Chapter 13 - Theraputic Exercise Program Flashcards
What are the grieving stages?
denial, isolation, anger, bargaining, depression, acceptance DIABDA
What is included in the subjective part of an evaluation?
primary complaint, MOI, symptoms, functional impairments, previos injuries, family and medical history.
What should be included in the objective part of an evaluation?
observation, palpation, physical examination /tests
What should be included in the assessment part of an evaluation?
problem list, limitations, injury impressions, major concerns
What should be included in the plan part of an evaluation?
short and long-term goals, treatment plan, intervention, exercises, modalities,
What are the four usual phases of the exercise program
- control inflammation (decrease pain, edema, & bruising)
- restore motion (ROM and proprioception)
- Develop muscular strength, power, and endurance
- return to sport/activity (sport specific, coordination, cardio)
When can an individual move into phase 2 of a rehab program?
- inflammation is controlled - minimal swelling, muscle spasm, and pain
- ROM, flexibility, strength power, endurance are maintained inthe unaffected areas of the body
- CV fitness is maintained at the preinjury level
What does PRICE stand for?
protect, rest/restrict activity, ice, compression, elevation
T/F: Electrical muscle stimulation (EMS) is not supported to improve function, reduce edema, or decrease pain in lateral ankle sprains.
True
Immobilization can lead to loss of muscle strength within how long?
24hrs
T/F: TENS can be used to reduce pain in acute injuries (during the inflammatory phase).
True
Why does immobilization lead to loss of muscle strength?
-decrease in muslce fiber size
- decrease in muscle weight
- reduction in size and number of mitochondria
- decrease in muscle tension produced
- decrease in resting levels of glycogen and ATP
- motor nerves become less efficient at recruitment and stimulation
- increased fatigue from reduction in oxidative capacity
T/F: More type 1 slow-twitch muscles are lost during immobilization.
True
How long after immobilization are there changes in the articular cartilage?
1 week
T/F: Muscles immobilized in lengthened positions degrade faster than muscles in shortened positions.
False, other way around
Which structure recieves the most damage from immobilization and what can it lead to?
Articular cartilage, can lead to progressive osteoarthritis
What can happen if two bones remain in noncontact for prolonged periods?
connective tissue can grow into the joint
What can happen if two bones remain in constant contact for prolonged periods?
pressure necrosis and chondrocyte death
T/F: Stress leads to a stronger, stiffer ligament.
True
T/F: Immobilization leads to a stronger, stiffer ligament.
False, leads to weaker more compliant lig.
Does immobilization lead to bone loss or bone calcification?
Bone loss
When does muscle repair start after remobilization?
3-5 days
How long to heal a muscle completely with remobilization?
approx. 6 weeks
T/F: Neither EMS or isometric exercise has been shown to prevent disuse atrophy.
T/F: Structural changes to articular cartilage may not be reversible after 30+ days of immobilization.
True
Which takes longer to heal, the ligament or the bone-ligament junction?
Bone-ligament junction
Following 12 weeks of immobilization, what is the usual timeline of ligament strength recovery?
50% after 6 months
80% after 1 year
100% after 1-3 years
What are the main parameters for crutches?
-2 inches in front and 6 inches out from the outside of shoe
- elbow flexed 25-30 degrees at level of greater trochanter
When can an individual move into phase 3 of a rehab program?
- inflammation and pain are under control
- ROM is within 80% of normal in unaffected limb
- bilateral joint flexibility is restored & proprioception is regained
- CV fitness and general strength are maintained at preinjury level
What are the benefits of joint oscillations?
- break up adhesions and relieve capsular restrictions
- distracting impacted tissues
- increase lubrication for articular cartilage
- reduce pain and muscle tension
- restore full ROM and facilitate healing
Describe the 5 Maitland grades.
I. small-amplitude at the beginning of ROM
II. large amplitude within availible ROM
III. Large amplitude up to the pathological limit.
IV. Small amplitude at the end of ROM
V. quick thurst at end ROM
What are maitland grades 1&2 for?
Reducing pain
What are maitland grades 3&4 for?
increasing ROM
What are the parameters for Maitland?
1-3 osciliations per second, for 30-60 sec, 3-6 times
What three factors make up flexibility?
normal joint mechanics, mobility of soft tissues, muscle extensibility
Describe how muscle spindles work.
They lie parallel to the muscle fibers, they stretch with the muscles, when stimulated cause muscles to contract reflexively to stop the stretch
Describe how golgi tendon organs work.
Located in tendons and joint ligaments, respond to muscle tension, if stimulated (stretch for longer than 6-8s) causes reflex inhibition in the antogonist muscle.
Is the agonist the working working muscle or the opposite one?
The working muscle.
Is the antagonist the working working muscle or the opposite one?
opposite one
T/F: Research has found that static stretching results in a decrease of power output up to 24hrs afterwards.
True
What is the priciple behind contract-relax, hold-relax, and slow reversal-hold-relax?
