Therapeutic Exercises PDF

♟ Therapeutic exercises week 1 Strength:- Greatest force produced bby a minute ( as hard as they can to overcome resistance) 3-5 days / 3-5 sets / 3-8 reps /3-5 mins Rest (1sec ECC:2sec CON) Muscular Endurance:- The ability of a muscle to contract againstaan exteral load and resist fatigue for a gi...

♟ Therapeutic exercises week 1 Strength:- Greatest force produced bby a minute ( as hard as they can to overcome resistance) 3-5 days / 3-5 sets / 3-8 reps /3-5 mins Rest (1sec ECC:2sec CON) Muscular Endurance:- The ability of a muscle to contract againstaan exteral load and resist fatigue for a given period of time ( to sustain a position for a period of time) 2-3 days / 1-3 sets / 15-20 reps/ 30-60 secs Rest Power :- The amount of performed by a muscle/muscle group per unit of time( for the least amount of time) ( best of max results) 4-6 days/ 3-5 sets/ 1-3 reps / 5-8 mins Rest Compare beteen sides: symmetry index:- Affecte side/unaffected side x 100 (As load increases movement velocity decreases)Agility :- The ability to change direction rapidly For high Intensity → use Power values ( 1-3 resps/3-5 sets) For low Intensity → use Endurance values (15-20 reps/1-3 sets) Balance :- Keeping your centre of mass over its bsed of support 2-3 days/ 20-30 mins/ 3-5 exercises Isometric :- no joint is moving but there is contraction → 10 reps x 10 hold Isotonic :- involve the change in length of the muscle while generating tension. Therapeutic exercises 1 Concentric :- joint movement muscle shortens Eccentric :- joint movement muscle lengths Isokinetic:- movement velocity at a joint is held constant → used in late stages of rehab week 2 Closed KC:- distal end is not moving , while body moves (in weight-bearing ) chin up and eg presses/ multi joint Open KC :- distal end is moving , while body does not move -: force is produced by the muscle that cross the moving joint(non- weightbearing) Types of resistance Body weight : single/multijoint/ balance can be a limiting factor External resistance: manual :- from the therapist or isometric contraction from clients mechanical:- free weight( highly adaptable but requires skill, expensive), barbells and dumbells, resistance (can be used to target muscles at single joint, easy to quantify, coordination is not challeged) Accommodating Resistance: Isokinetic contractions, velocity is controlled, dynamometre week 3 💡 Stretch : - designed to increase ROM, soft tissue extensibility / increases flexibility by elongating structures Mechanical Theory:- viscoeastic formation , plastic deformation , increased sarcomeres and neuromuscular relaxation Sensory theory :- a psychological alteration in sensory perception or willingness of subjects to tolerate a greater torque application Therapeutic exercises 2 Decreased performance in power activities (jumping) with 90 s stretch per muscle group Dynamic stretching increased jump power but not height and ballistic stretching had no effect Short duration stretches can be performed without compromise Static :- Forced applied is maintained over time → manual or self stretching → daily or 2-3 days /week 30-60 secs hold / 2- 4 reps Dynamic :- moves in and out of stretched position quickly → cyclic intermittent and basilic → daily or 2-3 days/ PNF stretching :- propioceptive neuromusclular facilitation ( an assistace stretch to you a deeper stretch) hold/relax or aginist contraction 3- 6 secs contraction of voluntary contraction/ 10-30 secs assisited stretch 💡 Program variables Load :- amount pof resistance lifted Complexity:- numbers of joints used, CKC,OKC, static to dynamic, base of support Context:- open or closed enviroments Training frequency 2 days/week allows more recovery time and is less consuming 1-2 days/week can maintain strength week 4 Therapeutic exercises 3 The big 3 1. Isometric co-contraction with head lifted:2. side plank 3. Bird dog Valsalva maneuver:- expiratory effort against a closed glosttis with isometric cocontraction of the trunk muscles Inflate lower abdomen and close the glottis and perform the isometric cocontraction necessary during high load/ high intensity resistance training Asymmetrical loading to apply load using one limb, so that there’s not only flexion the person has to maintain but also torsion Breathing is maintain at low loads Controling robust control of spine for better performance Martial Arts:- Trunk exercises improved torso stffness, allowing striker to impart greater impact forces Throwing athletes:- Lumbopelvic strengthening improved power especially during pitcing motion, but lacked shoulder horizontal abducion and elbow torque valgus Football :- trunk muscle endurance were not related to strength week 5 Therapeutic exercises 4 Progressions for Exercise week 6 Structural adaptations Mechanocoupling :- when we add physical load to a tissue that causes physical pertubation to the cells that make up that tissue ( Resistance training→ pertubation is being transfered to the myofibres that make up the tissue ) Mechanotransconducting :- the physiological that occur where cells respond to the mechanical load (the serises of respond that occurs with in cells because of that pertubation) Hypertrophy:- an increase in diametre of an individual myoibre increase in protien synthesis → satellite cell activation → located on the surface of a myofibre between the basal lamina and the sarcolema , after a muscle injury cells increase and fuse to the myofibre and additional nuclear material to maintain myonuclear domain size. → mTORC1 signalling pathway activation → a complex that contributes to the master regulaory signaling pathway of cellular protein synthesis → Amino acids, grwoth factors, mechanical load activates the mTORC1 Increased sarcoplasm