Musculoskeletal Exercise Assessment and Prescription 4-6 Flashcards
STRUCTURING AN EXERCISE PROGRAM
WARM UP
10-15 minutes of light, repetitive, dynamic, site-specific movements without applying resistance
EXERCISE PROGRAM
COOL DOWN
• Rhythmic, un-resisted movements, arm swinging, walking, cycling, gentle stretches
PROGRESSING AN EXERCISE PROGRAM
To continue to get physiological adaptations, you MUST progress the program to achieve overload until the desired exercise goal is attained (maintenance).
Principles of progression:
• Gradual progression to promote adherence and reduce risk of injury
• Progression can be achieved by manipulating load (e.g. frequency, intensity, reps,
sets), complexity (e.g. type of contraction, type of resistance) or context (open vs closed environment)
MACHINE VS OPEN WEIGHTS
machine weights guide the movements for you - free weights become more open movements which increases complexity
ACSM Guidelines for Resistance Training (2011)
FREQUENCY
Each major muscle group should be trained 2-3 d/wk
INTENSITY
Strength
• 60-70% 1RM (moderate-hard intensity) for novice to intermediate exercisers
• >80% 1RM (hard to very hard intensity) for experienced strength trainers
• 40-50% 1RM (very light to light intensity) may be beneficial for improving strength in
sedentary people
Endurance
• <50% 1RM (light to moderate intensity)
TIME
No specific duration of session has been identified
TYPE
Resistance exercise involving each major muscle group/specific type of resistance
REPETITIONS
8-12 reps for strength and power 15-20 for endurance
SETS
2-4 sets for strength and power
< 2 sets for improving muscular endurance
PATTERN
Rest intervals of 2-3 min between sets, >48 h between sessions
PROGRESSION
Should be gradual increase in prescription parameters.
Preparing for prescription of MSK exercise
• Check what kind of equipment your patient will have access to
• Select your exercise prescription
• Review your patients goals and ensure they are aware of how the exercise contributes to progress toward their goal
• Advise that they should perform exercises on a firm but comfortable support surface
* Demonstrate
* Observe – both minimal and prescribed load
* Provide feedback
* Adjust exercise – alignment, stabilisation, load (if patient isn’t able to complete
available ROM, reps, muscular tremor, or substitution occurs)
* LAST 4 IMPORTANT
Placement and direction of resistance
• Distal end of segment which is to be strengthened
• Can be placed across an intermediate joint if joint is stable/pain free and
adequate muscle strength.
• Revise if placement of load is uncomfortable
• Resistance applied in opposite direction to movement for concentric exercise,
in direction of movement for eccentric
• Ensure patient is aware of what joints need to be stabilised and whether this is
dynamic stabilisation (e.g. free weights) or provided through mechanical stabilisation (e.g. resistance machines)
Examples of exercises that target power
- multi joint exerises, fast and explosive, require strength • Plyometric push up • Push up with in/out of arms • Medicine ball chest pass • Jump squat • Box jumps • Plyometric lateral lunge (“shuffle tap”) • Reverse lunge with knee up/jump • Burpees – with or without tuck jump • Tuck jump • Jump squats • Judo roll with jump • Pistol squat roll with jump • Single leg deadlift into jump
AGILITY
COMES LAST
• Ability change position of body in space with speed and accuracy
• Requires integration of strength, power, balance, proprioception, quickness
• Tends to be prescribed in context of sport specific rehabilitation – but is this the only population that requires agility?
• Features later in exercise rehabilitation programs once sufficient strength, power, balance, proprioception attained
AGILITY ACSM GUIDELINES
FREQUENCY 2-3 days per week INTENSITY Unknown TIME 20-30 min total duration TYPE Exercises involving a combination of speed (and quickness), acceleration, deceleration, change of direction. Incorporate planned and unplanned changes in direction.
Examples of exercises that target agility:
• 30m forward run-backpedal • 20m agility square • Agility ladder drills * Illinois agility test • Change of direction drills (pictured)
FLEXIBILITY
STATIC STRETCHING
• Application of sustained force at greatest possible length
• Uses less overall force and energy, lowers likelihood of
muscle soreness
FLEXIBILITY
DYNAMIC STRETCHING
- Active movements that achieve a ROM that will elicit a stretch, but not sustained at end ROM position
- Use more force and energy, but attains functional range in preparation for exercise without reductions in performance
- Less effective than static stretching for improving ROM
FLEXIBILITY
BALLISTIC STRETCHING
- Tensile force applied to achieve maximum length of tissue, then rapid, inner range changes in length are performed (”bouncing”)
- Increased risk of muscle soreness/injury. Used selectively – typically with athletes preparing for ballistic exercises
CONTRAINDICATIONS TO STRETCHING
• A bony block limits joint motion
• Recent fracture, and bony union is not complete
• Evidence of an acute inflammatory or infectious process (heat and
swelling) or soft tissue healing could be disrupted
• Sharp, acute pain with joint movement or muscle elongation
• A hematoma or other indication of tissue trauma is observed
• Presence of HYPERmobility
• Shortened soft tissues provide necessary joint stability in lieu of normal
structural stability or neuromuscular control
• Shortened soft tissues enable a patient with paralysis or severe muscle weakness to perform specific functional skills otherwise not possible
