Lecture 1 and 2 - Therapeutic Exercise Foundations

What does TBC stand for?

Treatment Based Classification (TBC)

In order to Navigate the TBCs, what do we classify patients based on?

Impairments (Muscle Weakness/Tightness, Joint Stiffness/Instability, Optimal Movement/Non-Optimal)

What are the Treatment Based Classifications? (5)

Pain Control

Stabilize

Mobilize

Exercise

Correction of Movement Impairments

What 2 Main levels are the Rehabilitation Progression Pyramid Separated into?

Function Level (Skill --> Movements --> Synergies --> Balance and Gait --> Motor Function)

Impairment Level (Muscle Performance --> Sensory and Reflex integrity --> ROM and Muscle Length --> Joint Integrity and Mobility --> Posture --> Pain and inflammation)

What is the First law of Thermodynamics?

Energy CANNOT BE CREATED OR DESTROYED but TRANSFORMS from one state to another WITHOUT being depleted

What is Anabolism?

Is it Energy Storage or Release?

Give an Example

Creation of Large Molecules from Smaller Ones

Energy Storage

Glucose into Glycogen

What is Endergonic Reactions?

is it Energy Storage or Release?

Reactions ABSORB OR STORE energy from surroundings

Energy Storage

What is Catabolism?

Is it Energy Storage or Release?

Give an Example

BREAKDOWN of large molecules into Smaller Molecules

Energy Release

Glycogen broken down into Glucose

What is Exergonic Reactions?

is it Energy Storage or Release?

Physical or Chemical Reactions that RELEASES energy to surroundings

Energy Release

What process must occur in order for Muscles to keep contracting?

Hydrolysis

What is Hydrolysis?

What do you need?

Breakdown of 1 ATP molecule to create energy

Water

What are the 3 Biological Energy Systems?

Are they Anaerobic or Aeorobic?

Phosphagen System (Anaerobic)

Glycolysis (Anaerobic)

Oxidative System (Aerobic)

For the Phosphagen System

Anaerobic or Aerobic?

Where does it occur?

What intensity of exercise is it used for?

How much energy is created?

How long is it active for?

Anaerobic

Sarcoplasm

Short-term high intensity activities

LIMITED amount of energy

<30 seconds ALL OUT muscular effort

For Glycolysis

Anaerobic or Aerobic?

Where does it occur?

What nutrient gets broken down for create ATP?

How long is it active for?

How much energy is created?

Anaerobic

Sarcoplasm

Carbohydrates (Glycogen STORED in muscles, Glucose DELIVERED in blood)

30 seconds - 2 minutes

Larger amounts, but MADE SLOWER than Phosphagen System

For the Oxidative Phosphorylation

Anaerobic or Aerobic?

Where does it occur?

What nutrients gets broken down for create ATP?

How long does Glycogen/Glucose energy active for?

What activities is this system used for?

Aerobic

Mitochondria

Fats (1st), Carbs (2nd), Protein (3rd)

2min to 2 hours

Long Endurance activities

What are the muscle fiber types?

Do they have high or low oxidative activity, glycolytic activity, and ATPase activity?

Type 1: Slow Twitch (Oxidative Phosphorylation, High Oxidative, LOW ATPase activity)

Type 2a: Fast Twitch Oxidative (High Glycolytic Capacity, High Oxidative Capacity, High ATPase activity)

Type 2b: Fast Twitch Glycolytic (Low Oxidative, High Glycolytic Activity, High Myosin ATPase Activity)

What muscles contain slow oxidative fibers?

Postural muscles due to low force from them

When are type 2a fibers recruited?

POWER activities that require MULTIPLE repetitions

How resistant to fatigue are type 2a muscle fibers?

Relatively resistant

Which fibers are the "middle ground" fibers?

Why?

Type 2a

They are still slow to fatigue like type 1 but can still fatigue fast at the same time like type 2b fibers

How resistant to fatigue are type 2b muscle fibers?

Poor!

Fatigue rapidly

When are type 2b muscle fibers recruited?

High intensity, short duration exercises such as FULL EFFORT SPRINTS

Muscle force is related to what other physiological aspect of muscles?

Cross Sectional Diameter

Muscle Strength is related to what physiological aspect of myscles?

