Chapter 6 Therapeutic Exercises

Mechanical Resistance Exercise

-active-resistive exercise -external reisstance is applied through the use of equipment or mechanical apparatus -resistance often measured quantitatively and incrementally progressed over time -external resistance necessary is greater than what the therapist can apply manually

Factors that influence fatigue

-age -lifestyle -environmental factors: room temperature, air quality, atlitude -how much time is required for rexcovery from exercise -health status -diet

initial exercise load (amount of resistance) and documentation of training effects

-applying manual resistance the decision is subjective on therapist judgment and patient effort performance, and response during exercise

Initiation and Progression of Isokinetic Training During rehabilitation

-begun later stages of rehabilitation -when active ROM is through the full or available ROM is pain free

Reversibility Principle

-detraining begins within a week or two after the cessation of resistance exercises and continues until training effects are lost -gains in strength and endurance need to be incorporated into dialy activities as early as possible into rehabilitaion program

pain

-patient experiences severe joint or muscle pain during movements against no external load, dynamic exercises should not be initiated -acute muscle pain during resisted isometric contraction, resistance exercises not initiated -if a patient experiences pain that cannot be eliminated by reducing exernal resistance, exercise should be stopped

force velocity graph

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Table 6.5

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table 6.8

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table 6.8

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balance of strength, power, and endurance

produce slow and controlled movements, rapid movements, repeated movements, and long term positioning

SAID Principle

Specific Adaptaiton to Imposed Demands -Example: to increase muscle power the exercise program should consist of interventions that increase work demands while decreasing time that work is accomplished -body systems adapt over time to the stresses placed on them -framework of specificity-we can predict training effects -therapists will create specific training effects to best meet patient's functional needs and goals.

Endurance

The ability to perform repetitive or sustained activities over a prolonged period of time

mechanical resistance

a constant or variable load can be imposed such as free weights or weight machine

attention

a patient must be able to focus on a given task (exercise) to learn how to perform it correctly -screen out irrelevant information

motivation and feedback

a patient must be willing to put forth effort and adhere to an aexercise program over time. Feedback can have a positive impact on a patient's motivation and adherence to an exercise program

sets

a predetermined number of consecutive repetitions grouped together

internal stabilization

achieved by an isometric contraction of an adjacent muscle group that does not enter into the movement pattern but holds the body segment of the proximal attachment of the muscle being strengthened firmly in place

intensity

amount of resistance imposed

resistance exercise

any form of active exercise in which the dynamic or static muscle contraction is resisted by an outsdie force applied manually or mechanically. -also referred as resistance training -an essential element of rehabilitation programs for persons with impaired function

alignment

body segments during each unique exercise

Table 6.7 in book

book

overtraining

decline in physical performance in healthy individuals participating in high intensity, high volume strength and endurance training programs -inadequate rest intervals, fluid intake, diet, rapid progression

vascular metabolic adaptations

decreased capillaries and mitochondria (due to an increase in number of myofilaments per fiber and reduced oxidative capacity of muscle)

mode of exercise and application to function

essential if a resistance training program is to have a positive impact on function. When tissue healing allows, the type of muscle contractions performed or the position in whcih an exercise is carried out should mimic deisred functional activity as close as possible

factors that influence tension

fatigue recovery age physical and cognitive factors

Type I Muscle Fibers

high resistance to fatigue high capillary denisty aerobic small diameter slow twitch rate maximum shortening velocity slow

anaerobic exercise

high-intensity exercise performed for low number of repetitions because mscles rapidly fatigue at near maximal intensity

Stabilization

holding down a body segment or holding the body steady

accomodating resistance

implemented by use of an isokinetic dynamometer that controls the velocity by adjusting the external resistance to meet the internal effort during exercise

Type IIa Muscle Fibers

intermediate resistance to fatigue high capillary density aerobic intermedite diameter fast twitch rate maximum shortening velocity fast

threshold for fatigue

level of exercise tht cannot be sustained indefintley -could be noted as length of time a contraction is maintained or the number of repetitions of an exercise tht initially can be performed.

aerobic exercise

low intensity, high repetition effort over an extended period of time (increase muscular and cardiopulmonary endurance)

