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Rehabilitation Of Athletic Injuries > Strengthening/Edurance/Power > Flashcards

Strengthening/Edurance/Power Flashcards

1
Q

Muscle Strength Measurement

A
  • Grading System
    ~ Normal 5/5: Pt. can resist against
    maximal pressure
    ~ Good 4/5: Pt. can resist against
    moderate pressure
    ~ Fair 3/5: Pt. can move through full
    ROM against gravity
    ~ Poor 2/5: Pt. can move through full
    ROM in a gravity eliminated position
    ~ Trace 1/5: Pt. can’t produce
    movement, but muscle contraction is
    palpable
    ~ Gone 0/5
  • Manual Muscle Strength
    ~ Does 5/5 truly represent full strength?
    > Maybe. It’s strength compared to
    clinician’s resistance
    ~ Does 5/5 represent functional
    strength?
    > No
    ~ Subjective: opinionated
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2
Q

What is muscle strength?

A
  • Maximum force that a muscle or muscle group can exert
  • Non factors
    ~ Speed
    ~ Repetitions
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3
Q

Types of Strength/Contraction

A
  • Isometric Contraction
    ~ Contraction that produces muscle
    tension but no change in muscle length
  • Concentric Contraction
    ~ Contraction that causes muscle
    shortening while tension increases to
    overcome resistance
  • Eccentric Contraction
    ~ Resistance is greater than the
    muscular force being produced and
    muscle lengthens while producing
    tension
  • In the end stages of rehab, it should include all 3 types of contraction
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4
Q

Factors Influencing Strength

A
  • Size of Muscle
    ~ Proportional to cross-sectional
    diameter of muscle fibers
    ~ Increased cross-sectional area =
    increased strength and force
    production potential
  • Neuromuscular Efficiency (“old man
    strength”)
    ~ Ability of the neuromuscular systems
    to process information and produce
    an appropriate contraction
    > Input and output/sensory in and
    motor out
    > Extent to which the muscle mass
    may be activated by voluntary
    effort
    ~ Enhanced Efficiency Through
    > Appropriate motor unit
    recruitment
    > Enhanced synchronization of
    motor unit firing
  • Can both be trained by lifting weights
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5
Q

General Guidelines for Muscle Change

A
  • Overload Principle
    ~ Must challenge to muscle by asking it
    to perform in a way it’s not
    accustomed to performing to bring
    about change
    ~ Ways to overload
    > Volume (reps)
    > Intensity (load)
    > Speed
    > Decreased Rest Interval
    > Increased Sensorimotor
    Challenge (change in sensation/
    input)
  • SAID Principle
    ~ Specific Adaptation to Imposed
    Demands
    ~ Body will adapt specifically to the
    demands placed on it
    > Must consider the activity they
    will return to and design specific
    exercise to ensure successful RTP
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6
Q

Enhancing Muscle Size

A
  • Overload
    ~ Ask the muscle to perform
    contractions that it’s not able to
    efficiently perform or not
    accustomed to to performing
    > Increased force
    > Increased time under tension
    • Lower (6-12) reps due to
    higher loads
    • Parameters elicit contraction
    failure
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7
Q

Is enhancing muscle size a concern in rehab?

A
  • Sometimes
    ~ In sports where size is an advantage
  • During late stages of rehab, it’s not
    uncommon for pts. to perform very well
    in functional rehab activity, but show
    continued atrophy
    ~ Muscles are not commonly stressed
    to real life limits during rehab
    > Tendency is to build efficiency,
    but not size
    ~ Athletes who return without equal or
    near equal girths may have trouble
    when returning to real activity
    > Lack of full strength potential
  • If atrophy is present, try to return muscle
    to normal size
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8
Q

Enhancing Neuromuscular Efficiency

A
  • Overload with:
    ~ Volume
    > Use loads that are common for
    activity
    > Ask pt. to work against specific
    loads repetitively (higher reps)
    > What load should most commonly
    be used?
    • Proprioceptive (awareness of
    position in space)/kinesthetic
    (awareness of movement)
    demand
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9
Q

Is enhancing neuromuscular efficiency a concern in rehab?

