EXERCISE THERAPY - Foundation Flashcards
Definition 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 (Kotkeet al, 1982)
Define Rehabilitation:
Is a medical or clinical model for treating individuals (Joyce & Lewindon2016).
Define Reconditioning:
Reconditioning is a performance-based model for training athletes following injury. (Joyce & Lewindon2016).
Principles of Rehabilitation (TITS CIA)
Principles of Rehabilitation (TITS CIA)
- Avoid Aggravation
- Timing
- Compliance
- Individualisation
- Specific Sequencing
- Intensity
- Total Patient
What are the 2 Goals of Rehabilitation
- Objective & Measurable.
2. Short to Long Term Goals.
What are the 5 Basic Components of rehabilitation?
- Flexibility & Range of Motion
- Strength & muscular endurance
- Balance, coordination & agility
- Functional Activity
- Performance of physical based activities
What is the role of an ERI?
The ERI is the lead exercise professional within the MDT and will perform clinical assessments on all service users referred for treatment by either a Medical Officer (MO) and/ or Physiotherapist. ERIs will deliver clinically reasoned exercise programmes in either Class Therapy (CT) or as part of an Individual Exercise Programme (IEP).
What are the three key policies for ERI’s?
Key Policies
- StandardsofProficiencyto Practice (SPP) for Exercise Rehabilitation Instructors (ERI). V3.1 . Aug 2021
- Exercise Rehabilitation Instructor Code of Conduct. V1.0 Oct 20
- JSP 950 Part 1Lft2-22-1 (V1.1) Dec 10. Defence Medical Rehabilitation Plan (DMRP)
Define Regional Anatomy?
•Based on the organization of the body into parts/regions.•Emphasis of the regional anatomy is to support the relationship of the systemic anatomy (study of the organ systems).
Describe the anatomical start position?
- Head, eyes and toes directed forward.
* Arms adjacent to the sides with the palms facing anteriorly
- Describe the Principle of Orderly Recruitment.
Motor units are generally activated on the basis of a fixed order of fiber recruitment. This identifies that motor units within a given muscle appear to be ranked.
- Describe the Size Principle:
States that the order of recruitment of motor units is directly related to the size of their motor neuron. Motor units with smaller motor neurons will be recruited first. Because type I motor units have smaller motor neurons, they are the first units recruited in graded movement.
How are muscle actions categorised?
Muscle Action
Static -> Isometric
Dynamic -> Isokinetic & Isotonic -> Concentric Eccentric
Advantages and disadvantages of iso-metric training?
Advantages
1. Can strengthen a muscle without imposing undue stress on injured or surgically repaired structures.
2. Isometrics can be used early in the therapeutic exercise program until motion is permitted.
3. Isometrics can also be used when the muscle is too weak to offer sufficient resistance against gravity or other external forces.
Disadvantages
1. is that strength gains are isolated to no more than 20°to 30°within the angle at which the isometric is performed (10°to 15°on either side of the isometric position)
2. Can impede venous return to the right atrium, thus ↑ blood pressure and reducing cardiac output.
3. Isometrics are not sufficient alone, Isotonic exercises are required.
Describe iso-metric training periods and the optimum exposure time
It is unnecessary for a maximal isometric activity to be performed for more than 5 to 10 s at a time; 6 s is the recommended duration for one maximal isometric exercise.
5 s the tension is 75%
10 s the strength drops to 50%
Describe Eccentric training key points?
An eccentric action can produce 30% more force than concentric activity.
Speed Kills: Early stage ↓ Velocity –End stage ↑ Velocity
What is potentially an everyday activity that demonstrates eccentric control?
- Landing from a Jump
- Running
- Going Down Stairs
Describe Active Assisted:
Combination of voluntary (Active) and passive (Assisted) from an outside source.
Describe Gravity Eliminated:
a. Gravity is probably the most basic external force; we all deal with gravity continuously.
b. Provides constant acceleration of 9.8m/sc.Identifying methods to reduce the effects of gravity can be a useful regression
Why is improving ROM important to an ERI?
Enhancing Range of Movement (ROM) is a basic component of rehabilitation. In fact, it can underpin what we do as ERIs.
”You can’t strengthen a range you are unable to achieve”.
Define Flexibility:
Refers to a musculotendinous unit’s ability to elongate with application of a stretching force.
Define Mobility:
The ease with which an articulation or series of articulations is able to move before being restricted by the surrounding structures
Define Range of Motion (RoM):
Is the amount of mobility of a joint and is determined by the soft-tissue and bony structures in the area
Static Flexibility
Is the range of possible movement about a joint and its surrounding muscles during a passive movement
Dynamic Flexibility
Refers to the available ROM during active movements and therefore requires voluntary muscular actions. Dynamic ROM is generally greater than static ROM.
