therapeutic exercise exam 2
volume to improve muscle strength
•60%- 80% of 1-RM (rep max) •fatigue within 8-12 reps •2-3 sets
early childhood and preadolescence influence on tension generation in sk. muscle
•Muscle strength and muscle endurance increase linearly with chronological age in boys and girls throughout childhood until puberty.
adolescence influence on tension generation in sk. muscle
•Rapid increase in muscle strength in both sexes. •Marked difference in strength levels develops in boys and girls.
late adulthood influence on tension generation in sk. muscle
•Rate of decline of muscle strength accelerates to 15% to 20% per decade during the sixth and seventh decades and increases to 30% per decade thereafter
Children and resistance training
•There is now growing awareness that _______ can achieve health-related benefits from resistance training and can safely engage in weight-training programs if designed appropriately and closely supervised
application of overload principle for a strength training program
-the amount of resistance applied to the muscle is incrementally and progressively increased.
uniplanar to multi-planar anterior to posterior to diagonal sagittal to frontal/transverse
plane of direction of movement progression
muscle performance
strength, power, endurance
warm up
Prior to initiating resistance exercises, ______________ with light, repetitive, dynamic, site-specific movements without applying resistance.
D1 extension
Shoulder extension, abduction and internal rotation, forearm pronation, wrist extension and finger extension.
D2 extension
Shoulder extension, adduction and internal rotation, forearm pronation, wrist and finger flexion
D2 flexion
Shoulder flexion, abduction and external rotation, forearm supination, wrist and finger extension.
precautions for resistance exercise
Valsalva maneuver (at risk pt) substitute motions overtraining
ecentrically
When load is consistent there is less tension when working _____________
isokinetic contraction
When the velocity of limb movement is held consistent by a rate-controlling device
eccentric concentric
______________ is more efficient, fewer motor units are needed for the same load when compared to ______________, less tension in the muscle is created when eccentrically controlling a consistent load
Delorme and Oxford regimens
a randomized study comparing these regimens showed no significant difference was found in adaptive strength gains in the quadriceps muscle group in older adults after a 9-week exercise program
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 necessary for control of body in functional activities
2
able to move through full ROM gravity eliminated
with support to no support eyes open to eyes closed
balance progression
wide to narrow bilateral to unilateral fixed support surface to sliding on support surface
base of support progression
Wolff's Law
body systems adapt over time to the stresses placed on them
dynamic resistance exercise
can be performed using concentric (shortening) or eccentric (lengthening) contractions or both.
dynamic muscle contraction
causes joint movement and excursion of a body segment as the muscle contracts and shortens (concentric muscle action) or lengthens under tension (eccentric muscle action).
endurance training
characterized by having a muscle contract and lift or lower a light load for many repetitions or sustain a muscle contraction for an extended period of time.
speed of muscle contraction (determinants affecting tension generation of skeletal muscle)
concentric contraction (increase speed, decrease tension). Eccentric contraction (increase speed, increase tension)
SAID principle (specific adaptation to imposed demands)
create specific training effects that best meet specific functional needs and goals. specificity of training transfer of training (cross training effect)
cardiopulmonary (general) fatigue
diminished response of an individual (the entire body) as the result of prolonged physical activity
open chain
distal segment is free to move in space (ex: seated quad extension)
closed chain
distal segment remains in contact to a fixed surface (ex: squat)
factors that influence tension generation in skeletal muscle
energy stores and blood supply fatigue recovery from exercise
power training
enhancing power by either increasing the work a muscle must perform during a specified period of time or reducing the amount of time required to produce a given force
small to large ranges short arc to full arc
exclusion of limb movement progression
Despite assumption that joint position is enhanced to a greater extent under closed-chain than open-chain conditions, the *evidence is mixed*
for Proprioception, kinesthesia, neuromuscular control, and balance
is ample evidence that both open- and closed-chain exercises are effective, but exercises should be incorporated into a rehabilitation program that *simulate the desired functions*
for carryover to function and injury prevention
closed-chain exercises facilitate co-activation of agonists and antagonists (co-contraction), and consequently promote dynamic stability
for co-activation and dynamic stabilization
open-chain resisted exercises a greater level of control is possible with a single moving joint
for control of movements
Open-chain testing more effective
for isolation of muscle groups
joint approximation that occurs with the axial loading and weight bearing during closed-chain exercises is thought to cause an increase in joint congruency, which in turn contributes to stability
for joint approximation
eccentric, isometric, concentric type of muscle contraction (determinants affecting tension generation of skeletal muscle)
force output from greatest to least
recovery from exercise
from acute exercise, in which the force-producing capacity of muscle returns to 90% to 95% of the pre-exercise capacity, usually takes 3 to 4 minutes, **with the greatest proportion of recovery occurring in the first minute.**
3
holds test position against gravity
5
holds test position against maximal resistance
4
holds test position against moderate resistance
dynamic stabilization
how stable the joint is while moving
overload principle
if muscle performance is to improve, a load that exceeds the metabolic capacity of the muscle must be applied—that is, the muscle must be challenged to perform at a level greater than that to which it is accustomed
reps and sets for progressive overload
initially increase the number of repetitions or sets; at a later point in the exercise pro-gram, gradually increase the resistance.
