Therapeutic Exercise I Chapter 6

1. Therapeutic Exercise IChapter 6 Resistance Exercise For Impaired Muscle Performance

2. What is Resistance Exercise? (Resistance Training) It is any form of active exercise in which dynamic or static muscle contractions is resisted by an outside force applied manually or Mechanically Resisted exercises are good for injury prevention, reduce injury or disease, being healthy, and for impaired function

3. Benefits of Resistance Exercise-see box 6.1 pg. 159 • Enhanced muscle performance • Increased strength of connective tissue • Greater Bone Mineral density • Decrease stress on joints • Reduced Risk of Soft tissue injury

4. Benefits of Resistance Exercise-continued • Possible improvement in capacity for tissue repair • Possible improvement in balance • Enhanced physical performance • Positive changes in body image • Enhanced feeling of physical well-being • Possible improvement in perception of disability & quality of life

5. Muscle Performance and Resistance Exercises-Definitions • Strength-Muscle strength, functional strength, strength training • Power-Muscle power, anaerobic versus aerobic power, power training • Endurance-Cardiopulmonary endurance, muscle endurance, endurance training • Overload Principle • SAID Principle/Specificity of Training • Transfer of Training • Reversibility Principle

6. Factors that Influence Tension Generation in Skeletal Muscle • See Table 6.1 pg. 161 • Cross section & size • Muscle architecture • Fiber Type – I, IIA, IIB • Length-Tension • Recruitment of motor units • Frequency of firing of motor units • Type of contraction • Speed of contraction

7. Fatigue • Muscle fatigue • Signs and symptoms of muscle fatigue • Cardiopulmonary Fatigue • Thresholds for fatigue • Factors that influence fatigue • Recovery from exercise

8. Age Related Changes in Muscle Performance • See Box 6.3 pg. 164 • Psychological & Cognitive Factors

9. Physiological Adaptations to Resistance Exercise • See Table 6.3 pg. 168 • Skeletal Muscle Structure • Neural System • Metabolic System & Enzymatic Activity • Body Composition • Connective Tissue

10. Determinants of Resistance Exercises • Alignment • Stabilization are basic elements of any exercise • Intensity • Volume • Exercise Order • Frequency • Rest Interval • Duration • Mode of Exercise • Velocity of exercise • Periodization • Integration of function

11. Intensity • Submaximal loading --Exercise low/moderate intensities • Maximal loading --Exercise at high intensities Intensity of exercise should never be so great to cause pain….A patient must be reminded on correct breathing techniques to avoid increase cardiovascular risks

12. Volume • The summation of the total # of reps and sets of a particular exercise during a single exercise session multiplied by the resistance used • Remember: the reps/load will depend on of the goal is for increase strength or endurance or both • Muscle strength- 6 to 12 reps for 2-3 sets • Muscle endurance- 3-5 sets of 40-50 reps

13. Frequency • Refers to the # of exercise sessions per day or per week • Remember: Frequency will vary and will be patient specific pending other factors (NEED TO AVIOD OVERTRAINING) • For Children and older adults 2-3 x weekly and for highly trained athletes up to 6x weekly

14. Duration • Is the total 3 of weeks or months during which a resistance exercise program is carried out • Time required for significant changes past the neural adaptations, is between 6-12 weeks

15. Rest Interval (Recovery Period) • Purpose • Integration of rest into Exercise

16. Mode of Exercise • Type of Contraction • Position for Exercise: WB or NWB • Forms of Resistance • Energy Systems • Range of Movement • Mode of Exercise & application to function

17. Velocity of Exercise • See figure 6.6 pg. 176 • Concentric vs. Eccentric

18. Periodization • See Table 6.5 pg. 177 • Evidence is limited

19. Integration of Function • Pg. 177 • Stability – Mobility – Controlled Mobility - Skill

20. Types of Muscle Contractions: • Isometrics-Muscle contraction without visible joint movement (Muscle setting, stabilization) • Isotonic-Muscle contraction with visible joint movement -- Concentric-Muscle contraction that results in muscle shortening -- Eccentric-Muscle contraction that results in muscle lengthening • Isokinetic-The application of force at a constant speed against an equal force (BIODEX)