Passive
Movement is performed by the therapist or a mechanical device or by the patient without active muscle contraction
Active Assistance
Movement is performed by the patient with assistance from therapist, mechanical devices, or the patient using another limb
Active
Performed without any assistance from the therapist or mechanical devices, against gravity or external forces
Performed without any assistance from the therapist or mechanical devices, against gravity or external forces
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.
What is the the stress-strain curve?
A graph depicting a substances mechanical yielding and deforming points, therefore quantifying it’s elastic and plastic properties.
What are the 4 main areas within the stress-strain curve?
Toe Range: Pre-elastic slack (collagen fibres have a wavy crimp arrangement at rest) Can equate to 1.5-5% of total collagen fibre length that is possible.
Elastic Range: Force moves to elastic region. Collagen fibres elongates to 2-5% of total elongation. When force is released in this range it will return to pre-stretched length.
Plastic Range: Tissue loaded into this range undergoes permanent elongation due to collagen fibres loss of mechanical properties.
Rupture point:
Define the mechanical term Creep with regards to connective tissue tolerance:
Define the mechanical term Creep with regards to connective tissue tolerance:
is the elongation of tissue when a load. Preferably low level is applied over an extended time to cause plastic deformation. Creep is time dependent, low load over longer periods is more effective at causing change.
Define the mechanical term necking with regards to connective tissue tolerance:
Necking is the thinning and elongation of a substance (during the plastic phase) and stretching prior to full rupture. Usually focusing on specific parts of the fibre takin the most strain.
What are the effects of immobilisation on: muscles / articular cartilage / connective tissue?
Muscle:
- Reduction in size
- Reduced oxidative capacity
- Reduced reaction times
Articular cartilage
•Cartilage becomes thinner
•Contracture
Connective Tissue • Negatively affect soft tissue surrounding the joint including: •Ligaments •Tendon •Joint capsule
What are the 3 types of PNF stretch and the ERI caveat to this technique?
- Hold Relax
- Contract Relax
- Hold Relax with Agonist Contract
ERI to teach using bands, do not perform
Define Hysteresis:
When tissue is unable to keep pace with the forces, with each successive load application, its elongates more.
Define Reciprocal Inhibition and how it applies to stretching
Reciprocal Inhibition:
Because of the phenomenon of antagonist inhibition, if the person contracts the opposing muscle, relaxation of the stretched muscle occurs. Example: a better stretch occurs when the patient actively contracts the quadriceps as the hamstrings are stretched.
Define autogenic inhibition and how it applies to stretching?
Autogenic Inhibition
Autogenic inhibition is a protective mechanism, preventing muscles from exerting more force than the bones and tendons can tolerate.
What are the contraindication of stretching & flexibility training?
- Fractures when immobilisation necessary
- Bony block that restricts motion
- Acute Inflammation within a joint
- Extreme sharp pain with motion
- Presence of hypermobility
- Presence of instability of a joint (where tightness actually contributes to an areas stability)
- 0-48 hrs of acute injury (inflammation)
Define Balance and the 2 types.
The body’s ability to maintain equilibrium by controlling its centre of mass over its base of support. Static and Dynamic
Describe the Vestibular system( inner ear)and its balance responsibility
- Sends messages to the CNS static position and motion.
Describe the Oculomotor System and its balance responsibility:
- Position of the body in space.
What are the three Proprioception receptors within balance:
What are the three Proprioception receptors within balance:
- Exteroreceptors: Provide information on the external environment.
- Interoreceptorsprovide information about the body’s internal environment.
- Proprioceptors: provide information on the body’s or a segment’s position in space.
Define Proprioception
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
Agility: Is the ability to control the direction of the body or a body segment during rapid movement.
Define Co-ordination
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.
Regressions & Progressions for balance and proprioception lessons?
Regression:
Static BoS: BigCoG: LowLoG: Close to CoMSimple StableNo DistractionsNo Perturbation
Progressions:
Dynamic BoS: Small CoG: HighLoG: Further than CoM Complex Unstable DistractionsWith Perturbations
Define tensile strength
Tensile strength is the maximal amount of stress or force that a structure can withstand before tissue failure occurs. In other words, it is the amount of outside force applied to a muscle, tendon, ligament, or bone before it tears or breaks.
What are the 5 categories of strength?
Briefly describe them.
- Maximal Strength - Refers to the highest force that can be performed by the neuromuscular system during a maximum contraction
- Explosive Strength - Within S&C & Sports explosive strength is simple referred to as power. Power is precisely defined as the time rate of doing work.
- Reactive Strength - Reactive strength is the ability of the musculotendinous unit to produce a powerful concentric contraction after a rapid eccentric contraction. Reactive-strength training is commonly referred to as “plyometrics
- Relative Strength - Relative strength isthe total amount of weight your body can lift, relative to your body weight
- Strength Endurance - Is the muscle’s ability to sustain work for a prolonged period
Force Production via a Muscle is determined by (4)?