volume Therapeutic exercises 5 Neural adaptaion Creates neural drive to the skeletal muscle → increasesd electrical efficecy to agonist muscle , while limiting the antagonist muscle ativity → increased motor unit recruitment → decreased autogenic inhibition → inhibits generations of levels of force that could cause structural damage → coordination of agonist, synergist and antagonist muscle → Neuromuscular junction there is a greater terminal area and greater disersion of aceytacholine receptors → increases force and power production Bone health → osteoporosis and osteopnea → Resistance training consiting of deadlift, squat 5x5 reduced standing tall thoracic kyphosis, BDensity reduced , improved functional tests Other Benefits Depression → resistance programs systemic inflammation → resistance trainig that was more metabolic demanding (hypertophic) Therapeutic exercises 6 Skeleta muscle structure Muscle→ Fascicle→ myofibres (muscle fibres/skeletal muscle cells)→ myofibrils→myofilaments→ organized end to end into contractile units→ sarcomeres Muscle→ epimysium / Fascicle→ perimysium / myofibre→ endomysium Endomysium→ basal lamina (basement membrane)→ sarcolemma (plasma membrane of myofiber /skeletal muscle cell) Satellite cells are located between basal lamina and sarcolemma Myonuclei are located in the sarcoplasm adjacent to the sarcolemma Sarcolemma → Transverse “T” tubules (project into the myofiber) → Sarcoplasmic Reticulum (fine plexus around the myofibrils) → when depolarized release of Ca+2 into the sarcoplasm→ myofibrils→ contraction week 7 Design of Group exercise Advantages Disadavantages cheaper quality control socialisation individaulas needs may not be met peer supports negative at times encourages a wellness approach to exercise difficult member requires space greater self locus of control Benefits of group exercise stress, eating disorders, dementia Elements to consider Therapeutic exercises 7 Traditional classes:- one instructor everybody does the same thing at the same time → Pro → can be safer with the same level group, reduce independent participation → Con → more equipment needed, reduced specifity Workstations:- each station withdiffernt tasks → from one station to the next → Pro → increases intensity , cost effective, improved participation, effects of sttention /focus , self control adresses specific problems for each patients each task is graded challenging but safe each participant must be trained make the individual in control of their progress Therapeutic exercises 8 Week 9 Viva Review commonly used cardiorespiratory assessment procedures VO2 max → the maximal rate of oxygen transport, consumption and utilization with no further increased possible despite an increase in work rate. no matter how hard they work they achieve thier oxygen use VO2 peak → Maximum oxygen utilization for a given work rate, may or maynot ne equivilant to VO2 max can be used in a submaximam test 12 MINUTE RUN Therapeutic exercises 9 → A test where a client is asked to run for maximum distance in 12 minutes → uses this test to get VO2 max Advantage Limitation For groups maximum test less equipment Can’t monitor HR&BP familiar activity less motivation → its self paced 6 MINUTE WALK TEST → maximum distance a person can walk in 6 minutes → submaximal test of functionsl exercise capacity → can estimate VO2max Advantage Limitation For healthy & perople with CR Disease standarised instructions and encouragement easy to administer self paced -. no learning effect self paced waling aids not for groups 54 metres commonly used → 20 M SHUTTLE RUN /BEEP TEST → a progressive and maximal test where individuals completes as many 20 metre shuttles as possible. Therapeutic exercises Advantage Disadvantage Can test multiple clients at the same time Sound system needed appropirate for large space Externally paced Areas insufficient for testing 10 Maximal test outcomes influenced by agility → can predict VO2max and related to VO2peak INCREMENTAL SHUTTLE WALK TEST →Based on beep test , but more intense Test which reflects peak exercise capacity based on the distance walked around a 10 metres course according to different speeds dictated by at audio signal. Advantages Disadvantage Externally paced can be used in healthy individuals needs 2 tests to allow for learning effect & wiith CR disease Equipment needed Balance and dizziness issues, small turns Muscle strength and balance , agility YMCA CYCLE ERGOMETRE PROTOCOL Submaximal multistage progressive test using a cycle ergometre. Advantages Disavantages used for range of fitness levels in healthy individuals Expensive equipment ,with calibrations can measure BP and SPO2 levels easily May not be a familiar activity can predict VO2max Therapeutic exercises 11 ARM CRANK ERGOMETRE PROTOCOL → using arm crank ergometre in a seated position, individuals mainatin a steady cadence as work load increased every minute. Advantage Disadvantage When testsing with lower limb is not safe expensive equipment For healthy individuals & healthy could relate performance in upper limb functional tasks can predict VO2 peak not very familiar and strength and endurance can limit result during maximal → Lower Vo2peak and Lower HRmax during submaximal →higher HR, BP and VO2peak Identify the BEST assessment procedure to select based on the patient / patient centered SMART goal and resources available 1. Is the client healthy, or any physical limitations Therapeutic exercises 12 2. Do i have access to 1 or more than 1 client 3. What resources do i have Therapeutic exercises 13 5. What outcome measures do i get 6. How do i use that outcome measure Know the outcome measures for each assessment procedure and how those outcomes can be used Therapeutic exercises 14