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THE LUMBAR SPINE,

THE CERVICAL SPINE

AND THE KNEE

TESTING AND REHABILITATION

Arthur Jones

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INTRODUCTION

Prescribing Optimal Protocols for

Rehabilitative Exercise

By Vert Mooney, M.D.

Professor of Orthopaedic Surgery

Department of Orthopaedics and Rehabilitation

University of California School of Medicine, San Diego

Skillfully prescribed strengthening exercise is the most beneficial protocol of treatment during mus-

culoskeletal rehabilitation.

Modern medical care should have the same precision and reproducibility in rehabilitative exercise

programs that is expected in a dosage of prescribed medication. By using specific testing and

standardized conditions, the dosage of exercise can be brought to the level of accuracy inherent in

the prescription of medication.

For exercise to be definable it must be performed in a measurable manner with a specific treat-

ment response in mind. The specific treatment response can only be identified if accurate

objective quantification of pre-treatment strength is defined.

In the accurate quantification of strength, these factors must be considered:

Isolation: Accurate measurement, effective neuro-muscular education and muscular overload canonly be achieved in an isolated environment.

Non-muscular Torque: Within a joint's range of motion compression of soft tissues and the elas-

tic characteristics of stretched tissues create torque. These factors must be factored into the

measured output to correctly assess net muscular torque.

Motion: Movement during testing requires acceleration and velocity; attempts to control these fac-

tors create impact forces which inaccurately contribute to measured muscular torque output.

Movement also produces friction which is affected by speed and fatigue. Friction and impact

forces are essentially unmeasurable and should be eliminated during testing.

Accurate measurement of muscle strength must be done in an isolated static manner. Thismethod of testing allows for the identification and correction of gravity and other sources of non-

muscular torque, and it also eliminates the movement artifacts of impact forces and friction. Static

testing allows for a true maximal measure of voluntary effort and accurately co-relates position

and torque.

The dose of effective therapeutic exercise can be determined by measuring starting functional abil-

ity (strength, range-of-motion and endurance) accurately. The goal is to prescribe a specific dose

of exercise that will elicit a predictable, measurable response. The most effective method of testing

and prescribing the dose of exercise is the system described in the following pages.

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TABLE OF CONTENTS

Introduction 1

Table of Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Foreword 5

Chapter 1: Testing for Spinal Evaluation 7

Chapter 2: Risk Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 15

Chapter 3: Misleading Testing Procedures 24

Chapter 4: Abnormal Strength Curves. . . . . . . . . . . . . . . . . . . 34

Chapter 5: Rehabilitation............................... 43

Chapter 6: Meaningful Testing of Spinal Function 58

Chapter 7: Spinal Function 73

Chapter 8: Testing Knee Function 81

Chapter 9: UF Research Publications . . . . . . . . . . . . . . . . . . .. 89

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FOREWORD

by Arthur JonesFounder and retired Chairman of Nautilus Sports/Medical Industries, Inc.,

now Chairman of MedX Corporation.

This book is not intended to be a source of information on the subject of clinical rehabili-

tation. A supplement written by several doctors will be published during the latter part

of 1993,and will provide suggestions for treatment protocols based upon their experience

with thousands of chronic spinal patients.

Testing the strength of the muscles that extend the lumbar spine requires total isolation;

if the pelvis is free to move, the measured level of torque will be a result of forces pro-duced by muscles of the hips and thighs as well as the muscles of the lower back, and it

is then impossible to determine the true strength of the spinal muscles.

In addition to torque actually produced by the force of muscular contraction there are

three sources of nonmuscular torque (gravity, friction and stored energy) and these fac-

tors must be considered in order to perform a test of true muscular strength.

Strength varies from one position to another throughout any full-range movement, so it is

necessary to determine the relative positions of the involved body parts; true changes in

strength can be determined only when the tests are conducted in known positions.

Solving all of the problems encountered in the development of equipment that is capable

of performing meaningful tests of strength, range of motion and muscular endurance re-

quired fourteen years of continuous research; a program of research and development

that has now been ongoing for more than twenty-one years. This book outlines the dis-

coveries that resulted from these years of work.

At the moment (March, 1993),the treatment of spinal pathology remains one of the most

controversial subjects in the field of medicine; and, in my opinion, a large part of this con-

troversy is a result of the fact that earlier attempts to measure spinal functions were

incapable of producing meaningful test results.

Earlier testing procedures ignored a number of important factors that must be considered

in order to perform meaningful tests of spinal functions, and this book is primarily in-tended to explain these factors.

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CHAPTE'R 1

S,PECIFIC TESTIN'G F 'O R S PI'N .A L E ,V 'A LU ,A TIO IN

Evaluation e'.frundional improvement during r,ehabilitatiion must be based ' D E l objective test tesuUs.CJ:wllg:eS in stre ng th , endurance and :raJ;1 L,g eof ,motiOIl ,can provide tbe'lI'equired it, formatien if the I~estsarebaHl specific and accurate; but the requ~re1l'l.e11 ts for valid 'testing must be deai~yund.etsifuood and applied.

FII:GURE1-1 Meaningful test ingl 01 the musc l !es (hal e'.x t€ l 'ndi the' : I 'umbar sp~ne invohless eve ra l co n si',d era t 1 1 0 n s :

1 ••• T Ile , I !Dwer sp in e m us t be ~s ,o la1:e dIb , alli l lcll 'u::.rl 'ng the, peH/ is , to r,e :m o ve M II"C es produoedlb y nU Jlscles Df Ute h 1ps ,ana tl i l~:glhs,,,

2 " • . The 'Ior-so~ Ih ead an dl a rms must be cou nlerwe Ighte d to eomp ensa. '10r to:rque prod L I l c e dby 9 r. iJUit v ae l i n gl U p io n 'the mess o f tllese body piarts.

3 ••• AU other S'DUIrces, of nonmus,cu la lF tOlrqUB' must be measured by th e m ac ild ne , ,and factoredi'nlQ, test resulils by the computer.

4, ... T l ru 'e nUJscuJs lI I' strength must be measured in seve , r am po , s lt io , ns throughout f i I , fu'. m,nge 'of movem ent,

S , • • • Tested le v e d s , ,o f strength must be cOrlielal:ed w ith th e pos ition s; ln wh clhlhey

we re m easu re d .

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F IG UR:E '-2 . U se d on illy fO'I:' dlen'lOl'lstra:tmgllie·

: s.y s~emrequ ir ed to isolate th e lumbM' sp]_ne..th isma.~

chine has no dinical app]icatiOfi.. D:ruing medical

Senm1a l 'S , th e a ud ie no e otrulo t see h J : ) ' 1 l ' l l t h i s , SYSb:ml

works if a. cUl1 ica~mClde1 of the lu.mba_r.,~tetlsfon rna-

chine ·~sused for the' demonstration. But with thisV , C 3 I ' Y sfulple' milldID1Le/~heaudience can see exactlyWMt]S h a:-p pe nin g ;. F irst w e show whalt 'happens,wii l icmt propel' reStraint! the p elv :i.: s.r ota tm g a s the

subject moves. Then we show what happens when

th e subject is p110perJy]'.esttilllled: .f~-I'ange mQV'€'-

mellJ:tvvit l i lTl lo'peivic r ot .a no :n ~ io tn ll y j: SQ ].a ~ ed ] um -

bar-spinal l'WI,OVe:nlie!lt.

ls o lalin~gtn,! ~Iuml l l, ll r' sp ine , I"e! .quie sfOU f 1 '19s tra .in l:f e ! i a } l l J I I r e s , ~

1 ••• fOlrce ii IiiI1p'CI,slidiagaillills,t Ul:e bOUonl

'o f thle! feetl ~s:t l iaII iUi:mflied. by~he~ow,e I' ~e~!s 1 : 0 ' t lhe feElillillfS at: a n a ll1 l~ g 'le

of ap;p 'I i't I, xlm la te ly · 45 , f ie.g l rees.

;2 • • • L a l J ' i g e padls, I : D , C ' a ~ e d , a'bDVelh,E!! I Q w ' , e r

thighs ilimit lIIpwams m.QiVeDlenrt 'Q~

I'bl! knees.

3 , A bea·vybe ;I:1 pre:v,el i l l ts i u pwa .rc Ils m,QV I -

D il le n ! o f: th'e 'uppertli li:ghs andpe'lvis.

4 l • . . • A f\o 'liJ lild ;p ~a d 'p ,m 'llE !lfllt s m o vem le lillt Q , ·fth e

pellviis [nthe d iredlon fi lf , s l d e f l l s ; i : c n l l .

With this system of nstmint, the .h~~rvybelt above

the upper thi.ghs becomes a fulcrum. that redtrects

t he 1 i ,l !i pwa : rd so:r i:;e" l1Igamst thekneestoa d ow nw ard s

force tha: t prevent's the pelvisfecmrising; one poundcf force pushing the knees up becomes approxi-

matelytwo pounds. of force holding the pelvis down ..

Th.€: result befng forces im posed 'O n the pelvis he'P1-

P w " O d J ir ecHon s ; f orc e a ct in g towardsthe rearaloag

tnemi.d.[ine of l:lhef&nl1rs" and force holding the pe l -vi c Ihip sockets down, Pmpe : dy r("'Sh:.l]rl:ed ] 1 ' 1 : this

maehinesunwa n:tedmov'e~lr)en:tof the pelvis cannot

occur durh't,g~esting or exercise of th..eisolated mua-

des that extend UiLeambar spiue.

Thetwo mlomd biilr~graphs,shown on l the com-

pt~tm"mani~rrrme meesurements ,of~orce;the red bar-graphis a measurement offeree imposed on the oo't i tom

o:f~he[~t,. wh~]e th e groe:nba~1Jpl'l shows force pusll-'

ing the .femurs backagai.nst the pelvic/hlp sockets,

Without I t l r d s total restraint of tIw pelvis, force

bonf!~helJ], '~s of the Mpsand th~gl '1s would mi l k .e

~tWlpOSsJbne to ~es:fthe adual5tIreng~h oftbe muscles

~hm:te;x~d ti"lf: hID1 bi il r ; spine ; iUK! movfnlel'rto,f th e

pelws would make it ilnpassiole to determine thetrue :range of Isolated [um.bar~sp.fu:la[ mcvement.

D1iUfu.1tg~ tm:g and exetd ise. the mtl!scl.e8, Q I . F '~ehlps

and thighs will attempt to mcve the pelvis in thed irec tioo of ex t~ l1 L '6ion; but father lhancreating a.

problem, I : h : h i helps '~Qprovide the sornutiol1lj because

th e WKeS fr·onl the h ip a n d thig'l I T ! ! ! l L I ! S d e . sp u s h tile

pel vissoUdJy ag,ainst the pelvic-resb'am'[ pad , andprevent pel vic movement rather ~haincuuiiing:n..

