Exercise Therapy Flashcards
Define exercise therapy
Exercise therapy is defined as a regimen or plan of physical activities designed and prescribed to facilitate the patients to recover from diseases and any conditions, which disturb their movement and activity of daily life or maintain a state of well-being
Describe the role of an ERI
The role of an ERI is to work as part of the MDT where they will be the lead exercise professional. With the goal to rehabilitate the patient.
Principles of rehab
Timing Individualisation Total patient Specific sequencing Compliance Intensity Avoid aggravation
Objectives of rehab(2)
Prevent further deconditioning
Rehabilitate the injured area
Goals of rehab(2)
Measurable and objective
Short to long term goals
Basic concepts of rehab
- Decrease pain/ reduce inflammation
- Flexibility & Range of Motion
- Strength & muscular endurance
- Balance, coordination & agility
- Functional Activity
- Performance of physical based activities
Relevant policy relating to the ERI role
- Standards of Proficiency to Practice (SPP) for Exercise Rehabilitation Instructors (ERI). V3.1 . Aug 2021
- Exercise Rehabilitation Instructor Code of Conduct. V1.0 Oct 20
- JSP 950 Part 1 Lft 2-22-1 (V1.1) Dec 10. Defence Medical Rehabilitation Plan (DMRP)
Explain Regional Anatomy
Based on the organization of the body into parts/regions.
Head Back Lower limb Neck Abdomen Upper limb Thorax Pelvis/perineum
Describe the Anatomical Start Position
Head, eyes and toes directed forward
Arms adjacent to the sides with the palms facing anteriorly
Lower limbs, closed together with the feet parallel and the toes directed anteriorly.
Understand theTerms of Relationship
Anterior/ventral- closer to the front Posterior/dorsal - closer to the back Superior- closer to the head Inferior- closer to the feet Medial- closer to the midline Lateral- further from the midline Superficial- closer to the surface Deep - further from the surface Proximal - closer to the truck/origin Distal- further from trunk/origin Caudal- towards the buttocks Central- towards the centre of the body Peripheral- towards the surface Palmer- on or towards palm of the hands Plantar- on towards the sole of the foot Dorsum- the upper surface of the hand or foot
Understand theTermsofMovement
Extension, flexion, abbduction adduction and so on
Understand the Terms of Laterally
Bi lateral- occurring both sides
Uni lateral- occurring on one side
Ipsilateral- occurring on the same side
Contralateral- occurring on the opposite side
Describe the clinical start positions
Standing Sitting Kneeling Supine lying Prone lying Elbow support lying 4 point kneeling Long sitting Short sitting Crook sitting Stork standing Tandem standing
Identify the Roles Muscles Can Play
Agonist
Antagonist
Synergist
Fixator
Define What is a Static & Dynamic Muscle Action
Static- no lengthening or shortening of the muscle and no movement of the limbs.
Dynamic- change in muscle length
Understand the Theory of Isometrics
Isometric is the static contraction of muscle
Understand the theory of eccentric training
Eccentric is the lengthening of the muscle
Can produce 30% more force
Example- running down hill, landing from a jump
Understand the theory of concentric training
It is the shorting of the muscle and is the principle muscle action
progressive model of muscle actions
Isometric
Eccentric only - gravity assisted
Active assisted
Concentric/eccentric BW - GA and AA
Concentric/eccentric resistance
Define Flexibility ,Mobility & Range of Movement.
Flexibility: Refers to a musculotendinous unit’s ability to elongate with application of a stretching force
Mobility: The ease with which an articulation or series of articulations is able to move before being restricted by the surrounding structures, Oxford Reference
Range of Movement (RoM): Is the amount of mobility of a joint and is determined by the soft-tissue and bony structures in the area
Mechanical Properties of
Connective Tissue
- Elasticity: Is the ability of a structure to return to its normal length after application of an elongation force or load (stress)
- Viscoelasticity: Is in substances that have both elastic and viscous properties. Viscosity = thick, sticky & semi fluid in consistency.
- Plasticity: Is the ability of a substance to undergo a permanent change in size or shape after a deforming force is applied.
Discuss the Causes of Poor Flexibility
Direct/indirect
Direct-
injury
Pathology to soft tissue
Immobilisation
Indirect - Pain inhibition/fear Odema Damage to joints Muscle weakness/imbalance Age
Effects of Immobilisation- muscle, articular cartilage and connective tissue
Muscle-
Reduced size
Reduced oxidative capacity
Reduced reaction time
Articular cartilage -
Becomes thiner
Contracture
Connective tissue - soft tissue damage in
Ligaments
Tendon
Joint capsule
Discuss what Influences Mobility- extrinsic and intrinsic
Extrinsic- Gender Temperature Stage of recovery Age Restrictions of cloths
Intrinsic - Pain Injury Type of joint Bony integrity Status of soft tissue
How to assess hypermobility
Beighton score
Define what is Balance
The body’s ability to maintain equilibrium by controlling its centre of mass over its base of support.
Define what is Proprioception.
Is the body’s ability to transmit position sense, interpret the information, and respond consciously or subconsciously to stimulation through appropriate execution of posture and movement.
