Principles of Therapeutic Exercise

what are 2 TYPES of MUSCLE CONTRACTIONS

1. isometric

2. isotonic

what are 2 TYPES of ISOTONIC MUSCLE CONTRACTIONS

1. concentric

2. eccentric

with an ISOMETRIC MUSCLE CONTRACTION, do the muscles produce force WITH/WITHOUT SIGNIFICANT CHNAGE in LENGTH

WITHOUT significant change in length

when does an ISOMETRIC MUSCLE CONTRACTION typically occur

when joint is CONSTRAINED

what are 2 EXAMPLES of ISOMETRIC MUSCLE CONTRACTION

1. wall sit

2. plank

what should be considered with an ISOMETRIC MUSCLE CONTRACTION

length tension curve

regarding the LENGTH TENSION CURVE, when does ACTIVE INSUFFICIENCY occur

muscle is too shortened to generate max force

regarding the LENGTH TENSION CURVE, when does PASSIVE INSUFFICIENCY occur

muscle is too ELONGATED to generate max force

with a CONCENTRIC MUSCLE CONTRACTION, do the muscles produce force while it SHORTENS/LENGTHENS in LENGTH

SHORTENS in length

what MOVEMENTS are considered CONCENTRIC

many of the standard movements

what are 2 EXAMPLES of CONCENTRIC MUSCLE CONTRACTIONS

1. lifting something to head height

2. rising from seated position

what is CONTRACTION VELOCITY based on with CONCENTRIC MUSCLE CONTRACTIONS

load

with CONCENTRIC MUSCLE CONTRACTIONS, what do LIGHT LOADS result in

faster contraction velocity

what CURVE should be considered with CONCENTRIC MUSCLE CONTRACTIONS

length tension curve

with a ECCENTRIC MUSCLE CONTRACTION, do the muscles produce force while it INCREASING/DECREASING in LENGTH

INCREASING in length

what are 3 EXAMPLES of ECCENTRIC MUSCLE CONTRACTION

1. deceleration

2. walking downhill

3. descending stairs

what is CONTRACTION VELOCITY based on with ECCENTRIC MUSCLE CONTRACTIONS

load

with ECCENTRIC MUSCLE CONTRACTIONS, what do HEAVIER LOADS result in

faster movement

what CURVE should be considered with ECCENTRIC MUSCLE CONTRACTIONS

length tension curve

what do LEVER BASICS covert

force into a torque

what is the FORMULA for TORQUE

torque = force x distance

what is the LEVER BASICS between shoulder abduction + overhead press

SHOULDER ABDUCTION:

- higher torque

- longer distance = harder

OVERHEAD PRESS

- lower torque

- shorter distance = easier

what are the 3 LEVER CLASSES

1. 1st class

2. 2nd class

3. 3rd class

what is a FIRST CLASS LEVER

axis of rotation is BETWEEN INTERNAL + EXTERNAL FORCES

- internal force = external force

- fulcrum between muscle force (internal force) + gravity (external force)

ex: seesaw

where is the AXIS of ROTATION located with a FIRST CLASS LEVER

between internal + external forces

what is an EXAMPLE of a FIRST CLASS LEVER

head on occiput

- AO joint (fulcrum) between neck extensors (internal force) + gravity on skull (external force)

what is a SECOND CLASS LEVER

axis of rotation is located at END of ONE BONE

- internal force is at greater leverage than external force (internal force > external force)

- muscles attaches FURTHER from axis of rotation than the external force

ex: wheelbarrow

where is the AXIS of ROTATION located with SECOND CLASS LEVERS

at the end of one bone

with SECOND CLASS LEVERS, is the INTERNAL FORCE at GREATER/LESSER LEVERAGE than EXTERNAL FORCE

internal force GREATER LEVERAGE than external force

with SECOND CLASS LEVERS, does the MUSCLE attach FURTHER/CLOSER from axis of rotation than external force

