therapeutic exercise
Neuropraxia:
Action potential slowed or blocked at point of segmental demyelination and is normal above or below point of compression or traction No muscle atrophy with temporary sensory symptoms Mild ischemia from nerve compression or traction
Factors That Influence Tension Generation in Normal Skeletal Muscle: Age Late Adulthood
Age: ? Decrease in muscle strength 30%/decade during 60s and 70s Decrease in muscle fiber size Decrease in speed of muscle contractions Decreased flexibility leads to decreased force producing capacity of muscle Significant improvements in muscle strength, power, and endurance are possible with resistance training
Protection Phase
Control effects of inflammation
within 1-2 weeks after stopping resistive exercise _________________ will begin to happen.
Detraining
Unable to complete ROM
Example of fatigue
What is a irreversible contractures?
Fibrotic
Arthrogenic contracture (joint)
Periarticular contractures (soft tissues)
Recovery period from 1-4 minutes T/F
T Recovery period from 1-4 minutes
What are the stages of soft tissue lesions?
acute,sub acute,chronic
endurance training
having a muscle contract and lift or lower a light load for many repetitions or sustain a contraction for extended period of time
examples of power training is?
plyometric training or stretch-shortening drills
The 6 Principles Of Resistance Training
Overload Principle SAID Principle Transfer of Training Reversibility Principle Rest Principle Overtraining/Overwork Principle
Causes of Chronic Inflammation
Overuse, cumulative trauma, repetitive strain Repetitive microtrauma to tendons may result in tendon degeneration Poor healing response with collagen degeneration, fiber thinning and disorientation etc. Trauma May never completely heal May be result too early return to activity or too much Chronic inflammation and dysfunction Re-injury of "old scar" Chronic tennis elbow Contractures or poor mobility Faulty postural habits Prolonged immobility
Overwork Principle
Overwork weakness: Progressive ↓in muscle strength Progress slowly and cautiously with adequate rest periods for patients who are susceptible to muscle fatigue: Post-polio syndrome Polymyositis MS Guillain-Barre syndrome Peripheral Nerve Injuries
Proprioceptive neuromuscular facilitation (PNF)
PNF
Manual Resistance Exercise is provided by
PT
What stage is this__________? "Return to Function Phase"
PT Goals and Interventions Increase tensile quality of scar Progressive strengthening and endurance exercises Functional activity progression
During that acute stage, pain is the result of.....
Pain is result of altered chemical state that irritates n. endings, increased tissue increased tissue tension due to edema, m. guarding
hypomobility Intrinsic (think what's inside that making it difficult to move)
Pain, inflammation, joint effusion Bony or cartilaginous blocks, burns, skin grafts Soft tissue restrictions (capsules, ligaments, tendons, muscle) Sedentary lifestyle and habitual faulty postures Muscle weakness, paralysis, muscle spasms, and muscle tone abnormalities Congenital or acquired postural malalignments
T/F Patients who had abdominal surgery, eye surgery, disc surgery or hernias should allow do resistive exercise
Patients who had abdominal surgery, eye surgery, disc surgery or hernias
↑ ATP and PC storage ↑ myoglobin storage ↑ creatine phosphate ↑ myokinase Body composition ↑ lean body mass ↓ body fat
Physiological Adaptations to Resistance Exercise: Metabolic System/Enzymatic Adaptations
Deconditioning
Physiological change following a period of inactivity, bed rest or sedentary lifestyle. It results in functional losses in such areas as mental status, degree of continence and ability to accomplish activities of daily living.
Physiological overflow ____ in either direction of training angle; apply resistance every ____ for multiple joint positions
Physiological overflow 10° in either direction of training angle; apply resistance every 20° for multiple joint positions
Chronic Inflammation
Precautions Progressive loss of ROM Chronic inflammation with contracting scar vs protective muscle guarding
Thing to prevent during the acute
Prevent potential harmful effects of rest with PROM, massage, graded isometrics
hypomobility Extrinsic (think what's on the outside of the body that is making it difficult to move)
Prolonged immobilization (casts, splints)
PNF
Proprioceptive neuromuscular facilitation (PNF)
Increased number of motor units recruited, results in increased force production Small motor units are recruited before large motor units allowing smooth, controlled force development. Large motor units are recruited as task demands become greater. Large, proximal muscles rely more on recruitment of additional motor units.
Recruitment Of Motor Units And Force Production
Factors That Influence Force Production
Recruitment of motor units: The > the number and synchronization of motor units firing, the > the force Frequency of firing of motor units The > the rate of firing, the > the force Fiber type distribution: Type II (phasic, fast-twitch) large and rapid force production but fatigue quickly Type I (tonic, slow-twitch) low force production with slow rate of development but fatigue resistant
Size Principle
SO fibers are recruited first. FOG and FG recruited when force of maximal contraction is needed. Decrease in number and size of type II fibers with aging.
Selective overstretching:Hypermobility
Selective overstretching beyond normal ROM of a joint for sports ( baseball pitcher) Joint instability Stretch weakness
Selectively stretching some
Selectively stretching some muscles/joints, and allowing tightness with limited motion in other muscles and joints.
Concentric Exercise
Shortening of muscle as it generates tension against resistance (acceleration) Maximum concentric contraction produces < force than maximum eccentric contraction > number or motor units recruited to control same load with concentric vs. eccentric; less mechanical efficiency than eccentric; consume > O2 and greater energy stores than eccentric As velocity ↑, concentric tension ↓ Muscle tension varies throughout the range due to L-T relationship and changing torque of load
________________ intervals with lower intensity exercise Increase rest period up to _____ with elderly, children, and certain pathological conditions
Shorter rest intervals with lower intensity exercise Increase rest period up to 3 minutes with elderly, children, and certain pathological conditions
Single-set exercises at low intensities_____________ phase of rehabilitation
Single-set exercises at low intensities early phase of rehabilitation
Speed of Stretch
Slowly, gradually apply and release stretch force to minimize facilitation of muscle spindle and more effectively influence viscoelastic properties of connective tissue. Incorporate dynamic stretching in later stages of rehabilitation
Subacute Stage Precautions
Some discomfort may be experienced as activity level is progressed but shouldn't last longer than a couple of hours Watch for increased resting pain, fatigue, increased weakness and spasm lasting longer than 24 hours
SAID principle stands for
Specific Adaptations to Imposed Demands
Factors That Influence Force Production
Speed of contraction (Force-Velocity) - Decreased concentric contraction force with increased speed - Increased eccentric contraction force with increased speed Length-Tension Relationship: - Maximal tension is produced when the muscle fiber is at resting length. - Tension ↓ if the fiber is shortened, and it progressively decreases when it is lengthened beyond its resting length.