No atitempt is made '0 0 prevent f'llovmd mo"v~

U'lel1~of thetop of the pelvis; doillL.g so'would be am i sta ke .. D : u:u :in gfesting and exercise in I~helumbar-

,e xtensio n maclt; J; n@ : , there :]Sf!!O k~1iI.de:n.cyfur the top

ef thepelvis to move ferward, so limittng such move-

m .erlt of the pelvi;s,is,not required: but if trus m . ,) ve -mC;'lIl[ wa s res~1ri.cted, i'~would be imp ossible to '

d ete rn ru I.m eth e tn Je ram ge o f 1so]a too. lun"lbar-.sp'illaJ

n'lOv;e'lllent ~owa:rds llie f[e~ed pos iJ tion . . .

LUMBAR - EXTENSION MlACHllNIE

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F I.G U R iE 1~ 4 T nm :'m g this clank p ro d ue e s fa rc ea,~inst thti bottom ofthe feet,

IF tGUR E J 1,,5 T Im '(TaDk. tightens the heavy bell i :

above the upper thigh.s to prevent upwards move-

men t o f tJ ;u ~p elv is.

f l 'G UFiJE '1..6 B efor,e cO'UJ ' : tenvelght i l ' l "g "au 'be

peil'formoo/the centerline o f to rso ma .; SSmu...5 ·tbe de-

i e m m I 1 I ; e d and the coun~erw'clgh;teonnected in an oF"

'posite dir,ecliolI ' ! !; when the sliib je d is sn fu rL gsttaightupr tile ( lQw: : t~e fW' ,€ i : gh t must be :Shlligh~down.

F .r - G U I R Ii 1 . :~'l '\IVi ~L o;l.. b ["..:I _ th. i'u~u~e su '.j~t re_a>it . 'U in e ex-

tended p06itiOrrtr the rounte:nv'edght i s. a Jd jus t- ed by

t :u :ming fh is crank UJ'Ilil balance is p rro vid e d .; wh enproperly a.d;;l_,s~ed~he weight of I t [ ' l , e ' body parts. is

balenced by the torque &omthe ml.mJ.~ruweight act-ing [1 1 an opposite direction. Proper cOlIDb!U'N"€!lghfr -

fig i is dearly e s t 1 1 l M i s h . e d by th ~ c omp u~@ :]'monitor.whkh w . i l l . tell you W.Mf i .[h@ subject is bala nc e d ..

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IP IIG'1lJ :e : 1 ~· 8 Whe n p ro 'p er ]y l'I es tr E liI le d arid

oow1J.berweigMed~the sliibjed is requested w , slowlymove £orwmd.m the' diremol"! of £ 1 e x J O n l of ~he lum~

bacrspine. While the su.bj,ed moves forward, t]:te

fuenpisi~ should watch Ute reund pad.1Qcil l . ' l :ed.b~mnd

fhe' pelvis; this pad is .:free~o r-ol:a e areund :HsO~

axis, but should not rotate; a:nymnv,e.me:rd of thisp ad in d i,c aiie s tltat t .h e p ei vi s, li s also m eviag , T he

subject should s]!ow .[y.m a ve f orw a rd as lo ]]:g as thereis no movement ' O f f I~hepa.cli;but should s~0'P if the

pad startstn rotate.

tru e! fiill.n ge O I l Iso~ale.d IUlmlbiU~S!pi l !nia lmOiy ,e lme l i l : t is e s tab .IJ s li Jed by the ran g:e Il iIa.t [ ,s ·

plI 'odl lu:; ,edi 'Wilt,h .n o :move :men l of lh.e perrvil,epla d.. H avin g Id e,te li'm ~n ed th e lim it of 'fo f'IN ,ord s,mOlvement, th e I la rg e , gO ln li ome te !1 i ( an ,g le de te rC~tor') 'teilis ~liIle Ihe~a:pi,s,t 'the ranlg:e of~so ~.ed

, s ' p i i 1 1 1 1 a . 1 1 m,o:ue:me:nt.

'YV ]1 l; en au bje ct is p ,[1 o pe rly re stra in ed in th e U!(I;-dm '1 !~ l~l' l1e,elat io{ lJ Ish ip o .f l : . l 1 l e pelvis to t X l e pe l vie-re-stramt pa d becomes,idlentical ·~CI the rej,albonship of

t IW 'o geli lJl 'S' locked toge:ther by tlleir t€elth;w'helil,~thN

O I ' l @ o f such. 8 1 . 'pm o f g e a :r s m~ i l'I it es ,. th .e .n .t he other'g~M mustalsaretate, Exac(]y the semething occurs

in this macluitn~; if the peh I ' i Sn : lDves , then the pel-

vic-restraint pad must rotate around its own am;

mcvemen t of the pad that can be deadyseen.But

if 1l1"1epad does no tmove , you can be sure 1 1 1 Ia itth e

pelvfs is not moving.

p~GUR:e t.,g Will1.the ,,;,ubjed relaxed in the for~ward po.sjtion.~the computer monl tor will s l10V!,1 ' a

'b1ll'"g"Iaphofrorrque; 1l1l.Qvil1ighll~Qtlithiposi~ioncom-

presses tlss1l:[f'U:I the front and stretcb.estlsslilte ill the

·l!I%U· of the terso, and this stared energy will peoduee

tonlu'e LJi1t i h f ; t d~cijon of , e x tens i on of ate spine,

~f ril' llt m e B i s u l F e ! ! : i l . a J l l i l d c 1o n s i , c l e l r , e c l l , t t l 1 l i l s nOI l i l . -

m W1SiC!U~a r to rq U!E !' w ii il l p i fa il 3 Ul0ea s ig n ifi,caml'tove' li "s ta tem.el l1 lt I IlI t ru e s,trel i l lgtih i l l i l , t h a t . p o , s i t i , o n .

~'. II~ ' , _ E X . 1 U E H S !O .N I

:z~~75 .,i;----+--=---+-------ili----ti------iI

~' I

( 5

2~~'~ - - - r - - - - ~ - - ~ - - ~ ~ - - ~ - - ~

fiGURe 1~' I The bar~graF'h ,disp]ay,ed on the

m onitor ind icates the ]ev·eJl of noml:'liUS:Cw,aw torque

prndueedin th1ilt positiGn. A large man, totally re-

]axoo in the fully-flexed P O S t tion ..nliiY producemoret.han .300 f,ao~-pounds of nonmuseular torque.Torque thal is not produced by the fOl lce of muscular

contraction, but will overstate ~ h e t r 1 l J J A ~ level a . rstrength to an enormons degree,

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f'lGUR15'1~11 Having measuredand recorded

nonmuscular torque ~vhne relaxed, the S U b I C ' i H : t

should then grnduaUy pwduaemuscular :fo!rcell thedirection of e~reru;fon.of thelambar spine, As the

level of ,eHod is increlilseC!, the lfionilor shows a,r~ing

b ar- gra p h o f to rq ue . Haril 'lg reac hed a m axim um]!eve.~of effod, f ue s u; bj ed should maintain ~hat level

fot a p p rQx im a tily tv vo e ec c nd s , aadthenslowlyre-lax. Muscil.llax f-omces hould b e il't~al1dred1l[oed

sillowlYI'Mthout j~rkmg.

lhe max iimu m leve~ Q f m e ,a s lI l r le c im r q , lL I I e , [ i s

f I l. ll Il iH : : UCH f f lE i ~ . e ; ,t il r 'e l iI I~gtli l~ 1 i I I I n , a l posit iOln", W l h le t n l

noru li Il i. II :scWl la rtorque , is , s.ub lta:o ted ~ the feml;Jill'il-

Icier E S t h 1 e true l e v e l i ol f m l i J L I s c u l ar S it1r e l l 1 l l g t l i l :m l f q l l L l l e , a c t U r 8 II~y'p l l i C l l d L u : : : e d by-the folliCle 'C l I ,1m l ! l s ; - -

, c ll I i a r c C l n .~ r a e U c J I II ' " Net M U ls 'c u la r T c ::n 'lq lU e ~ I r r t IM i T ,

linW l S C I !. lI 'I la r s t r l ~ I r n ! 9 1 1 i 1 I J J I n b ~ r : l s e d l t I , . , a n i , SOUl \ce ,o f, li lo l l lm l lJ l s c lJ J I 'l :a : r l o : rq l lJ J l e "

WUhsta j l ic tesUrng l~ 't h e a r timc ts in'nereliilt w i t t 1 l

i a l i l l o i r n a m i c tesl~l i Ig l p , I I ' O C e d U l r e s ,are avoided.

All dJ(nan:icplm.1edmes pn.u:li.u.ceerrorintest re-

suUs hom several uJ1J.avoidab~esources: impact

forces, friction and stared energy- (torque producedby s t'r e: tc i'l lir lg a nd I c .omp re ss in g s of t tis su es ). W l f hout

proper ro1.m:~e~ghting.,addltlorud err-or ismtro-

duced by grnvHy.

F IG 1I IF IE 1· ,1 :2 Havi ] lgpe] '~o :rmed res t: sin. several

po s:iH on s th ro ug ho ul: a fu J1m n ge o f movement.themomto r s l \o \l 'i .. fSa ba~~-gnlpho if torque in each positio~.A nOnI,td . ratio, offuJ1J.ctioi£1i~l stten.gtliJ.wQuld show

Ule mgl'u;!:st level o f '~Q l'que .i n. l li@ f le x.e d posi t: i.o :n andthe lowest ]ev,e] in the m;:!;ended.position, withpro-

p()rtI.o.fla;~levels mrnbar.medja.t@· positions,

I LUMBLAI il ' I I! :X i l1 !NS~ON~ P---9F~~~~~~~~~~--~

.~ "!l I ! > & e N : S ~ I Q ~ 1 II IUx,b;~5:-+10 IiI:z A 1N CIlC :N A1> :s m~N :Gm -.

~ 3 :1 5 !\:~;:~E3::r:l::~

~2~,~~~--~_1"'~~~~~~--~1' - " j " ' .eu ... ,"""',~ 1 i : 1 : 5 lli----iF--iI-----i------;----+------fIC J~:01~, 0 b- __~ __~~ __~ __~ ~~_d

a 12 ~4 36 ,48 00

A N,a :LE I til IOIEGREEiS

72

FIGU'Re 1,~n; Basoo.lIfOll the torque measuredin several pas].tions~ the conlpulter will m~rpowte

snengthtlwoughout th e full rmge' o f mo 'V e tn@f i lt jfmd

Ute momtor will. then show, ..Mldfh~p.rln~ef'Wm prln~

tw o d istinc t sb :eng th C UIV e.s. The red curve shown

' O J 1 l ffie monitor is t h , e ' fuJl~mnge level of func·tiol'lru

5t1Jen.g t~, expressed in foot=pounds (or N eww II m e-ters) ottorq:ue and correlated wUlt positional meas-

urementsrwhile the yeen curve shows truemuseular

sttleIilgt~NMT.

In addition to I :n@~"D full-Ttlnge sbL'englh. curves,the' printed :report provides all of the raw' dat11l:oofuf tm ctio '][I1 ~ , . :e ' nd N ··M ;1c . .. . .. . . r, I.~..:l .. " "t l,. . _;1.. .' '. a. _ r~ a!l1: _ . QOul;:.ila~<;~ M_u 6ai!";n

bestedpQsitio'n.

