Therex Prescription

Introduction to Exercise Prescription

• Emphasis on exercise prescriptions for individuals with musculoskeletal conditions.

• Overview of discussion topics:

  • Common musculoskeletal tissues and injuries.

  • Exercise benefits and recommendations for different tissues.

  • Principles of exercise specificity: SAID principle and FITT-VP principle.

  • Additional considerations for exercise prescription.

Common Musculoskeletal Tissues & Functional Influence

Tendons

• Primary Function: Transfer loads between muscles and bones; designed to attenuate tensile loads; store and release energy.

• Hypertrophy: Tendons can hypertrophy similarly to muscles when exposed to high loads, although this occurs on a smaller scale (millimeters vs. centimeters in muscles) and is not usually measured clinically.

• Capacity: Larger and healthier tendons are stronger than smaller ones.

• Exercise Recommendations:

  • Needs exposure to resistance greater than 70% of one repetition maximum ($1RM$) for optimal benefits.

  • Recommended program duration: minimum of 12 weeks.

  • Eccentric exercises recommended for higher loads with lower metabolic cost.

  • Consider concentric and isometric training for adaptations in cross-sectional area and strength.

Articular Cartilage

• Function: Lines joint surfaces to protect against compression and shear.

• Repair Limitations: Avascular structure with a limited self-repair capacity when damaged.

• Exercise Recommendations:

  • Promote cyclic loading/unloading for increased glycosaminoglycan ($GAG$) production.

  • Multiple sessions per week for at least one month are necessary for repair and growth.

Bone

• Function: Provides structure, attachment points, and resists various loads (compression and tensile).

• Wolff's Law: States that bone adapts in response to the loads it encounters; strengthens with increased loading and is reabsorbed with reduced loading.

• Exercise Recommendations:

  • High-intensity resistance and impact exercises recommended, utilizing 80% to 85% of $1RM$.

  • Consider the stage of healing; post-acute injuries may require non-weight-bearing or limited weight-bearing initially.

  • Avoid overtraining, especially for deconditioned patients jumping to high-intensity exercises.

Muscle Tissue

• Function: Create active tension for movement.

• Training Benefits:

  • Increased force capability, enhanced neuromuscular efficiency, blood flow, and metabolism.

  • Target specific muscle adaptations based on patient needs.

  • Multi-joint exercises enhance motor control and efficiency.

Principles of Exercise Specificity

SAID Principle

• Definition: Specific Adaptation to Imposed Demands indicates that training loads must match desired outcomes.

• Parameters for Improvement:

  • Strength: Requires heavier loads.

  • Power: Requires varying loads, can be increased in weight or speed.

  • Endurance: Utilize lower loads for extended time frames.

• Functional Needs Consideration:

  • Assess activity requirements for type and combination of muscular contractions (concentric, eccentric, isometric).

  • Example scenarios:

  • Painter: Requires endurance and coordination with specific movement patterns (open-chained, standing).

  • Runner: Requires endurance, coordination, power; exercises should reflect these aspects.

• Limitations of SAID Principle:

  • For example, a runner's calf muscles will need significantly different training loads than the loads experienced while running (6-8 times body weight).

FITT-VP Principle

• Components: Frequency, Intensity, Time, Type, Volume, Progression.

• Frequency:

  • Number of exercise sessions per day/week influenced by goals and healing phase.

  • E.g., acute phase focuses on low-load exercises to reduce pain.

• Intensity:

  • Level of resistance or exertion during exercises.

  • Measurement methods: $1RM$, percentage of maximal heart rate ($HR_{max}$), Borg rating of perceived exertion.

• Time:

  • Duration of exercise sessions affects adaptability.

  • Needs vary with intensity—higher intensities require shorter durations for effective adaptation.

• Type:

  • Specific categories of exercise (aerobic, resistance, flexibility).

• Volume:

  • Contextual quality/quantity of exercises—calculated by parameters like frequency $ imes$ intensity $ imes$ time for aerobic; total repetitions for strength training.

• Progression:

  • Ensure adequate overload; adjust based on function level, healing phase, and psychosocial factors (e.g., fear avoidance).

Additional Considerations for Exercise Prescription

Type of Contraction

• Eccentric Contractions:

  • Higher loads with reduced metabolic cost; beneficial for degenerative tendinopathies and hypertrophy.

• Concentric Contractions:

  • Higher metabolic costs; improve blood flow in guarded muscles showing stasis.

Transference

• Definition: Unintended benefits from exercises targeting specific functions.

  • Example: Strengthening scapular retraction may improve balance due to stabilization demands.

Flexibility Exercises

• Definition: Movements aimed at increasing tissue extensibility.

• Historical Context: Static stretching has not been shown to reduce injury risk or enhance performance pre-activity.

• Dynamic Stretching Benefits: Shown to improve performance.

• FITT-VP Considerations in Flexibility:

  • Higher frequency and lower intensity stretches yield better outcomes.

  • Monitor total duration and volume of stretching.

  • Multiple stretch types include static hold, dynamic movements, ballistic techniques, and PNF patterns.

Conclusion

• Overview of principles for exercise prescription targeting musculoskeletal pain and dysfunction.

• Emphasis on tailoring interventions to address specific impairments and promote full participation in desired activities.