3) Strengthening Handbook Flashcards
Why do physios use strengthening
Improve muscle power and endurance
This occurs via: first neural adaptation and later through muscle fibre hypertrophy and other adaptations such as increased mitochondrial density
What are the key principles of muscle strengthening
Overload principle Work to fatigue Specificity Overload- FIIT principle Progression Diminishing results Reversibility
Overload
Neuro-muscular adaptation occurs when the exercise volume (comprised of intensity and duration) exceeds typical demands.
**Without overload, strengthening does not occur
Work to fatigue
Fatigue is the reversible decline in the output of a muscle due to an accumulation of metabolic by-products.
Shows overload has happened
Signs
• Shaking / tremor
• Loss of quality / control of the movement
• Inability to work the muscle through full range
60% 1RM do 10 reps before reaching fatigue
Specificity
Improvements in muscle performance will correspond with the training regime.
- Type of training (power Vs endurance)
- Range of muscle trained (early mid late)
- Type of muscle contraction (concentric/eccentric/isometric)
- Speed/tempo of the regime should replicate how the muscle needs to be used functionally by the patient.
Progression
As muscle adapts to meet the demands of an exercise programme, the same regime becomes less challenging over time and therefore strength gains will reduce.
This is known as the law of diminishing returns.
Increase weight as muscle gets stronger
Reversibility
If a strengthening programme is not maintained
(for example a patient does not comply with their home exercises)
any gains in muscle strength will be lost.
Prescribing an exercise plan
> Frequency
3 x weekly for MRC grades 4 to 5
Daily for MRC grades less than 4
> Intensity
60-80% 1RM
10 rep max (around 70% 1RM)
> Type
What’s the muscle’s function: power or endurance.
Weak muscles=start with power, then build endurance.
> Time
3 sets of 8-12 repetitions
1 minute rest between sets (reduces cumulative fatigue)
Progressing exercise plan
- Muscle contraction (concentric => eccentric)
- Strengthen the whole muscle range (Mid => inner => outer)
- Lengthen the lever (e.g. bent arm => straight arm for shoulder flexors)
- Add functional exercise (specificity)
- Vary speed – include ballistic (e.g. jumping) exercises if MRC grade 4+
- Increase resistance (heavier weight, progress theraband, use body weight)
How to progression exercise theory
1.Stops & starts
Newton’s 1st Law
Increases muscle work required to re-start the movement.
Reduce Momentum (slow or vary speed)
2.Newton’s 2nd Law
By slowing and/or varying the speed, greater muscle force is required to elicit a change
3.Newton’s 3rd Law
Increase friction
Increases muscle work required to start or sustain the movement.
4.Resisted movement
• Against gravity • Auto-resisted • Free weights • Theraband • Body weight Increases the muscle force required to move the limb
Therapeutic principles
- Use of targets (especially to work through range)
- Motivation (use of voice) & correction if required
- Competition (with self or others)
- Variety of exercise & individual approach (consider patient age & interests)
- Instruction & demonstration
- Explanation of potential benefits
Practical considerations
Patients should be appropriately undressed to allow the Physiotherapist to visualise the affected muscle group (need to see signs of fatigue).
- Consider the optimal starting position for each exercise from both patient comfort and exercise effectiveness perspectives
- Include a localised light warm-up for the body area that is being treated e.g. wrist circling for 1-2 minutes prior to wrist extensor strengthening
- Use any available equipment to improve efficacy and to add interest for the patient
- Always give the patient at least 2 exercises that are suitable for home use with clear instructions for frequency, reps and sets