muscle attaches FURTHER from axis of rotation

what is an EXAMPLE of a SECOND CLASS LEVER

plantarflexion

what is a THIRD CLASS LEVER

axis of rotation is located at the END of ONE BONE

- external force is at greater leverage than the internal force

- muscle attaches CLOSER to the axis of rotation than the external force

ex: bicep curl

where is the AXIS of ROTATION located with THIRD CLASS LEVERS

at the end of one bone

with THIRD CLASS LEVERS, is the EXTERNAL FORCE at GREATER/LESSER LEVERAGE than INTERNAL FORCE

external force GREATER LEVERAGE than internal force

with THIRD CLASS LEVERS, does the MUSCLE attach FURTHER/CLOSER to axis of rotation than external force

muscle attaches CLOSER to axis of rotation

what is an EXAMPLE of a THIRD CLASS LEVER

elbow flexors (bicep curls)

what are 2 TYPES of KINETIC CHAINS

1. open kinetic chain

2. closed kinetic chain

what are 2 CHARACTERISTICS of OPEN KINETIC CHAIN EXERCISES

1. DISTAL SEGMENT moving

2. PROXIMAL SEGMENT remains relative still (proximal segment fixed)

with OPEN KINETIC CHAIN EXERCISES, is the DISTAL SEGMENT moving/fixed

distal segment MOVING

with OPEN KINETIC CHAIN EXERCISES, is the PROXIMAL SEGMENT moving/fixed

proximal segment FIXED

what are 2 CHARACTERISTICS of CLOSED KINETIC CHAIN EXERCISES

1. PROXIMAL SEGMENT moving

2. DISTAL SEGMENT remains relative still (distal segment fixed)

with CLOSED KINETIC CHAIN EXERCISES, is the DISTAL SEGMENT moving/fixed

distal segment FIXED

with CLOSED KINETIC CHAIN EXERCISES, is the PROXIMAL SEGMENT moving/fixed

proximal segment MOVING

what are 2 EXAMPLES of OPEN KINETIC CHAIN EXERCISES

1. scaption

2. leg extension

what are 3 EXAMPLES of CLOSED KINETIC CHAIN EXERCISES

1. squat

2. step up

3. push up

what is the difference between OPEN KINETIC CHAIN + CLOSED KINETIC CHAIN

OPEN KINETIC CHAIN

1. no movement in adjacent joints

2. movement is only distal to joints

3. predominantly only primary mover muscle group activated

CLOSED KINETIC CHAIN

1. predictable movement in adjacent joints

2. can get movement throughout body

3. multiple muscle groups activated

with OPEN KINETIC CHAIN, is there MOVEMENT/NO MOVEMENT in adjacent joints

NO MOVEMENT in adjacent joints

with OPEN KINETIC CHAIN, where is MOVEMENT located

only distal to joint

with OPEN KINETIC CHAIN, what MUSCLE GROUP is only predominantly activated

primary mover muscle group

with CLOSED KINETIC CHAIN, is the movement PREDICTABLE/NOT PREDICTABLE in adjacent joints

PREDICTABLE MOVEMENT in adjacent joints

with CLOSED KINETIC CHAIN, where is MOVEMENT

throughout body

with CLOSED KINETIC CHAIN, what MUSCLE GROUP is activated

multiple muscle groups

what are 5 CONSIDERATIONS when PRESCRIBING ACTIVITIES

1. time under tension

2. heart rate response

3. rate of perceived exertion

4. percentage of 1 rep max

5. reps in reserve

what are 2 COMPONENTS of TIME UNDER TENSION

1. flexibility/ROM

2. strength

what is FLEXIBILITY/ROM described as regarding TIME UNDER TENSION

how long is the soft tissue in an elongated state

what is STRENGTH described as regarding TIME UNDER TENSION

how long is the contractile tissue working against an external load

what is HEART RATE RESPONSE traditionally considered

endurance

what is the FORMULA for calculating AGE PREDICTED MAXIMUM HEART RATE

207-(0.7 x age)

regarding HEART RATE RESPONSE, what TYPE of ACTIVITIES should be PRESCRIBED

activities to achieve a percentage of maximum heart rate

what is the RATE of PERCEIVED EXERTION SCALE

is a subjective assessment of intensity of activity

what are 3 DIFFERENT WAYS to monitor RPE for different activities

1. endurance

2. strength

3. overall session

what is PERCENTAGE of 1 REP MAX used for

strength training

what does PERCENTAGE of 1 REP MAX rely on

maximum strength testing

what is REPS in RESERVE used for

strength training

what is required when utilizing REPS in RESERVE during exercise

discussion with patient throughout session

what are 3 TRAINING PRINCIPLES

1. progressive overload

2. SAID

3. transfer of training

what does PROGRESSIVE OVERLOAD state

tissues responds to demands placed on it

regarding PROGRESSIVE OVERLOAD, what does MINIMAL EFFECTIVE DOSE (THRESHOLD) state