Diameter

Since muscle fiber diameter helps dictate strength, what should occur first before strengthening? (usually)

Hypertrophy

What percentage of intensity should adults train at in order to increase muscle fiber cross sectional area and force production?

60-70%

When it comes to muscle architecture, what does is the relationship between force and cross sectional area?

They are DIRECTLY proportional!

What is the relationship between velocity and excursion (distance traveled) between muscles?

They are proportional to the length of the muscle!

What are muscles with SHORTER fibers and LARGER cross sectional areas designed for?

GIve an Example

FORCE

Glutes

What are the muscles with LONG fibers designed for?

Excursion and velocity!

Movement!

What is the definition of torque?

Ability of force to produce rotation

What is the definition of Force?

Ability to change a state of rest or motion of an object

What is the definition of a Moment Arm?

Length between joint access and line of force acting on the joint

What is the torque formula?

Torque = force x moment arm

What is the length tension relationship?

Ability of a muscle to create force depending on the length of the muscle

What can cause changes to the length tension relationship? (2)

Postural Malalignment

Immobilization

Define Positional Strength

Lengthened muscles that might be interpreted as weak even though they are capable of producing tension at a better range

What are the factors that affect muscle performance? (8)

Fiber type

Fiber diameter

Muscle size

Force-velocity relationship

Training Specificity

Neurological Adaptation

Muscle Fatigue

Muscle Soreness

What is the timeframe for Neurologic Adaptation?

2-4 Weeks

When it comes to Muscle Fatigue, what is resistive exercises limited to?

Form Fatigue

Wolfs law is adaptation of what tissue type?

Bone

David's law is adaptation of what tissue type

Soft tissue

Rapid increases in strength after introduction of new exercises is due to what?

Neurological Adaptation and Motor Learning

What can interfere with proper nervous system control?

Bad instruction

Bad monitoring

Define Muscle Fatigue

Defined as reversible decrease in contractile strength that occurs after long lasting or repeated muscular activity

What can muscle fatigue lead to?

Injury!

What type of muscle contractions can cause DOMS?

When does this occur?

For how long?

Eccentric Contraction

2 Days Later

7 Days

What is important to understand about "Work" during Isometric contractions?

There is NO work being performed

Work = Force x DISTANCE

What are the characteristics of Isometric Contractions?

Static

No Joint Movement

No muscle length changes

Important for function

Isometric Contractions are important to maintain strength during _____________

Immobilization

Isometric Exercises are good for what type of purposes?

Strengthening weak points in ROM

Muscle Re-Ed Purposes

Stabilization Programs

Isometrics should be done cautiously with people who have what condition?

HTN

Cardiovascular Disease

In concentric contractions internal force is greater or less than external force?

Greater

In eccentric contractions internal force is greater or less than external force?

Less

Compared to concentric contractions, what are advantages eccentric contractions have over concentric?

More tension and LOWER metabolic cost

Important for functional movement pattern (decelerate limbs)

Most energy efficient form

Develop greatest tension in muscle actions

What are some advantages to manual resistance?

Individualized resistance (can meet the patients needs)

Isometric or dynamic

ROM can be controlled

More joint stabilization

Direct patient interaction

What are some disadvantages to manual resistance?

Subjective resistance

Lack of independence/HEP

Limited by strength of PT

increased PT labor and time

For exercise frequency, how many times should dynamic exercises be performed?

Every other day

For exercise frequency, how many times should Isometric exercises be performed?

Several times per day

For exercise frequency, how many days a week is optimum to improve?

3 days per week

For exercise frequency, how many days a week is optimum to maintain?

2 Days per week

Intensity of exercise dosage is based around what?

1 RM

What intensity should Hypertrophy be performed?

70-85%

What intensity should Power be performed?

0-60% Lower Body

30-60% Upper Body

What intensity should Strength be performed?

60-70%

What intensity should Endurance be performed?

<70%

What is the process for establishing a 1RM?

Detail it

1. Warm up

Perform 6-10 reps of a weight of 50% your 1RM

Rest 1-5 Minutes (until 100% recovered)

2. Increase the Weight

Do 3 reps of around 80% your 1RM

Rest 1-5 Minutes (until 100% recovered)

3. Do Heaviest lift

Increase load and do 1 Rep and increase weight till technique is compromised

Once highest weight achieved = your 1RM

For establishing intensity using the Borg Scale, how do we do it?

