What are resistance exercises?
any form of ACTIVE exercises in which dynamic or static muscular contraction is resisted by an outside force (manual/mechanical)
What type of resistance is supplied by a therapist or other person?
hard to quanitify, limited by therapists strength
What type of resistance is supplied by equipment or mechanical apparatus?
- weights, etc
- can quanitify
What must a pt be able to complete before performing resistance exers?
What are some goals/indications for resistive exers?
- increase strength (hypertrophy of m. fibers, recruitment of m. fibers)
- increase muscular endurance
- increase power
What is the increase in the size of diameter of m. fibers?
hypertrophy of m. fibers
What is happening as more motor units are firing?
recruitment of m. fibers
What is the m. ability to contract over and over again?
increased muscular endurance
What is the increase in rate and force of mm.?
What is the increasing number of muscle fibers?
What are some precautions/contraindications of resistance exers?
- cardiovascular (HTN, MI)
- fatigue (local, general)
- certain diseases (MS, diabetes)
- overwork/overtraining (if you do too much too soon, you can retard the m. strength your trying to build)
- substitute motions (check resistance)
- exercise-induced m. soreness
- acute m. soreness(during/directly following exers)
- delayed-onset m. soreness (DOMS) (12-24 hours after resistance training)
What are the contraindications of resistance exers?
- inflammation (use isometrics)
- severe cardiopulmonary
What are the types of resistive exers.?
- specificity training/transfer training
What type of training is used to achieve a very specific goal?
What type of traing has carry over effects from other exers?
What are some isotonic exercises?
- constant vs variable resistance
- concentric vs eccentric
- open vs closed kinematic chain
What is constant isotonic exers.?
DB, cuff weight etc..weight stays same at all times
What is variable isotonic exers?
loads m. more effectively, resistance is varied by the pt mvmt
Resistance=pt effort is part of what resistive exercise?
What is a precaution for plyometrics?
warm up first
What is amortization?
time between stretch and contraction
*with plyo, this time is short (shorter the better)
Before applying manual resistance, what should you do?
- know ROM and strength and identify functional limitations
- explain to pt (max effort, pain free)
- comfortable postition
- no valsalva maneuver occuring
Where do you normally apply resistance during exers?
- distal end-makes it harder for them, easier for us
- site varies depending on strength of pt and therapist, and stability of segment
- can apply resistance across an intermediate jt if jt is stable and pain free and has adequate strength
Where do you stabilize during manual resistance?
When should you revise the amt or site of resistance?
- pt unable to complete full range
- site of resistance is painful
- muscular tremor develops
- substitute motions occur
What is a PNF pattern?
proprioceptive neuromuscular facilitation
diagonal, involves all planes, strengthens multiple m. groups and better for functional activities
For neuro pts, if theyre floppy, flaccid, and weak, what do you want to do?
For neuro pts, if theyre hypertoned, tight, and spastic, what do you want to do?
What is a PRE?
progressive resistance exercise (giving exers and then progressing them)
What are some types of mechanical resistive exercises?
- active-resistive training
- overload training
- load-resisting exers
What is the purpose of mechanical resistive exers?
increase muscular strength, power, endurance
to increase strength, an overload must be applied progressively, as strength improves add resistance or number of reps
What helps determine the intensity and reps of mechanical resistive exers?
- pt goals
- stage of healing of injured tissue
- pts current condition and level of fitness
During mechanical resistive exers, when the goal is to increase m. endurance, or while pt is in the early stage of soft tiddue healing, what type of exers should you perform?
submaximal (below the max they can do)
During mechanical resistive exers, what type of exers do you perform in the later stages of rehab?
What increases as the intensity of exers increase?
What is RM and who developed it?
repetition maximum - DeLorme and Watkins
greatest amt of weight can move thru range 10 reps
What are the percentages of weight for bench pressing, leg extension, and leg presses?
