross-section and size of the muscle (includes muscle fiber number and size)

the larger diameter, the greater its tension-producing capacity

use for isometric exercise

the need for static strength and endurance is apparent in almost all aspects of control of the body during functional activities

frequency

the number of exercise sessions per day or per week

alignment and gravity

the patient or limb should be positioned so the muscle being strengthened acts against the resistance of gravity and the weight

exercise order

the sequence in which muscle groups are exercised during an exercise session

adaptations of connective tissues (bone)

there is a high correlation between muscle strength and the level of physical activity across the life span with bone mineral density

rest interval

time allotted for recuperation between sets and session of exercise

duration of muscle activation of isometric exercise

to achieve adaptive changes in static muscle performance, an isometric contraction should be held from 6-10 seconds

duration of exercise

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

duration

total time frame of a resistance training program

mode of exercise

type of muscle contraction, position of the patient form (source) of resistance, arc movement, or the primary energy system utilized

integration of exercises into functional activites

use of resistance exercises that approximate or replicate functional demands

periodization

variation of intensity and volume during specific periods of resistance training

when is isokinetic contraction used

when the velocity of limb movement is held consistent by a rate-controlling device - isokinetic= movement of joint is at a steady state

progression of base of support in closed-chain exercise

wide --> narrow - bilateral --> unilateral - fixed on support surface --> sliding on support surface

proprioception, kinesthesia, neuromuscular control and balance in open and closed-chain exercise

- -Conscious awareness of joint position or movement is one of the foundations of motor learning during the early phase of training for neuromuscular control of functional movements. After soft tissue or joint injury, proprioception and kinesthesia are disrupted and alter neuromuscular control. Reestablishing the effective, efficient use of sensory information to initiate and control movement is a high priority in rehabilitation -Despite the assumption that joint position or movement sense is enhanced to a greater extent under closed-chain than open-chain conditions, the evidence is mixed

isolation of muscle groups in open and closed-chain

- -Open-chain testing and training identifies strength deficits and improves muscle performance of individual muscles or muscle groups more effectively than closed-chain exercises. - -Open-chain does better at isolating muscle groups and has a greater level of control because there is more external stabilization

Oxford regimen

- 10 reps @ 100% of the 10-RM - 10 reps @ 75% of the 10-RM - 10 reps @ 50% of the 10-RM * heavy initially for first set and then keep getting lighter

how many sets/ reps do you do to improve muscle strength

- 60-80% of 1-RM (rep max) - fatigue within 8-12 reps - 2-3 sets

acute muscle soreness

- Develops during or immediately following strenuous exercise performed to the point of muscle exhaustion - response occurs as a muscle becomes fatigued during acute exercise because of the lack of adequate blood flow and oxygen and temporary buildup of metabolites such as lactic acid

special considerations for older adults and resistance training

- a major goal of resistance training in older adults is to maintain or improve their levels of functional independence and reduce the risk of age-related diseases

exercise load and strength gains in concentric and eccentric exercises

- a maximum concentric contraction produces less force than a maximum eccentric contraction under the same conditions - when a weight is lifted and lowered, maximum resistance during the concentric phase of an exercise does not provide a maximum load during the eccentric phase

multiple-angle isometrics

- a system of isometric exercise in which resistance is applied, manually or mechanically, at multiple joint positions within the available ROM - used when the goal of exercise is to improve strength throughout the ROM when joint motion is permissible but dynamic resistance exercise is painful or inadvisable

dynamic exercise-constant external resistance (DCER)

- addresses the primary limitation of dynamic exercise against a constant external load - resistance equipment imposes varying levels of resistance to the contracting muscles to load the muscles more effectively at multiple points in the ROM - resistance is altered throughout the range by means of a weight-cable system that moves over an asymmetrically shaped cam, by a lever arm system, or by hydraulic or pneumatic mechanisms

purpose of rest intervals

- allow time for the body recuperate from the acute effects of exercise associated with muscle fatigue or to offset adverse responses, such as exercise-induced, delayed- onset muscle soreness

overtraining

- commonly used to describe a decline in physical performance in healthy individuals participating in high-intensity, high-volume strength and endurance training programs -inadequate rest intervals between exercise sessions, too rapid progression of exercises, and inadequate diet and fluid intake

transfer of training

- cross training effect - in contrast to the SAID principle, carryover of training effects from one variation of exercise or task to another also has been reported -most studies support the importance of designing an exercise program that most closely replicates the desired functional activities *specificity is better than cross training*

