Untitled Quiz

FITT Principle

• Frequency: How often you exercise
• Intensity: How hard you exercise, monitored by target heart rate (avoid using for patients on medications like beta-blockers).
  • Calculate target heart rate:
    • HRmax: 220 - age
    • HRR: HRmax - HR rest
    • Target HR: HRmax x desired intensity (%)
• Type: The kind of exercise you do
• Time: How long you exercise

SAID Principle

• Specific Adaptation to Imposed Demands: The body adapts to the specific kinds of exercise it is subjected to.

PAR-Q (Physical Activity Readiness Questionnaire)

• Pre-screening test for exercise participation.
• Questions include:
  • Do you have any health conditions that might prevent you from exercising?
  • Do you understand the experiment instructions?
  • Are you comfortable continuing with the experiment?
• Informed consent should be obtained.

Balance

• Pre-screening: Assess patient's risk profile, blood pressure, and any existing blood pressure problems (hypotension).
• Types:
  • Static: Maintaining a stable position while at rest (standing, sitting).
    • Tests:
      • Rhomberg Test: Stand with feet parallel and together, eyes open then closed for 30 seconds.
      • Single-Leg Balance Stance Test: Predict falls in elderly and ankle sprains in athletes. Stand on one leg with arms across the chest for 5 trials of 30 seconds each.
    • Training:
      • Start on firm surfaces, progress to softer surfaces.
      • Progress from feet together to single-leg stance, lunge, and squat positions.
      • Gradually incorporate closing eyes and moving arms.
  • Dynamic: Controlling the body when the support surface is moving or the body is moving on a stable surface.
    • Tests:
      • 5 STS (Sit to Stand Transfers): Stand up and sit down quickly for 5 consecutive repetitions in under 15 seconds.
    • Training:
      • For older patients: Tandem walking with arms extended, progress by turning the head in different directions while walking.
      • Maintain weight distribution and upright posture on unstable surfaces like a therapeutic ball or wobble board, progress by varying arm positions.
      • Regress by shifting weight forward, backward, and laterally.
  • Anticipatory (Voluntary): Activating postural muscles before performing skilled movements (maintaining center of gravity).
    • Tests:
      • Star Excursion Test: Test lower extremity and detect deficits in chronic ankle instability. Reach as far as possible with one leg in 8 directions while maintaining balance.
      • Functional Reach Test: Reach as far as possible in different directions without changing base of support.
    • Training:
      • Reach in all directions to touch or grasp objects.
      • Catch or kick a ball in all directions.
      • Lift objects of varying weights.
  • Reactive (Involuntary): Adjusting to disturbances of balance without voluntary control.
    • Tests:
      • Pushes: Apply small, large, slow, fast, anticipated and unanticipated pushes to the sternum, posterior trunk, or pelvis in different directions.
      • Pull Test: Place a hand on the patient's shoulder and pull backward suddenly, ensuring safety by standing behind the patient.
    • Training:
      • Play dodgeball in an unpredictable environment to improve reaction time.
  • Sensory Organization: Target the weakest sense.
    • Tests:
      • Foam and Dome Test: Stand with eyes open, then closed, then with a dome/eyemask on a firm surface. Repeat this on a foam cushion.
    • Training:
      • Reduce visual support by closing eyes or wearing prism glasses.
      • Reduce somatosensory cues by narrowing base of support, standing on foam, or marching on a trampoline.
• Functional Tests:
  • Timed Up and Go: Get up from a chair, walk around a cone, and sit back down as quickly as possible.
  • Berg Balance Scale: Assesses functional balance.
  • Four Square Step Test: Complete a circuit by stepping into each square clockwise and counterclockwise as quickly as possible.
  • Dual Tasking Activities: Standing on one leg while counting backward, marching on the spot while naming objects in a category.
  • Help with fear of falling: Multi-directional step-ups, lunges with twists, marching and catching a ball.

Muscle Performance and Resistance Training

• Muscle Performance:
  • Strength: Ability to produce tension and force. Focus on increasing resistance.
  • Power: Strength and speed of movement, focus on increasing work performed or reducing time to produce force.
  • Endurance: Sustaining low-intensity, repetitive activities over time. Focus on increasing time and number of repetitions.
• Resistance Training: Dynamic or static muscle contraction resisted by manual or mechanical resistance.

