Anatomical terminology and exercise training principles

Basics of strength training

Muscle fiber types

Slow twitch (Type I)

• Slow contraction speed
• Low force production
• Highly resistant to fatigue
• Example: Postural muscles

Fast twitch (Type IIA)

• Fast contraction speed
• Fatigue resistant
• Can be influenced by training
• Examples: Muscles used for strength and movement

Fast twitch (Type IIB)

• Fast contraction speed
• High force production
• Susceptible to quick fatigue
• Examples: Muscles for quick movements and eye muscles

Guidelines for strength training

The foundational concepts of strength training are

Contraindications to strength training

Types of exercise for strength training

Isometric

• Muscle contraction without change in muscle length
• Example: Quad sets
• Typically used during the acute phase of healing or when learning muscle control

Isotonic

• A muscle produces force and changes length, with tension remaining relatively constant, allowing movement at a joint.
• Example: Bicep curls with a 20-pound weight
• Used during sub-acute and chronic phases of healing when pain and inflammation are reduced. Requires that adequate motor planning and movement control have already been established.
• Concentric: The muscle shortens, for example, standing from a seated position with shortening of the hip and knee extensors.
• Eccentric: The muscle lengthens while holding tension, for example, controlled sitting from a standing position, controlled with lengthening of the knee and hip extensors.

Isokinetic

• Muscle changes length (shortening or lengthening) while moving at a constant, controlled velocity.
• Example: Isokinetic machines using electric or hydraulic dynamometers
• Provides accommodating resistance that matches the force the muscle generates, it loads the muscle maximally throughout the entire range of motion
• Used during the sub-acute phase of healing when the concern of re-injuring muscle is a concern due to control of movement and resistance throughout the movement

Endurance training

Effects of endurance training

• Capillary growth: More capillaries in muscles improve blood flow and oxygen delivery.
• Cardiac adaptations: Stronger heart muscle, increased stroke volume, and improved cardiac output.
• Metabolic benefits: Enhanced ability to utilize fat as fuel during exercise.
• Improved VO2 max: The maximum amount of oxygen your body can use during exercise increases significantly with endurance training

Guidelines for endurance training

Signs to stop endurance training

Coordination and balance training

Effects of coordination and balance training

• Reduced fall risk
  • Improving ability to react quickly and maintain stability, overall reducing fall risk
• Improved coordination
  • Allows for smoother movements, better agility, and quicker reaction times
• Improved proprioception:
  • Balance exercises stimulate the nervous system to better sense your body’s position in space, enhancing proprioception.
• Better posture:
  • Regular balance training can help maintain proper alignment and posture by strengthening the muscles that support the axial skeleton
• Muscle strength and endurance:
  • Improved muscle activation, leading to increased muscle strength and endurance throughout the body

Guidelines for coordination and balance training

Interventions that can be used are as follows

• Therapeutic exercises
• Postural training
• Weight shifting activities
• Sit-to-stands
• Gait training
• Dual tasking
• Changing surfaces
• Sensory training

Contraindications for coordination and balance training

• Acute injuries
• Severe pain
• Unstable joints
• Recent surgery
• Significant neurological impairments
• Severe dizziness or vertigo
• Poor vision
• Cardiovascular instability
• Uncontrolled medical conditions

Aquatic therapy

Related physics

• Buoyancy: Force of water on immersed body segment, decreasing body weight and joint off-loading
• Cohesion: Water molecules adhere to each other, creating resistance
• Hydrostatic pressure: Increases in proportion to water depth; assists venous return and reduces edema
  • The deeper the individual is submerged, the greater the hydrostatic pressure and the more body weight is offloaded by buoyancy

Water temperatures

• Cooler water: Used for high-intensity exercises - seen more in athletes
  • Multiple sclerosis patients: 80 - 84°F (26 - 29°C) to reduce spasticity and fatigue
• Warmer water: Used to improve mobility and flexibility while decreasing pain - common rehab population
  • 83 - 86°F (28 - 30°C) is a common range for fitness
  • 88 - 92°F (31 - 33°C) is a common range for osteoarthritis

Precautions for aquatic therapy

• Fear of water
• Patients with heat intolerance

Contraindications for aquatic therapy

• Bowel/bladder incontinence
• Severe kidney disease
• Seizures
• Uncontrolled cardiac or respiratory disorders
• Peripheral vascular disease (PVD)
• Open wounds
• Active bleeding
• Active infections

Ways to progress therapeutic activities

Progressions examples