DeLorme regimen

- determination of 10-RM -10 reps @50% of the 10-RM - 10 reps at 75% of the 10-RM -10 reps @ 100% of the 10-RM *start off lighter and then go a little heavier each set

circuit weight training

- employs mechanical resistance - pre-established sequence of continuous exercises is performed in succession at individual exercise stations that target a variety of major muscle groups (8-12) as an aspect of total body conditioning *higher reps and less resistance *exercise order to allow for alternate muscle group fatigue and recover

when do you use PRE

- for health and non-healthy people - beneficial for many patients including those with musculoskeletal injuries, osteoarthritis, osteoporosis, hypertension, type 2 diabetes, COPD - benefits for healthy people include: strengthening the muscle around the bone to allievate some of the force going through the bone

mechanical resistance exercise

- form of active-resistance exercise in which resistance is applied through the use of equipment or mechanical apparatus - the amount of resistance can be measured quantitatively and incrementally progressed overtime

influence of fiber-type distribution of muscle- type 1 and type IIA and IIB

- high percentage of type 1 fibers- low force production, slow rate of maximum force development, resistant to fatigue - high percentage of type IIA and IIB fibers- rapid high force production; rapid fatigue

exercise-induced muscle soreness

- high-intensity eccentric muscle contractions are associated with a significantly higher incidence and severity of DOMS than occurs with high-intensity concentric exercise - possibly the result of greater damage to muscle and connective tissue when heavy loads are controlled and lowered

skeletal muscle adaptations to resistance exercise

- hypertrophy: is an increase in the size (bulk) of an individual muscle fiber caused by an increase in myofibrillar volume

preparation for resistance exercises

- if implementing mechanical resistance exercise, determine what equipment is needed and available -review the anticipated goals and expected functional outcomes with the patient - explain the exercise plan and procedures. make sure to get consent - have the patient wear nonrestrictive clothing and supportive shoes appropriate for exercise -demonstrate each exercise and the desired movement pattern

overload principle

- if muscle performance is to improve, a load that exceeds the metabolic capacity of the muscle must be applied- that is, the muscle must be challenged to perform at a level greater than that to which it is accustomed

indications of sub-max loading

- in the early stages of soft tissue healing when injured tissues must be protected - after prolonged immobilization when the articular cartilage is not able to withstand large compressive forces - when initially learning an exercise to emphasize the correct form -for most children and older adults - when the goal of the exercise is to improve muscle endurance - to warm-up and cool-down prior to and and after a session of exercise - during slow-velocity isokinetic training to minimize compressive forces on joints

prevention and treatment of DOMS

- initial onset can be prevented or kept to a minimum by progressing the intensive and volume of exercise gradually, by performing low-intensity warm-up and cool-down activities, or by gently stretching the exercised muscles before and after strenuous exercise

intensity of exercise/ amount of resistance

- initially have the patient practice the movement pattern against a minimal load to learn the correct exercise technique - have patient exert a forceful but controlled and pain-free effort. The level of resistance should be such that movements are smooth and non ballistic or tremulous

open-chain

- leg extension - distal segment moves in space - independent joint movement; no predictable joint motion in adjacent joints - movement of body segments only distal to the moving joint - muscle activation occurs predominantly in the prime mover and is isolated to muscles of the moving joint - typically performed in non-weight bearing positions - resistance is applied to the moving distal segment - use of external rotary loading - external stabilization (manually or with equipment) usually required

basic procedures with PNF patterns

- manual contacts - maximal resistance - position and movement of the therapist

neural adaptations to resistance exercise

- motor unit recruitment (increase in # of motor units firing) - increase rate of firing (decrease twitch contraction time) - increase synchronization of firing

how does age influence tension generation in skeletal muscle (young and middle adulthood)

- muscle mass peaks in women between 16 and 20 years of age; muscle mass in men peaks between 18 and 25 years of age - decreases in muscle mass begin to occur as early as 25 years of age

DOMS signs and symptoms

- muscle soreness and aching beginning 12-24 hours after exercise, peaking at 48-72 hours and subsiding 2-3 days later - tenderness with palpation throughout the involved muscle belly or at the myotendinous junction - increased soreness with passive lengthening or active contraction of the involved muscle -local edema and warmth - muscle stiffness reflected by spontaneous muscle shortening before the onset of pain - decrease ROM during the time course of muscle soreness - decreased muscle strength prior to onset of muscle soreness that persists for up to 1-2 weeks after soreness has remitted

how frequently should you exercise

- number of exercise sessions per day or per week (2-3 times per day, 2-3 times per week)

progression of % body weight in closed-chain exercise

- partial --> full weight-bearing (aquatic exercise, harness, wall push up --> modified prone push-up) - full weight bearing + additional weight (weighted vest or hand held weights)

how does age influence tension generation in skeletal muscle (adolescence)

