Principles of Therapeutic Exercise

What are the two types of muscle contractions

Isometric
Isotonic

What are the two types of isotonic muscle contractions

Concentric
Eccentric

Isometric contraction

Muscle produces force without a significant change in muscle length

When does isometric contractions typically happen

When the joint is constrained

What are some examples for isometric contractions

Wall sits
Planks

Active insufficiency

When the muscle is too shortened to generate max force

Passive insuffiency

When the muscle is too elongated to generate max force

Concentric contraction

Muscle produces force while it shortens in length

Which type of contraction is involved in many of the standard movements

Concentric

What are examples of concentric contractions

Lifting something to head height
Rising from seated position

What is contraction velocity based on

Load

In terms of contraction velocity what happens with a lighter load

Contraction velocity is faster

Eccentric contraction

Muscle produces force while increasing in length

What are some examples of eccentric contractions

Deceleration (stopping while running)
Walking downhill
Descending stairs

In terms of contraction velocity what happens with a heavier load

Movement is faster

What does force convert into

Torque

What does torque =

Force x Distance

What are the three types of levers

First class
Second class
Third class

First class lever

Axis of rotation is between the internal and external forces

What is an example of a first class lever

Head on occiput

Second class lever

Axis of rotation is located at the end of one bone

In a second class lever the internal force is at GREATER/LESSER leverage than external force

Greater

In a second class lever the muscle attaches FURTHER/CLOSER from the axis of rotation than the external force

Further

What is an example of a second class lever

Plantar flexion

Third class lever

Axis of rotation is located at the end of one bone

In a third class lever the external force is at GREATER/LESSER leverage than the internal force

GREATER

In a third class lever the muscle attaches FUTHER/CLOSER to the axis of rotation than the external force

Closer

What is an example of a third class lever

Elbow flexors

During an open kinetic chain exercise which segment is moving

Distal

During an open kinetic chain exercise which segment remains relatively still

Proximal

During a closed kinetic chain exercise which segment is moving

Proximal

During a closed kinetic chain exercise which segment remains relatively still

Distal

What are some examples of an open kinetic chain exericse

Scaption
Leg extension

What are some examples of a closed kinetic chain exercise

Squat
Step up
Push up

During an open chain is there movement in an adjacent joint

No

During an open chain movement is …

Only distal to the joint

During an open chain which muscle groups are activated

Predominantly only the primary mover

In a closed chain movement in an adjacent joint is

Predictable

Where can you get movement throughout a closed chain

Throughout the body/system

During a closed chain which muscle groups are activated

Multiple muscle groups

Which factors determine how to prescribe activites

Time under tension
HR response
RPE
Percentage of 1 rep max
Reps in reserve

What needs to be taken into consideration with time under tension

Flexibility/ROM: how long is the soft tissue in an elongated state
Strength: how long is the contractile tissue working against an external load

How do you calculate age predicated maximum HR

207 - (0.7 x age)

When prescribing activities what are you trying to achieve

A percentage of maximum heart rate

What is an example of of prescribing an exercise with a HR response focus

Perform 20 minutes of walking on a treadmill at 50% HR max

RPE

Subjective assessment of intensity of activity

What are different ways to monitor RPE

Endurance
Strength
Overall sessions

What does percentage of 1 rep max rely on

Maximum strength testing

Reps in reserve

How many more reps a person can do after a predetermined set of reps

What are the different types of training principles

Progressive overload
SAID
Transfer of training

Progressive overload

Tissues response to demands placed on it

What does progressive overload require

Minimum intensity to achieve a physiologic change
Threshold or Minimal Effective Dose

What happens to a muscle during progressive overload training

It gets stronger/longer

What happens to a tendon during progressive overload training

It gets stronger/more elastic

What happens to a ligament during progressive overload training

It gets stronger/more elastic

What happens to the bone during progressive overload training

It gets more dense

What happens to the cardiovascular system during progressive overload training

It becomes more efficient

What does SAID stand for

Specific Adaptations to Imposed Demands

What is SAID an extension of

Wolff’s law

In terms of SAID improvements are NON SPECIFIC/HIGHLY SPECIFIC to the training approach

Highly specific

Is there a carry over between tasks when considering transfer of training

Yes

What is an example of transfer of training

Strengthening weak knee extension to improve squat

What are the different types of periodization

Linear
Block
Undulated

Linear periodization

Straight line approach to progressively increasing load

What is the traditional S&C linear progression

Endurance/hypertrophy
Strength
Power

What is the traditional rehab linear periodization

Flexibility/ROM
Motor control/balance
Endurance/hypertrophy
Strength
Power

How long does linear periodization in rehab take

Slowly over time
Sometimes weeks to months

Block periodization

Spending “blocks” of time with a specific focus
Usually 4-6 weeks/block

What are examples of block periodization

Flexibility block to strength block

Block periodization focus

Focus on 1-2 ‘types’ of deficits

Undulated periodization

Working on various “types” at a time
One exercise of flexibility, a different exercise for strength, and a different exercise for endurance

During undulated periodization in rehab when can you alter exercises

Within visits and between visits to address multiple deficits

What does F stand for in FITT-P

Frequency - how often

What does I stand for in FITT-P

Intensity - how hard

What does the first T stand for in FITT-P

Time - how long

What does the second T stand for in FITT-P

Type - what is it

What does P stand for in FITT-P

Progression - what is the plan as the patient improves

Example of FITT for flexibility

F: 2-3 days/week
I: within limits of pain to point of tightness
T: hold for 10-30 seconds
T: static stretching
P: increasing ROM

Example of FITT for endurance

F: 3-5 days/week
I: moderate (either using HR or RPE)
T: combination of moderate and vigorous 30-60 min/day up to 150 min/week
T: continuous
P: increase 5-10% per week