Therapeutic Exercise Flashcards
Term: Safely return a pt. to his or her preinjury state with as little risk of reinjury as possible with the minimum amount of pt. inconvenience
Intervention
Term: Tool (object or therapist) used to restore and improve a pt.’s musculoskeletal or cardiopulmonary well being.
Therapeutic exercise
Q: What is the goal of a therapeutic exercise program?
Optimal level of symptom free movement during basic to complex physical activities
Q: How do you achieve symptom-free movement and function?
- Knowledge of basic principles
- Relationships of anatomy and kinesiology
Content: Components of TherEx (3)
- Activity
- Technique
- Elements
Term: TherEx - a posture and any movement occurring in that posture
Activity
Term: TherEx - the type(s) of muscle contraction(s) i.e. concentric, eccentric, isometric
Technique
Term: TherEx - sensory input used either to facilitate or inhibit a response
Element
Content: Parts of the intervention definition (5)
- Exercise to prevent muscular atrophy
- Restoring joint and muscle function
- Increasing muscular strength
- Improving efficient cardiovascular and pulmonary function
- Neurological elements
Content: Other bits of the TherEx puzzle (4)
- Understand state of the injury
- Understand surgical procedure
- Know potential rate of recovery
- Be aware of precautions, complications, and contraindications
Content: Intervention for Bone (2)
- Biomechanical energy in the line of stress
- Avoid sheer forces
Content: Intervention for Cartilage (2)
- Intermittent compression and decompression with gliding
- Avoid excessive overload
Q: How can posture effect TherEx? (2)
- Watch for compensatory mechanism
- Can lead to other injury
Content: Intervention for Collagen
Modified tension in the line of stress
Content: Things to keep in mind when addressing the problem (4)
- Where is the pt. lacking function?
- What are the pt goals?
- Are they the same as your goals?
- Assess the needs
Q: What is the PT problem solving approach?
Assess needs > develop a plan > implement plan > evaluate plan > ALWAYS return to ASSESS needs
Content: Skillful Decision Making Models (4)
- Disablement model
- Medical model
- Clinical reasoning
- Algorithms
Defn: Disablement model
Impairment, Function, Activity
Defn: Medical model
Scan, Illness scripts
Defn: Clinical reasoning
Reliant on experience
Defn: Algorithms
If and then
Q: What is a problem list good for?
Helps you develop your goals and plan
Content: Basic Principles of TherEx (6)
- Bi/Unilateral
- Un/stable
- Single/multiplanar motion
- Single/multijoint motion
- Simple/complex task/exercise
- Specific to job/sport
Content: 4 parts of specificity of training
- Bilateral vs. single loading exercise
- Balance
- Proporioception
- Kinesthetic
T/F: Balance should be progressed from simple to complex activites.
True
Content: Other considerations for TherEx (6)
- Posture/position
- Muscle type, contraction, fibers
- Repetition
- Rest/recovery
- Periodization
- Substitution
Q: In which phase is the area red, warm, swollen, and painful?
Acute
Q: In which phase is there pain present at rest and with motion of the involved area?
Acute
Q: In which phase is there coagulation and WBCs present?
Acute
Q: What are the 3 goals of the acute phase?
- Rest
- Relieve pain
- Protect
Q: What is an illness script?
Decision making that gets right to the point and treats the problem
Q: In which phase does pain occur with activity or motion of involved area?
Sub-acute
Q: In which phase is ROM and strength limited?
Sub-acute
Q: In which phase is there capillary growth, granulation tissue formation, fibroblast proliferation with collagen synthesis, and increased macrophage activity?
Sub-acute
Q: What is another name for the sub-acute phase?
Migratory/Proliferative Phase
Q: What are the 3 goals of the sub-acute phase?
- Optimal stimulus for regeneration
- Protect
- Gain motion
Q: In which phase may pain occur after activity?
Chronic
Q: In which phase does macrophage and fibroblast activity diminish?
Chronic
Q: In which phase does scar tissue density and tensile strength increase?
Chronic
Q: What are the 4 goals of the chronic phase?
- Increase tissue stress
- Full motion
- Strengthen
- Return to pain-free function
Content: Types of TherEx (7)
- ROM
- Strengthening
- Flexibility
- Coordination
- Endurance
- Balance/Neuromuscular control
- Functional/specific activities
Content: What 3 questions can you ask for any type of TherEx
- Does the pt. have the available ROM?
- What motion do you need to perform this stance?
- What exercises can you prescribe to achieve this?
Term: The ability of a muscle or muscle group to produce tension and a resulting force during a maximal effort, either dynamically or statically in relation to the demands placed upon it
Strength
Term: Relates to the ability of the neuromuscular system to produce, reduce, or control forces, contemplated or imposed, during functional activities, in a smooth, coordinated manner
Functional Strength
Defn: “Normal” strength
The amount or degree of strength of a muscle that allows that muscle to contract against gravity and hold against maximum resistance (one time)
Q: Is our definition of normal strength really a measurement of strength?
No, also need to look at endurance (a different type of strength)
Q: Muscle strength is a foundation for developing muscle ________.
Power
Content: 2 ways power can be enhanced
- Increasing the work a muscle must perform in a specific period of time
- Reducing the amount of time taken to generate the force
Term: The ability of a muscle to contract repeatedly against a load, generate and sustain tension, and resist fatigue over an extended period of time
Muscular endurance
T/F: The larger the diameter of the muscle the greater the tension-producing capacity.
