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
2
Q
What is muscle strength?
A
- Maximum force that a muscle or muscle group can exert
- Non factors
~ Speed
~ Repetitions
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
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
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
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
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
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
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
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
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
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
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
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
15
Q
Tibialis Anterior
A
- Action: Inversion and Dorsiflexion
- Function:
~ Decelerates STJ Eversion during
pronation/functional loading
16
Q
Soleus
A
- Action: Plantarflexion
- Function:
~ Decelerates STJ Eversion during
pronation/functional loading
~ Decelerates TCJ Dorsiflexion during
pronation/functional loading
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
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
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