- rapid increase in muscle strength in both sexes - marked difference in strength levels develops in boys and girls

progression of exclusion limb movement in closed-chain exercise

- small --> large ranges - short-arc --> full-arc

progression of support surface for closed-chain exercise

- stable --> unstable/moving (floor --> rocker board, sideboard) - rigid --> soft - height: ground level --> increasing height

intensity of muscle contraction during isometric exercise

- the amount of tension that can be generated during an isometric muscle contraction depends in part on joint position and the length of the muscle at the time of contraction

alignment

- the patient or a body segment must be positioned so the direction of movement of a limb or segment of the body replicates the action of the muscle or muscle groups to be strengthened *think force of gravity**

manual resistance exercise

- type of active-resistive exercise in which resistance is provided by a therapist or other health professional - this technique is useful in the early stages of an exercise program when the muscle to be strengthened is weak - useful when the range of joint movements needs to be carefully controlled

eitology of DOMS

- underlying mechanisms of tissue damage associated with DOMS is still unclear - form of contraction-induced, mechanical disruption of muscle fibers and/or connective tissue in and around muscle that results in degeneration of the tissue

progression of plane of direction for closed-chain exercise

- uniplanar --> multiplanar - anterior --> posterior --> diagonal - sagittal --> frontal or transverse --> side to side

guidelines for resistance training in conditioning programs for healthy adults (<50-60 years old)

- warm-up activities followed by flexibility exercises - perform dynamic exercises through full, pain-free ROM while targeting 8-10 muscle groups for total body muscular fitness - balance flexion-dominant (pulling) exercises with extension-dominant pushing exercises - include both concentric and eccentric - moderate-intensity (60-80% of 1 RM) 8-12 reps *increase intensity gradually - 2 sets, progressing to 4 sets of each exercise - 2-3 minute resting one muscle group while working the other - 2-3 times per week - slow to moderate speeds - controlled movements - do not interfere with normal breathing - train with partner - cool-down - after a lay-off of 1-2 weeks reduce resistance and volume

joint approximation during open-chain and closed-chain exercise

-Almost all muscle contractions have a compressive component that approximates the joint surfaces and provides stability to the joint whether in open- or closed-chain situations -The joint approximation that occurs with the axial loading and weight bearing during closed-chain exercises is thought to cause an increase in joint congruency, which in turn contributes to stability - -closed-kinetic chain has more joint stabilization

carryover to function and injury prevention in open and closed-kinetic chain exercises

-As already noted, there is ample evidence to demonstrate that both open- and closed-chain exercises effectively improve muscle strength, power, and endurance -That being said, and consistent with the principles of motor learning and task-specific training, exercises should be incorporated into a rehabilitation program that simulate the desired functions if the selected exercises are to have the most positive impact on functional outcomes - -depends on what you are trying to train your patient to do

co-activation and dynamic stabilization in open and closed-chain exercise

-Because most closed-chain exercises are performed in weight-bearing positions, it has been assumed and commonly reported in the neurorehabilitation literature that closed-chain exercises stimulate joint and muscle mechanoreceptors, facilitate co-activation of agonists and antagonists (co-contraction), and consequently promote dynamic stability - more than one muscle contracting at same time (closed-kinetic chain more than open-kinetic chain). Leads to more dynamic stabilization so the joint is more stable while we are moving

characteristics of isokinetic training

-Constant velocity -Range and selection of training velocities -Reciprocal versus isolated muscle training -Specificity of training -Compressive forces on joints -Accommodation to fatigue -Accommodation to a painful arc

control of movements in open and closed-chain exercise

-During open-chain resisted exercises a greater level of control is possible with a single moving joint than with multiple moving joints as occurs during closed-chain training

special considerations for eccentric training

-With a concentric contraction, greater numbers of motor units must be recruited to control the same load compared to an eccentric contraction, suggesting that concentric exercise has less mechanical efficiency than eccentric exercise -eccentric muscle contractions consume less oxygen and energy stores than concentric contractions

rationale for use of concentric and eccentric exercise

-a combination of concentric and eccentric muscle action is evident in countless tasks of daily life -want to incorporate a variety of concentric and eccentric resistance exercise in a rehab progression

reversibility principle

-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 exercise

determinants of a resistance exercise program

-alignment -stabilization -intensity -volume -exercise order -frequency -rest interval -duration -mode of exercise -velocity of exercise -periodization -integration of exercises into functional activities

signs and symptoms of muscle fatigue

-an uncomfortable sensation in the muscle, even pain and cramping -tremulousness in the contracting muscle - an untentional slowing of movement with successive repetitions of an exercise - active movements: jerky, not smooth - inability complete the movement pattern through the full range of available motion during dynamic exercise against the same level of resistance - use of substitue motions- that is, incorrect movement patterns- to complete the movement pattern - inability to continue low-intensity physical activity -decline in peak torque during isokinetic testing

advantages of mechanical resistance exercise

-can increase weight a lot more compared to manual - can track how much weight they are using

special considerations for children and resistance training

-children can achieve health-related benefits from resistance training and can safely engage in weight-training programs if designed appropriately and closely supervised