Type IIB Muscle Fibers

low resistance to fatigue low capillary density anaerobic large diameter fast twitch rate maximum shortening velocity fast

external stabilization

manually applied equipment such as belts and straps or by using gravity to hold the body against firm support surface such as the back of a chair or the surface of a treatment table

appropriate setup

may need to be altered to ensure that the exercise is safe for a particular joint

substitute motions

monitor your patients -appropriate amount of resistance msut be applied and correct stabilization

dynamic eccentric contraction

muscle lengthening

Dynamic Concentric Contraction

muscle shortening

open chain exercise

non-weight bearing position is assumed and the distal segment (foot or hand) moves freely during the exercise

frequency

number of exercise sesions per day or per week. The number of times per week specific muscle grops are exercised or certain exercise are performed

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 the work. -greater the intensity of exercise and the shorter the time period taken to generate force, greater in muscle power

static contractions

refered as isometric contractions done internally often called muscle setting or against an unmovable external resistance

Muscle Power

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) -represent a single burst of high-intensity activity (plyometrics)

functional strength

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

cardiopulmonary endurance

reptitive, dynamic motor activities, such as walking, cycyling, swimming, or upper extremity ergometry which involve use of the large muscles of the body

short-arc

resistance exercises executed through only a portion of the avialable range. It is used when a painful or unstable arc motion must be avoided or to protect healing tissue after injury or surgery

techniques: general bacckground

resistance to reciprocal movement patterns also enhances a patient's ability to reverse the direction of movement smoothyly and quickly, a neuromuscular skill that is necessary in many functional activities. -muscular control of both prime movers and stabilizers to decrease momentum and make a controlled transitiy. -manual resistance associated with PNF

body weight

source of resistance if the exercise occurs in an antigravity position

key elements of muscle performance

strength power endurance

Strength training

systematic practice of using muscle force to raise, lower, or control heavy external loads for a relatively low number of repetitions or over a short period of time. -the most common adaptation to strength training is an increase in the maximum force producing capacity of muscle, primarily the result of neural adaptations and increased muscle fiber size.

muscular endurance

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

muscle performance

the capactiy of a muscle to do work (forcexdistance) -a complex component of functional movement and is influenced by all of the body systems.

mode of exercise

the form of exercise, type of muscle contraction that occurs, how the exercise load is applied and manner in which the exercise is carried out

Repetition Maximum

the greatest amont of weight or load that can be moved with control through full, available ROM a specific nmber of times before fatiguing -Use: identify initial exercise load for a specified number of repetitions and document baseline measurement of dynamic strength of a muscle or muscle group

overwork

the progressive deterioration of strength in muscles already weakened by non-progressive neuromuscular disease -monitor close

Endurance Training

the systematic practice of using muscle force to raise, lower, or control a light external load for many repetitions over an extended period of time. -low intensity muscle contractions, high number of repetitions, and prolonged time period -results in improved aerobic metabolism: increases oxidative and metabolic capcities, allowing better delivery and use of oxygen -most patients have a more positive impact on improving function than strength training -using lower levels of resistance in an exercise program minimizes potentially harmful joint forces, produces less irritation to soft tissues, and more comfortable for patient than heavy resistance exercise.

duration

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

volume

total number of repetitions and sets of a particular exercise during a single session multiplied by the intensity of exercise

manual and mechanical resistance

two broad methods which external resistance is applied

training zone

usually falls between 40%-70% of the baseline 1RM (healthy untrained individuals)

closed chain exercise

weight bearing position is assumed and the body moves over a fixed distal segment

isokinetic contraction

when the velocity of limb movement is held consistent by a rate controlling device

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 length of the muscle at the time of contraction. - Duration of muscle activation: Should be held between 6-10 seconds and allow a 2 second rise time. Allows sufficient time for peak tension to develop and for metabolic changes to occur. - Repetitive contractions: Set of repetitive contractions held for 6 to 10 seconds each, decreases muscle cramping and increases the effectiveness of the isometric regimen. - Joint angle and mode specificity: only at or closely adjacent to the jointing angle which resistance is appliked as the trainingangle - Sources of resistance: perform a variety of isometric exercises with or without equipment