Aerobic Exercise

• Pre-screening: Assess for regular exercise and any underlying cardiovascular or metabolic diseases.
• Warm-up: Light intensity for 5 minutes at light resistance.
• Monitoring: Monitor for:
  • Onset of chest pain
  • Decrease in systolic blood pressure by >10 mmHg
  • Excessive increase in blood pressure (systolic > 250, diastolic > 115)
  • Shortness of breath, wheezing, leg cramps, lightheadedness, nausea
  • Physical or verbal signs of severe fatigue

Flexibility and Stretching

• Elongates muscle and increases range of motion, performed at low intensities, pulling sensation but no pain).
• Contraindications:
  • Recent injury/fracture that is not fully healed
  • Acute inflammation (heat and swelling)
  • Sharp acute pain
  • Hypermobility
  • Spasticity
• Types:
  • Static (PROM): Improves flexibility and ROM by holding the tissue past resistance for a prolonged time (each rep > 10 seconds). 15 minutes daily maintains flexibility. Progress by holding the tissue at a lengthened position until relaxation is felt.
  • Cyclic/Intermittent (AROM): Short-duration end-range stretches repeated at low velocities (each cycle 5-10 seconds).
  • Proprioceptive Neuromuscular Facilitation (PNF) (AROM): Incorporates active muscle contraction into stretching (each cycle 10 seconds hold, 3-4 sets).
    • Types:
      • Hold-relax/contract-relax: Lengthen target muscle to resistance, perform an isometric contraction, relax, then move limb into new range.
      • Agonist contraction: Concentric contraction of the opposing muscle, hold end-range position for several seconds to allow affected muscle to relax and lengthen.
      • Hold-relax with agonist contraction: Move tissue to resistance, isometric contraction, relaxation, and concentric contraction of opposing muscle.
  • Ballistic (AROM): Rapid, forceful intermittent stretches at high velocity and intensity (quick, bouncing movements). Mainly for young, healthy, and conditioned individuals at end-stage rehab.

Open Kinetic Chain and Closed Kinetic Chain

• Open Kinetic Chain (Non-weightbearing): Distal segment moves freely without causing simultaneous motion in adjacent joints. Focuses on single joint movement.
• **Closed Kinetic Chain (Weightbearing):**Distal segment is fixed or in contact with a support surface. Focuses on joint compression and are more functional.

Exercise Prescription Following Injury

• De-sensitisation and reducing overall load is important in the acute phase of injury.
• Informed reassurance and education should be provided to the patients.
• Pain management is crucial and can be monitored using the pain and activity traffic light system.
  • Green: 0-3 pain, safe zone.
  • Yellow: 4-5 pain, acceptable range.
  • Red: 6-10 pain, excessive/stop zone.
• Pain should settle within 24 hours of the activity.

Exercise Prescription for OA Patients

• For hip OA, isometric quadriceps contraction can be done.
  • Dorsiflex the foot and ask the patient to push downwards towards the bed for 5 seconds.
  • 10 repetitions should be performed.
• Bridges, ensure exercise is done till muscle fatigue for actual strengthening.
  • Progression: Bringing one leg up and elevating it before bringing it back down.
  • Progression: Putting a ball under the leg that is resting on the bed and carrying out the exercise.
• Squats should be done ensuring the back is straight and the knee goes over the toes.

Exercise Type - Grade 2 Strength

• Hip Flexion: While lying supine use a polished board with knees bent and a rolled towel under the heel, move the board towards the buttocks.
• Hip Extension: While lying supine use a polished board with knees bent and a rolled towel under the heel, move the board away from the buttocks.
• Hip Abductors: While lying supine, use a polished board with knees bent and a rolled towel under the heel, Move the board from side to side.
• Hip Adductors: While lying supine, use a polished board with knees bent and a rolled towel under the heel, move the board from side to side.

Exercise Type - Grade 3 Strength

• Stretches: Static = lying supine with one leg leaning against the wall, push the leg into the wall for 30 seconds.

Exercise Type - Grade 2 Strength

• Knee Flexion (Hamstrings): Leg curls in prone
• Knee Extension (Quadriceps): Sit to stand

Exercise Type - Grade 3 Strength

• Knee Flexion (Hamstrings): Squats, Lunges, Step-ups, Seated Marches, Seated Leg Extensions
• Knee Extension (Quadriceps): Seated heel-toe raises

Exercise Type - Isometric Exercises

• Wall sits
• While seated place a towel under the knee with the heel still on the bed and squeeze the quads for 5 seconds before releasing.
• Physio can place their hand on the towel to see if it's squeezing.
• Progression: When there is no pain/exercise done with ease.

Exercise Type - Grade 2 Strength

• Knee Flexion (Hamstrings): Static = lying supine and wrapping a towel under the arch of the foot, pull on the towel for 10 seconds.