PNF approach

-combines functionally based diagonal patterns of movement with techniques of neuromuscular control and function *used in neuro rehabilitation * used in orthopedic rehabilitation - use of diagonal patterns and the application of sensory cues- specifically proprioceptive, cutaneous, visual, and auditory stimuli- to elicit or augment motor responses

how does age influence tension generation in skeletal muscle (early childhood and preadolescence)

-early childhood and preadolescence * muscle strength and muscle endurance increase linearly with chronological age in boys and girls throughout childhood until puberty

joint angle and mode specificity during isometric exercise

-gains in muscle strength occur only at or closely adjacent to the training angle - when performing multiple-angle isometrics, resistance at 4-6 points in the ROM typically is recommended

what exercise causes you to hold your breath

-isometric contractions which causes a decrease in blood pressure - it particularly occurs when performed against substantial resistance - likely to cause a pressor response as the result of valsalva maneuver, causing a rapid increase in blood pressure

what should be your exercise order

-large muscle groups should be exercised before small muscle groups - multi-joint exercises should be performed before single-joint - higher intensity exercises should be performed before lower intensity exercises

muscle-setting exercises

-low-intensity isometric contractions performed against little to no resistance - used to decrease muscle pain and spasm and to promote relaxation and circulation after injury - ex: quads and gluteal muscles

fatigue

-muscle (local) fatigue: the diminished response of muscle to a repeated stimulus - cardiopulmonary (general) fatigue: diminished response of an individual (the entire body) as the result of prolonged physical activity

types of isometric exercise

-muscle setting exercises, -stabilization exercises, -multiple angle isometrics

which is better open or closed chain

-no evidence to support if either is better

manual contacts

-placed over the agonist muscle groups or their tendinous insertions - allow the HCP to apply resistance to the appropriate muscle groups

how does age influence tension generation in skeletal muscle (late adulthood)

-rate of decline of muscle strength accelerates to 15% to 20% per decade during the 6th and 7th decades and increases to 30% per cade thereafter - due to lifestyle changes (reversibility principle)

recovery from exercise

-recovery from acute exercise, in which the force-producing capacity of muscle returns to 90% to 95% of the pre-exercise capacity, usually takes 3-4 minutes, with the greatest proportion of recovery occurring in the first minute -90-95% occurs in 1 minute

detraining begins

-reflected by a reduction in muscle performance, begins within a week or two after the cessation of resistance exercises and continues until training effects are lost

SAID Principle

-specific adaptation to imposed demands - create specific training effects that best meet specific functional needs and goals

closed-chain exercises

-squat - distal segment remains in contact with or stationary (fixed in place) on support surface - interdependent joint movements; relatively predictable movement patterns in adjacent joints - movement of body segments may occur distal and/or proximal to the moving joint - muscle activation occurs in multiple muscle groups, both distal and proximal to the moving joint - typically but not always performed in weight-bearing positions - resistance is applied simultaneously to multiple moving segments - use of axial loading - internal stabilization by means of muscle action, joint compression and congruence, and postural control

stabilization

-stabilize the proximal or distal joints to prevent substitution - holding down a body segment or holding the body steady so the proper muscle is working

stabilization exercises

-used to develop a submaximal but sustained level of co-contraction to improve postural stability or dynamic - rhythmic stabilization, body blade, stability ball

precautions for resistance exercise

-valsalva maneuver *at risk patients *prevention during resistance exercise - substitute motions - overtraining

implementation of resistance exercises

-warm up -placement of resistance -direction of resistance -stabilization -intensity of exercise/amount of resistance -number of repetitions, sets, and rest intervals -verbal or written instructions -monitoring the patient -cool down

warm up

-warm up with light, repetitive, dynamic, site-specific movements without applying resistance

application of the overload principle

1) in a strength training program, the amount of resistance applied to the muscle is incrementally and progressively increased 2) for endurance training, more emphasis is placed on increasing the time a muscle contraction is sustained or the number of repetitions performed than on increasing resistance