Strength

-ability of contractile tissue to produce tension and a resultant force based on the demands placed on the muscle -greatest measurable force that can be exerted by a muscle or muscle group to overcome resistance during a single maximum effort

late adulthood

-after 50 strength decreases 15-20% decade -increases 30% a decade in the 60s -by the 8th decade, skeletal muscle mass will have decreased 50% compared to peak muscle mass -muscle fiber size, type I and II fibers, and number of alpha motor neurons all decrease -preferential atrophy of type II muscle fibers occur -muscle contraction speed and peak power production both decrease -endurance and maximum oxygen uptake gradullys but progressively decrease -force producing capacity of muscle is reduced -performance of functional skills begin to decline during 6th decade -significant deterioration in functional abilities by the eight decade associated with a decline in muscular endurance -with a resistance training program, significant improvements in muscle strength, power, and endurance is possible during late adulthood

signs and symptoms of muscle fatigue

-an uncomfotable sensation in the muscle, pain and cramping -an unintentional slowing of movement with successive repetitions of an exercise -active movements: jerky, not smooth -inability to complete the movement pattern through the full range of abialable motion during dynamic exercise against the same level of resistance -use of substitute motions-incorrect movement patterns to complete the movement pattern -inability to continue low intensity physical activity -decline in peak torque during isokinetic testing

alternate methods of determining baseline strength or an initial exercise load

-cable tensiometry and isokinetic or handheld dynamometer -body weight used to estimate external resistance to use in strength training -when maximum effort is inapproparitate the level of perceived loading, measured by Borg CR 10 scale to appropriate resistance and exercise intensity for muscle strengthening

mechanical resistance exercise

-can be measured quantitatively and incrementally -greater resistance

Manual Resistance Exercise

-can not be measured quantitatively -useful when muscle is weak -allow for varaince for techniques

Severe Cardiopulmonary Disease

-cardiopulmonary severe diseases or respiratory ones with accute symptoms contraindicate resistance training -severe CAD, hypertension , etc should not participate in physical activities, including resistance training -MI or CAbypass graft surgery resistance training postponed at least 5 weeks until clearance

risk prevention during resistance exercise

-caution patient about breath holding -ask patient to breathe rhythmically, count, or talk during exercise -have patient exhale when lifting and inhale when lowering -restrict high risk patients from high intensity resistance exercises

rationale for use of concentric and eccentric exercise

-concentric muscle contractions accelerate body segments -eccentric contractions decelerate body segments -eccentric contractions also act as a source of energy absorption during high-impact activities

isokinetic exercise

-constant velocity: short period at the start and end ranges of exercise motion where angular velocity is not constant. Remains relatively constant through ROM -range and selection of training velocities: a patient can prepare for the demands of functional activities that occur across a range of movement velocities. Match as specifically as possible to the demands of the anticipated functional tasks. -Reciprocal versus isolated muscle training: isokinetic dynamometry is the ability to provide resistance to opposing muscle groups at a joint, referred to as reciprocal training. -Specificity of training: Evidence of mode specificy with isokinetic exercise is less clear. Use a system of velocity spectrum rehabilitation (velocity specific) -Compressive forces on joints: lower at faster angular velocities than they are at slower velocities -Accomodation to fatigue: lower mucle force output does not necessarily result in cessation of motion. As the contracting muscle fatigues, the patient is still able to perform additional repetitions at the constant velocity even thoug hthe force output of the muscle is diminishing -Acomodation to a pinaful arc: if transient pain occurs the isokinetic training accomodates by reducing external reisistance applied to the limb.

verbal commands

-coordinate the timing of the verbal commands with the application of resistance to maintain control when the patient initiates a movement -simple, direct verbal commands -use different verbal commands to facilitate isometric, concentric, or eccentric contractions

propertieis of muscle and key neural factors and their impact on tension generation during an active muscle contraction

-cross section and size of muscle (muscle fiber number and size) -muscle architecture:fiber arrangement and fiber length (cross sectional diameter of muscle) -fiber type distirbution of muscle -length tension relationship of muscle at time of contraction -moment arm between muscle force vector and axis of joint rotation -recruitment of moment units -rate of motor unit firing -type of muscle contraction -speed of muscle contraction (force velocity relationship)

number of repetitions and sets/rest intervals

-dependent on the response of the patient -contigent on the strength and endurance of the therapist -after 8-12 repetitions, both the patietn and the therapist typically begin to experience some degree of muscular fatigue

open chain exercises chart

-distal segment moves in space -independent joint movement; no predictable joint motion in adjacent joints -movement of body segments distal to the moving joint only -muscle actication occurs predominantly in the prime mover and is isolated to muscles crossing the moving joint -typically performed in nonweight-bearing positions -resistance is applied to the moving distal segment -external rotary lading of joints is typical -external stabilization often required