A
  • Always!!
    ~ In many cases deficits here will be the
    only source of weakness
    ~ Largest possible muscle/maximal
    strength is rarely needed
    > Need is for neuromuscular
    efficiency
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10
Q

Muscular Endurance

A
  • Ability to perform repetitive muscular
    contractions against some resistance
    ~ Strength and endurance are closely
    related
    > Techniques to improve one tend
    to improve the other
    > Enhance endurance with the
    same exercises used for strength
    • Focus on overload with
    volume
  • Improves neuromuscular efficiency
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11
Q

Exercise Selection: Progression and Appraoches

A
  • Progression
    ~ Simple to Complex
    > Single Plane to Multi Plane
    ~ Traditional Actions to True Functions
    ~ Correct Execution to Increased Reps
    to Increased Intensity
    ~ Body weight before external
    resistance
  • Determine limitations and choose an exercise that will cause overload to increase strength/endurance
  • Two approaches
    ~ Overload isolated muscle with
    traditional muscle actions
    > Teaches isolated muscle
    contraction more/better
    ~ Overload muscle with true function in
    mind
    > Teaches muscle to function better
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12
Q

Exercise Selection: Resistance

A
  • Choice of Resistance Mode
    ~ Body weight
    ~ Manual: clinician can control
    resistance
    ~ Free weights: relies on gravity
    ~ Machines: relies on gravity
    ~ Tubing/Band
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13
Q

Exercise Selection: Advantages of Free Weights

A
  • Requires muscles to stabilize more while performing activity
  • Minimizes bilateral strength imbalances
    ~ Inability to shift or compensate with
    one side
  • Greater ROM
  • Ability to work in all planes of motion
  • Allow for multi-joint and multi-plane movements
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14
Q

Determining Limitations

A
  • Separating out specific muscles with manual testing is difficult
    ~ Ex: Weakness with inversion may
    indicate weakness in anterior tibialis
    and or posterior tibialis muscles
    ~ Some techniques attempt to isolate
    muscles, but still difficult to do so fully
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15
Q

Tibialis Anterior

A
  • Action: Inversion and Dorsiflexion
  • Function:
    ~ Decelerates STJ Eversion during
    pronation/functional loading
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16
Q

Soleus

A
  • Action: Plantarflexion
  • Function:
    ~ Decelerates STJ Eversion during
    pronation/functional loading
    ~ Decelerates TCJ Dorsiflexion during
    pronation/functional loading
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17
Q

How Much/Many?: Frequency

A
  • Depends on intensity, volume, health of pt./tissues
  • Interval between sessions should not exceed one week
    ~ Detraining
  • Too short intervals
    ~ Overtraining
  • One day of rest will allow for recovery and prevent detraining
    ~ Especially important when
    overloading with force/time under
    tension
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18
Q

How Much/Many?: Intensity

A
  • Can set intensity of healthy pts. based on 1RM (not good for injured pts.)
  • Intensity is random and a guessing game based off of pts. pain and ability
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19
Q

How Much/Many?: DeLorme

A
  • Based on 10 RM
  • 1st set of 10 reps @ 50% 10 RM
  • 2nd set of 10 reps @ 70% 10 RM
  • 3rd set of 10 @ 10 RM
  • Fatigue needs to be present, if not a new 10 RM needs to be determined
  • Better/safer for pts. who are injured
20
Q

How Much/Many?: Oxford

A
  • Based on 10 RM
  • 1st set of 10 reps @ 100% 10 RM
  • 2nd set of 10 reps @ 70% 10 RM
  • 3rd set of 10 @ 50% 10 RM
  • Fatigue builds strength
21
Q

How Much/Many?: DAPRE

A
  • Daily Adjusted Progressive Resistive Exercise
  • Based on 6 RM
  • 1st set of 10 reps @ 50% 6 RM
  • 2nd set of 6 reps @ 70% 6 RM
  • 3rd set @ 100% 6 RM until failure
  • 4th set based on performance during 3rd set
22
Q

General Guidelines for Load

A
  • Increase load 5-10% when all prescribed reps can be performed without significant fatigue
  • Overload with Force/Time Under Tension
    ~ Higher Weight and Lower Reps
    ~ Size
  • Overload with Volume
    ~ Lower Weight and Higher Reps
    ~ Neuromuscular Efficiency
23
Q