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2 1 0 0

U) .....~EX1IENS~O,NCZ: :1'1501 I F- - - - I --~~~-_tt_---+__--

~I

IIIii-

o0·····00LL,

z:

50

t U M B A R '

a7 . 22 24 36 48

A N G L E liN D E G R : E E S

ABNORMAJ J TY

f II G l!U ~ 'E 1 - 11 4 Tw o te sts of rumct ionru strengtll perfurmed by all abnormal subject T he i~ O 'Po f the ro d

area shows the level of fresh :Sb' f ! lng]h. while the bottom of th e red area shews remaining. strength atftu

'the subject was ,exeKised. . The redarea beween t i ' . , e nN'O OIfWS is fatigue from I b l l i e ' exercise.

IB 'Qr th o f lih es 'E lI Cll .!U've,S; ShO iU li d h i l . t J v , e b e e n st:rai'Q'ht l i i n rE ! l s . T , n e , , C U J : H i ! I : in I n , e mlid I i ' ,angle llilf m'Q IV ' e : -

menl s l r J i ! Q u t l d t n O i l . halve 'o c , c ru r re d t, i l i l d lt i c a te a b n : c [ I I l ' m a i flLllfnlc,ticna, T he ,-'act U lI:a .t ' t I i l e same, :a .bnlorma~s h~ape was pil10,dueedl durMlng lbo, th te :s ts ; Indh: la tesv,a l t~dtmest :r lesu l~s . Wh iile · th e JUJ l ss~b lerUJlmberof ,abnofimsi l shapes: Is . Inlfinite,there lS i C1nl; , Cline nO' l ima t lsli1;a,pela strai,ght line; :llnd s lgn~f ican l lv a r U l I f i : 1 0 1 i I I 'f 'w lm a ,s llia i:ghi I I~ne ~s :, i lUl ~'I1dlh:at l ion,0 ,1 a b n QllI'niI aU·ty· .

Th is s ub je c t" s s t r e : ! ! l , g t l l . w ~s less thannaH o fE l iv ,e :r ag e ro r a ncemal male o f his . f i I . g e an d si~:mid~'lliuHesl. fil ll€ ~ ee t te n inches, with a hodyt<velght of 1 60 poun ds. With :ffilohlstorty o·f spinal problems, A fol1 (J 1w: il 'l .g

series of lateral X~l"aysshowed no abuorn:udity, and a cr scan was also negative, but an!V:ml scan detectedpmble.n1. ' :3in tw o of the d isc s and in 1t1,\!Q of the vertebral bod ies .

.A f a l l I I I re ' to pro d W Ie E l CQ I I I ' i I s~stemJl.esu Its: ~ E i I tltile sh a~pe o f the C : U J v , e s ; d urJng l r,e pe a te d te s ts ;~s an iru:UcatthJIIiIeta ru)n.CO:D peraUve SIl i Ib:lect.

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~2 24 36 ,48 601 72

A_N@1 lli I t\I [) EG:RIE~S

IF~GU FiI:E i I . ~15 F a,t~g ,tlJ il~itJ a,r;ac,ter~sUcs a lied!etelrmi l J' iI e d lb :, a thl i 'ee~p:alr1 prQICedUl re ,~

11 • •• A fu lll~ ln :u il,g e le s f o f fre'EdlJ stifE!'ngth.,

2 : D ynam ic e.xE! !ml ise to lvol l l i i t iornal l

fa t i gue .3 A te ,s t , of r ema i: 1i I~ ng s t re ng t ih

h"llhl l!w~fIIgIUile e) l j e re ise .

The li L fu ghestClllwe is U te le ve l o ff :r es h sttel1gtl1l. , while

'~h e lo ,w er cu rve shows reIDilI1l_illgs,ue11l,g:tth fuUo,\>\r ing

exercise. 'fae l i e d ! C 1 J . ' e a between U'tecurves is 'fatigue

f rom th e 'e::<) erc ise. In this c ase ShQWllllg a . high level

of fntigue produced bra brief session of s . u ' b . n h 1 X i n " l i l l

exe:r :dse ; mdica!ting~bat t his s u. bje c ta pp aJ )~ :r llt Iy h as

a hig hp ~: h\r en ta ge o f f as ~- t" ",riJ ch f i i ' b e r : : s , m th e m U . s - d e s

that ,extend the spine. Knowled~tfuat is cri;t ica~ dur-ing re h.a hili~ tio n sin es slL ib jec lS 'W i lifh th ese e harae -

!~ef.i .sHcsom etimes ca l1no~ ~o le :r at e either frequentexerc tse o x h lg h -v e pe tit j,o n e x e rc is e ; w i n 'U S !la l~ ypr<rduce the b est results, & o_ nJ ,exeeelse io'r spulal muscles

ifworked 0 1 l . 1 1 y once each week...may lose glt rengi i l iif exercised mOlief'rfquently. S ub je cts w i th . a .~ at,@ [ '

proportion. of slow-twitch fi.bersrn tltes'e muscles

may produce b€n~:r:msulls duringrn:efuabmtalion if

exerdsed !:'!Nicea week, or even three times each

week.

Re lila b iit i ita li i'l/e ' le 'x e rc Is e mu s t be barsedu p e n a cle ar wU 'lId ers ta ll1d in g 'o il' fa li:g lU! char-ae~er is t i les Orl l an Im U vh lfua~ bas Is . A , sen e d IJl ie,o f e xe rc is e ~hat was ideal fo Ii ' a sub jl ec tw ilt lma h ii g .h p ,e rcen tag .e , o f s low~tw~tch t libe l i' s m.i:ghtproduce overnJra~n ing: fO l r a subjec t wit h i dif fer~,e l l1 l to th aramer is i : i ' c :s .

F I I ,G U F i I& 1 ! - 1 6 The h ll lnba !! '- .e xbel 1 !! li onmac rnne

p r- ov id e s 3 9 1 ]e v'e ls . ( l i f resj5:~aJ; '1.ce i o'r ~p e ci fi c l e xe i , dse ;le,wenough for {h~weakest subied', 0'1' h i g J . \ enocgh

~o r th e slT -onge.s~ subjec~ but apprDpr1Eli~:eresistance

fora :s ubje d w Ul1. m : n y ~ev,€ i l lot s t re r ng :U l I l. T I le l e v e e ]

o f r es is ta nc e Carl. b e!ild jllsted in .1 nO J~ nts 'Df one~ 'O ()t;"pound . .

Ran :g e Illf mlo~em:en l . f,o F bOUiI '~es:tl i ing : 8 ' l i 1 l d

!e\xieir,c,is,e ,can be · l i imn:el i l l '~!DI any desi redp l a r t 0 '1 a . f ! l . l ' I I I . , J r . ; ; t l l ' l l g em!Oll 'ement~ a n d ~ h e l l i i l i i l · ,

leni im i l E ! wiil i l l i l i l 'DI Iprovide r , Q ! s i s t a m l e e IQu ts h :t e !t tl e ,sel leHl ' Ied I r ,ange 1 0 1 1 m 'ove men t •.

FtGUR'Ei : 1 . . : 1 ' 7 ' B oU t tes ting ; and exe rcise for thetotally isolated muscles t l 1 a . t rotate '~h_eorso are ron-

d&ctedi in thismachine: but since movement occursin a ]a~mJ plane '[here is no need to cou:nter'l f l , l ',e:ig''I l t

t h e s u b j e c tl I D l " S C F m a S S torque i s . n o t fl. faetor. The

muscles tha t rotate the torso are seccndintmpertaneeonly to the muscles thi1ilt extend theIumhar -spine.

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flGLlIRIi 11-18 Clhddans usm,g . M o o > : : : evaluation andr ,eThl, ,, lbUitaf io:n equipmen. t c-an a~~nd on e ef the

six-day ,educationAl. programs 'th at ax >e co ,n d u c'ltMhv ic e eE l ch mon th . Dlreeted by Mic h ae '[ POUOC '~Ph,D.~this, school h as bo on l in operat icn by tll'leCeruilter:6orEXei! fc[se Sclenee of the Col ll ie geof Med i dnej Uwvasity,o f Florida, GaiIl l@svUle

f0 0 ' 1 ' [he la s i [ six : v e a l ' S .

As iln iilil1llProv lea CME spons(ur!,~heUI i I .~v,eI iSr l t :y of fhJ ' l i ld la CiOUeg.e O il:Mea ~cil i l ,e h81$:d 'es i :gml,ateUI

~ h . e s l e Ied W I ,c a U ( 'J I n a ~! p l J ' l o ! Q l r a m s fo r 37 l h i c : n l l i r s o ~ CategcH'Y 1 of th ,e Phy:sij,c'jia:n's: R . e c o g nUiio:n AW8J l fd,o, t the Amer iea r i l M'ed ~ea ll lA s s l C ! I c lla t~o ln l. --

A s a part of 'fS ach six.-daiy progr,am {Monday I .J J .wough the folbwing SahHday) .. a day~ 1 0 1 1 ; G semtnaris

cenducted OI'! F:ddaiY;in addition ito the sw.dents attending 'the onsoing class, theseseminars are open to

.pJlofessionals from any branch ofmedicmew.hohaiveal1, mt:e[ies~ inthe evaluation andr,Bt1libilitaJ;;n:on of

:spina..1 pa'~h(l]ogy.Cliniciat1Sa t~ e:l1 J.d jn gen e o f ~ hese F rid ay :sem in nsrlli:@ i .v ,e 6 1iLQ urs ,o f C on tin tilln g M ed Jic al

Ed.uc-at ioIIJ : cred i t,

Din~cted by Vert Mooney, M.D.. a second sehoul was epened in San. D1ego inSepte:mber, 1 9 9 - 2 . , ill!eeoperatien '\I\tith tile Um.vel'Sity of Ci i l i I l lO :m; ]aDepar tmm~ of Orthopaedics an d l&ehabi l i . tat ion. A third

school will be open.ed inJapan, and a fourfh school in Europe.