21. Isometric Contraction • Intensity of muscle contraction (60-80% of a muscle force) • Duration of muscle activation (6-10 second hold…this will allow a 2 second rise time, 6 second hold time, and a 2 second fall time) • Repetitive Contractions (6-10 second hold) • Joint Angle and Mode Specific (4-6 points is usually recommended) BE CAREFUL OF THE PATIENT BREATH-HOLDING WITH ISOMETRICS

22. Concentric/Eccentric Contractions • Concentric Contraction-accelerates body segments, less mechanical efficiency (requires more motor units for control of the load) than eccentric contractions, cross training occurs • Eccentric Contraction-Decelerate body segments, acts as a shock absorbent for high impact activities and quick change in direction activities, requires fewer motor units of control the load than concentric contraction, consumes less energy and oxygen than concentric contractions-therefore fatigues slower, cross training occurs, high incident of muscle soreness than concentric contractions (DOMS-delayed onset muscle soreness Remember: Have the patient maintain normal breathing pattern when performing an exercise program and base the program on functional activities

23. Isokinetic Contraction(Accommodating) Is a form of dynamic exercise in which the 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-equal (constant) velocity Remember: make sure the patient maintains normal breathing pattern during exercise performance

24. Examples of Muscle Contractions (Biceps): • a) Isometric • b) Isotonic Concentric • c) Isotonic Eccentric • Isokinetics (Which we will not be focusing on today)

25. Open Chain and Closed Chain Exercises: • Open Chain-involves motions in which the distal segment is free to move in space (typically performed in non-weight bearing positions) • Closed Chain-involves in which the body moves on a distal segment that is fixed or stabilized on a support surface (typically performed in weight bearing positions)

26. Rationale for use of open/closed chain exercises • Both: help to reduce deficits in muscle performance, improve muscle strength-power-endurance (need to be function based to have the greatest benefit) • Open: more effective with isolation of muscle groups, has greater level of control • Closed: joint approximation-increases joint congruency and contributes to stability, gives greater feedback-stimulates mechanoreceptors, engaging several muscle groups through co-activation and dynamic stabilization

