Lecture 4 Resistive Exercise Isometric PDF

Impairment -Immobilization Resistive exercise Isometric DR ABDELAZIZ ALI  Therapeutic Exercise intervention The application of carefully graded physical stresses and forces that are imposed on impaired body system, specific tissues or individual structures in a control...

Impairment -Immobilization Resistive exercise Isometric DR ABDELAZIZ ALI  Therapeutic Exercise intervention The application of carefully graded physical stresses and forces that are imposed on impaired body system, specific tissues or individual structures in a controlled, progressive, safe manner aiming to reduce physical impairments and improve function. 1. Aerobic conditioning and reconditioning 2. Muscle performance exercises: strength, power, and endurance training 3. Posture Awareness training 4. Stretching techniques 5. Balance Exercises and agility training 6. Relaxation Exercises 7. Breathing Exercises 8. Neuromuscular control technique 9. Task Specific functional training  Impairments Abnormalities at a body system ,organ and tissue resulting from pathological conditions that affects the physiological, anatomical, and psychological functions and structures of the body. Impairments Classified into 1. Primary impairments 2- Secondary impairments Direct impairments due to direct consequences That did not exist at the onset of primary of a disease or condition for example: impairments but developed subsequently for - Paraplegia following spinal cord injury example joint contractures in poliomyelitis. - Inability to walk after lower limb fracture  Common Physical Impairments Managed with Therapeutic Ex 1-Musculoskeletal impairments Pain.  Joint hypermobility Muscle weakness/reduced torque production.  Faulty posture Decreased muscular endurance.  Muscle length/strength imbalances Limited range of motion due to: Restriction of the joint capsule Restriction of periarticular connective tissue Decreased muscle lengthcreased muscular endurance Decreased muscle length 2-Neuromuscular impairments Pain Impaired balance, postural stability, or control Incoordination, faulty timing Delayed motor development Abnormal tone (hypotonia, hypertonia, dystonia) Ineffective/inefficient functional movement strategies 3- Cardiovascular/Pulmonary impairments Decreased aerobic capacity (cardiopulmonary endurance) Impaired circulation (lymphatic, venous, arterial) 4-Integumentary (skin) impairments Skin hypomobility (e.g., immobile or adherent scarring)  Immobilization Immobilization refers to the restriction of movement of a joint or body part, often used in the management of injuries to promote healing. It can be achieved using various devices, such as splints, casts, slings, or braces, and is commonly applied after fractures, ligament injuries, or surgeries. Purpose of Immobilization Promote Healing: Immobilization reduces movement, protecting injured tissues (bone, muscle, ligaments) and allowing proper healing. Pain Management: Restricting movement often helps in reducing pain and discomfort. Prevent Further Injury: Immobilization prevents aggravating the injury by limiting excessive or harmful movements Methods of Immobilization  Casts: Plaster or fiberglass molds used primarily for fractures.  Splints: Flexible devices that provide support but allow slight movement and swelling.  Braces: Used for support and stabilization, commonly in ligament injuries.  Slings: Support for upper limb injuries, typically in the shoulder or arm. Physiological Effects of Immobilization While immobilization is necessary for healing, prolonged use can lead to negative effects such as:  Muscle Atrophy: Decreased muscle size due to lack of use.  Joint Stiffness: Limited range of motion due to inactivity.  Bone Density Loss: Reduced mechanical loading can cause bone weakening.  Decreased Circulation: Prolonged inactivity may impair blood flow, leading to slower healing or complications like deep vein thrombosis (DVT).  Active resisted exercise strength muscle strength is the greatest measurable force that can be exerted by a muscle or muscle group to overcome resistance during a single maximum effort. Strength training: is a systematic procedure of a muscle or muscle group lifting, lowering, or controlling heavy loads (resistance) for a relatively low number of repetitions or over a short period of time.  Power Muscle power is the amount of work (force x distance) produced by a muscle per unit of time (force x distance/time). It is the rate or speed of work. The greater the intensity of the exercise and the shorter the time period taken to generate force, the greater is the muscle power. Power training: Power can be enhanced by either increasing the work a muscle must perform during a specified period of time or reducing the amount of time required to produce a given force. The greater the intensity of the exercise and the shorter the time period taken to generate force, the greater is the muscle power.  