F,OI l 'add'iUonal i l nmrmal io ,n I ' 0 , 1 1 ' $ 'ohed ' il d ed da te 's t o , r ' e~ass es , a nd s l s m i h 'l s : r s in Flor ida, eemae t

Dav iid C aJ pe nte :r, ,~ du ca .ti:Q ,I1l&. ,Resea rch .Annex, ,SllIn 'Cente l i ] , SUl l ie 120,,101

1 S lE 5econ d i P lace j,Gai ne ' svU l !e , ~f ll D : rl da3, 2601. Tele ipho:ne: ,(9D4 ) 377 '~ leD IO;F,{! I_X'~9 'D4)3n, . i9 1604I,

F,or ,add i t l,u la~ ~I lf tl lrma~ i ,onr ,orscl i lech. l led d ate s 'fo r c la s se s an d se :m ~n ars in Ca l'ltom iia , e en -tac t Ke "~ Kaza ls , E d:uca t~om J] P'rogrammr ,N !'u sc uillo sk e le ta ll E v al u atio n, 4 1 5 0 R e g e nts P:a.rkRow~ Suilte ·g ,OO~ L a ,J ,oU s1CA 9 .2 .137 . ie le ,p ho ne :: ,( SUI ')625 f "OD.26; F ,ax .: ( 619 ) 16~5~G2(i16.,

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R IS IK . F '.ACTORS

Controversy regarding i d en :t ii :f ia ble r is k f ac to rs

related to spinal pathology has been ,ongoing for

mo re 't:h amfifty years; w ith U tHe in~e w lIY ' o l f agree-m ent. W l'lUe it should be obvious tha t a low Leve l

o f s tr eng th is a risk factor for spinal in jw y .lile B o ein gs t u d y 1 1 , 8 .&been quoted as COll l i t rary evidence, But

what that study actually demonstrated was tU,e. fact

I U \ i S i l t thepreced ure used r o r t es ti ng s tt ,en .g i tl i , o Q l l d d .

n:o'taChieve its intended purpose. M uc h , 0 ' £ lli ,efunc~tional testing perfcnned durlng the last twenty yearshas been flawed in similar ways. Meaningful testingo .f spi l: 'L l il l sb ': €l1 I gl li c am he conduc te d onillywhen ai]_

of 'llierelated. factors are understned; and then onlywhen the actual requirements fo,r 'valid t,esth'lg are

provided, At the' time the Boeing study was eon-

dueted, the requireI:nents for valid test-mg were not

established, andthus eouldnot 'be' appliJed.

F.A'C: ·TO,R 'ONE: : I INADEQUATE ,

:STRUC 'TU IRA . IL . ST IR IENGiTH I-

AIP,ijlrtfr'II:iI'm lI 'adii8.t i[urII, burns alli ld a f,ewother , g ' 8 ' m , a : g ,& - . c a U S b i lQ I faelor:S t a n InJuflie·s , a r , e

a !raBUn , Q , I Q i n ~ tw :o f ao l,c n si: f oir ee .and i ln .ade~

qluates~ructuml s~l'\eng~hI.When ,an im lP IQsed l

10 1m B e xce ed s: th e coe·xis1i l l i lQI l!eve!11of s·tIrUC~

lu ra ill .s tIi9m1g th ~ a n ~ nj ll.lry willi be prt l ld~ lLI I !cedl ;butII h igh er le v,e l of s ,irll.ll,ctu r,a~strienglhcan wlt'n-sta.nd a h ighe r ~evel01 fQ 'J ce 'WUh'D lu t l ' iesul l t i lngin ju.ry, t hu s th e' iad van tag e o f ;hi l ,creased sk iuc-lu rail s t reng l th is beyolild question.

Unfortunately, we cannot measure structural

strength ina practical manner; s tru ctu ra l sb 're J.1 .g th an .be det~mined. O J : ; l l y by t : e s t , s carried. to a J lomt o f· de-struetion, However, there is an ,obvilotts. if unknown,

relationship between. functional stI'e~gthand strue-tur aI streng th, and we can measure functional

strength. ~t 'has been weJi1 documented that exercise

increases the s m a and strength of~he mnscles, tiu:~

tend ons" the lig am enbs and tile bones; 'thus inc reases

in funcetonal strength also increase structural

strength, Mid reduce the chances of injury. The op-

posite si m ation being self evid B l1 lt.. · 8 1 . low leve:[ o ,fstrength is a risk factor for' spinal injury.

. M e ru :W 1 g fu I '~ eslin g p ro ce du re s conducted with

sp np ltm : na tic pa tien ts p oo ve : this relationship beyond

question: the ~ypicaJ p a t 1 e 1 : 1 t ,wth spinal pain. dem-onstrates a level of sb:ength far below average.

Whi.c:h W'RS not sttrpdsing; but 'we were surprised

to . learn f ha t even subjeo~ \'\lith no history of spinal

pain u S l ! 1 ~ U yhavea 'VIery low level of spinal strength..

B ut low is a r ela 'ti ve term; liow ,compared to whal"?

La"! c om .p are d to a ve ra ge stre .n g:th ? N o, because av -erage str,ength even for lw~Uhysubjects proved to

be quite low ..

Low compared to the poten nal strength o .f these

muscles .. Thousands of subjectshave been. tested for

the isolated strength of their spinal muscles, so av-

erag e untrained srreng th is now w,e ll Ie st ab li sh ed W I "

both m en and women . MOI\e ' ~ l1 i'ln3 ,0 00 o f tb ese su b-

jec ts have been m vol ved in re s e ar ch . p ro g ram s fo rin crea sin g sp in al stren gth ; and, ,ri'lli feWex·tepti0l1S1the resulting Increases in strength have' been far

greater than e xpe cte d ..

RESEAR ,CH : : lOur ing t lne~ . a6~ : seven l '·ears·!, 4 5 ,d if fe 'r en t s tud ie · s . nave mee n c Q , n d u c t e c l i a t. t he

U l i l iVersUy of f lo rId a 'O on e.g e· ,or' Medic i ' ne USi l i lg l Moo.X equip:m.ent lor ms ,t ill1 g . Il1 Id e:xe.J'iclsefun cU cm s. T he se s :liud iie s we 're e'i l ' l I1fhJct,sd by ,I te 'e m ,of researc]iu i l 'rs l i l .eade 'd by Dli. Mrc'haelPolfc'c'k and ooUe·ctlve,ly invol,ved ,8 tota'i of 313,3'9 subJects,; to.g:e'lher with a lo,tal 'o f ',8,540fU l inct i lcmal les ts and m o o r e than 1100,000exercise IP ,rocedures . -

Addiliolil,al s1ud i ies u'si lng l MecnC equilpment h a ve ' b e en cO I1 la .um o by Q, ther r re · s e an :: h e rs h l l s e v e r s'~ D c a t i Q n S 1 1 I 1 1 1 1 i Js CD ' U I n t r y and , f J i,Dro·ad i .n ,order 1 0 C o n fo n n w: i :th '1ihe reguI aUCU'I IS, requh l ied b, fh ,sJap'anese, verst,on of D'UII 'IFD'A, cUn,icalstu,d"es were performed in ma io'" h 'o spi ta ls In Jajp1an. InJu .y 0 · ' U I i 9 1 . J ' ill s tud y was pl l iBsenl ted a l s ,n 'in te rn a tion a il s ym pos iium o f ph ys ica l 'fh e r,apis ls inI!ng.and. Sllil'il,will1g the resultsi Juoduced by a g l l'o up" of paraipl~egic s ub je cts , w ln io w e lle 'BXiereisedwith Meal!: . equ ipmen t

PagelS

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Many studies performed during the last twen'ty

years have dearly established the degree of resul ts

that can 'be expectedwhen < it previously-untramed

subject is exposed It o exercise; so we know what to

exp ct. Most such studies i rwol ve the penoJUlanceof three sets of the exercise durmg each o:f 'three\;v-eekly training sessions, with a brief rest between

exercise 5e'l ts; so' a ten-week programwould involve

ninety exercises, with the Ie l<,pecrnt ion that the s,tart inglevel of strength would be increased approximately

25 percent b¥ the end o,f nll~eprogram.

l iJu,t t lh,o,sa are th e r,!!'s iu lts I l! xp ,ec1ied f riDm ,e'K'·

e rt: ls e fio Ii ' tlil,e ,q ua dlr ie eps m us ch !s , o r 811m'D,stI nyother Imus :c le .When ~s,olated exer-Ciis,e ',DIll' ft l em 'u sc:I 'es, tlfl's te n e:n ,c ll tim e I l l I !mitior s!p'~li1ie'~s per-fomu:lo on a ' reglu' lar basis) nile results ,are,uSlIIallliy

fa Ii ' g mateI I ' : lilll the e lde I l ldedl posi i t i ionl , sl ren,91th

in cre as es 0 ,110 01 pe fioe nt are bellow ,ay,erag'R, iandiin cre as es ,o f sev,e' ra l l l iUJndlf led pe rcen t B rie com -

m,on.Since 'no Qi t lner musele in the bDdy dem -

o'nst , rates, ,an yth in g ,cE ose to , a n- e qu al ,deg, r ,ee cd

pD"le n Ua l s t.re n gth in ,c l i ' ,ease, i t . appea'rs 'W ,e ,a re

d e.aU ng w ilh m us ,c le s in a sm te lo f d is use a tlio IP ,h y;a cO 'lilic l:u sio n 'th at h as Ib ee n p 'ro v,e n by lon,g~l f 'an.ge

research 'W ith th .D u sa n d s ,0 " s, !J. I lb jects.

fREQUENCVOFEXERC~E

While WE i ' we~e surprised by the po l tenda l for

strength increases sho,.vt\ by spinal muscles. we wereeven more smprised to find that very little is requiredin 'theway of exercise toprnduee such ~eat increasesin sbengtll. Provided only t lri,a,i the exercise is spe-dik. The results sI10Vl i '1 .1 by the . fOHowing three exam-

pies demonstrate both of these po:in~s::mag;ni.b;ld.e of

Increases in spinal strerlg;th,atlld the relationship be-I : :w'eenu€ i stren gth in creases an d th e am o un t ,o fex er-

cise that was required"

1-

7 0 0 1

U)

Q

Z: : : » ' 52:5

~'

It-

Oo 350lUi.

z-176

l ,UMIBAR EXTENSI I I ,ON

a12 24 36 48 60

ANGLE liN D E G R E E S

F U N C T IO N A L S ,T R E N G T H IN C R E AS E

o 72

F~GlIFilE2~1 A healthy male subject with no hish:rryoflower-ba,ck pain, inhis mid-twenties with a 1ucight

of 6 fee t and iii. lean b od f \c "eigM o f 2 00 p ou nd s.

Page 1 6

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The lowest CW1re shows fresh s t reng th o r the J so -

la~d ~umbar-exten:sion muscles measured dlUJingm.

i:njti,al[est of funclionaJ stt~.ngth. The mg h@ l 'Ct l rve

shows strength ten ~ks later, Ths g r : e . e n area be-

tweenthetwoeurveseepresenes increases iillfunc~tional strengthprcduced by o,rily ten weeks of

] S i O l a : t e d exercise. W i t i 'l ! only one' exercise e a c h week

during tl~AI'~period.

Strtengith, in th e flex ed posi. t iol1 l increased 68 per-

cent, whHe strength J . r I . the extend,ed position in-

C W ie E lS O O ~.80perce:nt Initially, t h i s s u lb je d per10ITrned

rnneful l -Eange moveo1ent5 againstresista]. '1ce of .2 00

f ee t-p ou n ds : 't-e nwe ek s, l~ter he pet fu r tl il ied l'line repe-bticm.st¥ith 400 foot-pounds, aninerease i I I . dynande

strength of 100 percent.

