Advanced Rehab (Davies part 2) Flashcards
Neuormuscular Dynamic Stability Training (proprioception) for Rehabb of Sports:
Dose it work?
(ankle, knee, shoulder)
Ankle rehab: YES!
Knee Rehab: yes (??)
Shoulder: no studies
Neuromuscular Training for Rehab of Sports:
Where does the evidence say about the role of neuromuscular exercises (proprioception) in ACL rehab?
(I think it was used as an example for all neuromuscular exercises, not just for ACL)
Neuromuscular exercises should NOT BE PERFORMED to the exclusion of stengthening and ROM exercises.
(we need the FOUNDATION first)
Neuromuscular exercises are not likely t be harmful to pts, hower, their impacti is small, making them unlikely to yield large improvements in outcomes tor help patients return to sports faster.
THIS IS CONTRARY TO WHAT MOST CLINICIANS THINK
ALWAYS START FROM A GOOD FOUNDATION, REGARDLESS OF WHAT IS INJURED!
How does dr. Davies feel about new treatments (probably like functional/neuromuscular exercise approach)?
Although many new treatments are showing promise in treating patients, I recommend a back to the basics concept FIRST!
A lot of clinicians just want to do the sexiest procedure, the new kid on the block and they forget about the time tested utility of the basic procedures.
What does it imply when a “multi-modal” approach is recommended?
Multi-modal usually alterts us the fact that we don’t know what we are doing, so we try everything
What did a comparison of functional vs strength training show about improvements in functional capacity?
- there was no differences in improvements between the training group in their ability improve functial capacity measure by selectted outcome measures
- Functional training was less effective for women
Since we don’t really know the best way to rehab the shoulder, and a “multi-modal” approach is reccomended, how should we prescribe exercises?
- Isolated exercises for each link in the kinematic chain FIRST - “Top 10”
- Proprioceptive/kinesthetic training
- Neuromuscular reactive training
- Functional training
(this is similar to the rehab program order that he recommended to us before - in last flash card set)
What is accomodating resistance?
- When using an isokinetic resistance mahchine, the resistance will not push back on you any harder than you push against it.
- Therefore, it accomodates your strength level at every angle of ROM and optimally works each part of the ROM.
OKC Exericse and progressions
Rhythmic STabilizations (purturbations) clinical guidelines (3)
- Submax to max effort
- Slow to fast
- Know (pro-active) to random (reactive) pattern
Why is it important to know about fiber typing for rehab?
Fiber typing is important in modeling function, exericse training and rehabilitation..
Knowing the fiber type of a muscle is helpful in understanding how to activate it during rehab.
We need to rehab the injrued fiber types which may only be activated with a certain type of exercise.
What is the fiber composition of must muscles in the human body?
Most muscles in the human body are ~ 50% slow twitch and 50% fast twitch
Which muscles are generally an exception to the 50/50 fiber type rule?
Gastrocnemius
Soleus
How does the RTC muscles compare to the 50/50 fiber type rule?
The RTC has more fast twitch fibers
about 56% fast twitch fibers
So we need to rehab the fast-twitch fibers (this requires quicker movements during exercise)
During an injury/pathology what fiber type is most affected and how?
Fast twitch (FT) fibers are most affected.
- Reduction in size
- Increased variability
- Change in the frequency distribution of fiber cross sections
If we know that the RTC is prodominantly FT fibers
And FT fibers are preferentially affected by injury
Then the next question should be . . .
how can we preferentially recruit the FT fibers in hrehab?
How many ways are there to recruit FT fibers?
3
What are the three ways to recruit fast twitch fibers?
- All-or-none recruitment phenomenin (max intensity effort)
- resistance must be above 70-75% of 1 RM
- not practical for patients
- Electrical simulation
- recruits all typs of fibers
- Fast movmeent patters, which is more reason to perform manual rhythmic stabilization (purterbation) type exericeses.
- should be at least 60% resistance, but doesn’t have to be max
what is selective muscle fiber recruitment based on?