How Much/Many?: Endurance

A
  • Keep resistance low
  • Keep reps high
    ~ 40-50
    ~ As many as possible in a set time
    ~ Volume
24
Q

PNF Strengthening Exercise: Neuromuscular System

A
  • Use of specific movement patterns to fully engage the neuromuscular system in building strength
    ~ Afferents are stimulated in a number
    of ways
    > Contact from the clinician
    stimulate skin receptors
    > Stretch stimulates the MS
    > Pt. visually sees the movement
    > Clinician gives verbal cues to
    increase or decrease muscle
    activity
    > Joint movement activates
    proprioceptors
25
Q

PNF Strengthening Exercise: Movement Pattern Characteristics

A
  • Multi-joint and multi-plane
  • Diagonal
    ~ Cross the midline
    ~ Move between “flexion” and
    “extension” patterns
    ~ Brain is forced to sense movement on
    both sides of body
  • Manually resisted
26
Q

PNF Movement Patterns

A
  • Pair of diagonal patterns for the upper and lower extremities
    ~ D1 and D2
    ~ Each has both flexion and extension
  • First developed for people who had strokes
    ~ Neuro input/output
    ~ Manual resistance
    ~ Relatively easy exercises while laying
27
Q

PNF Patterns: Upper and Lower

A
  • Upper Extremity: Shoulder
    ~ External Rotation always goes with
    Flexion
  • Lower Extremity: Hip
    ~ External Rotation always goes with
    Adduction
28
Q

Power

A
  • Ability to generate force in the shortest amount of time
    ~ Speed by which motor units are
    recruited and synchronized
  • The more you utilize power, the better the pt. functions
  • Plyometric training is a good example of Power training
29
Q

What is Plyometric Exercise?

A
  • Quick powerful movements involving pre-stretching/eccentric loading of the muscle to produce a strong concentric contraction
    ~ Techniques heighten excitability of
    CNS due to increased sensory input
    ~ All muscles work more efficiently
    when eccentrically loaded and
    concentrically unloaded making
    Plyometric exercise very functional
30
Q

What is responsible for the strong concentric contraction?

A
  • Stretch Reflex
    ~ MS detects stretch
    ~ MS responds by stimulating the
    muscle to contract
    ~ Muscles need to eccentrically
    lengthen before concentrically
    contracting
  • Inhibition of GTO
    ~ GTO normally inhibits muscle
    contraction under sustained tension
    or heavy loads
    ~ Plyometrics cause GTO to be less
    sensitive so increased stimulation is
    necessary to activate the GTO
    > Increased level of inhibition =
    greater force production
  • Elasticity of the Muscle Structure
    ~ Elastin fibers contained in tendon
    and muscle
31
Q

Plyometric Exercise Phases

A
  • Eccentric (Loading Phase)
    ~ Phase where muscle is eccentrically
    contracting and elastic components
    are put on a stretch
  • Amortization
    ~ Phase where eccentric contraction is
    converted to concentric contraction
  • Concentric (Unloading Phase)
    ~ Phase where muscle is concentrically
    contracting
32
Q

Plyometric Prerequisites

A
  • Although very functional and useful, Plyometric training must be used carefully
  • Prerequisites for use:
    ~ Stable Base
    > Relative to intensity to Plyometric
    training
    > Components
    • Balance
    • Strength
    ~ Proper Flexibility
    > All links in the chain should be
    near normal to decrease
    compensatory overuse injuries
33
Q

Plyometric Prerequisites: Stable Base Testing

A
  • Balance
    ~ Romberg’s: standing still with eyes
    closed
    ~ BESS
    ~ Timed Balance Beam Test
    ~ Modified Force Platforms: measured
    force in all 3 planes
  • Strength/Balance
    ~ Power Squat Test
    > Squat 60% of body weight 5 times
    in 5 seconds
    ~ Balance Reach Test
    ~ Holding 25% and 50% single leg squat
    positions for 30 seconds with eyes
    open and closed
34
Q

