Therapeutic Exercise

isokinetic exercise

a form of dynamic exercise in which velocity of muscle shortening or lengthening and the angular limb velocity is predetermined and held constant by a rate-limiting device known as an isokinetic dynamometer

isometric exercise

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

active-assistive ROM

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

endurance

ability to resist fatigue

resistive exercise

any force of active exercise in which a dynamic or static muscular contraction is resisted by an outside force

proprioceptive neuromuscular facilitation

combines functionally based diagonal patterns of movement with techniques of neuromuscular facilitation to evoke motor responses and improve neuromuscular control and function

During a maximum effort concentric muscle contraction, as the velocity of muscle SHORTENING increases, the force the muscle can generate _____________.

decreases

T/F: Occurrence of substitute motions that compensate for and mask strength deficits of individual ms is greater with open-chain exercise vs. closed chain.

false-- greater with closed-chain

T/F: With isometric exercise, there is no mechanical work done and no measurable amount of tension or force output produced by muscles.

false-- there is a measurable amount of tension and force output produced by muscles even though there is no mechanical work done

strength

force output of contracting muscles

overload principle

if muscle performance is to improve, a load that exceeds the metabolic capacity of muscle must be applied

During a maximum effort eccentric contraction, as the velocity of active muscle LENGTHENING increases, force production in the muscle _____________.

increases

eccentric contraction

lengthening contraction

active ROM

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

passive ROM

movement of a segment within the unrestricted ROM that is produced entirely by an external force (i.e. gravity, machine, another individual, or another part of the individual's own body)

concentric contraction

shortening contraction

T/F: There is little to no voluntary muscle contraction with passive ROM.

true

indications for isokinetic exercise

typically begun in the later stages of rehab when active motion through the full (or partial) ROM is pain free

indications for active-assistive ROM

when patient has weak musculature and is unable to move a joint through desired range, A-AROM is used to provide enough assistance to muscles in a carefully controlled manner so ms can function at maximum level and be progressively strengthened

power

work per unit time (force x distance/ time) or force x velocity

Besides intensity, frequency and duration of exercise, what parameters can you modify in a progression of a closed chain activity?

-% body weight (partial, full WB) -Base of support (wide/narrow, bilateral/unilateral, fixed on support surface/sliding on support surface) -Support surface (stable/unstable or moving; rigid/soft; increasing height) -Balance (w/ or w/o external support; eyes open/closed) -Exclusion of limb movement (small/large ranges, short/long arc) -Plane or direction of movement (multiplanar, ant/post/diagnoal, sagittal/frontal/transverse) -Speed of movement or directional changes (slow/fast) -Cognitive

indications for passive ROM

-Acute, inflamed tissue where active motion would be detrimental to healing process -When patient is not able to or not supposed to actively move a segment of the body, as when comatose, paralyzed, or on complete bed rest

open chain exercise

-Completely unrestricted movement in space of a peripheral segment of the body, as in waving the hand or swinging the leg -Limb movement only occurs distal to the moving joint and muscle activation occurs in ms that cross the moving joint -Typically performed in non-weight-bearing positions -Exercise load is applied to the moving distal segment

plan of care during acute stage of healing

-Control pain, edema, spasm--> grade I or II joint oscillations with joint in pain-free position -Passive movements within limit of pain -Muscle setting or e-stim -Adaptive or assistive devices as needed to protect the part during functional activities

goals in subacute stage

-Controlled-motion phase: intermediate -Develop mobile scar-- selective stretching, mobilization of restrictions -Nondestructive active, resistive, open and closed chain stabilization, muscular endurance, and cardiopulm endurance exercises -Exercises carefully progressed in intensity and range

plan of care during cumulative trauma phase-- during chronic inflammation

-Counsel as to cause of chronic irritation and need to avoid stressing the part while inflamed -Adapt the environment to decrease tissue stress -Implement a home exercise program to reinforce therapeutic interventions -Cold, compression, massage, rest -Nonstressful passive movement, massage, and muscle setting within limits of pain -Develop support in related regions-- posture and stabilization exercises

indications for PNF

-Develop muscular strength and endurance -Facilitate stability, mobility, neuromuscular control, and coordinated movements -Lay a foundation for the restoration of function -Used throughout rehab process