Intensity of contraction
Draw and explain the graph Comparing fiber types and hwen they are activated:
When we perform exercises with resistance below 30% of 1 RM, whatfiber type are we pretty much exclusively recruiting?
Slow twitch fibers
What percent of 1 RM do we need to train at to preferentially cruit fast twitch fibers?
above 60%
What percent of 1 RM do we need to train at to preferentially recruit fastest twitch fibers?
up around 75-80%
How do purturbations help train fast-twitch fibers?
The larger fast twitch motor units may be preferentially recurited ov er the maller slow twitch units when rapid ballistic muscle actions are performed
Why is neuromusclular insufficience of the RTC an important issue for rehab?
Disturbance in coordination of the musculature can cause a functional RTC impingement
What are 2 reasons to perform perturbation types of exercises?
- Recruit FT muscle fibers
- Stimulate joint mechanoreceptors for sensorimotor training
Are OKC or CKC purturbations better for rehab of the shoulder?
A study said that both work to help improve shoulder rehab
A meta-analysis said it doesn’t , but Dr. Davies things it does
(this slide and notes were sparse and confusing)
Example of Integrated OKC and CKC excercises?
UE Treadmill Exericses and progressions
- picutre of soemone “walking” on a treadmill with her hands while kneeling on the floor
- can progress to doing the same exercise from the plank positions from toes which is much more difficult!!
eccentric loading, concentric pushing off
What does the research say about UE plyometrics?
There is a need for more research on UE plyometrics
There are not meta-anlysis studies or systematic reviews for UE plyos
What does the research say about LE plyometrics?
100s of studies that have shown the effeccitveness of LE plyometrics in developing LE power
There is no question about the effectiveness of plyos to improve LE power
what is the cycle associated with plyos called?
stretch-shortening cycle
Explain what happens during the eccentric pre-stretch phase of the stretch-shortening cycle:
- Pre-stretches muscle spindle to enhance it’s ability to generate force
- pre-stretches the SEC & PEC loading potential kenetic enrgy into the structures
SEC = series elastic component
PEC = parallel elastic component
What is the amoritization phase of the stretch-shortening cycle, and why is it called the Key?
Amoritization phase: the time between the eccentric pre-stretch and the concentric power phase.
The shorter the amoritization phase, the more effecteive the plyometric exercise. If the amortization phase is too long, all the energy stored during the eccentric pre-strech phase will dissapate and will not be transfered to the concentric shortening power phase
Explain the concentric power pruoduction phase of the stretch-shortening cycle
The concentric shortening power production performance phase is when the muscles start to concentrically contract. They are assisted by the energy gained and stored during the eccentric pre-stretch phase.
when did the initial research in the aria of training programs for the shoulder begin?
mid 1980s
why do we have to be careful of when doing plyos with overhead athletes?
this type of pt will probably have some laxity in ER so we must be careful when doing plyos
how long does it take for a plyometric training response to occur to shoulder IR?
alghough neurophysioloical training effects occur more quickly than morphological changes in the muscle, according to a study it takes more than 4 weeks for a plyometric training response to occur to the shoulder IR
When is it appropriate to use single arm UE plyos with patients?
use UE plyomentrics in the terminal phases of rehab if pts are trained
do not use plyometrics in untrained studies
when is the highest EMG activity during the throwing motion?
Highest EMG is during the deceleration phase
what is a muscle group that has been identified as one of the muscle groups that contributes to the velocity of a ball during throwing?
The elbow extensors
what is a better UE plyo for untrained poeple?
2-arm chest pass
what is the amount of plyo volume that was found to be adequate for producing a training response and why is this important to know?
- The most recent study showed that Lower volume group (60-120 reps/week had the same training response as a highe volume training, so lower volume is adequate
- This is important because it means we can be more effeicient in the clinic (get same response with less time spent on plyometrics) and we will run a lower risk of overuse injuries from repetiative plyos (definately a concern in overhead athletes)
List the heigherarchy of plyometric exercises for the upper extremity
- Low-Level Intensity
- OKC - 2-arm plyoback activiies
- CKC - Push-ups
- Magic gloves?
