therapeutic exercise written exam 2

mechanical resistance exercise

-Mechanical resistance exercise is a form of active-resistive 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.

wolff's law

-body systems adapt over time to the stresses placed on them -our muscles will adapt if given enough time to do so -ex: caluses

types of muscle contraction

-concentric -isometric -eccentric -isokinetic

determinants that affect tension generation of skeletal muscle -- speed of muscle contraction (force-velocity relationship)

-concentric increases speed --> decreases tension -eccentric increases speed --> increases tension

types of fatigue

-muscle (local) fatigue -cardiopulmonary (general) fatigue

isometric contraction

-muscle contracts but there is no movement -force is produced but no movement of the joint -muscle stays the same length

determinants that affect tension generation of skeletal muscle -- 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

2

-poor (P) -able to move through full ROM gravity eliminated

power

-related to strength and speed of movement -work produced by a muscle per unit of time fxd/t

muscle performance

-strength -power -endurance

types of isometric exercise -- stabilization

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

isokinetic contraction

a muscle contraction produced by a variable external resistance at a constant speed

endurance

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

co-activation and dynamic stabilization (open or closed chain)

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

component motions chart

component motions chart

weakest type of muscle contraction related to force production

concentric

eccentric contraction

contraction that results in lengthening of the muscle

concentric contraction

contraction that results in the shortening of the muscle

delorme and oxford regimens

delorme and oxford regimens

acute muscle soreness

develops during or directly after strenuous exercise performed to the point of muscle exhaustion. This response occurs as a muscle becomes fatigued during acute exercise because of the lack of adequate blood flow and oxygen (ischemia) and a temporary buildup of metabolites, such as lactic acid and potassium, in the exercised muscle.

cardiopulmonary (general) fatigue

diminished response of an individual (the entire body) as the result of prolonged physical activity

control of movements (open or closed chain)

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

DOMs typically associated more with

eccentric contraction

delayed onset muscle soreness (DOMS)

etiology: •Despite years of research the underlying mechanisms of tissue damage associated with DOMS is still unclear •form of contraction-induced, mechanical disruption(microtrauma) of muscle fibers and/or connective tissue in and around muscle that results in degeneration of the tissue. prevention and treatment of DOMS: •the initial onset of DOMS can be prevented or at least kept to a minimum by progressing the intensity 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

determinants that affect tension generation of skeletal muscle -- type of muscle contraction

force output from greatest to least = eccentric, isometric, concentric

endurance training

having a muscle contract and lift or lower a light load for many repetitions r sustain a muscle contraction for an extended period of time

increase strength

higher loads/resistance, shorter reps

isometric exercise

isometric exercise is a 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 -no motion at the joint when contraction occurs -holding a position -holding a joint so others can move

determinants that affect tension generation of skeletal muscle -- cross section and size of the muscle

larger the muscle, the greater the tension-producing capacity

how would you train to increase endurance of a muscle

low weight - high reps

factors that influence tension generation in skeletal muscle -- age: early childhood and preadolescence

muscle strength and muscle endurance increase linearly with chronological age in boys and girls throughout childhood until puberty.

open and closed chain table

open and closed chain table

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

factors that influence tension generation in skeletal muscle -- age: late adulthood

rate of decline of muscle strength accelerates to 15% to 20% per decade during the sixth and seventh decades and increases to 30% per decade thereafter

determinants of resistance exercise -- stabilization

stabilization of proximal or distal joints to prevent substitution

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

testing position chart

testing position chart

specificity of training

the adaptive effects of training such as improvement of strength, power and endurance are highly specific to the training method employed

characteristics and effects of isometric training -- intensity of muscle contraction

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.

muscle (local) fatigue

the diminished response of muscle to a repeated stimulus

determinants that affect tension generation of skeletal muscle -- recruitment of motor units