Perform 2 Reps of a resistance

If those 2 reps measure a 5-6 on the Borg Scale = the weight that will be used for 12-15 reps

What is the set range for Endurance Training?

2-4 Sets

What is the set range for Hypertrophy Training?

1-3 Sets

What is the set range for Strength Training?

1-3 Sets

What is the set range for Power Training?

1-3 Sets

What is the rep range Hypertrophy?

8-12 Reps

What is the rep range Endurance?

10-25 Reps

What is the rep range for Strength?

8-12 Reps

What is the rep range Power?

3-6 Reps

What are the rest intervals for Hypertrophy?

1-3 Minutes

What are the rest intervals for Strength?

1-2 Minutes

What are the rest intervals for Power?

2-3 Minutes

What are the rest intervals for Endurance?

30-60 Seconds

What is the importance of muscles and "overload"?

Define it

In order for muscles to improve the muscle has to be overloaded

Definition: Applying resistance to a tissue that they are used to

For patients, what is the proper way to sequence exercises?

1. Specifically isolate impaired muscles

2. Begin from Isometric to Multi Joints

3. Begin with slow --> Fast Speeds

For General Strength (Non Patients), what is the proper way to sequence exercises?

1. Large muscle groups before small

2. When training ALL major muscle groups ALTERNATE between Upper and Lower body activities

3. When training upper and lower body parts on DIFFERENT DAYS, SWITCH between Agonist and Antagonist Exercises

4. Multi Joint BEFORE Single Joint "activities"

5. When training INDIVIDUAL muscle groups, train HIGHER intensity exercises BEFORE lower intensity exercises

When designing an exercise program, what should it based around?

The TBC (treatment based classification)

Interval Training is used mainly for what metabolic system?

Anaerobic or Aerobic?

Anaerobic.....BUT CAN be aerobic depending on how you train it

What is Interval Training?

Training of bursts of SHORT intense activity then LONGER intervals of short activity

What is Circuit Training?

Sessions of exercise done by completing 8-15 stations that are completed in sequence of one another

When it comes to Neurological Changes and Biomechanical changes, do they occur before or after the 4-8 Week mark?

Neurological = Before (2-4 Weeks)

Biomechanical = After

What are the guidelines for exercise with pain?

Pain should be <2/10 and no greater than >5/10 (Ideally want 0-10)

Pain should NOT return after 1 Hour of exercise

Pain should NOT increase the next morning

Exercise should be adjusted depending on pain response

What should resistive training focus on the most when it comes to Preadolescent Kids?

(11 Years old in girls, 13 years only in boys)

Neurological Aspect in training

What should resistive training focus on the most when it comes to Adolescent Kids?

(12-18 year old girls , 14-18 year old boys)

Similar to Preadolescent

BE DONE WITH PROPER INSTRUCTION, SUPERVISION, AND SAFE PROGRESSION

What age range is strength potential the highest?

18-30

For Middle Aged people, how much exercise is needed to POSITIVELY affect strength?

2 Hours+ a week

A little bit of training makes a big difference between ACTIVE AND INACTIVE

For Advanced Aged people, how can exercise affect Joints?

Can PREVENT or moderate symptoms of degeneration

What tissues require adequate length to allow for full ROM of articular surfaces for Joint Mobility?

Interposed tissue

Joint Capsule

Ligaments

Tendons

Muscles

Bursae

Fascia, Skin

Decreased mobility can lead to what disorders/pathologies?

Trauma to soft tissue

Surgery (joint replacements)

Joint Disease (Osteoarthritis)

Prolonged Immobilization

Neuromuscular Disease

Immobilization has what effects on Muscle? (4)

Muscle fiber atrophy

Functional loss IS GREATER than muscle mass loss

Decreased electrical activity

Increased CT, subcutaneous fat

Remobilization has what effects on Muscle AFTER immobilization? (1)

Longer the immobilization requires longer rehab

Immobilization has what effects on Tendons?

(2)

Decreased collagen, water, GAGs, Stiffness, Tissue weight, Elastic Stiffness

Increased Synthesis and degradation of collagen

Remobilization has what effects on Tendons?

(3)

Improvement of tensile strength and energy absorption

Facilitations normal gliding and soft tissue relationships

PREVENTS scar tissue formation