hypertrophy
is an increase in the size (bulk) of an individual muscle fiber caused by an in-crease in myofibrillar volume
4 types of muscle contractions
isometric, isokinetic, concentric, eccentric
connective tissue adaptations to resistance training
it is believed that tendon and ligament tensile strength increases in response to resistance training to support the adaptive strength and size changes in muscle Bone: there is a high correlation between muscle strength and the level of physical activity across the life span with bone mineral density
(determinants affecting tension generation of skeletal muscle) cross section and size of muscle
larger the muscle diameter the greater its tension-producing capacity
type 1 muscle fiber-type (determinants affecting tension generation of skeletal muscle)
low force production, slow rate of max force development, resistant to fatigue
application of overload principle for endurance training
more emphasis is placed on increasing the time a muscle contraction is sustained or the number of repetitions performed than on increasing resistance.
co-activation
more than one muscle contracting at the same time
length tension relationship of muscle at time of contraction (determinants affecting tension generation of skeletal muscle)
muscle produces greatest tension when it is near or at the physiological resting length at the time of contraction
types of isometric exercise
muscle setting exercises, stabilization exercises, multiple angle
stabilization
necessary to avoid unwanted, substitute motions.
frequency
number of exercise sessions per day or per week
type IIA and IIB fiber-type (determinants affecting tension generation of skeletal muscle)
rapid high force production; rapid fatigue
power
related to the strength and speed of movement and is defined as the work (force × distance) produced by a muscle per unit of time.
muscle fiber arrangement and fiber length (determinants affecting tension generation of skeletal muscle)
short fibers designed for high force production long parallel fibers designed with high rate of shortening but less force production
Hypertrophy
skeletal muscle adaptations to resistance training
slow to fast
speed of movement or directional changes progressions
stable to unstable/moving rigid to soft ground height to increased height
support surface progression
strength training
systematic procedure of a muscle or muscle group lifting, lowering, or controlling heavy loads (resistance) for a relatively low number of repetitions or over a short period of time
endurance
the ability of a muscle to contract repeatedly against a load (resistance), generate and sustain tension, and resist fatigue over an extended period of time.
intensity
the amount of resistance (weight) imposed on the contracting muscle during each repetition of an exercise. (also referred to as the exercise load)
comprehensive examination and evaluation
the cornerstone of an individualized resistance training program.
recruitment of motor units (determinants affecting tension generation of skeletal muscle)
the greater number and sync of motor units firing, the greater the force production
strength
the greatest measurable force that can be exerted by a muscle or muscle group to overcome resistance during a single maximum effort.
frequency of firing of motor units (determinants affecting tension generation of skeletal muscle)
the higher the frequency of firing, the greater the tension
volume
the sum of the total number of reps and sets of an exercise during a single exercise session times the intensity of the exercise. inverse relationship of load on repetitions and sets
Hallmarks of PNF
the use of diagonal patterns and the application of sensory cues—specifically proprioceptive, cutaneous, visual, and auditory stimuli—to elicit or augment motor responses.
duration
total number of weeks or months during which a resistance exercise program is carried out.
