Therapeutic Exercise Intervention Flashcards
Rehabilitation program =
primary emphasis is restoration of muscular strength, endurance, flexibility
Physical Fitness =
improvement, CV fitness, body composition
risk factors for chronic disease
physical inactivity and sedentary behaviour smoking nutrition high blood cholesterol overweight and obesity alcohol high BP
health risks of obesity
low self esteem social isolation depression heat intolerance SOBOE fatigue
Heart disease and stroke abnormal blood lipids & metabolic syndrome hypertension diabetes cancer gallbladder disease & gall stones OA & gout Respiratory conditions infertility, incontinence, PCOS
Physical inactivity
associated with poor health outcomes and increased mortality
increased risk of diabetes, CV disease, cancer
Regular physical activity and high CV fitness decrease mortality
Benefits of regular physical activity
reduces risk of premature mortality reduces risk of death from CV disease reduces risk of stroke reduces risk of developing diabetes reduces risk of developing bowel cancer helps to control weight helps to build and maintain healthy bones, muscles, joints decreased risk of falls, improved mobility (elderly) Reduces depression/anxiety/stress levels promotes psychological wellbeing reduces cognitive decline & dementia
Immediate short term goals
- provide first aid + mgmt - swelling
- reduce or minimise pain
- restore full ROM
- establish core stability
- reestablish neuromuscular control
- improve postural stability and balance
- restore or increase muscular strength/endurance/power
- maintain cardiorespiratory fitness
- Incorporate functional progressions
Functional progression
graduated progressive activities to prepare return to specific activity or function
skills are broken down into components
advance if no additional pain or swelling
Stage 1 : stabilisation
muscle, joint, nerve, postural control and stability deficits addressed correct imbalances recondition injured structures prepare tissues for physical demands prevent tissue overload improve work capacity improve stabilisation strength
progress from isometric to incorporating movement
Improve neuromuscular efficiency, core stability, functional strength, functional flexibility
Stage 2: strength
enhance stabilisation strength and endurance
high volume resistance exercises
goal is to achieve adaptive changes by challenging NM system
- increase in muscle size
- increase fatigue resistance
-increased stabilisation strength to control joint translation
Stage 3 : power
important for return to high level activity
30-45% of max strength, accelerating through ROM
Goal : enhance NM efficiency and power production by increasing motor neurone excitability and speed strength throughout ROM
Consider healing factors
Injury extent - response is determined by extent effusion and or oedema haemorrhage poor vascular supply separation of tissue muscle spasm atrophy steroid use keloid or hypertrophic scars infection health/age/nutrition wound healing conditions
Establishing core stability
stabilises entire kinetic chain during FXN
maintains normal length - tension relationship of agonists + antagonists
normal force couple relationships in lumbo-pelvic -hip
Allows for optimal lumbo-pelvic-hip complex during functional kinetic chain movements
proximal stability - efficiency in limb movements
Revise core anatomy
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Range of motion and stretching
Flexibility = movement through full, unrestricted painfree ROM
Open chain =
distal segment is mobile, hand or foot not fixed or in contact with the ground/surface
Closed chain =
Distal segment fixed, hand or foot is weightbearing
Closed chain
safer, less stress and force to healing joints
co-contraction of agonist-antagonist decreases shear forces on joint
enhances joint stability
Open chain
isolated to single joint
strength and ROM
Useful when closed chain is not possible
Neuromuscular control
Reestablishing brains interpretation of proprioceptive and kinaesthetic info
retrain conscious control of specific movement
successful repetition - automatic
functional strengthening, closed chain kinetic
critical during early stages to prevent re-injury
Four crucial elements of neuromuscular control
- proprioceptive and kinaesthetic sensation
- dynamic joint stabilisation
- reactive neuromuscular control
- functional activity
Open and closed chain activities, balance training, eccentric + high rep/low load strengthening, reflex facilitation, plyometrics, biofeedback
Postural control and balance
ability to maintain stability and balance requires proprioception and kinesthesia decreased? - poor neuromuscular control -muscular weakness -ROM limitations -Vestibular, visual deficits
poor postural control - risk of re-injury
combination of open and closed chain
Postural control and balance
safety first train in multiple planes of motion consider multisensory progress - static, bilateral, stable surface > dynamic, unilateral, unstable surface progress towards sports specific
Strength, power, endurance
goal - work in full pain-free ROM Multiplanar : concentric, isometric, eccentric consistent, increasing effort against progressively increasing resistance isometic -early stage of rehab - limitation in ROM -Minimise atrophy -decrease swelling
progressive strengthening
progress: isometric - concentric/eccentric
aim to incorporate both into rehab program
ideal ratio of contraction?
-Conc: 1 Ecc 2
Isokinetics? Resistance dependant on speed
plyometrics
- later stages of rehab
-quick eccentric stretch to facilitate subsequent concentric contraction
-restore/develop dynamic movements associated with muscular power
- sports performance
Cardiovascular fitness
don’t forget to incorporate
start early in the program to maintain existing levels
cycling, swimming, water walking, walking, trainer, rowing machine, arm erg
compliance & adherence
compliance = obedience in following instructions
adherence = voluntary long term behavioural change
1/3 - 1/3 - 1/3 rule
30-60% dropout rate in first 3 months of exercise programs
pain tolerance, motivation, external support, positive attitude
educate about reasoning/healing/goals - written instructions
collaborative goal setting process, encouragement & positive reinforcement
clear guidelines
don’t forget about pain
consider amount, make it interesting and patient focused/specific
Full return to function
patient and injury specific monitor during rehab, outcome measures reassessment of function and goals during rehab process ability to perform functional tasks full return of deficits low risk of re-injury self management
Worst in australia
darling downs
SE region SA
best in australia
sydney east
melbourne inner
over the next 20 years
hospitalisations expected to double
2.7x diabetes
4x renal failure
obesity rates atm
1 in 4 Aussies (30%) BMI >30
7% are children
1 in 3 are overweight
Indigenous are 1.9x more likely to be obese
Orrow (2012)
significant increase in self reported exercise in 12 months
Lin (2010)
mod to intensive counseling - small improvements in secondary outcome, large changes to level of activity
Oglivie (2007)
tailored motivational counseling - incr. walking 30-60min/week
Hillsdon(2005)
interventions had moderate impact on self reported activity levels
summary
intense, individualised counseling with personalised exercise prescription
Witvrouw (2004) on stretching to improve flexibility
important for sports with high intensity stretch shorten cycle like soccer, football, sprinting
not so important for sports with less stretch- shorten cycle- cycling, swimming, jogging
Page (2012) on stretching to improve flexibility
dynamic /ballistic before exercise (warm up)
static before exercise is potentially detrimental to performance
after exercise can be beneficial for injury prevention
Sherry and Best (2004) on stretching to improve flexibility
- Faster to full ROM and improved effectiveness of
rehab program
• 2. Progressive agility and trunk stability exercises (PATS)
with static stretching and isolated hamstring resistance
exercise (STST) demonstrated:
– Nil difference in time until return to sport
– Significant reduction in re-injury 2/52 and 1 year post return
to sport with PATS
Katalinic (2011) contractures in neurological patients
no evidence to demonstrate clinically important changes
Injury prevention such as stretching, warm up cool down
conflicting evidence for stretching to prevent injury and does not reduce DOMS
Cool down may facilitate lactate removal
slow return form vasodilation, return blood to CC
increase in cardiac vagal tone, reduction in resting HR
Slow walking, stretching exercises, calisthenics
