therapeutic exercise Flashcards
contractile elements of muscle
muscles are composed of fibers, which are made up of myofibrils
myofibrils are composed of sarcomeres that are connected in series
the overlapping cross bridges of actin and myosin make up a sarcomere
when a muscle contracts, the actin-myosin filaments slide together and the muscle shortens.
-the cross bridges slide apart when the muscle relaxes and returns to its resting length
slow twitch fibers
type 1 low force (tension) production highly resistant to fatigue
fast twitch fibers
type IIa
- fast contraction speed
- fatigue resistant
- influenced by type of training
type IIb
- fast contraction speed
- high force production
- susceptible to quick fatigue
muscle hypertrophy
increase in muscle size as a result of resistance training
at least 6-8 weeks of training
metabolic effects of strength training
muscle contraction to about 60% of its force generating capacity causes a blockage of blood flow to the working muscle due to increased intramuscular pressure
-the energy source for this level of contraction is mainly anaerobic and doesn’t improve with aerobic conditioning
rhythmic activities increase BF to exercising muscles via a contraction and relaxation “milking action”
-primary energy source=aerobic
circuit training with high reps and low weights incorporates all modes of training and provides more general conditioning to improve body composition, muscular strength and some cardiovascular fitness
common errors associated with strength training
Valsalva’s maneuver
-increases intrathoracic pressure, slows HR
plyometrics
stretch shortening activity
an isotonic exercise that combines speed, strength and functional activities
used in later stages of rehab to achieve high level of performance
minute ventilation
Ve
volume o air breathed each minute = 6L
RR x TV
in max exercise may be as high as 200 L/min
energy is produced aerobically as oxygen is supplied to exercising muscles
-oxygen consumption rises rapidly during the first minutes of exercise, and then levels off as the aerobic metabolism supplies the energy required by the working muscles
exercise induced asthma
occurs when the normal initial bronchodilation is followed by bronchoconstriction.
the reduction in airflow from airway obstruction affects the ability of the lungs to provide oxygen to exercising muscles
acute, reversible airway obstruction that develops 5-15 minutes after strenuous exercise when a person doesn’t breathe through the nose, which warms and humidifies the air
-when a person breathes through the mouth- the air is cold and dry, contributing to bronchoconstriction
warm up and cool down
warm up presents the heart and circulatory system from being suddenly taxed
cool down reduces abrupt physiological alterations that can occur with sudden cessation of strenuous exercise
-venous pooling in the LEs causing decreased venous return to the heart
exercise at high altitudes
> 6000 feet =noticeable drop in performance of aerobic activities
PaO2 is reduced resulting in poor oxygenation of hemoglobin
this hypoxia at altitude can result in immediate compensatory hyperventilation and increased HR
reduction in CO2 from hyperventilation results in more alkaline body fluids
adjustments to altitude:
- 2 weeks at 2300 m and additional week for every 600m
- decrease in plasma volume and an increase in total RBC and hemoglobin improving oxygenation
- VO2 max is decreased 2% for every 300m above 1500m
exercise in hot weather
to decrease metabolic heat, blood is shunted to the periphery- working muscles are deprived of needed O2
core temp increases, sweating increases (excess fluid loss)- compromises cardiovascular functioning
repeated heat stress results in acclimatization in about 10 days of exposure
obesity is a major factor
ballistic stretching
high intensity, short duration “bouncing” stretch
by contracting the opposite muscle group, the patient uses BW and momentum to elongate the tight muscle
considered unsafe bc of poor control and potential of rupturing the weakened tissues
-shouldn’t be performed after injury or surgery
facilitates the stretch reflex, causing an increase in tension in the muscles that is being stretched -contraindicated in spastic muscles
dynamic splint
maintains limb positioned at end range and is typically applied for 8-10 hours to increase ROM
ex: reduce wrist and finger flexion contractures
serial cast
maintains the limb positioned at end range for 5-7 days
cast is removed and a new cast is reapplied with the limb positioned in the newly gained range
ex: gastroc contractures
facilitated stretching techniques
hold-relax:
- a relaxation technique usually performed at the point of limited ROM in the agonist pattern
- an isometric contraction of the range limiting antagonist is performed against slowing increasing resistance, followed by voluntary relaxation and passive movement by the PT into the newly gained range of the agonist