A toW . of only 1 0 ex ef 1'c is;e sd .urin g a perio d w h sa

most ~-dse p.m~ 'Would Ji:unree q ' w o o 90 ex~ereses. V VJ.tileit .." 'fit app~ari1tat .h e wolt ld IMl ' l i te

done betla if he p e . r : f u r m o o , .more ~er\cise.~t ispl'obab,1e thathis results would hnve been.beUa~T'h ..had "-···ned ~. _ """ - 1 '1 ! , .~ , - , 1. _e ~l~Lp erlu f.L _ . even. ess ","" ,ef!C!:Se. Au;:, < ; . . ' > , 2 ! m p c e

presen:m,t l l leresul i t 's 'that were prod uCiedby the subject

that showed the ]owest magnitude of strength m~Q\llla~ln. oW' first :study gmu.p; a r u J other stilbj~g~n

.l1USgroup produced beuet' reswltsFan d all of tile other

sub joo~ wa,e e'.)lff: icised cnly O]1(l@:ve:ry'MO weeks .

~ 17~

C JI i=:Q~. 0 b-~-b __ ~L_ __ ~~~ ~ __ _d

~ 12 .24 36 o1iB W 12

AiNGiiUI N DiGilElESF U N C 1 i IO N A L S m .E N ,G ;,1 IiH I IN C R E AS E

F~GUFilE24 Ano'frler member ot the M t re-

search gn:m.p. This. subject was a healthymale with

.a; l1::\vE:I iLty-ye. l l hisb:u;y o f h ard . ~etdoo, a man . t l 1 i i 1 t

would be @ xp@ c{c@ do D@ far a hove a v @ r ag e strength

a't the star~; mid~[thDties, five feet~nme inches, with

a m U . 5C U ], O lII bodJi f \ 'Vefght o f 1 90 pOU1~ds, In a period,

o f fiv e m onths and eight days, h e in cre a s e d . his fu nc-

tionru strength Inthe fl~ed 'poaiLioillmore than Hnpereent, in the exmnd e e l PQsition by 450 percent; as

a m n .s eq U'M ,c e .e lf : iso1<l1.tedexacise fer the s pm n[ mas -

c les only cnce every fo 'ud ee :n d ay s, during matps-riod, I " I i ~ dy.na~nj.cstrength, increased from. anwitial

JB repetitions a _ g a i J i l ; 5 t resistance of 150~oo["'poul'lds

to a late r pe rlm lu an ce o f 8 n ;~ petH io ns W J Jth ,[!es\istan ce

. ( ] I f SOD foot: -potuld s,

The results produced by both l ( l l f these subjeds

makeit ebvious tha t they staJ'too a1 a low level o.fstrength resuUrung froma s~ate of chronlc disuse

alrophy; their magnitudes of :stren.gtlit.ncreasecan

appaifu tly be jlilS~:fied. in..1'10 other manner, Atro-

phy ~~i1It centinued in spite of'a longlt is i~Ory ofprevi!ous e~erci se in both cases; atrophy tll.at was

corrected l o r d y a fier b h e ' y were exposed to specifier

isolated exereise.

Subsequent research has clearly demonstratedthat mOiSt ( I f I~ exerc ises perfenned liar the purpose

of im~Bmg sp in al str en gth . a n:" !w o rth le ss f O ] : ' ~h~

.m~end€dpmp09l1l; ma,l ' SI:ri!tl,gtlliW th e muscles of the

hips and thlghs" while lea1t:lngthe lumbar muscles

in. a continuing' sta~e of atrophied weakness ..

R IE S EA F litC H: IF O iu r .19 g el ' 9 1 1 ' O l i l J M i ,o f ra n.domsWI'bte,cts j botii' i l l1ale a li'i ld female ~we re s til.!ld ~

['ea IOlf twelveweeksi. AII[Isub, iects wen!!m s ;le d l 'e iP e a : t :e ,d l , f 'Olr ' t h , E I :~S( l la , teds:~rel!lglhof th e IliII1IIsictes tha. t extfHIld l ih,e ~1lImbar s p : i r i l ' E ! '

b e k l, r ,e l t 'h e l slarl ,of the le x ie r - G lis e P I i , Q ' Q i l r \ a 1 " 1 ,

and! wlE!re,~ested aQa~n in alll ldel 'nIUcal man-n e rr a t titil,e e na o f I lliu ! t .w ,e~V 'e4e , e i k pe rto d ...

D lu. ri ng 't he exerc is le p llo g ra rm , a lii s .liJ Ib je c ts inu r 1 1 1 1 ' , e elIthe In u :p s w e l t" e e~e:t(: : i :s ie( i l o n c e,e ac h w ee k; 1 0n e ! g r' f l lu p WiliJ:Sexe~c ised UShlQ

9 . MedX LU llb ,lr-e x te ne lon rmach i ne ~ • . aseco,ndi g 1 ' I0 ' I i J IP exeil"tcised: wiit l i ' l i il Nauti'IIiJISI Lower ., l, back mach il ll il E ! • . , . , a I hJ ri d : g r ' o l l l l P ' e'xel i"~

c, is 'ed l with B C :, ib e x Lowe r- ba c lk ~ machIne ....andUiI ,a f O l l l J lr n ln ig r o u p pell ' fo' l imed 1110 8X1S rels 9,

s9l iV i n g I .S a c o nt r,o l,g llf O ll llP I,

As ex'pected. , t ihe CCllll ' i ltir,o~ g'r,DtIIp s ll o:w iE ld no 'c ! J i l : a l 1 l g , s : I b u l t ' the N,IlIIliluSilnG Cyibex ' g ; ' ,QU p sa~s0 .s .h ow .e d n o , c lh , S i li lg e • •• whil le U 1 e MedXgr,ol l lp ,pnl lo . l IJced ve'!! ', . s ign i f i i csn l ' Inc : reasesi i i ' l l sp'i l l l lS Is tre n 9 1th .

8/4/2019 Spine Knee


T l h e ' Na1! l t i~us I ! . . > o w e r c · l i : m c k mac'hilils WliS mrnl'e:nI~

by m e s l11d th e pa~,enrt was ls sue dl lin Wly n l1l l1 li le i ro

tlte be st ,o~ our I!I;l1J owle dg ie ! it was t l! il ef ir 'S t m:8cl l ineev,elf tI'lJi~~i e . , th e Q X P : r e s s , JIIlJ!rpo!8e ,o~,e:.xi(!lrclsln:g]'tli1le

~l ! I l111ba~~re I i lSmOIf l museles. Subseqluernil!ly' lit h iss ,

been co;pioolby :B number c ,~o tl ff le r oompW'I 'i es I p I " 'O -

d ~ H : ln g , e , l t . ' ! eei.! l1rn!ac 1hi n e s . srnd l sevet r:al l sHg flUy (Ui f~

m l i i € ! l I 1 I t ' , , " ' a J I ' l l a : t l o : n . s O'~ t l r lm s m'8chlne a r , e ! f i lOW I i l e l n i g l

Imarketed.

Wlii lel i l l desrngnedtiila~: lm a c l rl~ l I1 e ~ l c r n e a r lr y utilder~

st :oodth 'at ii~pll\av~ded 9:l ! Ien:i iseror bon.. thie hlp

and~l1 i ig ' l1 l n U J s: c [e 's ' . ' . ' • b ut 1 1~ li1e nbell ievedl t l i 1 i 1 ! ~ : it

a lso , F ,lwyj :dedl meanilnghil re~erciseforl lr i !e ~t:lI ' ! 'balr-

e~de l i ls lo fi l ~us : cl \es ia l ll 1 l assullliilptiantliiall Inew re-

a li 1 !m e w ,a s w r o n iQ I . Th,e m achwlile WS: 1 I w s l r u i l m e d , . ~s [ 1 1 1

f ae~a I h l p ' :andl~hig h i mac[i1ine~pwrviidles l I Iean ' l n g J f t del(er~1se,Dli1llyf 'Dr~li ' Ieni lusc f f ies 'o f Ulle l l ' u l l /W cks ,andl rear o~ the 'Ulllglhs~

~ f o u n d e d I N a : U i l i i l u s 5~cns~Med l ieam ~l1Icih:lsWes,

IIIilC•.~ h , 1197iG~and Mli'Ved as rChall1i1i1anUnlUI fi t wasso ld iinJ'ulrill!I' € I f 198 16:;s'elli l l i lg ICC:II1ltJ:lolihilg intell'elil:t ~rn

tt lle c om pa ny In ,o rd er to d !e wte m yk li ll l at ten! lo l i I

toWie cQ li1tln ue de h !'v ,e lo pme ll! o ,f s pe cU lc t e ' S l i i i n g

and e~eK:1se eql!J~plllent~o:r s eve r al l e r lt lc a~81r eH

o f tl1 ie bad,.wil i:l part icular el1ilpll ' l8isi:son th :e I l u l I i I 1 b a r

spl ne,U1e ,cervf:eals ,p ine , ali!;d~lI1ekn,E!e. i I 1 ' I e p r o I D e e ~that evernruaU y did I h m d .~ t he d eve:IQ ( Ilmemt o fs a1 re ."

aCCiUlmm~ spQ { : lf ic t '& , i' U li Ig and e:ml iC~se eqllJffipl1e.nl~

w : a s s taJr i led lmC!re~ i1aJn tw 'e l il it y4W:o years iruS lo whi le, I was ; d~ rec il if il g Naull'l,dJs; i H , J ; t was no ts !. l! ce e s s ldIL lnl~ffil:afl lel i ' I I solid title c o m , P U J l n r Y .

1l11iS c le ar S fa 'l!e ~e n t o f fael Imust ,n;otbe mls-

'u n :d e a rs to o d l a s al1ll i l i1dilctmeli1to' INa\lt i~us,oran, oUterlProduct 'D f~ ha~ eom lp a n rY i wean m n a k e rn istaks$,an d t l il :e m iSin'BliJUH:il l iower-back mll1l£:hi lnewas, , one l lo f

my m l s ta lk le s ;, a m l !s ~ e l I ' I o w b e f f i n g cop il ed b " se<ve r ai lcompanlesllil t li le f ie il el r o f l e 'Xe fc l se .

NO irE ~Am ,a s· so ,c fa le ra is ,ed 'Uile POs! i ll l~ U ty o f

anotll1eliexpl,anationklli 'the inilliall ~ow ~e 've~ o f I

s t il 'e ngt lh in l t:he spi nal. lnl i lscrles of the last subje'ct I

l1enltioneo abo,'vi(!!II ' ( , IF~Qul ie2~2:). F i : a , l l i I I e r than d ~s'"use atro phy, he mi'ghI hav,e bee 'nsh ' lJ iW'~ng 'th 3 '

res'l.!Illts r O l f o ve rus e alro p l ! ' J i y .