- pressing- 30% of body weight
- extending- 20%
- pressing- 50%
If you want to improve muscular endurance, what do you increase?
number of reps, rather than load
How long must mechanical resistive exers be performed to significantly increase strength?
at least 6 weeks
(every other day or 4-5 times a week)
What does the speed of contraction during mechanical resistive exers influence?
amt of tension
as velocity of the shortening increases , the force decreases (doing reps really fast)
How should isotonic mechanical resistive exers be performed?
slow and controlled
What is speed specific isokinetic training?
provided accomodating resistance to limb throughout the ROM
machine only allows a certain degree of motion at a certain speed
What factors help determine the mode of exers?
injury/disease, stage of healing, condition of jt, goals, functional activities returning to
What types of exers do you use with static/dynamic strengthening?
- static- isometrics
- dynamic- concentric/eccentric
What does positioning (open/closed chain) affect?
- tension-developing capacity of m.
- amt of weight pt can control
- carryover to functional activities
What are the 5 regimens for isotonic exers?
- DeLorme technique
- Oxford technique
- DAPRE (daily adjustable progressive resistance exercise technique)
- circuit weight training
- plyometric-stretch-shortening drills
What is the DeLorme technique?
- determine 10 RM
- pt does: 1/2 of the 10RM, then 3/4 of the 10RM, then full 10RM
brief rests, weight increased weekly as strength increases
What isotonic technique decreases resistance as fatigue occurs; determine 10RM, pt does: full 10RM, then 3/4 of 10RM, then 1/2 of 10RM?
Oxford technique (reverse DeLorme)
general warmup before
What is the DAPRE technique?
daily adjustable progressive resistance exercise technique--developed by Knight
- determine working weight with 6 RM
- pt does: 10 reps of 1/2 working weight, then 6 reps of 3/4 working weight, then as many as possible of full working weight, then as many as possible of adjusted working weight
What are isotonic exercises carried out in a specific sequence using a variety of exers (free weights, weight-training units)?
circuit weight training
upper body, lower body, core sequence
What is the specific isometric regimen, and who developed it?
- BRIME- brief repetitive isometric exercise
- Hettinger and Muller
What are the characteristics of the BRIME regimen?
brief repetitive isometric exercise
- improve static m. strength
- up to 20 max contractions held for 6 seconds (20ish secs of rest inbetween)
- minimal effects on m. endurance
- if goal is to improve strength- must use multi-angle isometrics (every 20 degrees)
- can apply mechanical resistance
What are the 2 specific regimens for isokinetic exers?
- velocity spectrum rehabilitation
- eccentic isokinetic training
What are the characteristics of velocity spectrum rehabilitation regimens?
- work at various speeds (usually 3 contracile velocities- 60,120,180 degrees per second)
- mostly concentric
- in early stages begin with submaximal with slow speeds
- in later stages- max at a faster contractile velocity
- *increases m. endurance-extend time exers performed
- *specificity of training
What are the characteristics of eccentric isokinetic training?
- use in late stages of rehab
- performed at slower speeds than concentric isokinetics
- 60 to 120 degrees/sec for gen. population
- 180 degrees/sec for athlete
- submaximal levels
What are some benefits of mechanical resistance?
- can quanitify
- objective measurement of improvement in strength
- level of resistance not limited by therapists strength
- adds variety
What must you know about a patient before using equipment with them?
strength, ROM, joint stability, bone or joint deformities, pain, and integrity of skin
What is the disadvantage of theraband?
increased resistance as band lengthens- usually at the weaker part of the patients range
What are some closed chained resistance devices?
- elastic material
- balance boards (BAPS)
- stepping machines
- sliding boards
What type of resistance cannot accommodate to a painful arc?
constant and weight cable isotonic
What are some points to consider when using isotonic equipment?
- free weights and pully - weakest point in range
- free weights-can vary position-will change the point of max resistance
- standard weight pulleys- max resistance when angle of pulley is at right angle to moving bone (weight heaviest at 90)
- move slow except when using hydraulic or pneumatic pressure
What are some types of resistive equipment for isometrics?
- weights that are too heavy to move
- isokinetic machines set at 0
- pushing against the wall
What are some advantages of isokinetic machines (provide accommodating resistance and control velocity)?
- max resistance at all points of ROM
- high/low speed done safe and effective
- accomodates to painful arc
- exercise can continue as pt fatigues
- concentric and eccentric of same muscles
- reciprocals can be done
- visual/auditory cues from computer
What are some disadvantages of isokinetic machines?
- large and expensive
- set up time and assistance
- cant be used at home
- most provide only open chain exers