Lecture 5 - Therapeutic Strength

Question 1

Is therapeutic exercise different from regular exercise?

Answer 1

You must know: the mechanism of the injury, stage of healing, degree of the injury, patient’s previous exercise background, how much time (realistic) they have for rehab
You must know functional anatomy and the biomechanics of movement and sport

Question 2

Gray’s Rules of Rehabilitation

Answer 2

Create an environment for optimal healing
Above all else do no harm
Be as aggressive as you can, but do not break rule #2

Question 3

Salter’s General MSK Rehab Rules

Answer 3

Do no harm
Base treatment on accurate diagnosis and prognosis
Select treatment with SPECIFIC aims
Cooperate with the laws of healing
Be realistic & practical in your treatment
Select treatment for your patient as an individual

Question 4

Potach’s and Grinstaff’s View

Answer 4

First: healing tissue must not be overstressed as this can create damage to new structures that are being formed.
Therefore, need to chose a load that neither overload or under loads the athlete/patients healing tissue
Second: the athlete/patient must have specific objectives to progress from one phase of healing to the next

Question 5

Causes of Strength Deficits - Muscular

Answer 5

Atrophy/lack of use 
muscle imbalances (agonist/antagonist etc.)
Structural integrity

Question 6

Causes of Strength Deficits - Neural

Answer 6

Neural inhibition/damage

Question 7

Causes of Strength Deficits - Pain

Answer 7

Reflex inhibition/ pain-spasm cycle

Question 8

Causes of Strength Deficits - Poor Mechanics

Answer 8

Faulty movement patterns

Decreased motor control

Question 9

What is the goal? Stages of Healing: Inflammation

Answer 9

PIER, depending on the injury and individual, may include ROM, and exercises proximal and distal to the area of injury.
Remember to address the unaffected side so the athlete can maintain.

Question 10

What is the goal? Stages of Healing: Repair Phase

Answer 10

Maintain CV fitness and muscular function of the injured area, strengthening exercises, exercises for neuromuscular control etc.

Question 11

What is the goal? Stages of Healing: Remodeling Phase

Answer 11

Continue to progress your exercise selection

Question 12

Needs Analysis

Answer 12

Evaluation of the Sport
Assessment of the Athlete
Training Status (injuries, level of training)
Conducting any Physical Testing and Evaluation (may provide us answers to strength, flexibility, muscular endurance etc.)
Being aware of the Energy system utilized in the sport and applying the parameters to Rehab

Question 13

Dosage Dilemma

Answer 13

-We need to give them enough to overload the patient but don’t want to over-train them
-Start with an exercise they can do at least 10-12 times
-There must be no discomfort, no compensations and good biomechanical technique
-Slowly progress the patient to 12-15 reps then ↑ load
I-f retraining is your goal then breaking exercise up is more effective (prevents compensation)
-Don’t want pain or discomfort, inflammation, altered function, heat, decreased range of motion, decreased strength or muscle compensations

Question 14

What are compensations?

Answer 14

When muscles are weak, the body will attempt to perform required movements by any possible means (path of least resistance)

Question 15

What must you address with compensations?

Answer 15

Strength
Motor control
Segmental stability
Muscle patterning/timing
Correcting muscle imbalances

Question 16

Where to start?

Answer 16

Watch the patient walk into the clinic
History
Assessment of functional movement
Therapist should attempt to address injured tissue, injured quadrant and whole body

Question 17

Factors influencing the rehab decision

Answer 17

Pathology
Severity of injury
Presence of secondary deficits
Stage of healing
Age
Level of fitness
Ability to learn
Individual lifestyle     needs

Question 18

Contraindications

Answer 18

Pain
Inflammation
Severe cardiopulmonary disease

Sometimes you have to be creative and be able to work around Contra’s

Question 19

Describe Isometrics. When to use?

Answer 19

Tension is developed but no change in length of muscle
Optimal time under tension is 6 sec but can use 5-10 sec but tension will ↓
Move from middle to outer ranges
When to use:
Early stages of rehab
When immobilized

Question 20

Isometrics: Studies have shown that there can be as much as a ___% overflow to the joint angle at which training is performed

Answer 20

20%

Question 21

Consider the application of isometrics at multiple angles - _____Isometrics

Answer 21

Functional Isometrics

Question 22

Functional Isometrics: could be used until the healing process ______

Answer 22

progresses

Question 23

What is concentrics? When to use?

Answer 23

Shortening of muscle during contraction
Force produced to overcome load being acted upon
When to use:
Throughout rehab after initial inflammatory stage
To introduce strengthening for less active individuals

Question 24

Concentric portion of an exercise should require ____ seconds

Answer 24

1-2 seconds

Question 25

Muscles tend to ____ more rapidly with Concentric contractions as opposed to Eccentric contractions

Answer 25

fatigue

Question 26

What are eccentrics? When to use?

Answer 26

``` Lengthening of muscle during contraction When to use: Tendonitis/osus pathologies Later in rehab progression Simulating ADLs (i.e. descending stairs) As a component of power/agility training (plyometric) ```

Question 27

Eccentrics require a much lower level of _____ activity to achieve force.

Answer 27

Motor unit

Question 28

Eccentrics: Since fewer motor units are firing to produce a specific force, additional _____ can be recruited to generate force. Therefore more resistant to fatigue ( less ____ use)

Answer 28

Motor units. Oxygen

Question 29

Try each exercise regiment ___ before progressing (rule of ____)

Answer 29

twice, two

Question 30

Give as many cues (____, ____, ____) as you can

Answer 30

tactile, visual, verbal

Question 31

Define Rule of Two

Answer 31

If the individual can perform 2 or more repetitions over his or her assigned repetition goal in the last set in 2 consecutive workouts, you can increase the weight/resistance. Eg. 3 sets of 10 squats Individual is able to complete 12 reps in set # 3 for 2 consecutive sessions.

Question 32

For each exercise ask????

Answer 32

Am I stressing the injured tissue? What are my goals in prescribing this exercise? Is the exercise below, the same or at a greater level than what the patient has previously done? What are the biomechanical and physiological implications for each exercise? Does the exercise(s) mirror the actual activity/sport movement. SAID principle-Specific Adaptation to Imposed Demands Make sure to maintain Muscle Balance across joints and between opposing muscles Multi-joint vs. Single-joint exercises

Question 33

CKC vs. OKC

Answer 33

Open: distal segment moves freely in space Closed: distal segment is weight bearing and body moves over hand or foot CKC puts less shear on joints

Question 34

Isolation vs. Co-contraction

Answer 34

CKC stabilization occurs due to co-activation of opposing muscle groups OKC allows muscle to work when weight-bearing is contraindicated

Question 35

CKC preferred but OKC appropriate for conditions where _______ should be avoided (A/C jt, Effusion, meniscus)

Answer 35

compression

Question 36

What does CKC exercises do?

Answer 36

``` Increased joint compressive forces Increased joint congruency Therefore Stability Decreased shear forces Decreased acceleration forces Co-activation/Co-contraction of agonist and antagonist muscles ```

Question 37

What does OKC exercises do?

Answer 37

Help to isolate the specific joint movement. This proves beneficial because if using only CKC exercises the joints proximal and distal to the injury might not show the deficit OKC exercises may help identify deficits

Question 38

The brain looks at movement patterns and creates _______ between all the muscles needed

Answer 38

coordination

Question 39

Isolated ____ development does not play a major role in motor pattern development

Answer 39

muscle

Question 40

Training movement: progressions

Answer 40

- Analyze or Train movement as if it is a pyramid. - Start from the bottom up, build a solid base - Functional Movement>Functional Performance>Functional Skill