PTH 122 Lecture - strengthening pt 2

what do you take into consideration when designing an individual resistance program?

1. Patient’s age​

2. Level of fitness​

3. Type of injury or underlying disease​

4. Stage of healing​

5. Desired functional outcomes​

6. Patient readiness​

7. Patient goals

what is a resistance exercise? manual? mechanical?

A dynamic or static muscle contraction that is resisted by an outside force

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• Manual: cannot be measured quantitatively - useful early in exercise or when control is needed​

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• Mechanical: measurable quantitatively and force can be quantitatively progressed (example: dumbbells, ankle weights)

what are the elements of a safe, effective residence exercise program?

1. Alignment & Stabilization​

2. Intensity​

3. Volume​

4. Exercise Order​

5. Frequency ​

6. Duration​

7. Rest Period

what is intensity/dosage? maximal? sub-maximal?

• Submaximal: moderate to low intensity at start of the exercise program​

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• Maximal: high intensity exercise, advanced phase in rehab: preparing to return to work or sports

how much weight should you use for a pt? what is repetition max?

RM: the greatest amount of weight a muscle can move through the available ROM a specific number of times​

• 1RM = max amount of weight lifted one time (not functional)​

• In Physical Therapy: ​

• 10 RM = max amount lifted 10 times (this is more functional)

how do you determine volume: sets and reps?

In General: The higher the load – the fewer the reps: Exercise load dictates reps

what is the DeLorme’s method?

• 3 sets of 10 with progressive loading during each set: ​

• 10 reps @ 50% of 10 RM​

• 10 reps @ 75% of 10 RM​

• 10 reps @ 100% of 10 RM​

• The LIGHT to HEAVY approach

what are the different types of progressive resistance exercise programs?

1. DeLorme Regimen​

2. Oxford Regimen​

3. DAPRE Regimen

what is the oxford’s method?

• 3 sets of 10 with regressive loading during each set: Use the 10 RM:​

• 10 reps @ 100% ​

• 10 reps at 75% ​

• 10 reps @ 50%

what is the DAPRE method?

• Based upon a 6 RM system – 4 sets are performed​

• Set 1: 50% of the 6 RM weight x 10 reps​

• Set 2: 75% of the 6 RM weight x 6 reps​

• Set 3: the maximum weight (6 RM) - lifted until fatigue​

• The number of repetitions performed during the third set determines the amount of weight added or removed for the next set.​

• Set 4: The number of repetitions performed during the fourth set determined the amount of weight added or removed (working weight) for the next session.

what does DAPRE stand for?

DAPRE: Daily Adjustable Progressive Resistive Exercise technique (PRE)

what is the order for exercise?

• Exercise large muscles before small muscle groups​

• Multi-joint muscles before single-joint muscles​

• High intensity then low intensity

what is a proper rest period (recovery)?

• Rest 2-3 minutes after each set when it is a high intensity exercise​

• Active recovery is more efficient than passive recovery

what is DOMS?

delayed onset muscle soreness

what are the clinical signs of fatigue? who cares??

• Pain and cramping​

• Jerky, shaky contractions​

• Unable to complete the full ROM​

• Substitution of movement​

• Fatigued muscles are more susceptible to acute strains!

what should you do if your patient starts to fatigue early on?

Decrease the load or stop exercise

how often should a patient come to PT?

• depends on intensity, volume, goals, general health status, and insurance.

• 2-3 times per week is common up to 5 days a week to build strength

duration: how long should a pt come?

duration: the total # of weeks/months a resistance program lasts

treatment duration depends on the impairment

*at least 12 weeks for significant muscle hypertrophy to occur

what are the different modes of exercise?

• Isometric –Static: No joint movement​

• Concentric/Eccentric: Dynamic resistance exercises​

• WB (closed chain) or NWB (open-chain)?​

• Manual or Mechanical Resistance?​

• Exercise Machines, TRX, Pulleys, Bands?

what is transfer of training - aka overflow or cross training

there is a limited carryover of training effects from one exercise to another

training effects are not as great as the results of specific training in each area: strength, power, endurance

what is an isometric?

Static muscle contractions that produce force but result in no joint movement

how much muscle strength is lost with disuse?

Muscles lose 8% strength per week with disuse

when do you use static training isometrics?

To prevent atrophy when joint movement is prohibited (i.e., after surgery)

why are isometrics used in the acute phase of healing?

To develop joint stability: co-contractions

why are multiple angle isometrics used in the sub acute healing phase?

to improve strength throughout the range

what is a dynamic exercise of concentric and eccentric contractions (isotonic) ?

A muscle contraction in which the muscle lengthens (eccentric) or shortens (concentric) and causes joint movement

TRUE or FALSE concentric contractions produce less force than eccentric contractions, require more energy, and require more motor units to be recruited than an eccentric contraction

true

TRUE or FALSE eccentric contractions produce more force than concentric contractions, develop more tension at slower speeds, require fewer motor units to contract, and are easier for patients to perform in early stages of rehab

true

what does DCER stand for

Dynamic Constant External Resistance

what is a dynamic constant external resistance exercise? who cares??

a fixed weight is moved through a ROM

• What’s the drawback?​

• The contracting muscle is challenged maximally at only one point in the ROM

what is an isodynamic exercise? who cares??

Exercise using elastic bands or rubber tubing

• convenient but not physiological because resistance increases at the end range​

• Advantage: Exercises muscles in different ways to get the best results

what is a dynamic exercise? who cares??

An exercise machine provides a varying amount of resistance throughout the contraction​

• resistance varies in a fixed rate through the ROM

what is an isokinetic dynamic exercise? who cares??

accommodating variable resistance: speed of motion is fixed, and the resistance varies to accommodate the amount of force the patient can exert​

• The velocity of limb movement is set by the PT/PTA – not the load

what is a high velocity dynamic exercise? who cares??

Inertial: high velocity exercise​

• Advantage: concentric/eccentric loading overcoming momentum or inertia

why do we change velocity? so what?

To prepare the patient for a variety of functional activities

Have patients train both concentric and eccentric

how does velocity effect concentric contractions?

As the velocity of shortening increases the force produced decreases “SLOW DOWN!”

how does velocity effect eccentric contractions?

As velocity increases the force produced increases

when would a pt experience DOMS?

12 -24 hours after vigorous unaccustomed exercise

what exercises make DOMS the most intense? how do you treat it?

• High Intensity - Eccentric exercise particularly causes the most severe DOMS symptoms​

• Best Relief of DOMS: light exercise during the active recovery period

what are the 6 steps to creating a balanced therapeutic exercise program?

• warm up: increase blood flow, lubricate joints, increase elasticity and flexibility

• stretching

• strengthening: specific to problem, slow and controlled to avoid momentum

• endurance: cardiovascular or muscular

• coordination

• cool down

what is the MCID outcome measure? what does it do?

Minimal Clinically Important Difference

• A number that indicates the smallest change in an outcome measure that is considered clinically significant​

• Used to determine whether the patient is improving or declining – Quality of Life

what is the MCD outcome measure? what does it do?

Minimal Clinical Difference

• A number that signifies the smallest change in a patient’s score that is considered meaningful improvement in their condition​

• A threshold number for interpreting if a treatment is working or not – it can detect “true change” with a high level of confidence

what are factors that may influence pt satisfaction?

• Interpersonal attributes of the PT/PTA​

• Perception of the PT/PTA clinical skills​

• Extent of participating in setting own goals​

• Convenience to access of services​

• Administrative issues: clinic hours, waiting time, duration of treatment, hands on, cost of copay or insurance coverage