Therapeutic Exercise I

Chapter 6

Resistance Exercise For

Impaired Muscle Performance
 What is Resistance Exercise?
(Resistance Training)
It is any form of active exercise in
which dynamic or static muscle
contractions is resisted by an outside
force applied manually or
Mechanically

Resisted exercises are good for injury

prevention, reduce injury or disease, being
healthy, and for impaired function
Benefits of Resistance Exercise
-see box 6.1 pg. 159
Enhanced muscle performance
Increased strength of connective
tissue
Greater Bone Mineral density
Decrease stress on joints
Reduced Risk of Soft tissue injury
Benefits of Resistance Exercise
-continued
Possible improvement in capacity for
tissue repair
Possible improvement in balance
Enhanced physical performance
Positive changes in body image
Enhanced feeling of physical well-
being
Possible improvement in perception
of disability & quality of life
 Muscle Performance and
Resistance Exercises-Definitions
Strength-Muscle strength, functional
strength, strength training
Power-Muscle power, anaerobic versus
aerobic power, power training
Endurance-Cardiopulmonary endurance,
muscle endurance, endurance training
Overload Principle
SAID Principle/Specificity of Training
Transfer of Training
Reversibility Principle
Factors that Influence Tension
Generation in Skeletal Muscle
See Table 6.1 pg. 161
Cross section & size
Muscle architecture
Fiber Type – I, IIA, IIB
Length-Tension
Recruitment of motor units
Frequency of firing of motor units
Type of contraction
Speed of contraction
 Fatigue
Muscle fatigue
Signs and symptoms of muscle
fatigue
Cardiopulmonary Fatigue
Thresholds for fatigue
Factors that influence fatigue
Recovery from exercise
Age Related Changes in Muscle
Performance
See Box 6.3 pg. 164
Psychological & Cognitive Factors
Physiological Adaptations to
Resistance Exercise
See Table 6.3 pg. 168
Skeletal Muscle Structure
Neural System
Metabolic System & Enzymatic
Activity
Body Composition
Connective Tissue
 Determinants of Resistance
Exercises
Alignment
Stabilization are basic elements of any exercise
Intensity
Volume
Exercise Order
Frequency
Rest Interval
Duration
Mode of Exercise
Velocity of exercise
Periodization
Integration of function
 Intensity

Submaximal loading
--Exercise low/moderate intensities
Maximal loading
--Exercise at high intensities

Intensity of exercise should never be so great to cause

pain….A patient must be reminded on correct breathing
techniques to avoid increase cardiovascular risks
 Volume
The summation of the total # of reps and sets of
a particular exercise during a single exercise
session multiplied by the resistance used

Remember: the reps/load will depend on of the

goal is for increase strength or endurance or both

Muscle strength- 6 to 12 reps for 2-3 sets

Muscle endurance- 3-5 sets of 40-50 reps
 Frequency
Refers to the # of exercise sessions per
day or per week

Remember: Frequency will vary and will

be patient specific pending other factors
(NEED TO AVIOD OVERTRAINING)

For Children and older adults 2-3 x weekly

and for highly trained athletes up to 6x
weekly
 Duration
Is the total 3 of weeks or months
during which a resistance exercise
program is carried out

Time required for significant changes

past the neural adaptations, is
between 6-12 weeks
Rest Interval (Recovery Period)
Purpose
Integration of rest into Exercise
 Mode of Exercise
Type of Contraction
Position for Exercise: WB or NWB
Forms of Resistance
Energy Systems
Range of Movement
Mode of Exercise & application to
function
 Velocity of Exercise
See figure 6.6 pg. 176
Concentric vs. Eccentric
 Periodization
See Table 6.5 pg. 177
Evidence is limited
 Integration of Function
Pg. 177
Stability – Mobility – Controlled
Mobility - Skill
Types of Muscle Contractions:
Isometrics-Muscle contraction without visible
joint movement (Muscle setting, stabilization)
Isotonic-Muscle contraction with visible joint
movement
-- Concentric-Muscle contraction that
results in muscle shortening
-- Eccentric-Muscle contraction that
results in muscle lengthening
Isokinetic-The application of force at a constant
speed against an equal force (BIODEX)
 Isometric Contraction
Intensity of muscle contraction (60-
80% of a muscle force)
Duration of muscle activation (6-10
second hold…this will allow a 2 second rise time,
6 second hold time, and a 2 second fall time)
Repetitive Contractions (6-10 second
hold)
Joint Angle and Mode Specific (4-6
points is usually recommended)