Plyometric Prerequisites: Proper Flexibility

A
  • Must have the ability to properly load and unload the limb
  • Triple Flexion (hip flexion, knee flexion, and Dorsiflexion)
  • Triple Extension (hip extension, knee extension, and plantarflexion)
35
Q

Plyometric Program Terminology

A
  • Jump
    ~ 2 foot take off and 2 foot landing
  • Hop
    ~ 1 foot take off and 1 foot landing
    (same foot)
  • Bound
    ~ 1 foot take off and 1 foot landing
    (opposite foot)
  • Choosing on over the other is based off of pts. sport or if they can balance or not
36
Q

Plyometric Training Variables: Intensity and Speed

A
  • Intensity
    ~ External load
    ~ Single vs. Double leg landing
    ~ Height
    ~ Length
  • Speed (should always be worked on)
    ~ Emphasize shortening of the
    Amortization Phase
    > Takes better advantage of spindle
    and elasticity
    > Most important factor relative to
    function
    ~ Doing it too slow doesn’t take
    advantage of the MS and elasticity of
    a muscle
37
Q

Plyometric Training Variables: Volume and Direction of COG Movement

A
  • Volume
    ~ Total amount of work
    > Number of foot contacts
    > Generally low volume = 75-100
    contacts on average since intensity
    is generally high
    ~ Pt. should be sore, if not it’s too easy
  • Direction of COG movement
    ~ Vertical is more stressful and less
    functional due to gravity
    ~ Horizontal is less stressful and more
    functional
38
Q

Plyometric Training Variables: Recovery and Frequency

A
  • Recovery
    ~ Rest time between sets
    ~ Dependent on intensity and goals of
    program
    > Power: long rest so muscle can
    recover
    > Endurance: short rest
  • Frequency
    ~ Relative to intensity
    ~ Generally 48-72 hours needed to
    recover
    ~ Too often causes detraining
39
Q

Plyometric Program Design

A
  • Program must be designed to enhance factors that are required for the sport
  • Should follow general progression before using sport specific moves to ensure proper technique
  • General Progression
    ~ Landing
    ~ Stabilization Jumps/Hops
    ~ Jump Up
    ~ In place jumps
    ~ Short jumps/hops
    ~ Long jumps
    ~ Shock method
40
Q

General Plyometric Progression: Landing

A
  • Goals
    ~ Teach proper foot strike
    ~ Teach use of Triple Flexion
  • Techniques (very short, sub-maximal)
    ~ Step down off box
    ~ Standing long jump
    ~ Hop out onto one foot
41
Q

General Plyometric Progression: Stabilization Jumps/Hops

A
  • Goals
    ~ Reinforce proper “landing”
    ~ Teach eccentric loading
    ~ Improve ability to stabilize
  • Techniques (sub-maximal, but increased intensity)
    ~ Standing long jump
    ~ Hop out on one foot
42
Q

General Plyometric Progression: Jump Out

A
  • Goals
    ~ Teach use of triple extension
    ~ Teach the use of arms
    ~ Teach loading
  • Technique
    ~ Jump up onto stable surface that is
    knee height up to mid thigh height
43
Q

General Plyometric Progression: In Place Jumps

A
  • Goal
    ~ Teach to switch over speed/decrease
    Amortization Phase
  • Technique
    ~ Tuck Jump
    ~ Ankle bounce
    ~ Scissors Jump
44
Q

General Plyometric Progression: Short Jumps/Hops

A
  • Goal
    ~ Teach horizontal displacement
  • Technique (more towards maximal end)
    ~ Repeated standing long jumps
    ~ Repeated long hops
45
Q

General Plyometric Progression: Long Jumps

A
  • Goal
    ~ Maximize horizontal displacement
  • Technique (maximal effort)
    ~ Bounding
    ~ Combination of hops and bounds
46
Q

General Plyometric Progression: Shock Method

A
  • Goal
    ~ Overload neuromuscular system
  • Technique
    ~ Depth Jumps
    > Turns on MS and allows pt. to
    jumper higher due to maximal
    vertical displacement
    ~ Hurdle jumps

Rehabilitation Of Athletic Injuries (13 decks)

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