Strengthening/Edurance/Power Flashcards
Muscle Strength Measurement
- 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
What is muscle strength?
- Maximum force that a muscle or muscle group can exert
- Non factors
~ Speed
~ Repetitions
Types of Strength/Contraction
- 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
Factors Influencing Strength
- 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
General Guidelines for Muscle Change
- 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
Enhancing Muscle Size
- 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
Is enhancing muscle size a concern in rehab?
- 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
Enhancing Neuromuscular Efficiency
- 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
Is enhancing neuromuscular efficiency a concern in rehab?
- 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
Muscular Endurance
- 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
Exercise Selection: Progression and Appraoches
- 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
Exercise Selection: Resistance
- Choice of Resistance Mode
~ Body weight
~ Manual: clinician can control
resistance
~ Free weights: relies on gravity
~ Machines: relies on gravity
~ Tubing/Band
Exercise Selection: Advantages of Free Weights
- 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
Determining Limitations
- 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
Tibialis Anterior
- Action: Inversion and Dorsiflexion
- Function:
~ Decelerates STJ Eversion during
pronation/functional loading
Soleus
- Action: Plantarflexion
- Function:
~ Decelerates STJ Eversion during
pronation/functional loading
~ Decelerates TCJ Dorsiflexion during
pronation/functional loading
How Much/Many?: Frequency
- 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
How Much/Many?: Intensity
- 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
How Much/Many?: DeLorme
- 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
How Much/Many?: Oxford
- 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
How Much/Many?: DAPRE
- 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
General Guidelines for Load
- 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
How Much/Many?: Endurance
- Keep resistance low
- Keep reps high
~ 40-50
~ As many as possible in a set time
~ Volume
PNF Strengthening Exercise: Neuromuscular System
- 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