Alignment and Stabilization
Stabilize the proximal or distal attachment of the muscle-tendon unit. Stabilize with manual contacts, body weight, firm surfaces, belts Maintain proper alignment to effectively and safely isolate stretch force to appropriate structures.
Types of stretching techniques
Static Stretching - slow and held Ballistic Stretching - suddenly, bouncing movement Dynamic (Functional) Stretching - range of motion Proprioceptive Neuromuscular Facilitation (PNF) - contract-relax stretch Passive - outside force Active Stretching - opposing muscles
Static contraction with _________or ________changes used to ↑strength when dynamic not indicated
Static contraction with no joint movement or muscle length changes used to ↑strength when dynamic not indicated
Isometric Exercise
Static contraction with no joint movement or muscle length changes used to ↑strength when dynamic not indicated Limited cross-over effect contralateral muscle Use 60% - 80% maximal isometric contraction Hold for 6 - 10 seconds: Davies' Rule of Tens: 10 sets of 10 reps. and hold for 10 sec. (2 sec. Rise Time, 6 sec. Hold, 2 sec. Fall Time) Physiological overflow 10° in either direction of training angle; apply resistance every 20° for multiple joint positions No increases noted in dynamic strength Avoid Valsalva Maneuver promoting rhythmic breathing
Soft tissue Contraindications for treatment of soft tissue injuries
Stretching Resistive exercises
children and elderly what type of restrictive exercise for this age group?
Submaximal loading
cardinal signs of inflammation
Swelling, redness, heat, pain at rest and loss of function
factors that influence tension generation in normal skeletal muscle: Fatigue Type 11B is the only one that is Anaerobic T/F
T Fatigue Type 11B is the only one that is Anaerobic
T/F Insufficient muscular strength can contribute to major functional losses of even the most basic activities of daily living.
T Insufficient muscular strength can contribute to major functional losses of even the most basic activities of daily living.
T/F Muscular endurance ability of muscle to contract repeatedly against a load resisting fatigue over a prolonged period of time Low levels of resistance with high repetitions and prolonged period of time
T Muscular endurance ability of muscle to contract repeatedly against a load resisting fatigue over a prolonged period of time
T/F all daily living activities require some type of muscle or cardiopulmonary endurance?
T maintenance of balance and proper alignment of the body segment requires some degree of muscle and cardiopulmonary endurance.
T/F power training needs muscle strength before developing power
T power training requires strength and speed. therefore,re-rehabilitation muscle power may be an important priority in a rehabilitation program.muscle strength is necessary foundation for developing muscle power.
T/F A pt. needs needs to be continually reminded to incorporate rhythmic breathing into each repetition of an exercise to minimize these risk.
T pt. needs needs to be continually reminded to incorporate rhythmic breathing into each repetition of an exercise to minimize these risk.
Integration of Function
Task-specific movements to replicate functions demands in ADL, work, and sport (Specificity)
list examples of soft tissue lesions
Tendinopathy is general term for chronic tendon pathology Tenosynovitis is inflammation of the synovial membrane of the tendinous sheath Tendinitis is inflammation of the tendon **Tendinosis is degeneration of the tendon Synovitis Inflammation of the synovial membrane Hemarthrosis Bleeding into the joint Ganglion Cyst/ballooning of the wall of jt capsule or tendon Bursitis Inflammation of the bursa Contusion Bruising from a direct blow → capillary rupture/bleeding Overuse syndromes
Neural Tests of Provocation
Test the median N !
This principle is an extension of Wolff's law (body systems adapt over time to stresses placed on them)
The SAID principle helps therapists determine the exercise prescription and which parameters of exercise should be selected to create specific training effects that best meet specific functional needs and goals
Flexibility
The ability to move your body parts through their full range of motion
Myocardial oxygen consumption
The amount of oxygen used by the heart muscle to produce energy for contraction
FUNCTIONAL EXCURSION
The excursion of a muscle is that distance from maximum elongation to maximum shortening.
Repetitions and Sets: volume
The higher the intensity, the lower the number repetitions The lower the intensity, the > the number of repetitions Single-set exercises at low intensities early phase of rehabilitation Multiple-set exercises as rehabilitation progresses To ↑strength use loads that cause fatigue after 6-12 repetitions for 2-3 sets. To ↑endurance use submaximal loads for many repetitions (40-50 reps.) and 3-5 sets Hold isometric contraction longer
Detraining
The loss of functional fitness that occurs when one stops fitness conditioning
Roots exit near Vertebrae Trunks found in the Scalenes Divisions found under the 1st Rib Cords in the Pec Minor Branches are found in the armpit (axillary regions)
Thoracic Outlet Syndrome (TOS)
Rest Interval (Recovery Period)
Time allotted for recuperation between sets and sessions of resistance exercise Longer rest intervals with higher intensity - 2 to 3 minute rest with moderate intensity - 4 to 5 minute rest with high intensity exercise (multijoint muscles) Shorter rest intervals with lower intensity exercise Increase rest period up to 3 minutes with elderly, children, and certain pathological conditions 48 hour rest period between exercise sessions Decrease rest time for overload effect but use with caution.