Active inhibition
What is the principle behind CRAC (contract relax agonist contract)
Reciprocal inhibition
When is isometric exercise useful?
- motion contraindication with brace or by pathology
- motion limited by muscluar weakenss at certain point (sticking point)
- painful arc present
- prescribed postsurgical
What adverse effect can occur with isometric exercise?
Valsalva manouver increases BP - can be avoided with breathing
Strength gains are limited to what in isometric exercise?
Lim to 10 degrees ROM on either side of joint
What are the four types of nerve endings and what do they sense?
- Ruffini corpuscles = intra-articular pressure & stretchingof joint capsule
- Golgi receptors = ligaments at EROM
- Pacinian corpuscles = vibration
- free nerve endings = mechanical stress, deformation, loading
Why are CKC exercises recommended?
- stimulate and reeducate the proprioceptors
- increase joint stability and congruity
- provide greater joint compressive forces
- exercise multiple joints through WB and muscular contractions
- better control of velocity and torque
- reduce shear forces
- increase muscle coactivation
- allow better use of the SAID principle
- permit more functional movement patterns
- facilitate postural and dynamic stabilization mechanics
What are the advantages of OKC exercises?
isolate specific muscle for intense strength and endurance
What are the cons of OKC exercises.
Limited to one joint, usually uniplanar, more shear force, limited proprioception retraining, limited eccentric movement, limited functionality
When can an individual move into phase 4 of a rehab program?
- Bilateral ROM and joint flexibility are restored
- muscular strength, power, endurance are almost equal (or equal) to unaffected limb
- CV fitness and general strength better or equal to before
- Score on Y balance less than or equal 4 cm, four hop test scores 80-90%
- sport specific functional patterns completed with mild to mod resistance
- individual psychologically ready to RTP
Place the amount of force generation in the different muscle contractions from greatest to least
Eccentric > Isometric > Concentric
What is another name for Isotonic exercise?
Progressive resistive exercise
What are the two main componants of isotonic exercise?
Fixed resistance, variable speed
What are the two main componants of isokinetic exercise?
Variable resistance, fixed speed
T/F: Isotonic exercise is thought to be better than isokinetic exercise at achieving rapid gains in strength.
True
What are the main disadvantages of isokinetic exercise
expensive, hard to operate, usually only OKC, less gains than isotonic exercise
T/F: Muscular strength increase muscular endurance because it increases the amount of available motor neurons.
false, strength does not increase endurance
When is power training started?
after 80% strength is regained
How often should plyometrics be done?
Every 3 days
What is the SAID principle
Specific adaptations to imposed demands
Describe the DAPRE Technique
Sets 1 lift 50% of the target - 10 reps
Set 2 lift 75% of the target - 6 reps
Set 3, lift 100% of the target weight as many times aspossible
Set 4, adjust the weight based upon the number of repetitions performed in set 3 (if higher than 6 increase weight, if lower than 6 decrease weight)
The target weight for next session is based on the repetitions completed in set 4
When is the DAPRE Technique not usually useful
Chroinic injuries, postoperative rehab
What is a useful protocol for increasing strength and endurance in early stage rehab?
Start with 3x10
then 5x10
once 50 reps can be done, add 1 lbs and go back to 3x10.
What is the actual definition of duration?
How long it will take for the individual to return to 100% (full) activity.
T/F: Excercises performed twice daily generates more improvement than exercises performed once daily.
True
what is the average frequency of a rehab program?
3-4 times per week
At what speed should exercise be performed at initially?
60 degrees of movement per second
T/F: Small muscle groups should be exercised before larger muscle groups to avoid premature fatigue.
False, larger before smaller
What are the parameters for increasing strength?
3x/week 12-15 reps for 8-10 exercises of major muscle groups
When can an individual RTP after a rehab program?
- coordination and balance are normal
- sport specific functional patterns are restored in injured side
- Muscle strength, power, and endurance are equal to unaffected limb
- CV fitness greater or equal to before
- Quantitive testing complete (Y balance, four hop test, isometric strength, patient outcome scales)
- Individual recieves clearance by physician
What are the two categories of coordination?
Gross motor movements and fine motor movements
What is coordination directly linked to ?
Proprioception
What can be used to help increase coordination?
PNF patterns, repetition with sensory input, CKC, increasing speed, uneven surfaces,
What are the parameters/ ACSM guidelines for CV fitness
30 min moderate 5 or more times per week, or 20 min vigorous 3 or more times per week
What are the ACSM guidelines for CV fitness when bone health needs to be considered?
30-60 min weight bearing CV exercise 3-5x/week + resistance training 2-3x/week
What are the two HRmax calculations?
1: 220-age * %target HR
2: Target range =
[(HRmax - HRrest)*0.60 and 0.90] + HRrest
Whats the point of the Karvonen formula
Uses HRmax and HRrest to give target HR range for exercise.