Closed Chain Exercises Chart

-distal segment remains fixed or in contact with 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 -axial loading of joints through body weight is typical -internal stabilization by means of muscle action, joint compression and congruency and postural control

inflammation

-dynamic and static resistance training is absolutely contraindicated in presence of inflammatory neuromuscular disease -dynamic resistance exercises are contraindicated in the presence of acute inflammation of a joint -dynamic resisted exercise can irritate the joint and cause more inflammation

Benefits of Resistance Exercise

-enhance muscle performance -greater bone mineral density -enhanced physical performance during ADL's -increased lean muscle mass or decrease body fat -enhanced feeling of physical well being

general principles of resistance training

-examination and evaluation: perform thorough examination of the patient, evaluate findings to determine if resistance exercise is right, establish how resistance training will be integrated into plan of care with other therapeutic exercise interventions, re-evaluate periodically to document progress and determine dosage of exercises, and types of resistance exercises. -preparation for resistance exercises: select and prescribe appropriate forms of resistance exercise, anticipated goals, explain exercise plan and procedures, nonrestrictive clothing, comfortable support surface for the exercise, and demonstrate each exercise

special consideration for eccentric training

-exercise induced muscle soreness -appropriate following musculoskeletal injuries or surgery and in conditioning programs to reduce the risk of injury or re-injury associated with activities that involve high intensity deceleration

Transfer of Training (cross training effect, overflow)

-exercised limb to a non-exercised contralateral limb in a resistance training program -musuclar strength also has been shown to improve muscular endurance -endurance training has no impact on strength -strength training at one speed has been shown to carry over to other speeds (higher or lower)

valsalva maneuver

-expiratory effort against a closed glottis must be avoided during resistance exercise -increase risk of cardiovascular injury -risk for people with high blood pressure, history of CAD, MI, cerebrvascular disorders, hypertension

alignment and muscle action

-fiber orientation, line of pull, and the specific action desired of the muscle to be strengthened -patient positined in the direction of movement of a limb or segment of the body replicates the action of the muscle or muscle groups to be strengthened -gluteus medius: hip remain extended and pelvis shift slight forward as patient abducts lower extremity

manual resistance exercise definition and use

-form of active resistance exercise in which the resistance force is applied to either a dynamic or a static muscular contraction by the therapist -when joint motion is permissible resistance is usually applied through available ROM -resistance applied during exercise carried out in anatomical planes of motion and PNF techniques -specific muscle strengthened by resisting the action of that muscle -rehabilitation programs, manual resistance exercise may be preceded by active resisted and active exercise, of the continuum of active exercises available to a therapist to improve or restore muscular performance

alignment and gravity

-forms of weight or free weights -patient or limb should be psoitioned in a way that considers how gravity and weight provide external resistance to the muscle being strengthened -if a cuff weight is on lower leg patient should be positioned side lying so the muscle contraction overcomes external resistance to gravity and weight

special considerations of isokinetic training: availability of equipment

-go to a facility where the equipment is available -assistance to set up equipment -may need supervision during exercise

eccentric vs. concentric exercise: characteristics

-greater loads can be controlled with eccentric exercise -training induced gains in muscle strengrth and mass are greater with maximm effort eccentric training -adaptaitons associated with eccentric training are more mode and velocity specific than adaptations as the result of concentric training -eccentric muscle contractions are more efficient metabolically and generate less fatigue than concentric contractions -following unaccustomed, high intensity eccentric exercise, there is greater incidence and severity delayed onset muscle soreness than after concentric exercise

training to improve strength or endurance

-impact of load and repetitions -strength: DeLorme studies 3 sets of 10 RM -endurance: as many as 3-5 sets of 40-50 repetitions with low resistance

Hyperplasia

-increade fiber numbers -5% of increase in size -fiber splitting

hypertrophy

-increase in the size of an individual muscle fiber caused by increased myofibrillar volume -usually 4-8 weeks -as a result of increased protein synthesis, decreased protein degradation, and changes that stimulate ptake of amino acids -high volume, moderate resistance exercise -type II B

adaptations of connective tissues

-increases musculoskeletal junction, ligament bone interface, and connective tissue thickens -high correlation between muscle strength and physical activity with bone mineral density