To ↑___________ use loads that cause fatigue after 6-12 repetitions for 2-3 sets. To ↑___________ use submaximal loads for many repetitions (40-50 reps.) and 3-5 sets Hold isometric contraction longer
To ↑strength use loads that cause fatigue after 6-12 repetitions for 2-3 sets. To ↑endurance use submaximal loads for many repetitions (40-50 reps.) and 3-5 sets Hold isometric contraction longer
Duration
Total number of weeks or months: Strength gains after 2-3 weeks due to neural adaptation 6 - 12 weeks of resistance training for hypertrophy and vascularization
Muscle Fiber Types
Type I SO (Slow oxidative, slow twitch): Red, small diameter Tonic (postural muscles, stability muscles) Slow speed of contraction Generate relatively small amount of tension Fatigue resistant Aerobic metabolism with high capillary density High myoglobin content and oxidative enzymes Slow axon conduction velocity Small motor unit size
Muscle Fiber Types
Type IIA FOG (Fast oxidative glycolytic, fast twitch-fatigue resistance): Red with intermediate diameter Intermediate amounts of oxidative and glycolytic enzymes Intermediate rate of fatigue Intermediate myoglobin content Aerobic and anaerobic metabolism Fast speed of contraction Intermediate to large motor unit size
Muscle Fiber Types
Type IIB FG (Fast, glycolytic, fast twitch-fast fatigable): White, large diameter Phasic muscles produce large ROM of bony segments Generate large amounts of tension in short period of time Fatigue rapidly Anaerobic metabolism with low capillary density High glycolytic enzymes with low myoglobin content Fast axon conduction velocity Large motor unit size
Factors That Influence Force Production
Type of muscle contraction: Eccentric > Isometric > Concentric Cross-section and size of muscle: Larger the muscle diameter, the > the force Type of fiber arrangement: Muscles with short pennate muscle fiber arrangement produces > force production than parallel muscles Energy stores and blood supply: Aerobic vs. anaerobic capacity will affect force production in muscle and its ability to resist fatigue and recover from exercise.
Factors That Influence Tension Generation in Normal Skeletal Muscle: Signs and Symptoms of Fatigue
Uncomfortable sensation in the muscle Tremulousness in contracting muscle Unintentional slowing of movement Jerky movements Inability to complete the full movement Use of substitute motions Inability to continue Decline in peak torque during isokinetic testing
During Eccentric Exercise !
Use in preparation for activities requiring high- intensity deceleration and quick directional changes
Periodization
Variation of intensity and volume during specific periods of resistance training - Preparation - Competition - Recuperation
During the acute stage this is what is happening in side the body to heal.
Vascular changes, exudation of cells and chemicals, clot formation, phagocytosis, early fibroblastic activity
Self-assisted ROM exercises and/or Stretching Techniques
Wand exercises or T-bar Overhead pulley Finger ladder, shoulder wheel Powder board, skate board Wall walking/slides, table slides Therapeutic ball Pendulum exercises (Codman's) Reciprocal exercise devices (bike) Continuous passive motion (CPM) Self-assisted ROM exercises with uninvolved UE
Indications for Stretching
When ROM is limited from contractures, adhesions, and scar tissue formation causing functional limitations When limitations lead to structural deformities When there is muscle weakness and shortening of opposing tissue tightness When contractures interfere with functional activities and nursing care Prior to and after exercise as part of a total exercise program to prevent injuries and minimize post exercise muscle soreness
PASSIVE INSUFFICIENCY
When a multijoint muscle cannot be elongated any farther without tissue damage Limits joint motion
Contraindications for Stretching
When bony block limits joint motion After recent fracture Acute inflammatory or infectious process Whenever there is sharp, acute pain with joint movement or muscle elongation Hematoma or tissue trauma Hypermobility When shortened tissues are providing joint stability or basis for increased functional ability
Overflow
_______________ effects are less than the training effects from specificity of training
Static stretching:
a low-load and prolonged duration stretch of 15, 30, 60 seconds.
muscular endurance
ability of a muscle to contract repeatedly against a load (resistance), generated and sustain tension and resist fatigue over an extended period of time.
strength
ability of contractile tissue to produce tension
functional strength
ability of neuromuscular system to produce,reduce,or control forces during functional activities in a smooth and coordinated manner
what is endurance?
ability to perform low-intensity, repetitive, or sustained activities over a prolonged period. an example: cardiopulmonary endurance
specificity of training
adaptions are specific to the training method employed.
Factors That Influence Tension Generation in Normal Skeletal Muscle: Age Puberty/Adolescence
age: ? Acceleration of muscle mass (up to 30%/yr. in boys) Muscle mass increases: 5-fold in boys, 3.5-fold in girls With resistance training: strength gains average 30-40% above what is expected with normal growth Significantly greater muscle hypertrophy in boys
Aerobic exercise
all rhythmic activities that use large muscle groups for an extended period of time
what are two types of aspects of power ?
anaerobic power and aerobic power
Atrophy
at·ro·phy /ˈatrəfē/Submit verb 1. (of body tissue or an organ) waste away, typically due to the degeneration of cells, or become vestigial during evolution. "without exercise, the muscles will atrophy" synonyms: waste away, become emaciated, wither, shrivel (up), shrink; More 2. gradually decline in effectiveness or vigor due to underuse or neglect. "her artistic skills atrophied from lack of use"
Sensory Neurons
carry sensory information from the periphery to SC Afferent fibers with cell bodies in dorsal root ganglia
transfer of training
carryover of training effects from one exercise or task to another.
factors that affect muscle tension during active muscle contraction: speed of muscle contraction (force-velocity relation)
concentric contraction: increase speed to decrease tension. Eccentric contraction: increase speed to increase tension.
this is an example of cross training.
cross-training effect can occur from an excersied limb to a nonexercised contralateral limb in a resistance training program.
Mechanical passive stretching:
external load of 3-15 lbs. with a duration of 20-30 minutes
Contracture
fibrosis of connective tissue in the skin, fascia, muscle, or joint capsule that prevents normal mobility of the related tissue or joint
6 - 12 weeks of resistance training
for hypertrophy and vascularization
Near Maximal or maximal Loading
high intensity exercise increase strength and power advanced phase of rehabilitation conditioning program
factors that influence tension generation in normal skeletal muscle: Fatigue type 1
high resistance to fatigue, high capillary density, Aerobic energy system, small diameter, slow twitch, slow muscle shortening.