Thh; sUb. iec t , B l p ; P ! 8 I 1 ' e n l l l y has a very hi:g h pet-eenr tags ,of fa .st - twltch 'fiibers ~ 1 i I 1 his IU lmbar mus-c~e.s~ , a fl ld penon l f l, ed r eg r l,d a r, h e avy lex i l iu 'c ' jse: for

twent, Y1eSIrs p,rlolit;o his nrst:lest. o f sp ina l

stre:n.glth..Such mst.-tw itch 9L1IDi'ect:S!iuJ lme, t imes

eannet to~eli'ia~ere 'C\ fIuenl ex :ero ise . lut! QVei l ' IL i I ,Se

rDrf d J ;suse" h ls fo Illo wlrn :g ls t ren grth in c rease :s efea 1'1

e s ta bU s liI,e d i h :is In fU a l1 .st ;a~e o .f spir l i la~ a : t I l 'O p l i lr , , ,

Page HI

1m

l

!~I I -----I~-__-~--~-_I_-____"jl

5f i 2 aID ~·~t:::t::=-~~11~

'1~2 24 36< 4& ,00 72

ANlGl~ INDEiGR'EIES

FUNClI :ONAL51iRENGTH INCRE~E

IflG lU llf t:l!!l.2 ,, 3 A Hwd s ub je ct & .om . t he lll'st group;

a malewith it h i s t o r y o f sp Jin al 8 ' ! U ! l ' g e - f } ' p e r r o n r l J l o o i .about ten yearspri.O'lli' to l l i @ ' date of the first lest shown

011.this chart. Thls s l I A b j e c t increased 'his iso]ated lnm-

bf l ! r -ex~ensian. slreJJ!gJh by IDDre t h a I r I 93 peltleill~ ia

the flexed positio:n; and by 871 percent in the ex-h!lI ' tded. position, in a period of 27 weeks. Sh-engfhin cre ase s w h lc l1 i. i n d ic ate ' tna,t hestartedl In an atro-

pMed ! co nd itio ]; '! .

All three ofthese s m m F i : s , WGIie . fu lVONOOin . Iitgm.ue~ en ise prog rn :m .s fur a ]period o f s ev er al y,emskr: ime-diarely prior '~ o th~ia ' inina] nests; wotlJ!d · · b e e x p € c t O O

hJ tbe s IT !o f lge r thana .v~ge : ; bu t all we re b e lowaver ag esbiMgIlh. BU. twhen r~'fuese subj«:is were firntrested~

l li e a \ "Ba .g .~Lew ~] ,of strern'\gth R)f th es e mu sc le s hadnetbeen established; so w,e had no basis fur comparison

at th e tim e' o f . t T h 1 e i r initW t~ts.

12 24 M48, 6CI

A N : G l E n~1 , !! iG R i E I E S

IpilGU R E ! 2004 I m i l i m J s,trength cornpared . to av,erage

slre1 :ilg th .f ora fMt_'M itc lt sub Jec t inom fus~ study

grolli 'I F i g :u .r e 2 - 2 . TIl@ I 'M area represents th e c l l i f . .

ference between his s l:a rt ::U'g strength (below av,er,age)

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and aver ag e s lr eug th .F i vemQl1 .t l1 l .S later, he was 1 01

per-cent stronger in . t h . e flexed position and 450 per-

ce:n.tstrong~r i f ! . the I e:<t ended pos, ]t ion . Was t h enfat above average strenglli. -

12 2A 36, 48 0Il1 12

AN'S I . J E Ur I! I :H iGREE·$ ,

, f !! lI ~ / i u : : : :. ' n :O N A L S · 1 lU : N G · 'j iH ~ N C 1 R E A S E

F'IGUlRE 2~5 Initial strength compared tostre.ng thfolIow Ul.g 2 7 w eeks ,of spec ific exerc ise fur

a su.bj~t mentioned earlier. Fip@' 2-3 .. . with the

addition of a curve showing a v e r a g e s tr E ID g t l . '1 . Thissubject was not far above average slxenglli ,even at

the end of the tralnmgpe:riod; blilt he $tactedl ata

very low level of SKi!mjtl i l compared to average. HisI1Edativcly low level of final strength, 'compared tothe other 'MO subjects•.was a reswt {If the fad tlIat

be appearl';. to have a high percentage of slow-twitch

fibeis in these musclesi a fiber 'QTe that provides

greeit muscubir endurance but precludes a high iev,el

of strength.

:Six y · e s l l ' S l I a r ~ e l r l J . n 1h le mean time harvi in !Qiseen

s i lmUar resull:s,wUhliln:ulIsands of s l i J I b J , e c t s . , the

conc l 'us i ,on is un av ,o fd ab le : e ve n nOl rma l l~ 'piajn~' free i n .d iMdu ;ah li w i l l i IIu:s u,aU y s h,ow a ve :ry f o , w 1eve,1

Dfs:p~nal l s t ! l " , e : n g U 1 1 'win e·lI1l l11iUa.l l l , ~ e :d e d ' . • • b ' l ! . I i l

mos t will produce ra pitll g ailD s lin s lP imd str ,e ln ,gt ln l- -

w ih e n p riC l'I id .e d wU h s pB c iflc e xe liio is 8.

[FACTOR: TWO: : M U S C U L A RFIIB E.R '..TV P'E

A serondrisk. factor related. to spinal pafuology

is a result of differences ln fiber type. A majority

of iii. random group of subjects will show a.mixture

of fiber typestn these n~J!lScJes.Fiber types tha t canbe : :i den . ti fi .e dby . E l I th re e-p art pro ce d ure fo r delermin-

ing .fatigue characteristics on an individual basis.Tested ~ o rtheir ']ev,el .o f fresh SIT-ength, t he n e xe rc is ed

against an appropriate level of resistance, and nn-

mediately retested fer their remaining Ievel of

streng th, a eom pariso» of fresh :streng:t1'1!(pte-;ex,er~

eise) tor.e'maudng strength (post-~erci:se) will pr-o-

vide a clear pictu_re of tlile fatigu.e characteristics onan inwvidual basis. .

I l i O O I~c

:2: :: . 6 0 0 r--I---+--IF---~--: 2 '· a L ·e2 4 0 0 " " " " " - - - 1 1 - : : :

~

2'4 S6 48

MH Stl& liN DE GR EE -S

I FAST iliW'liliCH SLO ,W 1VJ1ICH

I F I :O I U . 1 F I l1 !2 '- 6 , A comparison of the fatigue c h a r -ac~ri8tks of t\ovoof th e subjects mentioned earlier,Figuf>e.s2 . - : 2 a nd 2 :~ 3 ,.T he red areas on this chart show

fa tig ue resuJ :1Wllg from exerc i sepmormed by a fast-

hvitch sulhjed:,.whilethe green area shews a gain ins tr en .g t hf -oU ow in g a f.l.identi·cal p rooedurepe r fonnedby a s lJ ( )'w~ l: iov :i .t chSiitbject. 50 th subjects. wem tested

for f re sh sw e n.g ith , welle then exercised bdefly with

a low level'(l,f t le s is tance , . .and were iuwlediateJ.y re-

tested for remaining strength fu110wing ·theexe.~cise.

But even followlng a brief, light session of 'exercise,

the fast-twitch subject lost a very l . a r g ;@ part of his

fresh strength, while the slow- twwtch subject WiihS

stronger following the exercise than he was beforeIthe~ercis~.

Pag, 19

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12 :'&4 3611ia 60

ANGll IN DEGRE:E:S

I F l I G I l J [ I : ; H ~ : 2 - 7 irdngfor'faigUl!' , o 1 1 J a _ F a a e r i s t i c s

, (muscu la r' f ib e r type) I pwV t id ;e s ,nam inm l'm iat io n du ri ng

r e h a t m i i l a t i; o l i l ' . T I H S C l iu K l 'u I 'e ! ofneroise must: be based' O : 1 i J c a l ' \ e 'h J J c c m s i d e r a .1 i o :1 i I of U i J i s : f , a c ! lo l l' .

F~gure 2-7 provides agraphic example o 'E md:i~vid.uru dif .~. l ices in response to e xe re lse p ru d ue ed

by v ,a ri at i,O t l.~ nmwc ' ll la r f ib er t yp e; these MO subjects

were re ste d . f or fresh s:bength, were then exereised

to 'Vol i tional! fa l tigu.ef and were ~ J l 1 . l l 'I O O : i a t e l y reltested

f ur re m ain in g stre ng tl'll af ter th e e : . \ ' ! e f i c i . s e . T e ste d . ,a nd

exercised in 00 identical fashion, , if I.m i il ja r it y o , f awn-dam grOttp of Wbjects,MU sh~)w a loss of appro,X"l~

IliHilirl\~]y20 pe:roMt o~ k-en s!J:ength.8ui~ these tw'o:rubj~produood. dif.fere:n~ responses, Ol'l:eshewed

a f as t- tw : il: ch re sp on se t{ )e '; i( ie rd se ..w h l~ eth e o th er p ro -

d ueed a slo lW '" 'bv i~ cl" l.e S p 0 1 1 l : S e .

T he g t,e en a re a, showsgains in.. sh stre n,g ithM lh

the slow~~tkh subject while tl:1H;l'Jiro ~]1easshow

losses .o f fresh strength hythe f as t- tw i b :: h s ub je c t.

Th@ curves , of f: !1 e sh s tr eng th 8ir ,e cioUed , w hile' ex-

hausted em -yes o f streng th ,are solid . T he fa st" 'bwUcl l l

su~bJ:edost 58 percent of his freSh strengthas aresulrof brieJ exereise: w hile the 51ow~~Mtch:= lubjec t was

23.5 percent s;tI'Ol,'ilg~rfollowing the exercise.

In th e n :udrnnge of m ovem ent, d 'l@ levels of fresh

S i t r e l 1 g i t l 1 : w e re id e ntic al, 2 5 4 f oo t- po un d s ,of iborque;but

d uring th el:ests o .F . x h a U E i i t e d sl1 ren gth " ~ .'le s]aw - ~ tc h

subj~::twes 119 pereent s l : roJ lger in the same position,299 C O l ) ]; l p 2 U J ' f l ;l d to OI'I !~y 1 07 foot-pounds. These differ-

enees are critical~ bul~can be eaBHy determined by a5intp!e l~est ing p rocedure . An ideal e x er cis e s ch ed u le

for one of these su bjecb)l" l i 'OUJd pmbab1y be in to le ra b le

for the other,

! : ! : : 17 5 :~~-

aI,et:

~ C D 1 ! b . . , 1 - _~_~_~_~-=~__,!Io ~ ~ • ~ ~

ANG le I N !DE 'G~RE :ES

f,lGU A E 2 ~a Fa.tigue dlilfilderislic:s ofa subject

wi[h a useal .mh:tt i l .ue: of' fiber I types. The redarea

represetl.ts fu e ]OSI'ii, (Y,ffresh strIDlgth~OU(Jwmg an ex-

ereise eeatinued 'to faihH'~ minef~petitiolls agliinst

resistance of 200 fOOt-POlU1I:ds. A_]1 Or'l Ie-al l ! loss of

b€Sh s tJ Ie ] lg i t:h of approxi:~I1ately 20 peocetlit

!tnl

0, I

~ 525 11---+---+--I i ! ' I

~eE 2 ' ~z

g::17.5I------/;----+--+----+----lf--------I

i1~:0'~ (I ~--,----,---..--- ........--.-_.

