A Framework for Exercise Prescription Flashcards
1
Q
5 levels of exercise prescription
A
- tissue healing
- mobility
- performance initiation, stabilization, & motor control
- performance improvement
- advanced skill, agility, & coordination
2
Q
Tissue healing interventions
A
- acute/post operative stage (inflammation)
- proliferative/repair stage (tissue integrity is stored but tissue strength is poor)
- remodeling stage (tissue returns to normal or near normal strength)
- main types of exercises that address tissue healing phase: ROM exercises, isometric exercises/quick flickering contractions to create blood flow, & unweighted concentric muscular contractions (AROM, AAROM)
3
Q
Describe what we do during the inflammation phase
A
- pain before tissue resistance (open end feel) during a ROM exam
- it is necessary to promote healing
- must be managed/controlled with graded exercise interventions
- most protective phase of rehabilitation
- inflammation must be resolved to progress to proliferation phase but can progress exercises based on “trend”
4
Q
Clinical signs of proliferation phase
A
- decreasing inflammation
- pain matches tissue resistance (typically at end range)
5
Q
Clinical signs of remodeling phase
A
- no inflammation
- pain only after tissue resistance/stretch
- time line depends on tissue type
6
Q
Exercise selection for muscle injury
A
- can control inflammation through light muscle contractions & pain-free ROM
- exercises can be active, passive, or active-assisted dependent on pain
- pain during exercise during inflammation phase = continued damage to injured tissues
- gradual increase in stress & strain (load) in a controlled manner assists int issue development
7
Q
Exercise selection for bone injury
A
- heals via regeneration/remodeling w/o permanent scarring
- fracture site must be protected during first 2 weeks to build the initial callus
- after 2 weeks, controlled stress (Wolf’s law) for the next 4 weeks is advised
- evidence of a hard callus (usually X-ray) will indicate return to full activity
- bone healing can take place over 5 years
- LIFTMOR study = 5x5, >85% 1-RM, 2x/week for 8 months
8
Q
Exercise selection for tendon/ligament injury
A
- heals by tenoblast proliferation at the cut ends of the structures
- typically immobilized for 2 weeks (short isometric exercises to increase blood flow, movement of injury tissue is ok for ligament but not for tendon)
- gradually increase loads from 2-12 weeks post injury
- avoid intensive exercise throughout remodeling phase (about 1 year)
9
Q
Exercise selection for cartilage injury
A
- difficult to heal due to avascularity with limited vascular response/inflammation
- best healing is in the periphery or deep injury close to vascular supplies
- motion is critical to stimulate synovial fluid which contains cells needed for healing
- unloaded motion is optimal in initial stages to stimulate fluid w/o cartilage damage
10
Q
Healing times based on tissue type and injury
A
- Exercise muscle soreness: 0-3 days
- Grade 1 muscle strain: 0-2 weeks
- Grade 2 muscle strain: 4 days to 3 months
- Grade 3 muscle strain: 3 weeks to 6 months
- Grade 1 ligament sprain: 0-3 days
- Grade 2 ligament sprain: 3 weeks to 6 months
- Grade 3 ligament sprain: 5 weeks to 1 year
- Ligament graft: 2 months to 2 years
- Tendinitis: 3-7 weeks
- Tendinosis: 3-6 months
- Tendon laceration: 5 weeks to 6 months
- Bone: 5 weeks to 3 months
- Articular cartilage repair: 2 months to 2 years
11
Q
Application of ROM exercises for tissue healing
A
- high frequency short duration exercise bouts to promote circulation & laying down collagen in a functional manner
- several bouts each day as often as each hour with 10-30 reps
- incorporate into daily life (ex commercial break when watching TV)
- intensity should be very low at an RPE of 3 or less
- use pain as your guide and work in your pain free ROM
12
Q
Application of isometric exercises for tissue healing
A
- high frequency of 20-30 reps every waking hour or as appropriate
- low intensity (25% or less of maximum voluntary isometric contraction (MVIC)
- perform a flicker, 1-2 sec holds for circulation; longer holds (10 secs) are used to progress or strengthen
- goal is not strengthening but to pump/increase circulation to the healing area
13
Q
Describe the different types of ROM
A
- ROM: motion gained is due to decreased pain, swelling, or guarding)
- PROM: only used when patient is unable to actively contract muscle or there is a contraindication (tendon or ligament injuries), does not improve local circulation, prevent atrophy, increase strength or endurance
- AAROM: used when patient is unable to complete the full arc of motion, therapist can assist to ensure full ROM as indicated, sensory feedback is provided, good muscle pump, & stimulation to bone/joint
- AROM: preferred motion of choice, muscle contraction must be permitted & must be able to go through ROM without assistance
14
Q
Contraindications and precautions during tissue healing
A
- Contraindications: stretching & resistance exercises should not be performed at the site of the inflamed or swollen tissue (can & should apply to joints above & below injury)
- Precautions: ensure proper dosage of rest & movement
- Signs of too much movement: movement increases pain or inflammation, too great of a dosage or it should not be done, monitor tolerance through verbal & non-verbal methods, and reassess at the conclusion of the session to ensure no damage has occurred
15
Q
Impairments at body structure & function to be expected during tissue healing phase of exercise program
A
- inflammation, pain, edema, or muscle spasm
- impaired movement
- joint effusion
- restricted use of associated areas
16
Q
Indications for exercises to address mobility impairments
A
- used for patients post acute injury or surgery
- commonly used after tissue healing exercises
- all signs of inflammation are absent or tending towards low levels
- pain should not increase during activities, want to avoid repetitive motions
- soft tissue restrictions such as capsular tightness, scarring, ligamentous tightness, & single joint muscle shortening may be addressed with mobility exercise
17
Q
Exercises to address mobility impairments
A
- PROM, AAROM, & AROM
- stretching: manual, self, passive, active, or proprioceptive neuromuscular facilitation (PNF)
- joint & soft tissue mobilization