- Motor Units & Muscle Size: More force can be generated when more motor units are activated. Type II motor units generate more force than type I motor units because a type II motor unit contains more muscle fibersthan a type I motor unit.
- Frequency of Stimulation of the Motor Units (Rate Coding): A single motor unit can exert varying levels of force dependent on the frequency at which it is stimulated.
- Muscle Fibre Length: There is an optimal length of each muscle fiber relative to its ability to generate force. Therefore, Force production is maximized at the muscle’s optimal length.
- Speed of Contraction: The ability to develop force also depends on the speed of muscle contraction. During concentric (shortening) contractions, maximal force development decreases progressively at higher speeds.
There are 4 principles of strength training in a Rehabilitation Setting (SNAP):
- Specific Exercises
- No Pain
- Attainable Goals
- Progressive Overload
Name 2 precautions of a strength training
- Fatigue
- DOMS
Name 2 contraindications to strength training
- Pain
- Inflammation
Name the acute variables for strength training? (RRRRMM)
Strength Training Acute Variables
1 Range of Motion Decrease or Increase exercise RoM
2 Resistance Decrease or Increase load
3 Resistance Arm Shorten or lengthen resistance arm
4 Rest Periods Increase or shorten rest periods
5 Muscle Actions Use Isometrics, Eccentrics & concentric muscle action interchangeably
6 Muscle Initiation Specifically target a muscle to initiate the movement
What are the three categories of monitoring intensity?
What are the three categories of monitoring intensity
- Internal - HR
- External – Pace
- Perception – RPE
Can you name the 7 categories of Cardiovascular training?
Continuous Aerobic Training (CAT): Continuous aerobic training conducted at a sub-maximal intensity Tempo Training: Continuous aerobic training at moderate to moderate hard intensity (<60min) Cruise Intervals: Moderate hard intensity with short rest periods (e.g. 4min @ RPE 6/60s rest) Long Intervals (3-8min): VO2 Max Intervals Short Intervals (1-3min) VO2 Max Intervals Repeat Sprint Intervals (RSI): Short sprints less than 60s. (20s sprint/40s rest) Sprint Interval Training (SIT): Focus on speed of movement. Short intervals <10s with long rest periods
Exercise in water provides weight relief,
give 3 guideline examples of how much BW is used at different depths
- Neck Deep = 10% Body Weight
- Chest Deep = 30% Body Weight
- Waist Deep = 50% Body Weight
Give an example of how hydrostatic pressure can aide recovery?
At 1m the pressure of water is slightly greater than diastolic blood pressure.
•This force can aid reduction in oedema.
There are 3 stages in hydrotherapy exercise therapy, what are they?
- Early Phase:•Gait Trg•Mobility •Early Strength Activities •B & P.
- Inter Phase:•More restoration of muscle strength and Endurance. •Change the resistance with Speed and lever length. •Running re-ed. •Increase Reps and Sets.
- Late Phase:•Progress towards the goal and integrate land based dynamic exercises.•ABCs of Proprioception.
Explain the paradox of water, in hydrotherapy
Exercise in deep water = Reduced loading but Increased stability
Exercise in shallow water = Increased loading but Reduced stability
What are the therapeutic effects 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
What are the disadvantages of hydrotherapy?
- Disadvantages:
- Increases Blood Pressure
- Fear of water
- Difficulty in isolating an Exercise
- Cross infection
- Expensive
What are the contraindications of hydrotherapy?
- Vomiting & Diarrhoea•Chlorine/Bromine sensitivity
- Cardiac Conditions
- Impetigo•Acute Systemic Illness/Pyrexia (Temp 37-40ºC)
- Circulatory Disorders -DVT, Aneurysm•Open Infected Wounds
- Poorly Controlled Epilepsy
- Unstable Diabetes
- POP
What are the principals of training (Rehab)? (LAGPRS)
- Law of individualisation
- Accommodation principal
- GAS (Alarm, resistance, super,exhaust)
- Progressive Overload
- Reversibility
- Specificity (SAID)
When conducting a test you need to consider 3 key areas. What are they?
Reliability: Is the test repeatable.
Validity: Is the test measuring what it should be measuring.
Sensitivity: Can the test detect change in the athlete.
What is the ultimate functional test?
The task that your patient is trying to return to!
Which 6 factors determine a patients rehab programme?
- Magnitude of the injury
- Type of injury
- Body segment involved
- Patient’s activity
- Patient’s response to the injury (physical, emotional, and psychological)
- Patient’s goals.
What are the 4 phases a patient should transit during rehab programme?
Phase 1: Inactive (Under care of physio/MO?)
Phase 2: Start of proliferation stage of healing
Phase 3: Resistive phase. Full RoM is established
Phase 4: Aggressive Phase. Exercises mimic the intended goal.