Endurance Is ability to perform low intensity, repetitive, or sustained activities over prolonged period of time. Cardiopulmonary endurance (total body endurance); is repetitive, dynamic activities as walking, cycling, swimming, involve use of the large muscles. Muscle endurance (local endurance) is the ability of a muscle to contract repeatedly against a low-intensity load, generate and sustain tension, and resist fatigue over an extended period of time. Endurance training. Endurance training (endurance exercise) is characterized by having a muscle contract and lift or lower a light load for many repetitions or sustain a muscle contraction for an extended period of time. Ex. Postural muscles in sustain tension to maintain balance and proper body alignment.  ACTIVE RESISTED EXERCISE Form of exercise resulting in static or dynamic muscle contraction when muscle resisted by an outside force; The external force may be applied manually or mechanically.  Indications for Low-Intensity Versus High-Intensity Exercise Submaximal Loading Near-Maximal or Maximal Loading In the early stages of soft tissue healing when injured tissues must When the goal of exercise is to increase muscle strength and power be protected. After prolonged immobilization rehabilitation program to high-demand occupational or recreational activities. When initially learning an exercise to emphasize the correct form. For individuals training for competitive weight lifting or body building. When the goal of exercise is to improve muscle endurance. In a conditioning program for individuals with no known pathology. To warm-up and cool-down prior to and after a session of exercise. Contra indications to Resistance Exercises 1- Pain; If a patient experiences pain that cannot be eliminated by reducing the resistance, the exercise should be stopped. 2- Inflammation; Dynamic and static resistance training is absolutely contraindicated in the presence of inflammatory neuromuscular disease. 3- Severe Cardiopulmonary Disease.  Potential Benefits of Resistance Exercise Enhanced muscle performance: restoration, improvement or maintenance of muscle strength, power, and endurance Increased strength of connective tissues: tendons, ligaments, intramuscular connective tissue Greater bone mineral density or less bone demineralization Decreased stress on joints during physical activity Reduced risk of soft tissue injury during physical activity Possible improvement in capacity to repair and heal damaged soft tissues due to positive impact on tissue remodeling.  Possible improvement in balance Enhanced physical performance during daily living, occupational, and recreational activities Positive changes in body composition: ↑ lean muscle mass or ↓ body fat Enhanced feeling of physical well-being Possible improvement in perception of disability and quality of life.  Precautions of Resistance Exercise 1- Good room temperature and comfortable clothes for exercise that facilitates heat dissipation and does not impede sweat evaporation. 2- Caution the patient that pain should not occur during exercise. 3- Do not begin resistance training at a maximal level of/resistance, especially with eccentric exercise. 4- Avoid use of heavy resistance during exercise for children, older adults, and patients with osteoporosis. 5- Do not apply resistance across an unstable joint of distal to a activate fracture site. 6- Have the patient avoid breath-holding during resisted exercises to prevent the Valsalva maneuver. 7- Avoid uncontrolled, ballistic movements as they compromise safety and effectiveness. 8- Prevent substitute motions by good stabilization and appropriate resistance. 9- Avoid exercises that place excessive, secondary stress on the back. 10- Be aware of medications a patient is using that can alter acute and chronic responses to exercise. 11- Avoid fatigue by giving adequate rest intervals. 12- Stop exercises if the patient experiences faint, dizziness, or shortness of breath.  Reversibility Principle Adaptive changes in the body’s systems, such as increased strength or endurance, in response to a resistance exercise program are transient unless training-induced improvements are regularly used for functional activities or unless an individual participates in a maintenance program of resistance exercises. Detraining, reflected by a reduction in muscle performance, begins within a week or two after the cessation of resistance exercises and continues until training effects are lost. For this reason, it is imperative that gains in strength and endurance are incorporated into daily activities as early as possible in a rehabilitation program.  