progression on isokinetic training for rehabilitatin

-initially, keep resistance low, submaximal isokinetic exercise is implemented before maximal -short arc movements are used before full arc motions, when necessary -slow to medium training velocities (60-180/sec) are incorporated into the exercise program before progressing to faster velocities -maximal concentric contractions at various velocities are performed before introducing eccentric isokinetic exercises

determinants of frequency

-intensity -volume -patient's goals -general health status -previous participation in resistance exercise program -response to training cause of decline is overtraining (inadequate rest intervals, and progressive fatigue)

implementation and progression of open and closed chain exercises

-introduction of open chain training -closed chain aexercises and weight bearing restrictions: use of unloading: aquatic therapy and body weight supported treadmill system to unload lower extremities -progression of closed chain exercises: plyometric and agility drills

rationale to use of open chain and closed chain exercises

-isolation of muscle groups: open improve performance of individual mscle grops more effective than closed -control of movements: during open a grater levelof motion control is posible with single moving joint than with multiple moving joints. In closed the patient uses muscular stabilization to ocntrol joints or structures proximal and distal to targeted joint. -joint approximation-compression vs. shear force: Joint approximation within axial loading and weight bearing during closed is through to cause increase in joint congurency which contributes to stability. -co-activation and dynamic stabilization-WB positions have better evidence to support: pper extremity closed are though to promote co-activation and improve dynamic stabiity of the shoulder. -proprioception, kinesthesia, neuromuscular control, and balance CKC >OKC: Closed kinetic chain elicits greater proprioceptive and kinesthetic feedback than open chain. Closed chan improves upward balance and postural control -carry to function and injury prevention: principles of motor learning and task specific training, if exercises are to have a beneficial effect on functional outcomes

young and middle adulthood

-max strength is in the 20s for females and 30s for males (then decrease 1% year) -muscle continues to develop in the second decade especially in men -muscle strength and endurance reach a peak in the second decade, earlier for women than men -decreases in muscle mass begin to occur as early as 25 years of age -in the third decade, strength declines between 8% and 10% per decade through 5th and 6th decade -strength and muscle endurance decline rapidly in physically active adults -improvements in strength and endurance are possible with only modest increases in physical activity

integration of rest in exercise

-moderate intensity 2 to 3 minute rest -high intensity is a longer rest interval (>3 minutes) -short rest interval after low intensity

adolescence

-muscle mass increases more than 5 folds in boys and approximately 3.5 in girls -rapid acceleration in muscle fiber size and muscle mass, espeicially in boys. Puberty more than 30% for boys -rapid increase in muscle strength for both sexes -in boys, muscle mass and body height and weight peak before muscle strength peaks -in girls, strength peaks before body weights peak -relative strength gains through training are comparable between seces, significantly greater muscle hypertrophy in boys

delayed onset muscle soreness: signs and symptoms

-muscle soreness and aching begin 12 to 24 hours after exercise, peaking at 48 to 72 hours, and subsiding 2 to 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 invovled muscle -local edema and warmth -muscle stiffness reflected by spontaneous muscle shortening before onset of pain -decrease ROM during time course of muscle soreness -decreased muscle strength prior to onset of muscle soreness that persists for up to 1 to 2 weeks after soreness has remitted

early childhood and preadolescence

-muscle strength and endurance increase linearly with age -muscle mass and mscle strength is approximately 10% greater in boys than girls from early childhood to puberty -trainign induced strength gains occur equally in box sexes during childhood without evidence of hypertrophy until puberty -preadolescent boys and girls participate in training programs before, during, and after season

purpose of rest intervals

-necessary to allow time for the body to recuperate for muscle fatigue or to offset adverse responses such as exercise induced, delay onset muscle soreness -rest between sets of exercise and between exercise sessions must be carefully implemented

task specific movement patterns with resistance exercise

-pushing, pulling,lifting, and hold activities can initially be done against a low level of resistance for a low number of repetitions -overtime, intensity and dose of resistance is progressed until the patient returns to using the same movements during functional activities in an unsupervised work or home setting.

balance of stability and active mobility

-requires a balance of active movement superimposed on a stable background of neuromuscular control -stability achieved through proper agonist and antagonist muscle activation at individual joints -mobility requires correct activatin sequencing and intensity across multiple muscle groups

application of manual resistance and stabilization

-review principles and guidelines for placement and stabilization. Proximal attachment of contracting muscle with one hand and apply resistance distally to the moving segment -Grade and vary amount of resistance to equal the abilities of the muscle throughout the available ROM -gradually apply and release the resistance so movements are smooth, not unexpected or uncontrolled -hold the patient's extremity close to your body so some of the force applied is from the weight of your body not just the strength of your upper extremities -manual resistance to alternating isometric contractions of agonist and antagon ist muscles to develop joint stability, maintain manual contacts at all times as the isometric contractions are repeated.