plan of care during chronic stage of healing

-Educate pt on safe progression of exercises and stretching, biomechanics, ergonomic counseling -Increase soft tissue, muscle, joint mobility -Stretching techniques specific to tight tissue -Progress exercises-- submax to max resistance -Low reps to high reps at slow speeds, progress complexity and time, progress speed and time -Improve cardiopulm endurance -Continue progressive strengthening exercises and advanced training exercises

plyometric exercise

-Employs high-velocity eccentric to concentric muscle loading, reflexive reactions, and functional movement patterns -A second pause between eccentric to concentric, then burst of activity

plan of care during cumulative trauma phase-- during controlled motion and return to function phases

-Ergonomic counseling, home instruction, instruction on signs of too much stress -Develop strong, mobile scar: friction massage, soft tissue mob -Correct cause of faulty ms and joint mechanics with appropriately graded stretching/strengthening exercises -Train muscles to function according to demand, provide alternatives -Train coordinating and timing -Develop endurance -Analyze job/activity and adapt as necessary

sources of resistance with isometric exercise

-Holding against a force applied manually -Holding a weight in a particular position -Maintaining a position against the resistance of body weight -Pushing or pulling an immovable object

plan of care during subacute stage of healing

-Home exercises and encourage functional activities consistent with plan -Monitor response of tissue to exercise progression, decrease intensity if pain/inflammation increases -Protect healing tissue with assistive devices, tape (progressively decrease use) -Gradually increase scar mobility, mobility of surrounding tissues -Progress from isometric/ PROM to A-AROM to AROM within limits of pain -Apply progressive strengthening and stabilizing exercises

indications for open chain exercises

-Identifies strength deficits and improves ms performance more effectively than closed-chain -Greater level of control is possible with a single moving joint than with multiple moving joints as during closed-chain—particularly advantageous in early phases of rehab

cumulative trauma

-Musculoskeletal symptoms from excessive or repetitive motion causing connective tissue or boney breakdown -Initially the inflammatory response from microtrauma is subthreshold but eventually builds to the point of perceived pain and resulting dysfunction -Symptoms: shin splints, carpal tunnel, bursitis, tendonitis, etc. -Also called overuse syndrome -Keep going back to acute phase

goals in acute stage of healing

-Protection phase: early -Control effects of inflammation (RICE) -Prevent deleterious effects of rest: nondestructive movement, PROM, massage, muscle setting with caution

indications for closed chain exercises

-Provides greater proprioceptive and kinesthetic feedback because multiple ms groups that cross multiple joints are activated and more sensory receptors are activated to control motion -Weight-bearing element is believed to stimulate mechanoreceptors in muscles and in and around joints to enhance sensory input for control of movement -Obvious to improve balance and postural control in upright position

examples of PNF

-Quick stretch -Manual contacts -Compression -Rocking

goals during chronic stage of healing

-Return to function phase: advanced -Increase tensile quality of scar: progressive strengthening and endurance exercises -Develop functional independence: functional exercises and specificity drills

closed chain exercise

-The peripheral segment meets with considerable external resistance -A closed kinetic chain motion in one joint is accompanied by motions of adjacent joints that occur in reasonably predictable patterns -Typically performed in weight-bearing positions

specific adaptation to imposed demands (SAID) principle

-Tissues that are stressed will adapt to demands -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

indications for isometric exercise

-To minimize muscle atrophy when joint movement is not possible (i.e. immobilization) -To activate muscles (facilitate ms firing) to begin to re-establish neuromuscular control but protect healing tissues when joint movement is no advisable (i.e. after surgery) -To develop postural or joint stability -To improve muscle strength when dynamic resistance exercise could cause pain

isotonic exercise

-Uniform tension in muscle -Not found in the "real world"

indications for active ROM

-When patient can contract muscles actively and move a segment w/o assistance -When a segment of the body is immobilized for a period of time, AROM is used on the regions above and below the immobilized segment to maintain the areas in as normal a condition as possible and to prepare for new activities, such as walking with crutches -Can be used for aerobic conditioning programs and is used to relieve stress from sustained postures

_____________ contraction is the hardest to train; you wouldn't want to start with this.

Eccentric