True
Term: Increase in fiber size
Hypertrophy
Term: Increase in fiber number
Hyperplasia
Q: Which fiber type can generate large amounts of tension, but fatigue quickly?
Type 2A-B
Q: Which fiber type develops less tension but are resistant to fatigue?
Type 1
Q: Which type of contract produces the most tension?
Eccentric
T/F: Greater torques are produced at higher speeds.
False: lower
T/F: During eccentric contractions, increased speed of lengthening produces more tension.
True
Q: At what length is the greatest tension produced?
Near or at resting length
T/F: The length tension relationship can be altered by pt. position, thus positional weakness should be considered for MMT and TherEx.
True
Term: Advanced skill that is built on flexibility, strength, and power first, followed by coordination and balance.
Agility
Term: The ability to use the right muscles at the right time with appropriate sequencing and intensity
Coordination
Term: The ability to perform smooth, accurate, and controlled movements.
Coordination
Term: Ability to maintain equilibrium.
Balance
Q: What 3 systems are used for balance?
- Sensory
- Biomechanical
- Motor
Term: The body’s ability to transmit position sense, interpret the information and respond consciously or unconsciously to stimulation through appropriate execution of posture and movement
Proprioception
Q: What does functional movement allow use to do?
Gives us the ability to change direction of movement quickly and efficiently and adapt to surfaces
Q: What is the overload principle?
Progressive loading of the muscle by manipulating intensity or volume of the exercise
Q: What does the overload principle look like for strength training?
Amount of resistance applied is gradually increased
Q: What does the overload principle look like for endurance training?
Emphasis on increasing time muscle contraction is sustained or number of repetitions performed
Q: What is the acronym SAID?
Specific Adaptation to Imposed Demands
T/F: According to SAID, exercised should be selected to create training effects specific to pt.’s funcitonal needs and goals
True
Content: Progressive Resistance Exercise - DeLorme (3)
- 3 sets of 10 RM
- Progressive loading during each set
- Warm up build in
Content: Progressive Resistance Exercise - Oxford (2)
- Regressive loading
- Diminished the resistance as the muscle fatigues
T/F: Oxford PRE results in better outcomes than DeLorme PRE.
False; same outcome
Q: The following example is what type of PRE? 10 reps @50%, 10 reps @75%, 10 reps @100%
DeLorme
Q: The following example is what type of PRE? 10 reps @ 100%, 10 reps @75%, 10 reps @50%
Oxford
Content: DAPRE (4)
- Daily adjustable progressive resistive exercise
- Based on 6RM
- Adjusted working weight is based on the max number
- This determines the weight for the next session
Content: How to calculate DAPRE (5)
- 0-2 reps decrease 5-10#
- 3-4 reps decrease 0-5#
- 5-6 reps keep same weight
- 7-10 reps increase 5-10#
- 11+ increase 10-15#
Diagram: Oddvar Holten Curve
Term: Distal portion free in space
Open Chain Exercise
Term: Distal protion of segment is fixed
Close chain exercise
Q: What are open chain exercised used for?
To isolate one joint motion
Q: What are closed chain exercises used for?
When you want multiple joints and muscles involved
Content: Periodization (4)
- Method used to prevent overtraining
- Helps maximize results in minimum time
- Improves muscular endurance, strength, power, motor performance, and/or muscle hypertrophy
- Can alter exercise variables (mode, order, frequency, intensity, volume)
Q: What are plyometrics good for? (3)
- power training combined with strengthening
- using max force in short time period
- eccentric to concentric
Q: What is the plyometric theory related to series elastic components?
Stored energy created with rapid stretching, energy released immediately with concentric contraction
Q: What is the plyometric theory related to the neurophysiological model?
Stretch reflex occurs as a response to overstretching, reaction is to recoil spring into concentric contraction
Q: What are the 3 phases of plyometrics?
- Pre-stretch
- Amortization (time between pre-stretch and concentric contraction)
- Muscle contraction
Content: TherEx Dosage (5)
- Choose 1-2 types of exercise
- 1-3x/wk for 6-12 wks
- 2 sets of 10 OR 4 sets of 8
- 48-72 hours rest per body part
- Ample rest between sets
Content: Delayed Onset of Muscle Soreness (DOMS) (4)
- can occur 48-72 hours after exercise
- usually related to eccentric exercise or lack of preparation
- low load and high rep will assisst in healing
- proper hydration and nutrition are key
Q: What 5 things should you consider when prescribing TherEx?
- Target Muscles
- Adjust to activity and posture
- Strength vs. endurance
- Frequency
- Pt personality
Q: What is the exercise prescription for an endurance training objective?
Very short rest periods, 2-3 sets, reps > 15
Q: What is the exercise prescription for a hypertrophy training objective?
Rest 30-45 secs or before full recovery, 3-4 sets, reps to fatigue
Q: What is the exercise prescription for a strength training objective?
Rest 1-2 mins, 3-6 sets, reps 4-8
Q: What is the exercise prescription for a power training objective?
Rest 2-5 min, sets 2-4, reps 3-6
Content: Exercise selection (3)
- Multiple exercises for the same muscle group
- Stable and unstable surfaces
- Incorporate interval training
Q: How should you structure a HEP?
So that is compliments your program in the clinic