Placement of Resistance
typically applied to the distal end of the segment in which the muscle to be strengthened attaches. Distal placement generates the greatest amount of external torque with the least amount of load (manual or mechanical resistance)
closed chain exercises
use of axial loading. muscle activation across multiple muscle groups typically in weight bearing positions resistance applied to multiple moving segments internal stabilization
open chain exercises
use of external rotary loading external stabilization usually required typically non weight bearing muscle activation primarily in the prime mover no predictable joint motion in adjacent joints
weight variable
weight changes at some point during the movement
eccentric
what muscle contractions consume less oxygen and energy stores
cardiac patients
you should not do isometrics with what type of patient because of tendency to breath hold or valsalva maneuver occuring
older adults and resistance training
•A major goal of resistance training in ___________ is to maintain or improve their levels of functional independence, and reduce the risk of age-related diseases
Etiology of DOMS
•Despite years of research the underlying mechanisms of tissue damage associated with __________ is still unclear form of contraction-induced, mechanical disruption(microtrauma) of muscle fibers and/or connective tissue in and around muscle that results in degeneration of the tissue
2 to 3
•For moderate-intensity resistance training, a ________ minute rest period after each set is recommended. (most recovery in the first minute)
transfer of training
•In contrast to the SAID principle, carryover of training effects from one variation of exercise or task to another also has been reported •Despite evidence that a small degree of it occurs in a resistance exercise program, most studies support the importance of designing an exercise program that most closely replicates the desired functional activities.
Volume to improve muscle endurance
•Low resistance •Fatigue with 40 - 50 reps •4-5 sets
young and middle adulthood influence on tension generation in sk. muscle
•Muscle mass peaks in women between 16 and 20 years of age; muscle mass in men peaks between 18 and 25 years of age. •Decreases in muscle mass begin to occur as early as 25 years of age.
contraindications to resistance exercises
•Pain •Inflammation •Severe Cardiopulmonary Disease
sets
•a predetermined number of consecutive repetitions grouped together
multiple angle isometrics
•a system where resistance is applied, manually or mechanically, at multiple joint positions within the available ROM (ex: shoulder flexion at 20,40, 70, 90, 120, degrees etc.) •used when the goal of exercise is to improve strength throughout the ROM when joint motion is permissible but dynamic resistance exercise is painful or inadvisable.
Dynamic Exercise-Constant External Resistance (DCER)
•addresses the primary limitation of dynamic exercise against a constant external load Machine MUST be involved to do this - resistance equipment imposes varying levels of resistance to the contracting muscles to load the muscles more effectively at multiple points in the ROM. - resistance is altered throughout the range by means of a weight-cable system that moves over an asymmetrically shaped cam, by a lever arm system, or by hydraulic or pneumatic mechanisms.
rest interval (recovery period)
•allow time for the body to recuperate from the acute effects of exercise associated with muscle fatigue or to offset adverse responses, such as exercise-induced, delayed-onset muscle soreness.
Proprioceptive Neuromuscular Facilitation (PNF)
•an approach to therapeutic exercise that combines functionally based diagonal patterns of movement with techniques of neuromuscular facilitation to evoke motor responses and improve neuromuscular control and function. -Used in neuro rehabilitation -Used in orthopedic rehabilitation
Mechanical Resistance Exercise
•any form of exercise in which resistance (the exercise load) is applied by means of some type of exercise equipment. -resistance training, weight training, and strength training commonly used in rehab programs and fitness/conditioning programs
PRE (for non-healthy people)
•beneficial for patients with a variety of pathological conditions including musculoskeletal injuries, osteoarthritis, osteoporosis, hypertension, adult-onset (type II) diabetes, and chronic obstructive pulmonary disease
muscle-setting exercises
•low-intensity isometric contractions performed against little to no resistance •used to decrease muscle pain and spasm and to promote relaxation and circulation after injury •Examples: quadriceps sets and gluteal muscles sets.
repetitions
•number of muscle contractions performed to move the limb through a series of continuous and complete excursions against a specific exercise load.
-Prevention and treatment of DOMS
•the initial onset can be prevented or at least kept to a minimum by progressing the intensity and volume of exercise gradually, by performing low-intensity warm-up and cool-down activities, or by gently stretching the exercised muscles before and after strenuous exercise
stabilization exercises
•used to develop a submaximal but sustained level of co-contraction to improve postural stability or dynamic Example: Rhythmic stabilization, body blade, stability ball (push on limb have person try to not move)
Neural adaptations to resistance training
↑# of motor units firing -↑rate of firing (↓twitch contraction time) ↑synchronization of firing
partial to full weight bearing to additional weight
% body weight progression
less force
-A maximum concentric contraction produces ___________ than a maximum eccentric contraction under the same conditions when a weight is lifted and lowered, maximum resistance during the concentric phase of an exercise does not provide a maximum load during the eccentric phase.
