GAF FPP, Wk13, Lect2, Warm up cool down 2023-24.pptx

Foundations for Physiotherapy Practice 2023-24 Warm-Up and Cool-Down UH FPP 2023-24 Learning Outcomes By the end of this session and associated independent study, the successful student will be able to: • Understand the psychological and physiological effects of a warm up and cool down • Discuss...

Foundations for Physiotherapy Practice 2023-24 Warm-Up and Cool-Down UH FPP 2023-24 Learning Outcomes By the end of this session and associated independent study, the successful student will be able to: • Understand the psychological and physiological effects of a warm up and cool down • Discuss the various ‘techniques’ included in a warm up and cool down • Justify the cardiovascular and musculoskeletal components for warm up and cool down sessions in the healthy population UH FPP 2023-24 Warm-Up - as being activity that ‘prepares the body for exercise’ Brukner & Khan (2012) Aim: Facilitate the preparation of the body from a state of rest to one of exercise  Period of gradually increasing exercise • As physios we often try to enhance motor performance by reducing/removing any constraints to movement, this includes loss of joint range of movement UH FPP 2023-24 Cool Down (Warm down) Definition: an activity that involves voluntary, low- to moderate-intensity exercise or movement performed within 1 h after training and competition (Van Hooren and Peake, 2018). Aim: Facilitate the return of the body from a state of exercise to rest . Period of gradually reducing exercise Intensity decreasing to light • Rhythmic physical activity following strenuous activity • Intensity: Light to moderate activity UH FPP 2023-24 Warm Up - Psychological factors • Sports people at all levels believe that doing an activity related to the skills they require helps prepare them mentally to focus on their upcoming event. • There is also a belief that exercise prior to strenuous activity prepares the person to ‘all out’ activity without fear of injury. A strong belief will therefore be difficult to overcome when researching the difference of warm-up versus no warm-up. • Because if the athlete believes they need a warm-up, are they going to obtain maximum effort without it? UH FPP 2023-24 (McArdle et al., 2016) Warm Up – Psychological Factors Mental Rehearsal • Rehearse the movement slowly before performance Arousal Level • Direct relation between arousal and performance • Yerkes-Dodson Law UH FPP 2023-24 Warm Up –Physiological Effects • Increasing blood flow will increase oxygen to the tissues • Facilitated oxygen utilisation by warmed muscles • Increased muscle force capability due to the previous muscle activity • Increased speed of contraction and relaxation of warm muscles • Facilitated nerve transmission • Warm tissues are more elastic and for longer • Warm synovial fluid is less viscous • Increase in body temperature, core and muscle temperature may rise 1-3°C UH FPP 2023-24 Warm Up - Sudden strenuous activity • Sudden strenuous exercise can induce cardiac changes in asymptomatic males • Study showed abnormal ECG traces in 70% of the subjects, 25% showed improved ECG traces when they had warmed up prior to the exercise UH FPP 2023-24 The effect of a warm-up on: • Performance • Injury prevention • Delayed onset muscle soreness (DOMS) UH FPP 2023-24 Warm Up performance • Warm-up exercise at moderate and high intensity improved intense cycling performance by 2-3% and pre-exercise warm-up enhanced a 3km cycling trial time (McArdle et al., 2010). • Warm-up period of 10-15mins results in improved explosive performance (Silva et al 2018) UH FPP 2023-24 Warm Up – Injury prevention • Warming up stretches the muscle – tendon unit to allow for greater length and less tension at a given load • Warm up reduces the risk of acute muscle strain injuries • Warm-up can reduce the risk of injury in study looking at handball players (Olsen 2005). • Warm-up can reduce ankle injury in soccer players (Imai et al, 2018) • Many studies include many components in their warm up routines so it is difficult to ascertain which element(s) contribute to the injury risk reduction UH FPP 2023-24 Warm –Up - Delayed Onset Muscle Soreness (DOMS) DOMS • exercise-related muscle pain develops after excessive and unaccustomed exercise associated with muscle and/or connective tissue damage Law & Herbert (2007) Randomised controlled trial • Demonstrated a warm-up immediately prior to eccentric exercise provided a small reduction in DOMS • no evidence that a cool-down is effective at reducing DOMS This Photo by Unknown Author is licensed under CC BY-SA UH FPP 2023-24 Warm Up – Types and Techniques Active Warm Up General warm up General bodily movements Unrelated to the specific actions to be carried out in the main task Specific warm up Bodily movements related to the main task Skill rehearsal, evidence supports the benefits in terms of improved skill