Lecture 5 - Therapeutic Strength Flashcards
Is therapeutic exercise different from regular exercise?
You must know: the mechanism of the injury, stage of healing, degree of the injury, patient’s previous exercise background, how much time (realistic) they have for rehab
You must know functional anatomy and the biomechanics of movement and sport
Gray’s Rules of Rehabilitation
Create an environment for optimal healing
Above all else do no harm
Be as aggressive as you can, but do not break rule #2
Salter’s General MSK Rehab Rules
Do no harm
Base treatment on accurate diagnosis and prognosis
Select treatment with SPECIFIC aims
Cooperate with the laws of healing
Be realistic & practical in your treatment
Select treatment for your patient as an individual
Potach’s and Grinstaff’s View
First: healing tissue must not be overstressed as this can create damage to new structures that are being formed.
Therefore, need to chose a load that neither overload or under loads the athlete/patients healing tissue
Second: the athlete/patient must have specific objectives to progress from one phase of healing to the next
Causes of Strength Deficits - Muscular
Atrophy/lack of use muscle imbalances (agonist/antagonist etc.) Structural integrity
Causes of Strength Deficits - Neural
Neural inhibition/damage
Causes of Strength Deficits - Pain
Reflex inhibition/ pain-spasm cycle
Causes of Strength Deficits - Poor Mechanics
Faulty movement patterns
Decreased motor control
What is the goal? Stages of Healing: Inflammation
PIER, depending on the injury and individual, may include ROM, and exercises proximal and distal to the area of injury.
Remember to address the unaffected side so the athlete can maintain.
What is the goal? Stages of Healing: Repair Phase
Maintain CV fitness and muscular function of the injured area, strengthening exercises, exercises for neuromuscular control etc.
What is the goal? Stages of Healing: Remodeling Phase
Continue to progress your exercise selection
Needs Analysis
Evaluation of the Sport
Assessment of the Athlete
Training Status (injuries, level of training)
Conducting any Physical Testing and Evaluation (may provide us answers to strength, flexibility, muscular endurance etc.)
Being aware of the Energy system utilized in the sport and applying the parameters to Rehab
Dosage Dilemma
-We need to give them enough to overload the patient but don’t want to over-train them
-Start with an exercise they can do at least 10-12 times
-There must be no discomfort, no compensations and good biomechanical technique
-Slowly progress the patient to 12-15 reps then ↑ load
I-f retraining is your goal then breaking exercise up is more effective (prevents compensation)
-Don’t want pain or discomfort, inflammation, altered function, heat, decreased range of motion, decreased strength or muscle compensations
What are compensations?
When muscles are weak, the body will attempt to perform required movements by any possible means (path of least resistance)
What must you address with compensations?
Strength Motor control Segmental stability Muscle patterning/timing Correcting muscle imbalances
Where to start?
Watch the patient walk into the clinic
History
Assessment of functional movement
Therapist should attempt to address injured tissue, injured quadrant and whole body
Factors influencing the rehab decision
Pathology Severity of injury Presence of secondary deficits Stage of healing Age Level of fitness Ability to learn Individual lifestyle needs
Contraindications
Pain
Inflammation
Severe cardiopulmonary disease
Sometimes you have to be creative and be able to work around Contra’s
Describe Isometrics. When to use?
Tension is developed but no change in length of muscle
Optimal time under tension is 6 sec but can use 5-10 sec but tension will ↓
Move from middle to outer ranges
When to use:
Early stages of rehab
When immobilized
Isometrics: Studies have shown that there can be as much as a ___% overflow to the joint angle at which training is performed
20%
Consider the application of isometrics at multiple angles - _____Isometrics
Functional Isometrics
Functional Isometrics: could be used until the healing process ______
progresses
What is concentrics? When to use?
Shortening of muscle during contraction
Force produced to overcome load being acted upon
When to use:
Throughout rehab after initial inflammatory stage
To introduce strengthening for less active individuals
Concentric portion of an exercise should require ____ seconds
1-2 seconds
Muscles tend to ____ more rapidly with Concentric contractions as opposed to Eccentric contractions
fatigue
What are eccentrics? When to use?
Lengthening of muscle during contraction When to use: Tendonitis/osus pathologies Later in rehab progression Simulating ADLs (i.e. descending stairs) As a component of power/agility training (plyometric)
Eccentrics require a much lower level of _____ activity to achieve force.
Motor unit
Eccentrics: Since fewer motor units are firing to produce a specific force, additional _____ can be recruited to generate force. Therefore more resistant to fatigue ( less ____ use)
Motor units. Oxygen
Try each exercise regiment ___ before progressing (rule of ____)
twice, two
Give as many cues (____, ____, ____) as you can
tactile, visual, verbal
Define Rule of Two
If the individual can perform 2 or more repetitions over his or her assigned repetition goal in the last set in 2 consecutive workouts, you can increase the weight/resistance. Eg. 3 sets of 10 squats
Individual is able to complete 12 reps in set # 3 for 2 consecutive sessions.
For each exercise ask????
Am I stressing the injured tissue?
What are my goals in prescribing this exercise?
Is the exercise below, the same or at a greater level than what the patient has previously done?
What are the biomechanical and physiological implications for each exercise?
Does the exercise(s) mirror the actual activity/sport movement.
SAID principle-Specific Adaptation to Imposed Demands
Make sure to maintain Muscle Balance across joints and between opposing muscles
Multi-joint vs. Single-joint exercises
CKC vs. OKC
Open: distal segment moves freely in space
Closed: distal segment is weight bearing and body moves over hand or foot
CKC puts less shear on joints
Isolation vs. Co-contraction
CKC stabilization occurs due to co-activation of opposing muscle groups
OKC allows muscle to work when weight-bearing is contraindicated
CKC preferred but OKC appropriate for conditions where _______ should be avoided (A/C jt, Effusion, meniscus)
compression
What does CKC exercises do?
Increased joint compressive forces Increased joint congruency Therefore Stability Decreased shear forces Decreased acceleration forces Co-activation/Co-contraction of agonist and antagonist muscles
What does OKC exercises do?
Help to isolate the specific joint movement.
This proves beneficial because if using only CKC exercises the joints proximal and distal to the injury might not show the deficit
OKC exercises may help identify deficits
The brain looks at movement patterns and creates _______ between all the muscles needed
coordination
Isolated ____ development does not play a major role in motor pattern development
muscle
Training movement: progressions
- Analyze or Train movement as if it is a pyramid.
- Start from the bottom up, build a solid base
- Functional Movement>Functional Performance>Functional Skill