Maximum oxygen consumption
highest rate and amount of oxygen achieved at maximal physical exertion
neural Adaption
increase in muscle strength primarily an increase in muscle fibers size
Reversibility principle
increased strength or endurance (adaptive changes) are transient training induced improvements need to be used regularly with functional actives or a maintenance program of resistance exercises.
power can be enhanced by
increasing the work of a muscle during a period of time or reducing the amount of time required to produced a given force which mean the greater the intensity of the exercise and shorter time period to generate force, the greater is the muscle power.
factors that effect muscle tesion during active muscle contraction: fiber-type distribution type 1 (tonic,slow-twitch)and type 11A & 11b (phasic, fast twitch)
influence: a high percentage of type 1 fibers-low force production, slow rate of maximum forces developed, resistance to fatigue.
Gamma Motor Neurons
innervate intrafusal muscle fibers of the muscle spindle Efferent fibers with cell bodies in lateral horn of spinal cord
Alpha Motor Neurons
innervate skeletal muscles. Efferent fibers with cell bodies in anterior horn of spinal cord
Sympathetic Neurons
innervate sweat glands, blood vessels, viscera, and glands. Afferent fibers with cell bodies located in sympathetic ganglia
factors that influence tension generation in normal skeletal muscle: Fatigue type 11A
intermediate resistance to fatigue, high capillary density, Aerobic energy system, intermediate diameter, faster twitch, fast muscle shortening
T/F resistance training is the same dam thing as resistive exercise!
is an essential element of rebilitation programs for persons with impairments to maintain and promote well being to enhance motor skills and reduce the risk of injury and disease
what is resistive exercise?
is any form of active exercise in which dynamic or static muscle contraction is resisted by an outside source applied manually or mechanically.
total body endurance (cardiopulmonary endurance) is and can you thing of some examples?
is associated with repetitive, dynamic motor activities,such as walking,cycling,swimming,or upper extremity ergometry . which involes the use of large muscles
Precautions To Resistance Exercise: Valsalva Maneuver
is performed by moderately forceful attempted exhalation against a closed airway, usually done by closing one's mouth, pinching one's nose shut while pressing out as if blowing up a balloon.
Functional Mobility
is the ability to initiate, control, or sustain active movements to perform simple to complex motor skills.
Functional ROM
is the ability to move the body or joint with adequate ROM to perform functional activities.
overload principle
load needs to exceed metabolic capacity of the muscle performance to improve the overload principle focuses on the progressive loading of muscles by manipulating, for example, the intensity of resistance exercise refers to how much weight (resistance) is imposed on the muscle, wheres volume encompasses variables such as repetitions,sets or frequency of exercise, anyone or more of which can be gradually adjust to increase the demands on the muscles.
factors that influence tension generation in normal skeletal muscle: Fatigue type11B
low resistance to fatigue, low capillary density, Anaerobic energy system, large diameter, fast twitch, fast muscle shortening
Submaximal loading
low to moderate intensity early stages of healing beginning of exercise program children and elderly increase endurance after periods of immobilization warm-up and cool-down sessions
Submaximal loading:
low to moderate intensity early stages of healing beginning of exercise program children and elderly increase endurance after periods of immobilization warm-up and cool-down sessions
Proteins troponin and tropomyosin regulate the
making and breaking of contacts between the actin and myosin myofilaments
Exercise program should
match the desired functional activities
for endurance training,
more emphasis is placed on increasing the time a muscle contraction is sustained or the number of repetitions performed than one increasing resistance.
the basis of specificity of training is related to
morphological and metabolic changes in muscles as well as neural adaptions to the training stimulus associated with motor learning.
Concentric Exercise: > number or___ to control same load with concentric vs. eccentric; less mechanical efficiency than eccentric; consume > O2 and greater energy stores than eccentric
motor units recruited
Stretching
moving the joints beyond the accustomed range of motion
unlike strength exercise
muscle adapt to endurance training by increase oxidation and metabolic capacities, which allow better delivery capacities,which allow better delivery and use of oxygen. This is why endurance training is better for pt with impaired muscles performance the impact is more positive impact on improving function then strength.
local endurance and aerobic is also known as?
muscle endurance
This can be enhanced by resistive training.
muscle performance
factors that affect muscle tension during active muscle contraction: length-tension relationship of muscles at time of contraction
muscles produce greatest tension when it is near or at physiological resting length at the time of contraction.
factors that influence tension generation in normal skeletal muscle: phosphagen (ATP -PC) systems
phosphagen (ATP -PC) systems: energy stores and blood supply phosphocreatine and ATP stored in m. cell Anaerobic ATP-PC is replenished when muscle is at rest provides for short, quick bursts of activity Major source of energy during initial 30 secounds of intense excercise
can you names some benefits of resistance exercise?
potential benefits of resistance exercise examples: enhance muscles performance restoration, improvement maintenance of muscle strength, power and endurance. increased strength of connective tissues: tendons ligaments, intramuscular connective tissue. greater bone mineral density or less bone deminerailation decrease stress on joints and reduces the risk of soft tissue during physical activity possible improvements in balance possible improvement in capacity to repair and heal damages soft tissue due to a positive impact on tissue remodeling improved ADL increase lean muscle mass or decreased body fat possible improvement in the perception of disability and quality of life
Ballistic stretching:
rapid, forceful stretches facilitate stretch reflex, and may produce tissue injury from uncontrolled force
Cyclic stretching:
short duration stretch force that is repeatedly but gradually and slowly applied at end-range, released and then reapplied.
factors that affect muscle tension during active muscle contraction: muscle architecture- fiber arrangement and fiber length (also relates to cross-section diameter of the muscles
short fibers with pinnate and multi pinnate design in high force-producing muscles (ex. quadriceps,gastronomic , deltiod ,biceps brachii
When a pt. has a new brace you need to do what?
skin check
Carpal Tunnel
space between carpal bones and flexor retinaculum know whats in side the carpal tunnel regards of nerves
What are the key elements of muscle performance?
strength,power,and endurance
strength training
systematic procedure of a muscle or muscle group lifting,lowering or controlling heavy loads (resistance) for relatively low number of reps or over a short period of time
Therapeutic exercise
systematic, planned performance of bodily movements, postures, or physical activities
In strength training program,
the amount of resistance applied to the muscle is incrementally and progressively increased.