there is a minimum intensity required to achieve physiologic change

what is the MUSCLE response to PROGRESSIVE OVERLOAD TRAINING

muscle get STRONGER/LONGER

what is the TENDON response to PROGRESSIVE OVERLOAD TRAINING

tendon gets STRONGER/MORE ELASTIC

what is the LIGAMENT response to PROGRESSIVE OVERLOAD TRAINING

ligament gets STRONGER/MORE ELASTIC

what is the BONE response to PROGRESSIVE OVERLOAD TRAINING

bone gets MORE DENSE

what is the CARDIOVASCULAR SYSTEM response to PROGRESSIVE OVERLOAD TRAINING

CV system becomes MORE EFFICIENT

what 2 TRAINING PRINCIPLES work together

1. SAID

2. transfer of training

what does the SAID TRAINING PRINCIPLE state

improvements are highly specific to training approach

1. specific adaptation to imposed demands

what LAW is the SAID training principle an extension of

Wolff's Law

what does TRANSFER of TRAINING suggest

that there's CARRY OVER between tasks

what type of training is the TRANSFER of TRAINING PRINCIPLE used for

cross training

what are 3 TYPES of PERIODIZATION

1. linear

2. block

3. undulated

what is LINEAR PERIODIZATION

is a straight line approach to progressively increasing load

what is the LINEAR PERIODIZATION for TRADITIONAL STRENGTH + CONDITIONING

endurance/hypertrophy > strength > power

what is the LINEAR PERIODIZATION for TRADITIONAL REHAB

flexibility/ROM > motor control/balance > endurance/hypertrophy > strength > power (if needed)

what are 3 GUIDELINES for LINEAR PERIODIZATION in REHAB

1. happening slowly over time - sometimes weeks to months

2. long term plan of care

3. work with outside providers

what is the focus of BLOCK PERIODIZATION

spend "blocks" of time with specific focus

what is an EXAMPLE of BLOCK PERIODIZATION

flexibility block > strength block

what is the USUAL TIMEFRAME for BLOCK PERIODIZATION

usually 4-6 weeks/block

what are 2 GUIDELINES for BLOCK PERIODIZATION in REHAB

1. shorter term plan of care

2. heavy focus on 1-2 "types" of deficits

regarding BLOCK PERIODIZATION, what is there HEAVY FOCUS on

1-2 types of deficits

what is the goal of UNDULATED PERIODIZATION

working on various "types"/deficits at a time

what is an EXAMPLE of UNDULATED PERIODIZATION

1. one exercise for flexibility

2. different exercise for strength

3. different exercise for endurance

what are 2 GUIDELINE for UNDULATED PERIODIZATION in REHAB

1. alter exercises within each visit to address multiple deficits

2. alter exercises between visits to address multiple deficits

what does the F stand for in the FITT-P PRINCIPLE

frequency (how often is the exercise done)

what does the I stand for in the FITT-P PRINCIPLE

intensity (how hard)

what does the T stand for in the FITT-P PRINCIPLE

time (how long)

what does the T stand for in the FITT-P PRINCIPLE

type (what is it)

what does the P stand for in the FITT-P PRINCIPLE

progression (what is the plan as the patient improves)

what is the FITT-P for FLEXIBILITY

Frequency: 2-3 days/week

Intensity: within limits of pain to point of tightness

Time: hold for 10-30 seconds

Type: static stretching

Progression: increase ROM

what is the FITT-P for ENDURANCE

Frequency: 3-5 days/week

Intensity: moderate (either using HR/RPE)

Time: combination of moderate + vigorous 30-60 min/day up to 150 min/wk

Type: continuous

Progression: increase time/intensity 5-10% per week

regarding order of activities within session, when should COMPOUND BEFORE ISOLATED be implemented

for total body training before focusing on deficits

regarding order of activities within session, when should ISOLATED BEFORE COMPOUND be implemented

for warm up before whole body