NUR FARHANA MD YUNUSPT DEPARTMENT

Upon completion of this course, students should be able to:

Explain the concept, selections, effects and uses of the strengthening exercises (C2,A2, PLO1)

Show the procedures of strengthening exercises. (C3, P2, A2, PLO1,PLO2)

Any form exercise in which a dynamic/static muscular contraction is resisted by an external force.

3 types: Isotonic resistance exs. Isometric resistance exs. Isokinetic resistance exs.

To increase:

Muscle strength Muscle power Muscle endurance

Contractility Ability of a muscle to shorten with force

Excitability Capacity of muscle to respond to a stimulus

Extensibility Muscle can be stretched to its normal resting length and beyond to a limited degree

Elasticity Ability of muscle to recoil to original resting length after stretched

Muscle size Muscle structure fusiform, pennate Proportion of muscle fibres Biomechanical and histochemical properties Neurological factors: Coordination Limitation by disease that affect neuromuscular system.

Cross-sectional size Length and tension relationship at the time of contraction Recruitment of motor units Type of muscle contraction Speed of muscle contraction Motivation of patient

TYPE ITYPE II Red fibers Smaller Endurance More blood Slow twitch

It is the most common form of resistance training exercise which uses free weights such as dumbells and barbells.

Dynamic form of exercise Muscle contracts and shorten (concentric and lengthen (eccentric). Produces visible motion A measurable amount of tension and force output are produced by the muscle with mechanical work done (force x distance) Sources of resistance manual, body weights, free weights, machine

It involves muscular actions in which the length of the muscle does not change and occur against an immovable resistance.

Static form of exercise Muscle contracts and produces force without change in length No visible motion occur A measurable amount of tension and force output are produced by the muscle but with no mechanical work done (force x distance) Sources of resistance manual, maintaining a position against body weights and pushing or pulling an immovable objects

Types: Manual resistance Mechanical resistance

Definition: Any form of exercise in which resistance is applied by therapist using a static and dynamic muscle contraction

Limitation: Force cant be measured Mild to moderate force Depend on therapist strength

Prior to the exercise:- Evaluate patients ROM and strength Explain the plan ad procedure Position the patient comfortable, supported Demonstrate movement Explain to patient to perform with maximal effort Ensure that patient does not hold breath

During the exercise: Consider the site of application of resistance Passive on distal end Determine the direction of movement Provide stabilization Apply appropriate amount of resistance (dynamic, smooth, pain-free)- Reduce the resistance if: Patient unable to complete ROM Site of resistance is painful Developing of muscle tremor Substitute motion occur

Isotonic concentric Isotonic eccentric IsometricPNF (Proprioceptive Neuromuscular Facilitation)

Definition: Any form of exercise in which resistance is applied by some type of equipment.

Advantage: Best form exercise to increase power, strength and endurance Pt can exercise independently Force is measurable Variable resistance - Mild to full resistance No limitation Constant resistance

Free weights Barbells Dumbells Sandbags Weight boots Elastic resistance Thera-band Medicine/physio balls Pulley and spring system Working stations Others ergometer, rower, quads bench, leg-press bench

Load and number of repetition Sets and frequency Duration Speed Type of muscle contraction Submaximal vs maximal ROM short arc vs full arc Starting position

Used as a starter strength Comparison for progression Type: - One repetitive maximum (1RM) Ten repetitive maximum (10RM). Spring balance technique. Trial and error techniques.

Common formula used to calculate 1RM

- Epley Formula:

r is the number of repetitions performed w is the amount of weight used

maximum amount of weight one can lift in a single repetition for a given exercise can be used for determining an individual's maximum strength method for determining the winner in events such as powerlifting and weightlifting competitions can also be used as an upper limit, in order to determine the desired "load" for an exercise (as a percentage of the 1RM)

Definition: A weight that muscle can lift with maximal effort for 10 times without fatigue.

Can be estimated in 2 ways: Using spring balance Trial and error: Using specific weight Using therapist manual resistance testing

Set spring balance 90 to the middle range of motion Ask patient to perform 3 max effort Calculate mean for load

Depend patient strength kg, 1 kg, 3, kg, 5 kg.. Try and error Ask patient to perform 10 lift effort Observe the muscle for sign of tremor

Perform manual muscle testing on patient Take weight that almost on the therapist resistance Ask patient to perform 10 lift effort Observe the muscle for sign of tremor For experienced physiotherapist

Regime DeLormeOxfordMcQueenUsageRehabilitation Progressive Resistive Exercise (PRE) Strengthening Rehabilitation Strengthening Endurance Rehabilitation Endurance Sets10 x 10RM 10 x 10RM 10 x 10RM 10 x 10RM 10 x 10RM 10 x 10RM 10 x 10RM 10 x 10RM 10 x 10RM 10 x 10RM ProceduresDetermine 10RM Sets lifting Repeat 10 RM testing every weekDetermine 10RM Sets liftingRepeat 10 RM testing every weekDetermine 10RM Sets liftingRepeat 10 RM testing every weekIntensity Minimum of 4 sets per week Minimum of 4 sets per week Minimum of 4 sets per week

RegimeDAPRECircuit trainingUsageConditioning using daily adjustable progressive resistance exercise Endurance Strengthening Using sequence of variety of exercise for total body conditioning Endurance Strengthening Sets10 x WW 6 x WW As many as possible x WW As many as possible x WW Bench press, leg press, push up, chin up, sit up, shoulder press etc using repetition and time

Commence at the level of patients capabilityProgress gradually Stick to safety aspects - eg warm up, stretching React appropriately if patient experience pain or discomfort

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