Types of resistance exercise: Resistance exercises can be carried out either: ◦ Isometric exercise: muscle developed tension without obvious ROM. (static exercise) ◦ Manual or mechanical. ◦ Dynamic exercise (concentric or eccentric): Constant muscle tension with a change in muscle length, it could be eccentric or concentric Concentric contraction: When muscle shortens under tension. (accelerate body segments) Eccentric contraction: When muscles lengthens under tension. (decelerate body segments) also act as a source of shock absorption during high-impact activities. Isokinetic resistance exercise: perform muscle contraction against fixed velocity and accommodating resistance. (cycling) Open-Chain and Closed-Chain Exercise.  ISOMETRIC EXERCISE Isometric exercise, also known as static exercise, involves muscle contraction without a change in muscle length or joint movement. Despite the absence of visible motion, tension and force are produced by the muscles. Resistance in isometric exercises may come from holding a position against external force, weight, body weight, or immovable objects. Types of Isometric Exercise for Physical Therapy Isometric exercises vary in intensity and purpose, and they are used throughout different phases of rehabilitation. All except muscle-setting exercises involve significant resistance and aim to improve static strength or endurance.  Muscle-Setting Exercises ◦ Low-intensity contractions with little to no resistance. ◦ Aimed at reducing muscle pain and spasm, promoting relaxation and circulation in the early stages of healing. ◦ Common examples include quadriceps and gluteal setting. ◦ Muscle setting helps prevent atrophy and maintain muscle fiber mobility, but it does not significantly improve muscle strength, except in very weak muscles.  Stabilization Exercises Used to develop sub maximal but sustained co-contraction to enhance postural or joint stability. These involve midrange isometric contractions against resistance (body weight or manual resistance) and are often performed in antigravity or weight-bearing postures. Techniques such as rhythmic stabilization and alternating isometrics (from proprioceptive neuromuscular facilitation, PNF) are commonly used for this purpose. ISOMETRIC OBLIQUE STABILIZATION DIFFICULTY: EASY - ALL FITNESS LEVELS TYPE: CONDITIONING GOAL: BUILD CORE STRENGTH PROCEDURE 1.Lie on your back with both knees bent. 2. Bring one knee up towards your head, keeping a bend of about 90 degrees in your knee and hip. 3. Place resistance on the lifted knee by pushing back against it with the opposite arm to contract your obliques (these are your side abdominal muscles). 4. Make sure to keep your head and shoulders on the floor while doing so, and note that there should be minimal movement of the knee as you contract your obliques. 5. Hold 5 seconds. 6. Perform the same exercise as above using your other knee and arm. 7. Repeat 10 times. 8. Complete 2 sets per day  Multiple-Angle Isometrics Resistance is applied manually or mechanically at multiple joint angles within the available range of motion (ROM). This method is ideal when joint motion is permitted but dynamic resistance exercises are painful or not advisable. It helps improve strength throughout the ROM. Characteristics and Effects of Isometric Training Intensity of Muscle Contraction: ◦ The tension generated during isometric contraction depends on joint position and muscle length. ◦ To improve strength, an intensity of at least 60% of the muscle's maximum voluntary contraction (MVC) is required. ◦ Resistance should be progressively increased as the muscle strengthens to maintain overload.  Duration of Muscle Activation Isometric contractions should be held for 6-10 seconds to allow sufficient time for peak tension and metabolic changes. Muscle fatigue occurs quickly. A typical 10-second contraction includes a 2-second rise time, 6-second hold, and 2-second release.  Repetitive Contractions Performing multiple repetitions, each held for 6-10 seconds, helps reduce muscle cramping and increases the training's effectiveness.  Joint Angle and Mode Specificity Strength gains occur primarily at or near the joint angle used during the exercise. The physiological carryover is minimal, about 10° in either direction. Multiple-angle isometric exercises are recommended, with resistance applied at 4-6 points throughout the range of motion (ROM). Isometric training improves static strength, but has limited impact on dynamic strength (concentric or eccentric).  Sources of Resistance Isometric exercises can be performed with or without equipment. Resistance can come from manual sources, immovable objects (e.g., a wall), or modified dynamic exercise equipment (e.g., weight-pulley systems, isokinetic devices).  Precaution: Breath-Holding Breath-holding during isometric exercises can trigger the Valsalva maneuver, causing a rapid rise in blood pressure. Patients should be instructed to breathe rhythmically, exhaling during contractions.  Contraindication High-intensity isometric exercises are contraindicated for patients with cardiac or vascular conditions due to the risk of increased blood pressure. Thank you