power (muscle power)
the aspect of muscle performance is related to speed and strength and speed of movement and is defined as (force x distance) produced by a muscle per unit of time (force x distrance/time) in other words, it is the rate of performing work.
muscle peformance
the capacity to do work (force x distance)
Passive flexibility refers to
the degree a joint is passively moved through the available ROM, and is dependent on the extensibility of the muscles and connective tissues surrounding the joint
Dynamic flexibility refers to
the degree an active muscle contraction moves a joint through the available ROM.
factors that affect muscle tension during active muscle contraction: Recruitment of motor skills
the greater the number synchronization of motor units firing,the greater the force produced.
factors that affect muscle tension during active muscle contraction: Frequency of firing of motor units.
the higher the frequency of firing, the greater te tension.
resistive exercise precautions
the intensity of workout should not be as great as to cause painful.As work out intense the pt. exert a maximal or near- maximal effort,cardiovascular risk increase substantially.a pt. needs reminded to breath rhythmic breathing in each repletion of an exercise to minimize these risk.
factors that affects muscle tension during active muscle contraction: cross-section and size of muscle (include muscle fiber number and size)
the larger the muscle diameter,the greater its tension-producing capacity.
factors that affect muscle power?
the rate in which a muscle contracts and produces a resultant force and and velocity are factors that affect muscles.
Manual passive stretching:
therapist applies external force slightly beyond the point of tissue resistance Self-stretching exercises
precaution of application of the overload principle
to ensure safety, the extent and progression of overload must always be applied in the context of underlying pathology, age of the pt,stage of tissue healing,fatigue,and the overall abilities and goals of the pt.the muscles and related body systems must be given time to adapt to the demands of an increased load or repetitions before the load or repetitions before the load or number of repetition is again increased.
for muscle impaired pt. during an endurance exercise program, you would have them do what?
use low levels or resistance in an exercise program minimize adverse forces on joints,produces less irritation to soft tissues and is more comfortable then heavy resistance exercise.
a method of stretching muscles to maximize their flexibility that is often performed with a partner or trainer and that involves a series of contractions and relaxations with enforced stretching during the relaxation phase
what is PNF?
Maximal amount of tension a muscle can produce during a single contraction to overcome resistance. High resistance with low repetitions or short period of time Neural adaptation and an increase in muscle fiber size
what is strength?
Physiological Adaptations to Resistance Exercise: What is increasing during Neural Adaptations?
↑ motor unit recruitment ↑ rate of firing ↑ synchronization of firing
Local muscle fatigue results in
↓muscular response, and gradual decline in force-producing capacity; normal and reversible
Static progressive stretching:
(stress-relaxation) static stretch until tissue relaxation occurs, and then lengthened further and held in new end-range position.
F.I.T. (Overload)
- Frequency (↑sets, frequency of exercise) - Intensity (progressive increase in load) - Time (↑ time of muscle contraction or reps.) - (FITT) = include type of muscle contraction
Each sarcomere contains myofilaments:
- Thick myosin protein molecules - Thin actin protein molecules
Pseudomyostatic contracture
- muscle guarding or muscle spasms - UMN lesion resulting in spasticity/rigidity
Myostatic contracture
- shortening of musculotendinous unit
Davies' Rule of Tens:
0 sets of 10 reps. and hold for 10 sec. (2 sec. Rise Time, 6 sec. Hold, 2 sec. Fall Time)
Detraining begins within
1 -2 weeks after stopping resistance exercises.
Recovery period from
1-4 minutes
Strength gains after
2-3 weeks due to neural adaptation
Strength-Training Zone
60% - 70% of the RM for healthy, untrained adult 30% - 40% of the RM for sedentary, untrained adult 30% - 50% of the RM for muscular endurance
Concentric Exercise: > number or motor units recruited to control the same load with concentric vs. eccentric; less ______________than eccentric; consume > O2 and ______________ stores than eccentric
> number or motor units recruited to control same load with concentric vs. eccentric; less mechanical efficiency than eccentric; consume > O2 and greater energy stores than eccentric
Adaptation
A characteristic that improves an individual's ability to survive and reproduce in a particular environment.
What is Endurance?
Ability to perform low-intensity, repetitive or sustained activities over a prolonged period of time.
Isokinetic Exercise
Accommodating resistance with constant speed Speed of movement is controlled and remains constant through the ROM. Resistance accommodates for pain, muscle weakness, and fatigue Speed-specific training
Contraindications To Resistance Exercise
Acute Inflammation of joint/muscle Pain with active and or isometric resisted movements Inflammatory neuromuscular disease (Guillain-Barre, polymyositis) Severe cardiopulmonary diseases, MI, CABG
Typically lasts 4-6 days
Acute stage
Factors That Influence Tension Generation in Normal Skeletal Muscle: Recovery
Adequate time to recover from fatigue (intersession and intersession) 3-4 minutes during acute exercise (greatest during the first minute) Recovery allows oxygen and energy stores to replenish Lactic acid is removed from skeletal m. and blood within first hour after exercise Glycogen is replaced over several days If adequate time is not given to recover: plateau or decrease muscle performance
Factors That Influence Tension Generation in Normal Skeletal Muscle: ageEarly Childhood and Preadolescence
Age: ? Muscle mass, muscle strength and fiber size increase linearly until puberty (slightly greater in boys vs girls) Training induced strength gains = both sexes during childhood without hypertrophy until puberty
Factors That Influence Tension Generation in Normal Skeletal Muscle: Age Young and Middle Adulthood
Age: ? Muscle mass peaks 16-20 (females), 18-25 (males) Decrease in muscle mass begins as early as 25 Muscle mass makes up about 40% total body weight 30s- strength declines between 8%-10% per decade until 50s or 60s Can increase strength and endurance with only modest increases in activity
Determinates Of Resistance Training
Alignment Stabilization Intensity Volume Frequency Duration Exercise Order Rest Interval Mode of Exercise Velocity of Exercise
Determinants of Stretching Interventions
Alignment and stabilization Intensity of stretch Duration of stretch Speed of stretch Frequency of stretch Mode of stretch
Alignment & Stabilization
Alignment: Determined by direction of muscle fibers and line of muscle pull. Muscle should act against resistance of gravity and/or weights/resistance bands Stabilization: Stabilize proximal or distal segment to prevent substitution. - stable surface - body weight - internal stabilization (fixating muscle) - external stabilization (manual, belts/straps)
Motor Unit
All of the muscle fibers on which a branch of the axon terminates are part of one motor unit, along with the cell body and the axon. Cell body of alpha motor neuron is located in the anterior horn of the gray matter of the spinal cord. Axon extends from the cell body to the muscle where it divides into a few or as many as thousands of smaller branches. The fibers of each motor unit are not contiguous, but are dispersed throughout the muscle with fibers of other motor units. The contraction of the entire muscle is the result of many motor units firing asynchronously and repeatedly.