Define Agility & Coordination
Agility: Is the ability to control the direction of the body or a body segment during rapid movement.
Coordination: Is the complex process by which a smooth pattern of activity is produced through a combination of muscles acting together with appropriate intensity and timing.
Understand the systems and receptors required for Balance
& Proprioception.
Ears(vestibular)
Eyes(oculomotor)
Proprioceptors -categorised
1 exteroceptors
2 inter-receptors
3 proprioceptors
Progressions & Regressions
available for B&P exercises
Regressions
Static BoS big CoG low LoG close to CoM Simple Stable No distractions No perturbations
Progressions- Dynamic BoS small CoG high LoG further away from CoM Complex Unstable Distractions Perturbations
Understand and Differentiate Motor Control & Motor Learning
Motor control is defined as the ability to regulate or direct the mechanisms essential to movement.
Motor Learning: We define the field of motor learning as the study of the acquisition and/or modification of movement.
Recognise the different types of feedback
intrinsic feedback: • Visual • Audible • Tactile • Proprioceptive
Extrinsic Feedback: Is information that supplements intrinsic feedback. For example, when you tell a patient that he or she needs to lift their foot higher to clear an object while walking, you are offering extrinsic feedback.
Identify the varied “Practice Conditions” that motor learning
can be implemented in.
- Massed vs Distributed
- Constant vs Variable
- Random vs Blocked
- Whole vs Part
- Guidance vs Discovery
- Mental Practice
Define the Different Types of Strength
- Maximal Strength
- Explosive Strength
- Reactive Strength
- Relative Strength
- Strength Endurance
Identify what Determines Muscular Strength
Motor unit and muscle size
Frequency of stimulation of the motor unit
Muscle fibre length
Speed of contraction
Strength Training Variables
ROM Resistance Resistance arm Rest periods Muscle actions Muscle initiation
Discuss the Principles of Strength Training in Rehab.
- Specific Exercises
- No Pain
- Attainable Goals
- Progressive Overload
Understand how to Measure Strength
Numerical grade 0 - 10
% of normal
Observations eg no contraction to full strength
Understand how to Quantify Load
RPE
How to work out volume load
Volume load = sets x reps x load
Precautions & Contraindications to Strength Training
Precautions -
Fatigue
DOMS
Contraindications-
Pain
Inflammation
Monitoring Intensity
Perception - RPE
Internal - heart rate
External - power/pace
Describe the various types of CV
Continuous aerobic training
Tempo training
Cruise intervals
Long intervals( 3-8 mins)
Short intervals( 1-3 mins)
Repeat sprint intervals ( less than 60s)
Sprint interval training ( less than 10s long rest)
The Advantages of hydrotherapy
- Weight Relief
- Warmth
- Induced Relaxation
- Manoeuvrability of Patient
- Pain Relief Fine Graduation/ Progression in Exercise
- Unencumbered by Clothing
- Exercise (Mobility, Strength, B+P
- Improves Moral
The Disadvantages of hydrotherapy
- Increases Blood Pressure
- Fear of water
- Difficulty in isolating an Exercise
- Cross infection
- Expensive
Describe the Principles of Training
- Law of Individual Differences
- Accommodation Principle
- General Adaptation Syndrome
- Progressive Overload
- Reversibility
- Specificity of Adaptation
Types of Periodisation
Linear
Undulating
Block
Periodisation terminology
Multi year plan
Annual training plan
Macrocycle
Mesocycle
Microcycle
Training day
Training sessions
Why do we do testing
Conducting tests and assessing the collected data provides Objective Information regarding the strengths and weaknesses in a client’s physiological and functional capacities
different types of testing
- Range of Movement
- Strength
- Balance & Proprioception
- Motor Control & Skill
- Cardiovascular
- Functional
3 considerations while testing
Reliability: Is the test repeatable.
Validity: Is the test measuring what it
should be measuring.
Sensitivity: Can the test detect change in the athlete.
Order of testing
Non fatiguing - eg BCM
Strength - power then strength
Muscular capacity(endurance)
Aerobic capacity
Ultimate function test
IT IS THE TASK THAT YOUR PATIENT IS TRYING TO RETURN TO DOING
What is planning
“A Goal Without a Plan is a Wish”
Exercise performed systematically to improve physical abilities and to acquire skills connected to the performance of sporting or occupational activity.
1. All training effects are based on exercise induced changes in the organism.
2. Change is specifically dependent on type,intensity and duration of the exercise.
Rehabilitation variables in planning
- Magnitude of the injury
- Type of injury
- Body segment involved
- Patient’s activity
- Patient’s response to the injury(physical,emotional,andpsychological)
- Patient’s goals.
Acute program variables
- Exercise and muscle groups trained
- Order of exercise
- Number of sets and set structure
- Rest periods
- Load or resistance used
- Repetition speed
Key considerations in programming
- Keep it simple.
- Have the end goal in mind.
- Set achievable short goals that work to the overall goal. Use this as an exit
strategy throughout - Monitor your patients. Use effective testing.
- Utilise the principles of training to facilitate the appropriate adaptation.
Individualisation is key. - Ensure your patients & MDT are included in the programme design