body mechanics of the therapist

-select a treatment table on which to position the patient that is a suitable height or adjust the height of the patient's bed -assume a position close to the patient to avoid stresses on your lower back and to maximize control -wide base of support to maintain stability

Application of the Overload Principle

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

Cardiopulmonary (general) fatigue

-systemic diminished response of an individual to stimulus as the result of prolonged physical activity such as walking, jogging, cycling, or repetitive work. Factors: -decreased blood sugar (glucose) levels -decreased glycogen stores in muscle and liver -depletion of potassium, espeicaly in the elderly patient

Muscle (local)fatigue

-the diminished response of muscle to a repeated stimulus is relected in a progressive decrement in the ampltiude of motor unit potentials. -when mscle repeatedly contracts statically or dynamically against an imposed load -characterized by gradual decline in the force producing capacity

Specificity of Training

-the effects of training, such as improvement of strength, power, and endurance, are highly specific to the training method employed. -exercise incorporated in a program should mimic the anticipated function -if a patient requires greater muscular endurance than strength, lower intensity exercise over a long time should be emphasized -should be considered with respect to type and velocity of exercise as well as patient or limb position (joint angle) and movement pattern during exercise

repetitions

-the number of times a particular movement is performed consecutively -number of mscle contractions performed to move the limb through a series of continuous and complete excursions against a specific exercise load

Recovery from exercise

-time for recovery must be built into every resistance exercise program -applies to both intra-session and intersession recovery -recovery from acute exercise, in whcih force producing capacity of muscle returns to 90% to 95% of the pre-exercise capacity, usually takes 3 to 4 minutes, with the greatest proporiton of recovery occuring in the first minute -during recovery oxygen and energy stores are replenished quickly into muscles. Lactic acid is removed from skeletal muscle and blood within approximately 1 hour after exercise and glycogen is replaced over several days

Overload Principle

-to improve muscle performance, a load that exceeds the metabolic capcity of the muscle must be applied -if the demands remain constant after the muscle has adapted, the level of muscle performance can be maintained but not increased

isometric exercise: summary of rationale and indications

-to minimize mscle atrophy when joint movement is not possible (casts, splints) -to activate muscles to begin to re-establish neuromuscular control but protect healing tissues -to develop postural or joint stability -to develop static muscle strength at a particular points in the ROM

Muscle fiber adaptation

-type IIB to type IIa is common with endurance training

manual resistance exercise

-type of active-resistive exercise in which external resistance is provided by a therapist or aother health professional -patient taught to apply self-generated manual resistance -useful when range of joint movements need to be carefully controlled -useful in early stages when muscle needs to be strengthened is weak and can overcome minimal to moderate resistance

percentage of body weight as an initial exercise load for selected exercises

-universal bench press: 30% BW -universal leg extension: 20% BW -"" leg curl: 10-15% BW -"" leg press: 50% BW

training effectsand carryover to function (isokinetic)

-velocity of limb movement during many daily living and sport realted activities far exceed macimum velocity settings available on isokinetic equipment -multiple velocities (functional tasks) -single joint movement -adapting setup of the equipment to allow multi axis movements in diagonal planes

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

neural adaptaitons

-weeks 1-4 -intial, rapid gain in the tension generating capacity of skeletal muscle from a resistance training program is attributed largely to neural responses -attributed to motor learning and improved coordination through increased recruitment and rate and synchronization of motor unit firing (due to decreased inhibition of CNS)

Questions to Consider

-were deficits in muscle performance identified? If so do these deficits contribute to limitations of functional abilities? -could identified deficits cause future impairment of function -what is the irratibility and current stage of healing of involved tissues? -is there evidence of tissue swelling? -is there pain? (at rest or with movement? At waht porition of the ROM? in what tissues) -Are there other deficits affecting much of the performance? -what are the patient's goals or desired functional outcome? Are they realisitc in light o the findings of the examination? -Given the patient's current status, are resistance exercises indicated/contraindicated?

look at table 6.4

6.4

Exercise Order

Large muscle groups before small, multijoint before single joint, high intensity before low intensity