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

determinants that affect tension generation of skeletal muscle -- frequency of firing of motor units

the higher the frequency of firing, the greater the tension

rationale for using isometric exercise

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

determinants of resistance exercise -- frequency

the number of exercise sessions per day or per week

rationale for use of open and closed chain exercises

there is no evidence to support the global assumption that closed-chain exercises are "more functional" than open-chain exercises

how is exercise program to increase strength different from an exercise program to increase power

to increase power, manipulate the variables

determinants of resistance exercise -- duration

total time frame of a resistance training program

determinants of resistance exercise -- integration of exercises into functional activities

use of resistance exercises that approximate or replicate functional demands

determinants of resistance exercise -- periodization

variation of intensity and volume during specific periods of resistance training

eccentric more efficient?

yes, produces less tension

PNF

•approach to therapeutic exercise that combines functionally based diagonal patterns of movement with techniques of neuromuscular facilitation to evoke motor responses and improve neuromuscular control and function. -Used in neuro rehabilitation -Used in orthopedic rehabilitation •Hallmarks of this approach to therapeutic exercise are the use of diagonal patterns and the application of sensory cues—specifically proprioceptive, cutaneous, visual, and auditory stimuli—to elicit or augment motor responses.

circuit weight training

-Another system of training that employs mechanical resistance is circuit weight training. A pre-established sequence (circuit) of continuous exercises is performed in succession at individual exercise stations that target a variety of major muscle groups (usually 8 to 12) as an aspect of total body conditioning •Higher reps and less resistance Exercise order to allow for alternate muscle group fatigue and recover

proprioception, kinesthesia, neuromuscular control, and balance (open or closed chain)

-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

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

basic procedures with PNF patterns

-Manual contacts •placed over the agonist muscle groups or their tendinous insertions •allow the HCP to apply resistance to the appropriate muscle groups -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 Position and movement of the therapist : along the diagonal

progressive resistance exercise (PRE)

-PRE is a system of dynamic resistance training in which a constant external load is applied to the contracting muscle by some mechanical means (usually a free weight or weight machine) and incrementally increased -Used for health and non-healthy people •PRE also was beneficial for patients with a variety of pathological conditions including musculoskeletal injuries, osteoarthritis, osteoporosis, hypertension, adult-onset (type II) diabetes, and chronic obstructive pulmonary disease

characteristics and effects of isometric training -- duration of muscle activation

-To achieve adaptive changes in static muscle performance, an isometric contraction should be held for*** 6 seconds and no more than 10 seconds

rationale for use of concentric and eccentric exercise

-a combination of concentric and eccentric muscle action is evident in countless tasks of daily life, such as walking up and down inclines, ascending and descending stairs, rising from a chair and sitting back down. -it is advisable to incorporate a variety of concentric and eccentric resistance exercises in a rehabilitation progression to improve muscle strength, power, or endurance and to meet functional demands.

characteristics and effects of concentric and eccentric exercise -- exercise load and strength gains

-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.

types of isometric exercise -- 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.

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 exercises -detraining, 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 -"use it or lose it"

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.

determinants of resistance exercise

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

determinants of resistance exercise -- alignment

-alignment of segments of the body during exercise -positioned so acts against gravity

joint approximation (open or closed chain)

-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

carryover to function and injury prevention

-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

diagonal patterns

-composed of multijoint, multiplanar, diagonal, and rotational movements of the extremities, trunk, and neck. -Multiple muscle groups contract simultaneously. -There are two pairs of diagonal patterns for the upper and lower extremities: diagonal 1 (D1) and diagonal 2 (D2). Each of these patterns can be performed in either flexion or extension. Hence, the terminology used is D1Flexion or D1Extension and D2 Flexion or D2Extension of the upper or lower extremities.

which type of contraction is more efficient

-eccentric -fewer motor units are needed for the same load when compared to concentric -less tension in the muscle is created when eccentrically controlling and consistent load

factors that influence tension generation in skeletal muscle

-energy stores and blood supply -fatigue -recovery from exercise -age

determinants of resistance exercise -- intensity

-exercise load (level of resistance) imposed on the contracting muscle during each repetition of an exercise

characteristics and effects of concentric and eccentric exercise

-exercise load and strength gains -exercise-induced muscle soreness

3

-fair (F) -holds test position against gravity

3+

-fair + (F+) -holds test position against slight resistance

3-

-fair - (F-) -gradual release from test position

characteristics and effects of isometric training -- joint angle and mode specificity