Concentric Exercise: As ___________ ↑, ____________ tension ↓
As velocity ↑, concentric tension ↓
Short arc of movement:
Avoid painful arc Avoid unstable arc Protect healing tissues after surgery or injury
Precautions To Resistance Exercise
Avoid using heavy resistance with children and elderly Emphasize exhalation during exertion to avoid Valsalva Maneuver: - Common with isometrics and heavy-resistance - High risk patients (MI, CVA, HTN) - Patients who had abdominal surgery, eye surgery,disc surgery or hernias Osteoporosis from prolonged immobilization, bed rest, flaccid paralysis, ↓WB, postmenopausal, meds Pathological fractures caused by minor stresses to already weakened bone
Precautions To Resistance Exercise
Avoid using heavy resistance with children and elderly Emphasize exhalation during exertion to avoid Valsalva Maneuver: - Common with isometrics and heavy-resistance - High-risk patients (MI, CVA, HTN) - Patients who had abdominal surgery, eye surgery, disc surgery or hernias Osteoporosis from prolonged immobilization, bed rest, flaccid paralysis, ↓WB, postmenopausal, meds Pathological fractures caused by minor stresses to already weakened bone
Motor (Efferent) Neuron
Axon leaves anterior horn, is bundled with other axons in the anterior root, continues down the peripheral nerve to the motor endplate (axon terminal) of a muscle fiber
What is cardiopulmonary endurance?
Cardiopulmonary endurance: repetitive activities using large muscle groups for walking, cycling, and swimming
CVA
Cerebrovascular accident. Cerebrovascular accident: The sudden death of some brain cells due to lack of oxygen when the blood flow to the brain is impaired by blockage or rupture of an artery to the brain. A CVA is also referred to as a stroke.
_______________Stage Precaution! Same as subacute Joint swelling Pain >4 hours or that requires meds ↓ strength fatigue
Chronic Stage Precaution
Distal segment fixed on support surface Performed in weight bearing position Interdependent joint movements with predictable pattern in adjacent joints Multiple muscle activation distal and proximal to moving joint Internal stabilization Promote joint approximation, co-activation and dynamic stabilization. Promotes proprioception, neuromuscular control, and balance Functional carry-over (squats, lunges, step-ups)
Closed Kinetic Chain Exercises
Factors That Influence Force Production
Combined active and passive tension produce total tension: - Entire muscle is invested in a large network of CT that is bound to the tendon CT (epimysium, perimysium, endomysium). - As a muscle is stretched, there is some length at which the muscle begins to resist the stretch as a result of the elastic recoil of the passive structures (CT) within the muscle and tendon. - Tendons on either end of the muscle also provide a force against the stretch. - Force of active contraction peaks in midregion, and the passive components make an increasing contribution to force after midrange. - Overall tension (force) of the muscle is greatest when the muscle is stretched maximally. - The force output of multijoint muscles is influence by the L-T relationship
MI
Commonly used abbreviation for myocardial infarction, otherwise known as a heart attack. The term "myocardial infarction" focuses on the heart muscle, which is called the myocardium,and the changes that occur in it due to the sudden deprivation of circulating blood.
Neurotmesis:
Complete severance of nerve fiber and disruption of CT Wallerian degeneration distal to lesion Atrophy with sensory loss No recovery without surgery Gunshot or stab wounds, avulsion, rupture
Sliding Filament Theory
Contraction results from the formation of cross-bridges between the myosin and actin myofilaments, causing the actin chains to "slide" on the myosin chain. The greater the amount of actin and myosin, the greater the contractile force. The greater the number of cross-bridges formed, the greater the amount of active force generated.
CABG
Coronary artery bypass graft: Abbreviated CABG. A form of bypass surgery that can create new routes around narrowed and blocked coronary arteries, permitting increased blood flow to deliver oxygen and nutrients to the heart muscle.
Rest Principle
Critical to establish a balance between work and rest to develop effective training program. Integrate rest into exercise program. Higher intensity of exercise, the longer the rest interval.Greater recovery if perform light exercises (active recovery). Recovery period from 1-4 minutes
Delayed onset muscle soreness
DOMS Muscle soreness, tenderness, aching, and stiffness 12 - 24 hrs. after exercise and peaking at 48 - 72 hrs. Muscle soreness ↑with passive stretching or active contraction of involved muscle Local edema/warmth, muscle stiffness and ↓ROM ↓strength 1-2 weeks after soreness subsides Eccentric exercise causes the most severe DOMS Gradually increase intensity/duration of exercise Regular routine of exercise
Frequency:Number of exercise sessions per day or week
Daily basis 2-3 times/day for low intensity exercise The > the intensity and volume of exercise, the more time needed between session to recover - eccentric exercise Elderly, children, and maintenance programs 2-3 times/week
Overtraining Principle
Decline in physical performance (burnout): Inability to recover from exercise, lowered resistance to injury, and chronic fatigue/exhaustion. Overtraining may be the reason for a lack of progress, decreased performance, or development of joint pain and swelling. Reversible by ↓volume and frequency of exercise.
Hypomobility
Decrease in normal movement and functionality of a joint, which affects range of motion.
__________ rest time for overload effect but use with caution.
Decrease rest time for overload effect but use with caution.