C D '12 M 36 A - i 60

A :N IG I! .E I IN I D I E ~I IE ES72

flGUlAE 2-9' Fatigue dwmderislics of the sames1 ll Ib j ed , F l :gu r 'l !! 2-8 r a t a .m uc h highe:r]eve~ OfSITe l1gl i l .

m t i n s case, h € ! failed af te r n i l' le r ,epef it io f lS cw it h 4 (J []

foot-pounds. h-v:iceas muchresistaneeasused in the

previoustesc and then showed an overall loss offresh strength of approximately 25 percent,

While there w as a slight d li'l:m :lgen the fa tigue char-a cte ri: !itf (; s, f rom a n in itia l 1066 o f 2 0 pE f ce nt of fresh

streJlgtl'll to it later lass of25petc~nll:" these t< esuHs d o n :o ~

ind icate a sigrn;mcantdlang~m a pp are nt fib er ' type. The

k~ word inthatlasesentence being apparent museularf ib e 'r 't yp e dQe5 not change a 5 1 iii result o f str en g ;th . in -c re ase s, b u~ V i fil~ so m etim e s a pp ea r ID change .

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Muscu la r a t r 1 o , p h Y I ! bo th ,d is us e! atrophy andO ' ll le r use , a ll 'iO lphY l i s I ,a rge l l! y s e'I'e c:Uye g ,n th e basls

IOi f ibertyp,e; f as ;l -t w ,i ic h l ib e rs , ,a lr ' lJ lphyfaster ,andto a, gllre:alte r le x te n t: than sl low,~,tw.tc h i fibers, Thefa·st : . ,witch sub lect mle'lI1tihlned ela l ineir~,i gU il le , : 2 ,:, 2 1 ,

when ' fi jr :s ; I:~es red , ,ap,peaMedbo , h a l l , e ' a. U 9 1 J J ~ U Imb:~till re , O ' f tilDell' IJ lpe s; burt ,IS h is s tre n g U Ii ~m::::l i 'easledf

til ts II I b ar '!Y IPe appealredi to chan'ge. A t a ~eveI:

of s ltle ng U,far all:love hlis i iniUia.1I 'eve l , ne 'sh 'D 'wedt he cha r, B c t,Q r ii s ti cs lo t a su lbJ ieCi wUIh ,8 v ,e ry h ig lhpercentag,e 0,' f:a sHwiitc h .Iib ers ,.

~,w~~~~-4--~+-4-~-+~--~

C I l 'IX ,

' e0-

0 1 1 1 ( 1 1 20 30 4 0 1 0 0 60 ' 1 1 ) 1 a o w ~e n '1 H I ]2 ll11

A N G L ! E ~ N : D EG R E E S

FIGURE2~1 0 Seleedve ,atropby of quadnoeps

muscles. The highest curve represents fr;esh strengthof a norma] leg, the lowest curve is fresh. strength

of an inju:red leg, and the middle C1lU'Ve .is fresh

strength of the same injured leg following a, periodof rehabilitation,

H~ed kI failure af ter ten repetillion.s. the in-jured leg lo st only 1 1 percent of fresh strength; a slow -

tVllitch response ..

Exercised in the same manner, !:hepartially re-

habilitated 1~ lost 25 percent of fr-e.sllstrengt'l.l; a

usual fiber-type response.

As strengthi nereased, fiber type appeared to

change. '\lVhen fully rehabilitated, [email protected]«i leg

showed a fast=tl;vitci1response 1.0~'ru!dse. a lass of

44 percent of fresh strength ~ollowing exercise.

The nsk associat,ed w'ith a high peree,ntage,offaet-twitch 'fibers is clear: 'while sueh subjectsmay be s, lr 'Dngl l ! f ' than l e xpec t ed , based upon se. l( ,age ' an d s ize , th e y .h ave ' U tH e ln the way ,o f m ua-ICIIJl iarB'n,ciur : a nee. Wi1'1IbBeorne exhausted evenf rQ F I ll ve : ry b:r~elIB 'xpoau,re to rig ht e,xerc lse, .

A high percentage of slow-twih:h fibers "in the

amscles that extend the lumbar spine does, not pre-

elude injury..but it appears that such subjects, have

an advantage not shared with fast-twitch subjects.

While finalfigul"e5 are not r e t a,vaiJIable1an initial

ex am in atio n o f th e' ~ es.t:il.1 gesu lts p ro duc ed by thou-sand s o·fS)ll ' : l," l iptomatk .s ub je c ts dw i n ,g : r eh a h il if a.lio n

indicates that fast-twitcil subjec:1:sepresent a dispro-

portiona rely high percentage of a r,aftdom pathologi-cal population, whi le ~dow-twitC:hsubjects are less

common than they would be in a population Q if nor-mal subjects,

f .ACTrOR ' T ' H i R ' E E : RANG E , ,O F NJIOTl rONI

Av,erage.. nnrmal r,ange ofmotiOJI. has been es-

tabllshed for both. men and women, ~nd a sig.nificantloss of normal range m ay be an indication ,of spinal

pathology. While there is variation on an individu.al

basis, full range movement of the lumbar spine (flex-ion/ extension) is'n degrees, witb an average, normal

subject: with no pelviemovemeat. Normal. torso-

rotation, M th no movement of the pelvis, is 120 ' die-

gw',ees;0 degrees to t he r ig h t,lU 'I d . 6 0 degrees to theh~f t of a l ' I1eu: lnd (sb:aight-:fDn'!lfird) · pos it ion . .

S blrn g,ard s 'for j;u dg I ng pa'lh o h::l'!J JYbs ,s ed IiJIPon

a 1 :0 5 1 D f n .D lrm a l ran ge ,o f mO'Vie!menl hlsve n o tb een estaJ'bIEs:hed; bu t manly ' s:ymploms' t i IC s,L lb-.ee ts sh 'D ,wa ma lr i1c:ed ,d leC I!1Eu !l se , iIAnOr lma l l rang les

o f Im o ve m en t" andl s ome p ;a /t fe lilit 5 pI rD 'd l!J oo ' Ilar,g:e

inereasea In ran g'e' 0'1 mQive:mef l l ! : during filiiej i! :I DU rSe o f . l !Iehab iIi lat i jcmI.

IF AC TOR ' F OU R : S ,IP ECIF IC,RESPON lS ,IE 'TO EXE BC . S E

A 1 1 additionalrisk fador for spmal pathology isill result of , i l l ! specific (Type 8 ) , response to limited-

range exercise. Some subjects, produce limited -range

strength gains whenexercised with limited-range

movements: may produce enormous gain.s ] 1 ' 1

strength within. th e 'worked range ofmoveman t whi le

showtng no change instr-ength within th e unworked

rang~; m ay even produce gains in Ute worked rangewhile shm,,-ing losses instrength in the unworkedr a .n g @ .

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LUMBA R EX TENSION

I

~: - ~,

~

~

I

I

I

~2 ' 2 : 4 1 Jl 6 48 ti{)

AN'GLE IN D'ESREES

AVE:RAG:E ~ NORMA Il. 'MME '

72

F'IGlUIR [ I! 2~111 A dis proportmnate streng th

c urve prod cc ed by l imlted,-range work Sl:£iength

in the flexed position, whieh is nonnaUy the strong-

est position, was aVl'lmge for an untrained man;

whlle strength in and near full extension, normally

'the weakest positions, was far above average... Thered curve shows average strength for a normal, un-trained man.

A proportionate C1 J IV1 f ' of functional stre:ngti]"r at

,any Ievel of S~Mg:t['1. should be a .str aig ht lin e,; a ny

meaningful dm8itlon f l I ' - Qm a straight line is an in-

dication of abnormality. The subject illustratedabove produced this abnormal strength curve as a

consequence of thirty-six years of competinve water-

ski acl:]vj:ty;a sport that exposed his spinal muscles

ttl a heavy workloadnear full. extension, Wor.k that

produced an abnormally high. level. of strength inthe extended part of the range, whila doing nothingto in cr ea se ' h is strength neru' , t h i 2 Hexed . ·pooBf io I l . A

specific reswt produced by limited-range work.

D :r. M lic h a,e l :F uU on has se rve d as , team phy-sic'i.an f,orsev,eral internaflon,al teams 1 0 , 1 w,ater-

s kie rs d !u r:ln g t l iU ! ! , [ Is,st 'few' yeats; Which prov'ldedthe op:p,or1unity 1 0 , con.du,ct tes.1:s on a I re~a.1 i IVie ly

, I , B r g e ' number ,o f [peo;p,l[e lbo~h m ale ,an d fe ,m a'J j~"

tha t. ha .ve been l l e l C I f J os 'ed lo such IliM Ued-r iang,e

work for I[om ,g lps rhJds"

an e ll the aborve examlp,l,e-

.

i s ' ly p: lca l ,ol'U"liestrength ICiLU'\II'esshDwn by' mlos~

SLi Ich ISubjects: very s trong neS lf ·Inn 'Ixt,l,nsio rr ,

b'ul av,era,ge str:englih , n e a r ·the flexed I J U J , s i t i o n J .

z. . .

F IG LIIR E 2 ~1 i:2 S u e:n g ili in cre as es produced bythe subject shewn in. Fjgme2-11 during a pedod often \¥leeb; during whichpedod he performed a ,total

of only five testing and exercise procedures, at ill-

t ,e : tV.a ls of approximately tw.ri weeks.

After thirty-six years of water-ski activity •.hisstrength. inthe flexed position was still.only av,er8.gefor an untrained man; but five exerdses performed

during a per~od oftenweeks increased his strength

inthe fli!xro position by 601 :percen:t •.w hile increasingstrength in. hill exb;nsion 'by 33 percent, and ma,eas-

ing strength 2 - 0 degrees away from f u . I i l extension,his initial position Q 1 f peak s·b:,engtl.,,_by 22 pereent,

His dynamic s'l~r;engthncreased by 60 peroen~ during

that same period; from tID .inU:iaJperformance of fif-teen full-range movements against resistanceof 175

foot-pounds, t08J later performance of fifteen repe-titions with 28D6oot-pounds.

EVlen then his streng th in U ~e'fiex ed po.siition was

not inproportion toms stre:ngtb infull extension; a

few more ~el\,s of continued train:in:g with specificexercise would probably have produced a full-range,

proportionate, 5tn~ngth curve, but his week schedulemade additional exercise tmpossible.

Because m.any subjects show such a specific re-

sponse to lirruted-range WOt~ and since most exer-

rises pruvrde little or no work for U n e spin.al musclesin. a position of full e:denslol'l, even. normal subjects

will. usually show if dispmportionatel y low level 0 '£

strenglli near full extension whim initially te b ad ..

Which explains why most subjects produce beuer

resalts in t.lle extended posldon than ~heydo in the'

flexed position when provided with specific exercise:

while tlileir spinal muscles ale weak from disuse atro-

ph y in . every position, the b ti tlal s tate of atrophy bij ,usually worse-in the extend edposition.