and co-ordination patterns Passive warm up Warm up by raising temperature by external means UH FPP 2023-24 Warm Up - techniques Individualise • Fitness level • Exercise to be performed Intensity • Light to moderate • Mild sweating • Should be aiming for about 70% of maximal heart rate – but this will depend on the activity you are warming up for Clothing • To keep heat in Type • Continuous and rhythmical Time • Depends – for example may need longer warm up if environment cold UH FPP 2023-24 Cool Down (Warm down) - Physiological effects Aim: Facilitate the return of the body from a state of exercise to rest . Physiological effects: • facilitates: • blood flow through vessels and heart • Removal of lactate • Monitor return of HR and RR to near normal • Commonly involves stretching UH FPP 2023-24 Active cooldown interventions and their commonly proposed psychophysiolog ical effects (Van Hooren and Peake, 2018) The only prove n effect UH FPP 2023-24 Stretching Stretching often forms part of a warm up and/or cool down Lets look at what we mean by stretching and how it fits into warm up and cool down UH FPP 2023-24 Golgi Tendon Organ Detects • Tension in muscle when it shortens • Tension in muscle when passively stretched Results in •Autogenic inhibition – sudden relaxation of muscle UH FPP 2023-24 Muscle spindle Detect and respond to: • changes in muscle fibre length Results in: • contraction of muscle and reciprocal inhibition UH FPP 2023-24 Stretching – physiological effects Short/Medium term changes • Habituation of stretch reflex • Changes the viscoelastic properties of muscle • Creep and stress relaxation • Stretch tolerance/pain threshold Long term Changes • Increase in serial sarcomere number UH FPP 2023-24 Many factors that will potentially alter the effect of stretch e.g. Muscle Position of stretch Intensity, duration, frequency Types of stretching Static Passive–relaxation for all voluntary and reflex muscular resistance followed by passive assistance from another person or device to take to end of range and hold Active – using muscle contraction (isometric or concentric) of opposing muscle group to take to end of range and hold Dynamic –(active) through full range of movement Ballistic – repeated vigorous full range movements Proprioceptive neuromuscular facilitation (PNF) Contract-relax(CR)/Hold relax- contract muscle, relax then static stretchdepending on which technique may involve isotonic or isometric muscle contraction Contract relax with agonist contraction (CRAC) – isometric contraction of muscle, relax then active stretch using opposing muscle group UH FPP 2023-24 Passive Stretching Muscle-tendon units can be lengthened by passive stretching • Biomechanical Effect: The increase in flexibility is due to • Increase in stretch tolerance/pain threshold • Change in the viscoelastic properties – creep • Neurological Effect: The increase is due to: • Reduction in neural sensitivity • Autogenic inhibition • Reciprocal inhibition • Post-synaptic inhibition UH FPP 2023-24 Comparison of static vs dynamic stretching Static Dynamic Isolates muscle or specific joint(s) Several muscle groups and joints moved simultaneously Focus on specific stretch More functional movement Controlled and slow Faster Supported starting position Mental rehearsal Less skill required Requires skill and timing UH FPP 2023-24 PNF – proprioceptive neuromuscular facilitation Contract Relax /Hold relax Hold relax - Contract muscle isometrically - relaxation of muscle, then slow Passive static stretch – starting point usually end of ROM (outer range) e.g. a hamstring stretch – the person isometrically contracts the hamstrings while the therapist applies resistance, no movement occurs and there is an isometric contraction Contract relax- as above but muscle contracts isotonicaly e.g a hamstring stretch, the therapist provides resistance as the person contracts the muscle and pushes the leg down to the floor. Contract Relax Agonist Contract (CRAC) – note ‘antagonist’ is the muscle being stretched the antagonists (e.g. hamstrings) are first passively stretched, followed by a six to 15 second isometric contraction against resistance at the point of limitation. This contraction is immediately followed by a six to 15 second concentric contraction of the agonists (e.g. quadriceps). Consider how autogenic inhibition and reciprocal inhibition work during these stretching techniques UH FPP 2023-24 Static stretch– muscle performance Static Evidence that passive static stretching (>60sec) pre performance can induce significant reductions in maximal muscle performance: • slow speed strength • Moderate and high speed power production Kay and Blazevic, 2012 It is suggested not to include passive static stretching prior to the performance of maximal strength, power or speed dependent activities (ACSM, 2010) Dynamic UH FPP 2023-24 Dynamic stretching – muscle performance (Opplert et al 2016, 2018. Iwata et al 2019) Improve power, sprint or jump performance Temperature effect Ensure the individual has sufficient ROM to perform optimally Decrease muscle stiffness and increased tolerance to stretch Increase rate of torque development Post activation potentiation Increase in muscle co-ordination Rehearsal of movement UH FPP 2023-24 Stretch - injury • Many factors both psychological, physiological and environmental will contribute to exercise related injury • Inconclusive DOMS Herbert et al 2011, Dupuy et al 2018 Systematic review They showed there was little or no effect of stretching on the muscle soreness experienced in the week after the physical activity. UH FPP 2023-24 This Photo by Unknown Author is licensed under CC BY-SA Stretch equipment • Towel/belt • Continuous passive motion (CPM) machines • Positioning using e.g. pillows, wedges • Splints and casts • Foam roller UH FPP 2023-24 This Photo by Unknown Author is licensed under CC BY- Ensure you can evidence base your practice UH FPP 2023-24 References • Bishop, D,. (2003). Warm up I: potential mechanims and the effects of passive warm up on exercise performance. Sports Med. 2003;33:439-454 • Bishop, D,. (2003). Warm up II: performance changes following active warm up and how to structure the warm up. Sports Med. 2003;33:439-454 • Dupuy, O., Douzi, W., Theurot, D., Bosquet, L., & Dugué, B. (2018). An evidence-based approach for choosing post-exercise recovery techniques to reduce markers of muscle damage, soreness, fatigue, and inflammation: A systematic review with meta-analysis. Frontiers in Physiology, 9, 403-403.eApostolopoulos, N., Metsios, G. S., Flouris, A. D., eKoutedakis, Y., & Wyon, M. A. (2015). The relevance of stretch intensity and position: A systematic review. Frontiers in Psychology • Herbert, RD. , de Noronha, M. , Kamper, SJ. (2011). Stretching to prevent or reduce muscle soreness after exercise The Cochrane Library. DOI: 10.1002/14651858.CD004577.pub3 http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004577.pub3/abstract • Imai, A., Imai, T., Iizuka, S., & Kaneoka, K. (2018). A trunk stabilization exercise warm-up may reduce ankle injuries in junior soccer players. International Journal of Sports Medicine, 39(4), 270-274 • Iwata, M., Yamamoto, A., Matsuo, S., Hatano, G., Miyazaki, M., Fukaya, T., . . . Suzuki, S. (2019). Dynamic stretching has sustained effects on range of motion and passive stiffness of the hamstring muscles. Journal of Sports Science & Medicine, 18(1), 13-20 • Kay, AD. , Blazevich AJ (2012). Effect of acute static stretch on maximal muscle performance: A systematic review. Med Sci Sports & Exercise. 44:154-164. • Law, R. & Herbert, R. (2007). Warm-up reduces delayed- onset muscle soreness butt cool-down does not. Australian Journal of Physiotherapy Vol. 53 91-95 • Lewis, J. (2014). A systematic literature review of the relationship between stretching and athletic injury UH FPP 2023-24 prevention. Orthopaedic Nursing, 33(6), 312-320. References • McArdle, W. , Katch, F., & Katch, L. (2016) Essentials of Exercise Physiology.(5th ed.). Wolters Kluwer. • McGowan, C.J., Pyne, D.B., Thompson, K.G. et al. (2015). Sports Med. 45: 1523 • Olsen, O., Mykelbust, G., Engebresen, L., Holme, I., & Bahr, R.(2005). Exercises to prevent lower limb injuries in youth sports: cluster randomised controlled trial. BMJ 330:449 • Opplert,J. J.-B. Genty, N. Babault. (2016) Do Stretch Durations Affect Muscle Mechanical and Neurophysiological Properties? Int J Sports Med; 37(09): 673-679 • Opplert, J., Babault, N (2018) Acute Effects of Dynamic Stretching on Muscle Flexibility and Performance: An Analysis of the Current Literature. Sports Med 48, 299–325. • Shrier,I. (2004). Does Stretching Improve performance? A systematic and critical review of the literature. Clin J Sport Med. Vol 14: 5 267-273 • Silva, L.M., Neiva, H.P., Marques, M.C. et al. Sports Med (2018) 48: 2285. Effects of Warm-Up, PostWarm-Up, and Re-Warm-Up Strategies on Explosive Efforts in Team Sports: A Systematic Review. • Small, K. & Naughton, L. (2008). A systematic review into the efficacy of static stretching as part of a warm-up for the prevention of exercise related injury. Research in Sports Medicine. 16:213-231. • Soligard, T., Myklebust, G., Steffen, K. Holme, I., Silvers, H., Dvorak, J., Bahr, R., Einar Andersen, T. (2008). Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial. BMJ;337:a2469 • Sullivan, K., Murray, E., Sainsbury, D. (2009). The effect of warm-up, static stretching and dynamic stretching on hamstring flexibility in previously injured subjects. BMC Musculoskeletal Disorders, 10:37. • Van Hooren, B., & Peake, J. M. (2018). Do we need a cool-down after exercise? A narrative review of the psychophysiological effects and the effects on performance, injuries and the long-term adaptive UH FPP 2023-24 response. Sports Medicine, 48(7), 1575-1595.