- Medium-Level intensity
- OCK - 1-arm plyoback activities (arm at side)
- CKC - low depth-drop box plyos
- High-Level Intensity
- OCK - 1-arm Plyoback activities
- CKC - High depth-drop box plyos
- CKC - Clap Pushups
what is the research agenda for UE plyometrics?
and why?
- One of the goals of the plyometric pushup research is to develop a classification system and a hierarch of plyometric exercises for the upper extremity
- There are numerous examples and guidelines for LE
- However, there is no research and no guildelings for the upper extremity
Hierarchy of plyometric exercises for the UE: List Low-level intensity excercises
- OKC - 2-arm Plyoback activities
- CKC - push-ups
- Magic Gloves???
Hierarchy of plyometric exercises for the UE: List Medium-level intensity excercises
- OCK - 1-arm Plyoback ACtiviteis (arm at side)
- CKC - low depth-drop box plyos
Hierarchy of plyometric exercises for the UE: List High-level intensity excercises
- OCK - 1 -arm Plyoback Activities
- CKC - high depth-drop box plyos
- CKC - Clap pushups
what is the Gold standard for measurement of LE power?
Vertical Jump vGRM measures using two force plates
Peak Force (vGRF) %BW
vGRF = Vertical Ground reaction force
what is a plyoback training system?
it is the trampoline rebounder thing
“Training Methods - Athletes” chart, Resistance Training:
Frequency
2-3days/week
“Training Methods - Athletes” chart, Resistance Training:
Intensity
60-80% MVC
“Training Methods - Athletes” chart, Resistance Training:
Time (rehab program duration)
~ 6 weeks
“Training Methods - Athletes” chart, Resistance Training:
type
isolated training of each mm group; progressing to variety & functional (super sets)
“Training Methods - Athletes” chart, Resistance Training:
Repetitions
8-12 reps - strength/power
15-20 endurance
“Training Methods - Athletes” chart, Resistance Training:
Sets
2-4 sets
“Training Methods - Athletes” chart, Resistance Training:
Pattern (rest intervals)
2-3 min between sets
48 hours between sessions
“Training Methods - Athletes” chart, Resistance Training:
Progression
10% increase/week in volume
Draw the “Training Methods - Athletes” chart: Resistance Training
“Training Methods - Athletes” chart, Plyometric Training:
Frequency
2 days/week ***
(48 hours between)
“Training Methods - Athletes” chart, Plyometric Training:
Intensity
80-100% MVC
FT MM Fibers
“Training Methods - Athletes” chart, Plyometric Training:
Time (duration of rehab program)
4 weeks *** (6-8)
“Training Methods - Athletes” chart, Plyometric Training:
Type
Isolated to functional (?)
“Training Methods - Athletes” chart, Plyometric Training:
Repetitions
5-10/set
“Training Methods - Athletes” chart, Plyometric Training:
Sets
1 set per motion pattern
(patterns-6)
“Training Methods - Athletes” chart, Plyometric Training:
Pattern (rest intervals)
2-3 min between sets
48-72 hours between sessions
“Training Methods - Athletes” chart, Plyometric Training:
progression
10% increase per week of volume (?)
Draw the “Training Methods - Athletes” chart: Plyometric Training
what should you do before starting plyos and why?
Do top 10 shoulder exercises before starting plyos to have a good foundation
plyos can help bring in what type of fibers?
fast twitch
what happened when reverse plyos were done to try to train deceleration phase of throwing?
- It did not provide enough stimulus to the RTC for it to improve
- But the elbow estensors did improve
- this is good because we still use elbow extensors during throwing
Resistive Exercise Training: Strength
(reps and percent of 1 RM)
Strength:
High intensity exercises (> 90% 1RM) 3-9 reps
Minimum of 66%
Resistive Exercise Training: Endurance
(reps and percent of 1 RM)
Low intensity exercise (<70% 1 RM) > 20 reps
Moderate Intensity exercises (70-90% of 1 RM) 6-12 reps