Aging
Decreased muscle strength with loss of muscle fibers with selective atrophy of Type II Decreased number or motor units Increased amount of CT resulting in decreased ROM and increased muscle stiffness Decreased speed of muscle contraction and ability to produce adequate power for quick responses Decreased muscle endurance Decrease in muscle mass begins to occur at age 25 Strength and endurance ↓less rapidly in physically active vs. sedentary adults Improvement in muscle strength, endurance, power possible during late adulthood
Peripheral Nerve Nerve Structure
Dendrite: afferent impulses towards cell body Axon: efferent impulses away from cell body Connective tissue covering: Endoneurium surrounds each axon Perineurium surrounds fascicles/axon bundles Epineurium surrounds entire nerve fiber Schwann cells form myelin which insulates the axon and increases the speed of conduction of action potential
Subacute stage of healing
Develop neuromuscular control, m. endurance, and strength in involved and related mm. Progress multiple angle isometrics Begin mild resistance Protected wt bearing and stabilization exercises Progress isotonic exercises as tolerable (increased reps initially, increased resistance later) Maintain integrity and function of associated areas Progressive strengthening and stabilization exercises Progress functional activities
Types Of Isometric Exercise Stabilization exercises:
Develop postural or joint stability Alternating isometrics (PNF) Rhythmic Stabilization (PNF) Dynamic, core, segmental (trunk/postural control) Multiple-angle isometrics: Resistance applied at multiple joint positions
Open Kinetic Chain Exercises
Distal segment moving freely in space in non-weight bearing positions Independent joint movement Muscle activation only at moving joint External stabilization Use to improve strength of isolated muscles Greater level of control with < substitution
ROM is painful- pain is before tissue resistance
During the Acute stage
Chronic Inflammation- Management Guidelines more in the early stages
Education Counsel as to cause of chronic irritation Adapt environment prn HEP to reinforce therapeutic interventions Promote healing, decrease pain and inflammation Cold, compression, massage Rest (cast, splint prn) Maintain integrity and mobility of involved tissue Non-stressful passive movement Massage Muscle setting as tolerable Develop support in related regions Postural training Stabilization exercises
Chronic Inflammation- Management Guidelines
Education Ergonomic counseling Counseling on safe progression of HEP What to look for? Develop strong, mobile scar Friction massage Soft tissue mobilization Develop balance in length and strength of the muscle Correct causes of faulty m. and joint mechanics with properly graded stretching and strengthening exercises Progress functional independence Functional training Coordination and timing endurance Analyze job/activity Adaptations to home/work/sport environments
Guidelines for Application of Stretching
Explain goals and procedure to patient. Relax patient by applying heat, massage, and/or warm-up exercises Joint traction and oscillations (Pendulum exercises) Cool in lengthened position Cryotherapy to decrease muscle tone and spasticity (UMN)
Eccentric exercise causes the least severe DOMS T/F
F Eccentric exercise causes the most severe DOMS
T/F Concentric Exercise: Maximum concentric contraction produces greater force than maximum eccentric contraction
F Maximum concentric contraction produces < force than maximum eccentric contraction
(MS, COPD, Cardiac, Vascular, Postpolio Syndrome)
Fatigue associated with specific clinical diseases
factors that affect muscle tension during active muscle contraction: Type of muscle contraction
Force output from greatest to least- eccentric, isometric,concentric muscle contraction.
Speed Of Exercise Force-Velocity Relationship concentric and eccentric
Force production decreases as the velocity of concentric (shortening) contraction increases Force production increases as the velocity of eccentric (lengthening) contraction increases and then quickly levels off. Speed-Specific Training: Strength-training effects are speed specific with carry-over at 15 degrees/sec.
EQUIPMENT FOR RESISTANCE TRAINING
Free weights Simple Weight-Pulley Systems Variable Resistance Units Elastic Resistance Devices Body Blade Total Gym Swiss Balls Slide Boards (ProFitter) BAPS BOSU Rebounders (mini-trampoline)
Number of exercise sessions per day or week
Frequency
factors that influence tension generation in normal skeletal muscle: Anaerobic Glycolytic System
Glycogen (glucose) is fuel source (glycosis) Anaerobic ATP resynthesized lactic acid produced Major source of energy from 30-90 seconds of excercise
factors that influence tension generation in normal skeletal muscle: Aerobic System
Glycogen, fats and proteins are fuel sources and are utilized relative to heir availability and intensity of exercise. Aerobic ATP is resynthesized in mitochondria of muscle cell used over another energy systems after 2nd minute of exercise.
Repetition Maximum (RM)
Greatest amount of weight a muscle can move through available ROM a specific number of times The exercise load to be used is calculated as a percentage of the RM - DeLorme (↑load with each set) - Oxford (↓load with each set) - DAPRE - Percentage of body weight: bench press 30% leg press 50% leg extension 20% Once establish RM, initiate training at % of RM
Avoid ballistic stretching. Don't passively force joint beyond its normal ROM. Caution with osteoporosis. Joint pain and muscle soreness should not last more than 24 hours after stretching. Avoid stretching edematous tissues. Avoid stretching weak muscles.
Guidelines for Application of Stretching precautions
Do's: 1. Gentle, slow, and sustained stretch force 2. Hold stretched position at least 15 - 30 seconds. 3. Gradually release the stretch force. 4. Stretch multi-joint muscles over one joint at a time, and then progress to all joints crossed.