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

determinants that affect tension generation of skeletal muscle -- fiber distribution of muscle

-high percentage of type I fibers = low force production, slow rate of max force development, resistant to fatigue -high percentage of type IIA and IIB fibers = rapid high force production, rapid fatigue

characteristics and effects of concentric and eccentric exercise -- exercise induced muscle soreness

-high-intensity eccentric muscle contractions are associated with a significantly higher incidence and severity of delayed-onset muscle soreness (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

physiological adaptations to resistance exercise -- skeletal muscle adaptations

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

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

application of overload principle

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

transfer of training (cross training effect)

-in contrast to 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

characteristics and effects of isometric training

-intensity of muscle contraction -duration of muscle activation -joint angle and mode specificity -sources of resistance

types of isometric exercise -- muscle setting

-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 -examples: quadriceps and gluteal muscles. -usually when someone is super weak

manual resistance exercise

-manual resistance exercise is a 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 -it is also useful when the range of joint movements needs to be carefully controlled.

physiological adaptations to resistance exercise -- neural adaptations

-motor unit recruitment -increase number of motor units firing -motor unit: motor neuron and the skeletal muscle fibers innervated by that motor neuron's axonal terminals -increase rate of firing --> decrease twitch contraction time -increase synchronization of firing

factors that influence tension generation in skeletal muscle -- age: 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.

types of isometric exercise

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

physiological adaptations to resistance exercise

-neural adaptations -skeletal muscle adaptations -adaptations of connective tissues

5

-normal -holds test position against maximal resistance

factors that influence tension generation in skeletal muscle -- age: adolescence

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

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 to 4 minutes, with the greatest proportion of recovery occurring in the first minute. -only need one minute of rest and you are back to about 90%

determinants that affect tension generation of skeletal muscle -- 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

SAID principle

-specific adaptations to imposed demands -this creates specific training effects that best meet specific functional needs and goals

types of resistance exercise

-static (isometric) or dynamic -concentric and eccentric -isokinetic -open-chain and closed-chain -manual and mechanical -constant and variable

**determinants of resistance exercise -- volume

-summation of the total number of repetitions and sets of a particular exercise during a single exercise session times the intensity of the exercise -repetitions: •number of muscle contractions performed to move the limb through a series of continuous and complete excursions against a specific exercise load. -sets: a predetermined number of consecutive repetitions grouped together -the inverse relationship of load on repetitions and sets -to improve muscle strength •60%- 80% of 1-RM (rep max) •fatigue within 8-12 reps •2-3 sets -to improve muscle endurance •Low resistance •Fatigue with 40 - 50 reps •4-5 sets

physiological adaptations to resistance exercise -- adaptations of connective tissue

-tendons, ligaments and connective tissues 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 -bone: there is a high correlation between muscle strength and the level of physical activity across the life span with bone mineral density

strength

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

determinants of resistance exercise -- exercise order

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

determinants of resistance exercise -- rest interval (recovery period)

-time allotted for recuperation between sets and sessions of exercise -purpose: allow time for the body to recuperate from the acute effects of exercise associated with muscle fatigue or to offset adverse responses, such as exercise-induced, delayed-onset muscle soreness. -integration of rest into exercise: for moderate-intensity resistance training, a 2- to 3-minute rest period after each set is recommended.

determinants of resistance exercise -- mode of exercise

-type of muscle contraction -position for exercise: weight-bearing or non-weight-bearing -forms of resistance: manual resistance, mechanical resistance, accommodating resistance (isokinetic dynamometer), body weight -energy systems: anaerobic (high intensity) aerobic (lower intensity) -range of movement: short-arc or full-arc exercise

overtraining

-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

special consideration 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

isolation of muscle groups (open or 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.