Strengthening Flashcards
Types of patient populations that may present with muscle weakness
- Neurological Conditions (Central adn peripheral)
– Ex: Central - TBI, Stroke, Peripheral - Ulnar neuopathy, severed nerve - Any period of immobilization
– EX: Femur Fracture -> lower limb weakness - Specific injury to the muscle itself, now healed
– Ex: Hamstring strain, Ligament Tear - Any surgery where the incision is through the muscle
– Ex: Scope through vastus medialis, TKA - quad weakness - Any metabolic disease that leads to muscle disuse or atrophy
Input -> Output -> Return to Function Triangle
When prescribing exercise we cannot forget about ____ of motion and ____ control
- quality
- motor
Common Examination findings associated with Diminished Force Production
- Subjective:
– Symptoms aggravated with ACTIVE motions especially with increased resistance or load
– DESCRIBES WEAKNESS - FUNCTIONAL: Altered movement patterns during functional activities to compensate for muscle weakness (ex: someone with weak quads on the right may shift weight onto the left when sitting in a chair)
- AROM: Impaired QUALITY AND QUANITY of motion
- PROM: May have GREATER PROM than AROM if significant weakness
- End range overpressure: No significant findings
- Palpation: Associated tenderness of weak muscles
- Motor: Weakness and/or pain with MMT
When creating strengthening programs for patients what do we need to remember?
- Take there current status and create a plan to get to acheivable goals.
- Based on this you create appropriate exercise dosage and functional retraining
What are some questions that can guide your thinking for muscle weakness?
Dosage - Muscle Weakness - What to consider?
- Disease/injury/other treatments
- Specificity of training - S.A.I.D. principle
- What’s the objective? Function?
- Optimal load of the tissue
- Pt age and/or previous activity level
- Personal contextual factors: motivation, fear and other psychosocial aspects
Types of Muscle Strengthening to enhance force production
- Isometrics
- Manual resistance exercise
- Isotonic exercise (concentric and eccentric)
- Functional training
Concentric - definition
tension of muscle (force production) > external resistance (muscle shortening)
Eccentric - definition
tension of muscle < external resistance (muscle lengthening)
Things to consider with isotonic exercise
- Internal and external moment arm
- Muscle length
- Constant vs. variable loads
- Eccentric vs. concentric contraction
- Open chain vs. closed chain exercises
- Use of weight machines vs. use of free weights
- Speed of contraction
When considering moment arms with exercises, what do you need to think about?
- Consider the muscle moving and the placement of the resistance
Ex: Bicep Curl - Greatest internal (muscle) moment arm is at 90 degrees
- Greatest external (weight) moment is at 90 degrees
How does the external moment arm change the bicep curl?: weight vs theraband
Weight: Greatest moment at 90
Theraband: Greatest moment at the top of the bicep curl (Muscle is weakest and shortest here
Why is the length tension curve important for exercise development?
- It is the optimal position for active force production
- Example: Bicep Curl at 90 degrees has the most overlap of myosin and actin
Constant vs Varibale resistance
Constant:
* Resistance constant through ROM
* Ex: Hand weights, Cable columns, weight machines
Variable
* Resistance changes throughout the ROM
* Ex: Resistance bands
Concentric vs Eccentric Contraction
Eccentric:
* Develops more force production
* Uses less energy
* Has less perceived exertion
* BUT has greater potential for DOMS
OKC vs CKC
OKC = Open Kinetic Chain
* Exercise allows movement of the terminal segment
* “non-weightbearing exercise”
* Ex: Knee Extension
CKC = Closed Kinetic Chain
* Terminal segment fixated and movement occurs at proximal joints
* “Weight bearing exercise”
* Ex: Squat
OKC - Advantages vs Disadvantages
Advantage:
* Isolate joint movement
* Isolate muscle recruitment
* Better control of movement (Less ability to compensate)
* Single or multiple planes of motion
* Joint is non weight bearing (yet experiences benefits of loading)
Disadvantages:
* Little proprioceptive input
* Minimal muscle co-contraction
* Not as functional for lower extremity
OKC - Clinical Application
- Isolate muscle weakness in a specific muscle or muscle group
LE:
* Common in early rehabilitation phases or when isolated weakness is noticed while assessment of function
* Non-weight bearing or WB restrictions
UE:
* Utilzed to replicate functional patterns of UE
CKC - Advantages and Disadvantages
Advantage:
* Motion in multiple planes and joints
* Muscle activity in every moving joint
* Enhances joint stability due to muscle co-contraction
* Provides more proprioceptive input (understanding)
* More functional for LE
Disadvantages
* Difficult to isolate muscles that are weak because multiple muscle groups are working
* More joint compressive forces (injury precautions; post ops)
* Stronger muscles may compensate for weaker muscles
CKC - Clinical Application
- Ideal for co-contraction of multiple different muscles to enhance joint stability and function
- LE: Mid to Later Rehab to replicate function
- UE: Used for select group of patients that need to weightbear through UE
Weight Machines - Pros and Cons
Pros:
* Cam system
* Safety
* Provides proximal stability
* Facilitates eccentric motion
Cons
* Cost
* Often bilateral
* Single plane movement
* No need to integrate proprioceptive input or coordinate movements
Free Weights and Cables
Pros
* Cost (Cheaper)
* Tri-planer motion
* Proprioceptive component
* Work on proximal stability
* Activity specific
Con
* Potential for poor form
* Greater risk of injury
Speed of Contraction
Slow and Controlled
* Allows for muscle to generate more tension
* Allows for better focus on control and quality of motion
* Diminishes likeihood of patient compensation with other muscles
Rapid
* Better replicates speed of the function
* Less focus on form and control of motion
Functional Training Examples
- Squat related activity
- Lunges
- Step Ups
- Pushing related activity
- Pulling related activity
