STRENGTHENING

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STRENGTHENING
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OVERLOAD PRINCIPLE

• To increase muscle performance, muscle must be
  loaded to exceed the metabolic capacity.
• Amount of Resistance
• Number of Reps
• QUESTION How can you determine if you are
  overloading to an appropriate level?

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MUSCLE FIBER TYPE

• TYPE I Slow, oxydative, high endurance
• TYPE II Fast, glycolytic, low endurance
• Type IIa Fast with some O2 capacity
• Type IIb Fast Glycolytic
• Type IIc Developing, reinnervating, transferring

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CONVERSION OF FIBER TYPE

• Endurance training can cause conversion of type
  IIb to IIa (fast with some O2 capacity)
• 10 Hz ES can cause conversion of type II to I
• Immobilization causes atrophy
• Decreases cross sectional area
• Type I fibers atrophy more than II
• Endurance, then, is significantly affected
• Aging Decrease type II proportional to type I
  fibers

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MUSCLE FIBER RATIOS
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MUSCLE FIBER RATIOS
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FIBER TYPE BY ACTIVITY
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DISCUSS

• Change in training work load from continuous to
  intermittent paralleled a decrease in Type I
  fibers with proportional increase in Type IIc or
  transitional fibers (Jansson et al, 1978)
• SPRINTERS ARE BORN AND NOT MADE

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Rehab of Patellar Pain
McConnell VMO is Only medial stabliizer Of
knee VMO 52.1 Type I Disuse Decrease Type
I Fibers Lateral Drift of Patella
REHAB Restore normal Levels and strength Of
Type I fibers Restore normal Pain free function
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DISCUSS

• VMO Normally 52 Type I Fiber
• VL Normally 39-51 Type I Fiber
• How does loss of endurance of VMO affect patellar
  tracking?
• McConnell approach to patellar problems.
• Taping-reeducation-strength

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LENGTH TENSION RELATIONSHIP
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ISOMETRIC EXERCISE

• Muscle Setting vs. Fixed Resistance
• Can Muscle Setting Increase Strength?
• Duration of Hold
• Number of Reps
• Vigor Can it be varied?

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ISOTONIC EXERCISE

• Definition
• Different methods

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ACCOMMODATING RESISTANCEISOKINETIC STRENGTHENING

• Resistance changes to adjust to the force given
  by the muscles
• Advantages?

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CLOSED CHAIN STRENGTHING
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CLOSED VS. OPEN CHAIN

• CLOSED
• Increases strength
• Requires M Stabilization
• Joint Approximation
• Coactivate agonist and antagonist
• Improve balance and posture
• EXAMPLES

• OPEN
• Increases strength
• Allows isolation of muscles
• Coactivaton of agonists and antagonists may not
  occur except at high speeds
• EXAMPLES

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PLYOMETRICS

• Demo (21)
• Series elastic properties of muscle (21)
• Stretch reflex (23)
• Can be open chain (22)
• Progression (19)

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SPECIFICITY OF TRAINING
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TRANSFER OF TRAINING
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FATIGUE

• Local vs. Generalized fatigue
• Why do we need to be aware of fatigue?
• Do we want fatigue?
• How much is enough time between sets?

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(Pincivero et al, 1997)

• Isokinetic strengthening of quad and HS 3X/week
  for 4 weeks. 4 sets of 10 reps. Added one more
  set each week.
• Compared 40 sec inter-set rest to 160 sec
• Those with 160 sec inter-set rest showed greater
  hamstring, but not quad strength
• Allow recovery (intramuscular stores of
  phosphocreatine, ATP)

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DELAYED ONSET MUSCLE SORENESS

• When
• Why
• Treatment and Prevention

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LOIS RULES FOR DEVELOPING A STRENGTH PROGRAM

• RULE 1 DO NO HARM
• RULE 2 DONT WASTE TIME
• RULE 3 REASSESS WEEKLY
• RULE 4 HAVE A PLAN (Delorme) BUT..
• RULE 5 LET THE PATIENT BE YOUR GUIDE
• RULE 6 BE SPECIFIC
• Target Specific Tissues
• Target Specific Functional Activities

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DEVELOPING A REHABILITATION STRENGTHENING PROGRAM

• Precautions, protocols, guidelines
• Vigor
• Strength vs.
• Endurance

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De Lorme Protocol

• Repetitions Max
• 10 RM
• 3 RM
• Progression Protocol
• ½ 10 RM
• ¾
• Max
• Followed next visit by 3/4 , Max, Then New Max
• Endurance 30 X ½ RM

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OXFORD

• First determine 10 RM
• 10 x 100 10 RM
• 10 x 75 10 RM
• 10 x 50 10 RM

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DAPRE

• 50 6 RM X 10 reps
• 75 6 RM x 6 reps
• 100 6 RM x max reps possible
• 100 adjusted working weight x max reps

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BREATHE!

• Val Salva
• Form
• Substitution

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BEST PRACTICES

• Hughes CJ, McBride A. 2005
• Question Is there a difference in muscle
  activation between tubing vs. isotonic
  resistance.
• Method 12 (male female)
• EMG recording of upper trap/supraspinatus,
  andterior and posterior deltoid, infraspinatus,
  middle trap, pec major, lat dorsi, bicep brachii.
• Different positions done using dumbbell and band

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Exercises

• Free wt.
• Sidelying ER
• Scaption full can
• Prone retraction
• Prone extension
• Thera Band
• Standing shoulder ER (elbow 90)
• Scaption ex line D2 PNF
• Standing shoulder retraction
• Standing shoulder extension

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RESULTS

• ACTIVATE INFRASPINATUS
• Greater using tubing (65-87 MVIC) than free
  weight (36-79 MVIC)
• ACTIVATE UPPER TRAP SUPRASPINATUS
• Greater using green tubing (24 MVIC) than 5
  weight (10 MVIC)
• ACTIVATE POSTERIOR DELT
• Greater using 8 weight (67 MVIC) than blue
  tubing (40)

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RESULTS

• ACTIVATE ANTERIOR DELT
• Greater using 8 weight (45 MVIC) than blue
  tubing (23 MVIC)
• ACTIVATE RHOMBOID/MID-TRAP
• Greater using red tubing than 2 weight

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CONCLUSION

• Body position and type of resistance influences
  muscle recruitment in rehab exercise.