BE CAREFUL OF THE PATIENT BREATH-HOLDING WITH ISOMETRICS

 Concentric/Eccentric Contractions
Concentric Contraction-accelerates body segments, less
mechanical efficiency (requires more motor units for control
of the load) than eccentric contractions, cross training
occurs

Eccentric Contraction-Decelerate body segments, acts as a

shock absorbent for high impact activities and quick change
in direction activities, requires fewer motor units of control
the load than concentric contraction, consumes less energy
and oxygen than concentric contractions-therefore fatigues
slower, cross training occurs, high incident of muscle
soreness than concentric contractions (DOMS-delayed onset
muscle soreness

Remember: Have the patient maintain normal breathing pattern

when performing an exercise program and base the program on
functional activities
 Isokinetic Contraction
(Accommodating)
Is a form of dynamic exercise in which the velocity
of muscle shortening or lengthening and the
angular limb velocity is predetermined and held
constant by a rate-limiting device known as an
isokinetic dynamometer-equal (constant) velocity

Remember: make sure the patient maintains

normal breathing pattern during exercise
performance
 Examples of Muscle Contractions
(Biceps):
a) Isometric

b) Isotonic Concentric

c) Isotonic Eccentric

Isokinetics
(Which we will not be focusing on today)
 Open Chain and Closed Chain
Exercises:

Open Chain-involves motions in which the

distal segment is free to move in space
(typically performed in non-weight bearing
positions)

Closed Chain-involves in which the body

moves on a distal segment that is fixed or
stabilized on a support surface (typically
performed in weight bearing positions)
 Rationale for use of
open/closed chain exercises
Both: help to reduce deficits in muscle
performance, improve muscle strength-
power-endurance (need to be function
based to have the greatest benefit)
Open: more effective with isolation of
muscle groups, has greater level of control
Closed: joint approximation-increases
joint congruency and contributes to
stability, gives greater feedback-
stimulates mechanoreceptors, engaging
several muscle groups through co-
activation and dynamic stabilization
 Examples of Open Chain and
Closed Chain Exercises:

Open Chain (leg extension)

Closed Chain (squat)

 Videos:
Muscle Basic Video
http://rds.yahoo.com/_ylt=A2KLqILih7pO_xAAqJP7w8QF;_ylu=X3oDMTB2ZTc4MDljBHBvcwMxNwR2dGlkA1YxMTYEc2xrA3JlcwRzZW
MDc3I-/SIG=1m9vh00c9/EXP=1320876130/**http%3a/video.search.yahoo.com/video/play%3fn=21%26ei=utf-
8%26js=1%26fr2=piv-
web%26tnr=20%26p=types%2bof%2bmuscle%2bcontractions%26vid=1326739751307%26dt=1272956400%26l=166%26turl=htt
p%253A%252F%252Fts4.mm.bing.net%252Fvideos%252Fthumbnail.aspx%253Fq%253D1326739751307%2526id%253D62d6666
14ea3383f6456b07364e9bf48%2526bid%253DF9fivexKEG0DCg%2526bn%253DThumb%2526url%253Dhttp%25253a%25252f%25
252fwww.youtube.com%25252fwatch%25253fv%25253dpQSS2R-
4bwY%26rurl=http%253A%252F%252Fwww.youtube.com%252Fv%252FpQSS2R-
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http%253A%252F%252Fwww.youtube.com%252Fwatch%253Fv%253DpQSS2R-4bwY%26sigs=11an12njl