27. Examples of Open Chain and Closed Chain Exercises: • Open Chain (leg extension) • Closed Chain (squat)

28. Videos: • Muscle Basic Video • http://rds.yahoo.com/_ylt=A2KLqILih7pO_xAAqJP7w8QF;_ylu=X3oDMTB2ZTc4MDljBHBvcwMxNwR2dGlkA1YxMTYEc2xrA3JlcwRzZWMDc3I-/SIG=1m9vh00c9/EXP=1320876130/**http%3a/video.search.yahoo.com/video/play%3fn=21%26ei=utf-8%26js=1%26fr2=piv-web%26tnr=20%26p=types%2bof%2bmuscle%2bcontractions%26vid=1326739751307%26dt=1272956400%26l=166%26turl=http%253A%252F%252Fts4.mm.bing.net%252Fvideos%252Fthumbnail.aspx%253Fq%253D1326739751307%2526id%253D62d666614ea3383f6456b07364e9bf48%2526bid%253DF9fivexKEG0DCg%2526bn%253DThumb%2526url%253Dhttp%25253a%25252f%25252fwww.youtube.com%25252fwatch%25253fv%25253dpQSS2R-4bwY%26rurl=http%253A%252F%252Fwww.youtube.com%252Fv%252FpQSS2R-4bwY%2526autoplay%253D1%2526fs%253D1%2526autoplay%253D1%26tit=Muscles%26sigr=11vche7dh%26newfp=1%26surl=http%253A%252F%252Fwww.youtube.com%252Fwatch%253Fv%253DpQSS2R-4bwY%26sigs=11an12njl • Ultrasound • http://rds.yahoo.com/_ylt=A2KLqIOhgrpOaDsAJPr7w8QF;_ylu=X3oDMTB2NXN2OGpsBHBvcwMxMQR2dGlkA1YxMTYEc2xrA3JlcwRzZWMDc3I-/SIG=1ltdssh3c/EXP=1320874785/**http%3a//video.search.yahoo.com/video/play%3ffr2=piv-web%26p=3%2btypes%2bof%2bmuscle%2bcontractions%26vid=1363702973202%26dt=1237273200%26l=25%26turl=http%253A%252F%252Fts3.mm.bing.net%252Fvideos%252Fthumbnail.aspx%253Fq%253D1363702973202%2526id%253Dafbb35ce76fd165368626c62ed59d5bd%2526bid%253DS%25252bfxPjFLiqN3TA%2526bn%253DThumb%2526url%253Dhttp%25253a%25252f%25252fwww.youtube.com%25252fwatch%25253fv%25253d12PHUGdn3dU%26rurl=http%253A%252F%252Fwww.youtube.com%252Fv%252F12PHUGdn3dU%2526autoplay%253D1%2526fs%253D1%2526autoplay%253D1%26tit=muscle%2bcontraction%26sigr=11vs9707p%26newfp=1%26surl=http%253A%252F%252Fwww.youtube.com%252Fwatch%253Fv%253D12PHUGdn3dU%26sigs=11akelenn • Manual resistance • http://rds.yahoo.com/_ylt=A2KLqIC.ibpO3koAEhT7w8QF;_ylu=X3oDMTB1ZTQwbHFpBHBvcwM0BHZ0aWQDVjExNgRzbGsDcmVzBHNlYwNzcg--/SIG=1od8hfan9/EXP=1320876606/**http%3a//video.search.yahoo.com/video/play%3fn=21%26ei=utf-8%26js=1%26fr2=piv-web%26tnr=20%26p=quadreceps%2bmuscle%2bcontractions%26vid=1364144816530%26dt=1311490800%26l=0%26turl=http%253A%252F%252Fts3.mm.bing.net%252Fvideos%252Fthumbnail.aspx%253Fq%253D1364144816530%2526id%253Da532db210ea749f8aa1d92c063d3f3b6%2526bid%253D5uFP2o3oL6XWhQ%2526bn%253DThumb%2526url%253Dhttp%25253a%25252f%25252fwww.youtube.com%25252fwatch%25253fv%25253drU6eWFFINDg%26rurl=http%253A%252F%252Fwww.youtube.com%252Fv%252FrU6eWFFINDg%2526autoplay%253D1%2526fs%253D1%2526autoplay%253D1%26tit=Manual%2b%2bEccentric%2b%2bMuscle%2b%2bResistance%2b%2bfor%2bthe%2b%2bQuad...%26sigr=11vkjep9n%26newfp=1%26surl=http%253A%252F%252Fwww.youtube.com%252Fwatch%253Fv%253DrU6eWFFINDg%26sigs=11a2sv6jg

29. Lets Practice!!!!!!!!!!

30. How did you do????? 1.) Concentric; open chain 2.) Isometric; closed chain 3.) Eccentric; open chain 4.) Concentric; open chain 5.) Isometric; open chain 6.) Eccentric; closed chain

31. Precautions for Resistance Exercise • Valsalva Maneuver • Substitute Motions • Overtraining and Overwork • Exercise Induced Muscle Soreness • Pathological Fractures

32. Valsalva Maneuver • An expiratory effort against a closed glottis, must be avoided during resisted exercises. If it occurs, this will increase intra-abdominal and intra-thoracic pressure, which in turn forces blood from the heart, causing an abrupt, temporary increase in arterial blood pressure • Ways to prevent valsalva maneuver: --Caution the patient about breath-holding --suggest patient to breathe rhythmically, count of talk during exercise --Exhale on the resisted effort --high risk patients should avoid high-intensity resistance exercise

33. Contraindications to Resisted Exercises • Acute Inflammation • Acute Pain • Acute disease and disorder • Remember: the patient must be cleared by the supervising PT and the MD prior to implementing resisted exercises; you must review the POC and if there is a discrepancy or something that is unknown to you….you must clarify the information with the PT

34. Proprioceptive Neuromuscular Facilitation (PNF) Principles • Is an approach the 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 • Can be used to facilitate: muscle strength, stability, endurance, mobility, neuromuscular control, coordinate movements, and lay a foundation for the restoration of function • Is a combination of multi-joint, multi-planar, diagonal, and rotational movements of the extremities, trunk, and neck

35. Break for Lab with Lecture on UE Manual Resistance Exercises, Mechanical Resisted Exercises,Selected Resistance Training Regimens, Equipment for Resisted Training Resistance Techniques in Anatomical Planes of Motion/Diagonals of the UE’s (If time permits may review LE’s)