Guidelines for Application of Stretching what you should do
Local edema/warmth, muscle stiffness and ↓ROM ↓strength 1-2 weeks after soreness subsides
Happens during the DOMS
_____________exercises before lower intensity exercises
Higher intensity exercises before lower intensity exercises
Chronic Inflammation- Contributing Factors
Imbalance between length/strength of a muscle Rapid or excessive repeated eccentric demand Muscle weakness Bone mal-alignment Change in usual intensity or demands Return to activity too soon Sustained awkward postures or motions Environmental factors Age-related factors Training errors
Decline in physical performance (burnout): Overtraining Principle
Inability to recover from exercise, lowered resistance to injury, and chronic fatigue/exhaustion
Rate Of Firing Of Motor Units And Force Production
Increased stimulation of motor units results in greater force production A single stimulus produces depolarization of the muscle and a twitch contraction. If stimulation of the muscle occurs at a sufficiently high frequency, new cross-bridges are formed before prior interactions are completely severed causing a fusion of succeeding contractions. If the stimulus is repeated before the muscle relaxes, the twitches begin to fuse and a sustained or tetanic contraction is produced. Small distal muscles rely more on increased frequency
Cumulative Trauma: Chronic Recurring Pain
Interruption of the normal healing process Connective tissue is repetitively stressed beyond ability to repair itself Inflammatory process is perpetuated Proliferation of fibroblasts, increased collagen production, degradation of mature collagen leads to excessive new/immature collagen Inherently weak
Types Of Muscle Contractions
Isometric: 1. Length of muscle fiber is constant Concentric: 1. Active shortening of muscle Thin actin myofilaments are being pulled toward the thick myosin myofilaments. Eccentric: Lengthening contraction Thin myofilaments are pulled away from the thick, and cross-bridges are broken and re-formed as the muscle lengthens.
Muscles that produce large forces Large cell bodies Large-diameter axons Faster conduction velocity
Large Motor Units
______________groups exercised before small muscle groups
Large muscle groups exercised before small muscle groups
Exercise Order
Large muscle groups exercised before small muscle groups Multijoint muscle groups exercised before single-joint muscle groups Higher intensity exercises before lower intensity exercises
Eccentric Exercise
Lengthening of muscle as it generates tension against resistance (deceleration) Use in preparation for activities requiring high- intensity deceleration and quick directional changes Maximum eccentric contraction generates more force than maximum isometric and concentric contractions Greater loads can be lowered than lifted due to active and passive tension components ↑ eccentric tension with ↑velocity Mode-specific with some transfer of training DOMS
Axonotmesis:
Loss of axonal continuity but CT intact Wallerian degeneration distal to lesion Atrophy with sensory loss Prolonged compression or stretch causing infarction and necrosis Incomplete recovery
Intensity of Stretch you should do what to prevent?
Low intensity and low load to decrease soft tissue damage and post-exercise soreness
Physiological Adaptations To Resistance Exercise: Vascular Adaptation
Low-intensity, high-volume resistance training Heavy resistance training results in ↓ capillary bed density, and ↓oxidative capacity of muscle
Physiological Adaptations To Resistance Exercise:Connective Tissue Adaptation
Low-intensity, high-volume resistance training Heavy resistance training results in ↓ capillary bed density, and ↓oxidative capacity of muscle
Physiological Adaptations To Resistance Exercise: Vascular Adaptation
Low-intensity, high-volume resistance training Heavy resistance training results in ↓ capillary bed density, and ↓oxidative capacity of muscle Connective Tissue Adaptation: Increased tensile strength of tendons and ligaments; greater with eccentric training Increased bone density
Types Of Resistance Exercise
Manual Resistance Exercise: resistance is provided by a therapist Mechanical Resistance Exercise Isometric (static) Dynamic: Concentric Eccentric Open-Chain Exercises Closed-Chain Exercise Isokinetic Exercise
Types Of Isometric Exercise Muscle-setting exercises
Minimize muscle atrophy, activate muscles, and maintain mobility between muscle fibers Quadriceps Sets (QS) and Gluteal Sets (GS)
_____________ groups exercised before single-joint muscle groups
Multijoint muscle groups exercised before single-joint muscle groups
ACTIVE INSUFFICIENCY
Multijoint muscle produces simultaneous movement at all of the joints it crosses. Multijoint muscle reaches a point where it cannot shorten any further Muscle unable to produce maximum torque in shortened position
Physiological Adaptations To Resistance Exercise
Muscle Adaptations: Hypertrophy of muscle fibers - preferential hypertrophy Type IIB fibers - transformation of Type IIB to Type IIA with endurance training Hyperplasia of muscle fibers Neural Adaptations: Motor learning Increased recruitment of motor units Increased firing rate and synchronization of motor units
Immobilization
Muscle atrophy and weakness: ↓ cross-sectional size of muscle ↓ motor unit recruitment ↑ fibrous and fatty tissue especially if immobilized in shortened position resulting in decreased extensibility greater atrophy in tonic postural muscle fibers (slow-twitch) faster atrophy/weakness when immobilized in shortened position decreased number and length of sarcomeres when immobilized in shortened position (sarcomere absorption) increased number and length of sarcomeres when immobilized in lengthened position
Physiological Adaptations to Resistance Exercise: Skeletal Muscle Adaptations
Muscle fiber hypertrophy Hyperplasia of muscle fibers Remodeling of type IIB to type IIA ↓ or no change in capillary density ↓ in mitochondrial density and volume
Muscle soreness ↑with_________________________ or ________________ of involved muscle
Muscle soreness ↑with passive stretching or active contraction of involved muscle
Delayed onset muscle soreness start within.
Muscle soreness, tenderness, aching, and stiffness 12 - 24 hrs. after exercise and peaking at 48 - 72 hrs.
Small Motor Units
Muscles that control fine movements Small cell bodies Small-diameter axons Slower conduction velocity Generate less tension and require less energy expenditure
are aligned to create a band pattern called a sarcomere.
Myofibrils
Sliding Filament Theory
Nerve impulse from motor neuron causes depolarization of the muscle fiber. The action potential initiates the release of Ca+ which causes troponin to reposition the tropomyosin molecules so that receptor sites on the actin are exposed. The myosin head group attaches to open binding site on the thin filament forming a cross-bridge. Cycling of cross-bridges continues as long as the action potential and supply of Ca+ remains. Cessation of the nerve's stimulus causes a reduction in Ca+ levels inhibiting the cross-bridges between actin and myosin, and the muscle relaxes.
Neural Tests of Provocation
Nerve palpation (Tinel's test) Sensation testing Reflex testing Manual muscle testing Nerve tension tests - stretch pain or paresthesias (numbness) - test positions and maneuvers become treatment positions and maneuvers
chronic stage
No signs of inflammation May have limited range from contractures or adhesions May have m. weakness Connective tissue strengthens and remodels in response to applied stress May have pain when stressing tight tissue at the end of their range May last 6 months - 1 year