Ultrasound
http://rds.yahoo.com/_ylt=A2KLqIOhgrpOaDsAJPr7w8QF;_ylu=X3oDMTB2NXN2OGpsBHBvcwMxMQR2dGlkA1YxMTYEc2
xrA3JlcwRzZWMDc3I-/SIG=1ltdssh3c/EXP=1320874785/**http%3a//video.search.yahoo.com/video/play%3ffr2=piv-
web%26p=3%2btypes%2bof%2bmuscle%2bcontractions%26vid=1363702973202%26dt=1237273200%26l=25%26t
url=http%253A%252F%252Fts3.mm.bing.net%252Fvideos%252Fthumbnail.aspx%253Fq%253D1363702973202%25
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1%2526autoplay%253D1%26tit=muscle%2bcontraction%26sigr=11vs9707p%26newfp=1%26surl=http%253A%252F
%252Fwww.youtube.com%252Fwatch%253Fv%253D12PHUGdn3dU%26sigs=11akelenn

Manual resistance
http://rds.yahoo.com/_ylt=A2KLqIC.ibpO3koAEhT7w8QF;_ylu=X3oDMTB1ZTQwbHFpBHBvcwM0BHZ0aWQDVjExNgRzb
GsDcmVzBHNlYwNzcg--
/SIG=1od8hfan9/EXP=1320876606/**http%3a//video.search.yahoo.com/video/play%3fn=21%26ei=utf-
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526autoplay%253D1%26tit=Manual%2b%2bEccentric%2b%2bMuscle%2b%2bResistance%2b%2bfor%2bthe%2b%2b
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Lets Practice!!!!!!!!!!
 How did you do?????

1.) Concentric; open chain

2.) Isometric; closed chain
3.) Eccentric; open chain
4.) Concentric; open chain
5.) Isometric; open chain
6.) Eccentric; closed chain
 Precautions for Resistance
Exercise

Valsalva Maneuver
Substitute Motions
Overtraining and Overwork
Exercise Induced Muscle Soreness
Pathological Fractures
 Valsalva Maneuver
An expiratory effort against a closed glottis, must be
avoided during resisted exercises. If it occurs, this will
increase intra-abdominal and intra-thoracic pressure, which
in turn forces blood from the heart, causing an abrupt,
temporary increase in arterial blood pressure

Ways to prevent valsalva maneuver:

--Caution the patient about breath-holding
--suggest patient to breathe rhythmically, count of talk
during exercise
--Exhale on the resisted effort
--high risk patients should avoid high-intensity resistance
exercise
 Contraindications to Resisted
Exercises

Acute Inflammation
Acute Pain
Acute disease and disorder

Remember: the patient must be cleared by the supervising

PT and the MD prior to implementing resisted exercises;
you must review the POC and if there is a discrepancy or
something that is unknown to you….you must clarify the
information with the PT
 Proprioceptive Neuromuscular
Facilitation (PNF) Principles
Is an approach the therapeutic exercise that combines
functionally based diagonal patterns of movement
with techniques of neuromuscular facilitation to evoke
motor responses and improve neuromuscular control
and function
Can be used to facilitate: muscle strength, stability,
endurance, mobility, neuromuscular control,
coordinate movements, and lay a foundation for the
restoration of function
Is a combination of multi-joint, multi-planar, diagonal,
and rotational movements of the extremities, trunk,
and neck
Break for Lab with Lecture on UE Manual
Resistance Exercises,
Mechanical Resisted Exercises,
Selected Resistance Training Regimens,
Equipment for Resisted Training
Resistance Techniques in
Anatomical Planes of
Motion/Diagonals of the UE’s

(If time permits may review LE’s)