Exercise Type - Grade 3 Strength

• Knee Flexion (Hamstrings):
  • Progression: Cyclic/dynamic leg swings (only when pain is completely gone).
  • Cyclic: In tandem, the knee in front should be straightened and the back knee should be slightly bent and bend the upper body holding it for 5 seconds.
  • Ballistic: Doing the same as cyclic but doing it rapidly by pulsing downwards without holds.

Exercise Type - Grade 3 Strength

• Knee Extension (Quadriceps): Static = lying supine with one leg leaning against the wall, push the leg into the wall for 30 seconds.

Exercise Type - Grade 3 Strength

• Knee Extension (Quadriceps):
  • Cyclic: Lying prone lift the leg towards the butt as much as possible for 5 seconds before relaxing.
  • Progression: Putting a pillow under the knee.
  • Regression: Putting a pillow under the pelvis.

Exercise Type - Grade 2 Strength

• Shoulder Flexion: Placing a slider under the affected arm, try to move the hand away from the body and use the unaffected arm to pull it further.

Exercise Type - Grade 3 Strength

• Shoulder Flexion: While sitting, the patient actively lifts their arm and the physio will provide assistance to elevate their arm and slowly lower them.

Exercise Type - Grade 2 Strength

• Shoulder Extension: Sitting sideways, place the affected arm on the surface with a slider underneath and slide it further out towards the side letting the unaffected arm guide the movement.

Exercise Type - Grade 3 Strength

• Shoulder Extension: While sitting, the patient will actively abduct their arm and the physio will provide assistance to move the arm outwards.

Exercise Type - Grade 2 Strength

• Shoulder Abduction: While sitting, the patient actively abducts their arm and the physio will provide assistance to move the arm outwards.

Exercise Type - Grade 2 Strength

• Shoulder Adductors: Placing a slider under the affected arm, try to move the hand away from the body and use the unaffected arm to pull it further.

Exercise Type - Grade 3 Strength

• Shoulder Adductors: While sitting, the patient actively lifts their arm and the physio will provide assistance to elevate their arm and slowly lower them.

Exercise Type - Grade 2 Strength

• Elbow Flexion (Biceps): None specified

Exercise Type - Grade 3 Strength

• Elbow Flexion (Biceps): None specified

Exercise Type - Grade 2 Strength

• Elbow Extension (Triceps): None specified.

Exercise Type - Grade 3 Strength

• Elbow Extension (Triceps): None specified.

Exercise Type - Grade 2 Strength

• Elbow Flexion (Biceps): None specified.

Exercise Type - Grade 3 Strength

• Elbow Flexion (Biceps): None specified.

Exercise Type - Grade 2 Strength

• Elbow Extension (Triceps): None specified.

Exercise Type - Grade 3 Strength

• Elbow Extension (Triceps): None specified.

Stretches For Elbows

• Ballistic: Cross-body arm swings. Standing hip-width apart, extend the arms outwards and swing both arms across the body rapidly touching the opposite shoulder.

Squats

• If knees buck inwards, make the BOS narrower.
• Regression (especially if they have poor ankle mobility/cannot maintain an upright posture).
  • Place small plates under the heel and also promotes a vertical torso.

Facilitating Trunk Awareness

• Early Phase: Learning neutral positions and those of bias and those causing the most symptoms.
  • Head/Upper Neck: Cervical retraction/protraction.
  • Lower Neck/Upper Back: Stand against a wall/flat surface and look at their posture.
  • Lower Back: Pelvic tilts.

Exercises

• If pain in lumbar flexion (early stage), stop when unable to control position.
• If pain in lumbar extension (early stage), do 4-point kneeling extension.

Shoulder Flexors

• Open: Front raises, overhead presses.
• Close: Push-ups of any variation.

Shoulder Extensors

• Open: Lats pulldown, rear delt fly.
• Close: Pull-ups, shoulder dips.

Shoulder Abductors

• Open: Lateral raises.
• Close: Side-plank with arm abduction, wall slides, chest-fly.

Shoulder External Rotators

• Open: Resisted/dumbbell external rotation, kettlebell windmill.
• Close: None specified.

Elbow Flexors (Biceps)

• Open: Bicep curl, hammer curl.
• Close: Pull-ups.

Elbow Extensors (Triceps)

• Open: Triceps pulldown, overhead triceps extension.
• Close: Push-ups.

Knee Flexors (Hamstrings)

• Open: Nordic hamstring curls, hamstring curls.
• Close: Squats, step-ups, lunges, wall sits.

Knee Extensors (Quadriceps)

• Open: Straight leg raises, isometric quad contractions.
• Close: Squats, step-ups, lunges, wall sits.