- muscle relaxes as a result of autogenic inhibition, possibly from GTO firing and decreasing muscular tension
hold -relax-active contraction
- following hold-relax, active contraction into the new range of the agonist pattern is performed
- additional muscle relaxation is achieved through active contraction and reciprocal inhabition (Ia spindle response)
contract-relax-active contraciton:
- a relax technique usually performed at a point of limited ROM in the agonist pattern
- isotonic movement in rotation is performed followed by an isometric hold of the range limiting muscles in the antagonist pattern against slowly increasing resistance
- voluntary relaxation and active movement into the new range of the agonist pattern
- utilizes effects of both autogenic and reciprocal inhibition
autogenic inhibition
slow stretching, especially applied at end range, causes the GTO to fire and inhibit the muscle, allowing it to lengthen (stretch-protection reflex)
noncontractile CT affecting joint flexibility:
ligaments, tendons, joint capsules, fascia, skin
low magnitude loads over long periods increase the deformation of non contractile tissue, allowing a gradual rearrangement of collagen bonds (remodeling)
15-20 min of low intensity sustained stretch repeated 5 consecutive days can cause a change in muscle and CT length
without healing time a breakdown of tissue will occur as in overuse syndromes and stress fractures
Stabilizing reversals
Rhythmic stabilization
alternating isometric contractions between antagonists can enhance stabilizing contractions and develop postural control (PNF techniques):
Stabilizing reversals: isometric holding is facilitated first on 1 side of the joint followed by alternate holding of the antagonist muscle groups. may be applied in a variety of directions (AP, med-lat, diagonal)
Rhythmic stabilization: simultaneous isometric contractions of both agonist and antagonist patterns performed without relaxation, using careful graying of resistance; results in cocontraction of opposing muscle groups; RS emphasizes rotational stability control
postural stress syndrome
movement adaptation syndrome
postural stress syndrome: abnormal shortening or lengthening of muscles and ligaments
movement adaptation syndrome: habituation of compensatory movement patterns that contribute to the persistence of pain
strategies to promote relaxation
jacobson’s progressive relaxation technique- systematic distal to proximal progression of conscious contraction and then relaxation of muscle
Guided imagery
AROM
rhythmic rotation: slow passive rotational movements of the limbs or trunk (hooklying with LEs on ball rocking)
slow vestibular stimulation: gentle rocking techniques (gently rocking an infant)
biofeedback training
stress management
buoyancy
the upward force of water on an immersed or partially immersed body or body part
equal to the weight of the water that is displaces
this creates an apparent decrease in the weight and joint unloading of an immersed body part, allowing easier movement in water
cohesion
the tendency of water molecules to adhere to each other. the resistance encountered while moving through water is due to cohesion; some force is needed to separate water molecules
density
the mass pet unit volume of a substance
the density of water is proportional to its depth; deeper water must support the water above it
hydrostatic pressure
the circumferential water pressure exerted on an immersed body part.
a pressure gradient is established between the surface water and deeper water, due to the increase in water density at deeper levels
pascal’s law states that the pressure exerted on an immersed body part is equal on all surfaces
increased pressure counteracts effusion and edema, and enhances peripheral BF
turbulence
movement of a body part through water creates circular motion of the water (eddy current) near the surface of the part, producing frictional drag
as speed of movement increases, greater resistance is encountered
moving through turbulent water creates greater resistance as compared to calm water
thermodynamics
watepr tem affects body temp and performance
cooler temps are used for higher intensity exercise
warmer temps are used to enhance mobility, flexibility and relaxation (arthritis)
ambient air temp should be close to water temp
there is decreased heat dissipation through sweating with immersion
temps >98.6 F - patients have increased cardiovascular demands at rest and during exercise
temps
contraindications and precautions to aquatic exercise
contraindications:
- bowel/bladder incontinence
- severe kidney disease
- severe epilepsy
- severe cardiac or respiratory dysfunction (cardiac failure, unstable angina, severely reduced VC, unstable BP)
- severe PVD
- large open wounds, skin infections, colostomy
- bleeding or hemorrhage
- water and airborne infections (flu, GI infections)
Precautions:
- fear of water, can’t swim
- heat intolerance (MS)
- waterproof dressings on small open wounds