Circuit Weight Training
-A pre-established sequence of continuous exercises is performed in succession at individual exercise stations that target a variety of major muscle groups (usually 8 to 12) as an aspect of total body conditioning •Higher reps and less resistance •Exercise order to allow for alternate muscle group fatigue and recover
Reversibility Principle
-Adaptive changes in the body's systems, such as increased strength or endurance, in response to a resistance exercise program only last for a short time unless training-induced improvements are regularly used for functional activities or unless an individual participates in a maintenance program of resistance exercises **Detraining, reflected by a reduction in muscle performance, begins within a week or two* after the cessation of resistance exercises and continues until training effects are lost.*
characteristics of isokinetic training
-Constant velocity -Range and selection of training velocities -Reciprocal versus isolated muscle training -Specificity of training -Compressive forces on joints -Accommodation to fatigue Accommodation to a painful arc
direction of resistance
-During concentric exercise apply _________ in the direction directly opposite to the desired motion, whereas during eccentric exercise apply ______________ in the same direction as the desired motion
Joint angle and mode specificity for isometrics
-Gains in muscle strength occur only at or closely adjacent to the training angle. -when performing multiple-angle isometrics, resistance at four to six points in the ROM typically is recommended
Intensity of Exercise/Amount of Resistance
-Initially, have the patient practice the movement pattern against a minimal load to learn the correct exercise technique. -Have the patient exert a forceful but controlled and pain-free effort. The level should be such that movements are smooth and non ballistic or tremulous.
6 seconds and no more than 10 seconds
-To achieve adaptive changes in static muscle performance, an isometric contraction should be held for _________________
concentric eccentric
-With a ___________ contraction, greater numbers of motor units must be recruited to control the same load compared to a _____________ contraction, suggesting that ___________ exercise has less mechanical efficiency than ___________ exercise.
Progressive Resistance Exercise (PRE)
-a system of dynamic resistance training in which a constant external load is applied to the contracting muscle by some mechanical means (usually a free weight or weight machine) and incrementally increased used for both healthy and unhealthy people
signs and symptoms of muscle fatigue
-an uncomfortable sensation in the muscle, even pain & cramping -tremors in the contracting muscle -active movements jerky, not smooth -inability to complete the movement pattern through the full range of available motion during dynamic exercise against the same level of resistance -use substitute motions, incorrect movement patterns -inability to continue low intensity physical activity -decline in peak torque during isokinetic testing
overtraining
-commonly used to describe a decline in physical performance in healthy individuals participating in high-intensity, high-volume strength and endurance training programs. inadequate rest intervals between exercise sessions, too rapid progression of exercises, and inadequate diet and fluid intake.
diagonal patterns
-composed of multijoint, multiplanar, diagonal, and rotational movements of the extremities, trunk, and neck. -Multiple muscle groups contract simultaneously. There are two pairs for upper and lower extremities D1 Flexion or D1 Extension and D2 Flexion or D2 Extension
acute muscle soreness
-develops during or directly after strenuous exercise performed to the point of muscle exhaustion. This response occurs as a muscle becomes fatigued during exercise because of the lack of adequate blood flow and oxygen (ischemia) and a temporary buildup of metabolites, such as lactic acid and potassium, in the exercised muscle.
delayed-onset muscle soreness (DOMS)
-high-intensity eccentric muscle contractions are associated with a significantly higher incidence and severity of ________________________________ than occurs with high-intensity concentric exercise -possibly the result of greater damage to muscle and connective tissue when heavy loads are controlled and lowered
stabilization
-holding down a body segment or holding the body steady so the proper muscle is working (think about strengthening the biceps brachii)
exercise order
-large muscle groups should be exercised before small muscle groups -multi-joint exercises should be performed before single-joint -higher intensity exercises should be performed before lower intensity exercises.
Basic Procedures With PNF Patterns
-minimal contacts -maximal resistance (max amt possible that still allows pt. to move smoothly and wo pain thru available ROM) -Position and movement of the therapist : along the diagonal
specificity of training
-the adaptive effects of training, such as improvement of strength, power, and endurance, are highly specific to the training method employed •exercises incorporated in a program should mimic the anticipated function
muscle (local) fatigue
-the diminished response of muscle to a repeated stimulus
no evidence
-there is _________________ to support the global assumption that closed-chain exercises are "more functional" than open-chain exercises
Number of Repetitions, Sets, and Rest Intervals
-use 8 to 12 repetitions of a specific motion against a moderate exercise load. -Decrease the amount of resistance if the patient cannot complete 8 to 12 repetitions. - After a brief rest, perform additional repetitions
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
power
= (force × distance)/time
D1 flexion
Beginning with arm at sides > flex and add shoulder - crossing midline, external rotation, supination, finger flexion. eg. pulling a sword