8/4/2019 Spine Knee


1 b ! s u n ique n a . ' ~ U l r ! e of th ,s mLlls lc~es th at e x , ' r e l l 1 d

t i l i l e I l l IInlba.li 's,pi'l ' l le! f a I re lnmr 'ced i b : y t h e r e s F ,l , o J 1 ls ,e

0 , 1 ' ' Q ~ h e l1 " I i i I ' I I l l I l s c l e , s I I 1 I 'Ule s a I i i l 1 : e a r e a ' G l t h . a ' bod:y ;eMpemienoo w i:t, hU I e u s an d s o f nonna ,1 lres.elarcl'l

s lub jec1:s l jtog;e l iJe rw,i ti h l ~owel l'. .back"p la i iii ipaUents~h a s c ile a .r liy shiaWlrnti l1a,t: OlE! ' n l I l 1 1 s ' c l e . s .a t l I ',o,tat:e!

theterse d,o n a t. In a .v e ,a n: e qu a'i po ,te niti£ d f(H I'

s tmngU i I ~ 1 I 1 : c m a l 5 ! e s . Spe ti'liic 'e 'X ie ro is es l kI:r~i i1le

b ) I ! 'S I O ' - I: 1 O ' ta U o l l 1 l i ll II' m . U S l c l e s w m i lncrease I le s tre 'li 1, g;t ho ft lrle se m us cl:e s to a n la lM ke :d 1'd eg re e ••.. bu .t n 0, 1

b !l !U l :e d e g r e e SlhC,WiIiI by l ih le e x te n sio n m u s'c le s.

"akentogetihell'~ the r isk fa,c~ors,' f1o' fsp,[na Iin jury co ,v'B red bylli 'llis cln I , p ,t e r 1 9 0 1II11, 0'l1'li9ay

- - -

i n~he · cUireetiorll , 0 , ' , e x : p ! l a l , l i I I ~ n , g willi' ill1Jjulry h ~ s o'CO' l1mD'1 i I I ln the III IInb i E l l r S,ph llB : i i li ll jU l ry t~a.l ll1' Iig lh l l

h alv e b ee n prevenled ~ 1 1 1 m an y case s I:)y specif~c. _' -

eXJeiTeis le~lrndt i i1a1 cam be reha'bi iUta.tedi in most :

cases wiit lh 'D 'U l t. s ur ge ry . .

.~ ..• " low I l e ; ' I I e , 1 1 9 :f I l l I . ncUona l , and i

: s t rI L H z t u lr a ll s t re n . g th I re . s rL ! ll i ~ i . n Qfr,om

disuse a t l J ' lO p t i I Y " .

4 : S , p e c i j f i , c l i ' , e s ; p o n s ; e IQ l il ii11n:ed~ra l il geW i D i v k .

A III ' f ,our ,Qij 'th es e f\a cta rs ea n be · r i ! r t ' B l l ' l t l n eQ by

M e d X r e s l i ln 'g ' . • • a n d tlt lire e '0 " l ih ,sm cam I b e r u m -

, p ! I ! ' D V ed l by spe;c~f~'c e l l l i e r e i s e . W.h Ue w e CIJn!liIio1

,chsl r l iQe nJrl.i l.s,cliJ~aifi ibe rt'y pe" we earn hlCI i ,ease

Ib'oth f u r l n J ' C l r i O nai l ;a n if J ! s t ll1 . l ic tu r r a ll l S t ll " 6 !< 1 1 1 g tl i1 ir , e g S l r d l -

less o :f nbelr ' type,il lrnd d~o i inQ lsow i~11 f\eaUiCe t lnte

risk , O ' f lmiury.

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CH .A P 'TE R 3

MIIS,LEAD'INiGi T 'E ST IN 'G PRO I ICE ,DURES

,F'IJu.r ,dlisUliIlct I r ;sk. factors r-elated tD ' spi ina I I P S ' ·

' lh ID II !oQIY li lave l itO 'l l be ,en ,sstabl , is :h,ed' ; ; 'factors til l lit,ca11'IIeld e-nUlie d by meani l l' llg~ul ! te 's ;t ing P l i o , c e d l l J r e s

••• DllJltthis Iiie,qll!.llrtresan unders tandIng ol f the

di i l ferences Ibetweenmestslhat are'l1iIesninglll l l l ;and

tests 'ha:t ,alre mils. l 'ea.di lng.

Space devoted to things th_a·tdo not work is. no~

wasted ..• on the contrary, learning is largely a processof elimina li.,an; until th~e failures are carefulily ex-

amlaed and understood. our efforts milly condnne

i n a : v l. r l ! o n , g :direcdon,

The most cemmonmistake has been Ui.e'use of

dynamic testing procedures, '/\Ihidl was sometimes

'r,ationalized .o n the gr<ound.s that d yn am ic s 'h 'e 'l."Ig th

is m ore relevant tllal;~. st at ic . s'l :r .I :r ~gl li .Bu t bo th . , at atic

and dynamic ~ests of strength are a c : m O l U y tests of

the same factor. an.mdirect measurement of the forceof muscular centractinn.

IER :R 'OR IFROM P'EAK TOR ,QUE

,C o n rfu s~o n has re s u 11ed Ifliio :m a . t t e n l I P ' ~ s to ;mon i~

1 , 0 1 1 'c li 1ange;s i n s : li r, eng l h I b , m;e.a,s'udng I p e - E l l l I I : . l o : r q u e ' j :

t U J I I ,even w h e ! 1 i 1 1 I ' tSiElcS,lJ,Ilred : a c c l l J l l r : a t e l f y , e J h a l l' t g : e s ; '1n

peat : tor 'q l! J le do , net p f C J V ' t d e a m:ea :n i ,rng ltu l p,j'dum

,of ga ins : ~Clli' I IQ sses ) iinstrength. line f,olll l,owl.n:gl

e : x : a m p ! l e demons1..a~:e$tlnlis poild c f e a r I J y .

600

z-150

o

I I

12 604 .

AN 'GLE

36

I I IN ,

72

F~GUR IE 3-1 C om parison of three male subjects \ I V J 1 ' t i 1 th e same l eve l: o f s t. re :ng il :hin l1 ,e H ex ed position,

~ be usual position of peak torque; in th e f le xe d positi.on f th eir s ltm : ng l: h l ev els v ar ie d by le ss th an t h r - e e percel1 t.

48

D.EGR'EES,

Page2-1 l

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BU '~v>ery sigamk.ant d i ff er er n: :e s in .strength existed

in all otherpooitjons; :subje\::]~ Apf;Qd U O O O O l 1 k ] Y 26

:lOot-pounds of t~)rque in the extMdedpo.sition . . ..

B w,S ls n ea r]y f ive t i l l m . e s f lh .a ' ts : l rong: inth e s am e po -

sil:ion~.125 foot-pounds ... and C was much s l b r 1 l l n g e r

than the other two,. 343 fOOt~p0U11tds.

.FoUowil.iJ.g theh" ininal stre' l ' lgt l. i ' l t e s 1 t t s , these su bj:ec~

wel'\~ ,e~€fd.sedwith wi'n.at \W ccnsid ered an. appm -p ,r ]a r e l ev e l I).fresista.nce.r b a sed upol l~h~ i :r te sood 1 J e ' V -

els ef fresh stlllength. In one case w e ,pessed.ri,gM~bu t'm M O cases our estimateswere ' It ~ 1 T O ' l1 1 . g . S,ubject

B w as giw:n 200 fO O 't-pOW ld .s of resistanc e fur t h . e

exercise, and performed nine repetitlons; so OID e lY-

ti:mab'! was correct ine'hat case.

SubJed t A r given o~y 1 50 feot-paund s of resis-~nce~ cO'!.ddnot perfom~ even. (me ' fu ll - tm, ' l_gemove-

ment was forced It o sbJp beforereadul1g the midrange

o f mov ,eme r ll t. Weakness beyoJiLd~t point prevented

add]t]onal movemeotagainst the ]e-ve[ .o f -ms[stanCl~

p rovid e d . VVhen the~e sl istl l.m . ae~S' red uced to o m 1 y

100 foot-pow.'1m l he was able to produce full~range

movemen~; b 1 il~ e· ve n ,;vith.ll i is 1()!" , ,~er[eve1of reslstance,

movement in. ~he , e x r e . n d . o o part of~be rangecould

b e pro du ce d only w i i ' ! : i l i t greatdiff i .o:. i l l i ty.

Subject C~given 175 foot-pounds 'of resistance,performed fifteen fu]l-range mcvementssthe resis-tance wastoo l.ow.With.:225 fOOit~POUl'l(ishewould

probably have ped:onned rune or ten repe,'tiiUons.

'frying to evah:t8Jibel::h~€t:l1tree S1l1b~~ by compar-

in g ~beirpeak .reveil lscf ta'Ique. p6lltiw~dy if 'klrque

in the ~ed position w as oomp~l100!, \ V e m a be m i l l s -

~eading. Judgi_l,gtheir later pw~bf .tlI~ d f t a J f l g e

m peak ~orqlle would producemunrt der sl ti lhm1€ . 'J 'l t of

I l 'i eu. actua l ga ins in ~lI'ength. for.my meaWngfu l

evruWl'llOfi o:fspinru function.torquemust 00me-as~.

throughQ~t a full mnge ofpo55ible movement.

Subject C,in~h.efuJJy ex~en.dedposition, was more

than thirteen times as strong as A 00 compared. to

only 2.:6foot-pounds); bringing subjeet A upbo the5~:me level in tha~ position wonld r~~ a gamin

strength of l.219 percent, But is 5' t Ich anincrease

even possible? In our :first srud y group ( I I f male Bub-

jects (all members or m.rr researt:h. stam f two of these

m en in creased th.eir fuj'tiialleveffi()fsITeug:t;h in the

fully-extended position b, an evengreatet degree.

The potentia[ . f m : streng:tU1 increases is · 1argely de-

I~erm.inedby the lltilial1evel of strength; and when S'ltalt-

ing with ifd'llevery I,ow level shown by subject A in i a l e

ex~ l&Ided 'po s~Hon r t l l . e potential fo w gains · i U m l . S!~~

l i s , enormous . 6ut m~sing· his s'~hin t:ll.e f lexed

pos-lion to the S lim e d egree w ould not be pG §S ible; in

th e f le x ed p o s i t iO I l1 l . " . fm mO !€a se ·o f8 0pe rr e.n tis p ro bably

as mUCA as ( 'O ~ d o ore aSO l'la bly ' ~x .pec ted •

Two lo f these s.ubjedst Band C1 wer,e ~erdsed

and rerested over a period of te n weeks .~oUo'\ 'Ving:

llieli.r iru tia Jte sts sh oli"m . above. SUbject 13 mereased

his mnlial1~\I!~]ofp~ ak torque by 68p@f1 ren t during

Ul@ Jtperiod; but ,evahJating ·lm[mph\ov~.ent byl'be·c h~g e III pe ak s tfilM 'lg U tl-V O uJ dbe ntisl.eadrng, becaus e

h1:3strength ill. th e fu.lly ex rend ed position inc reased

by tSQ Ipercent d urh"lg ~he same period. And Iu s full-ran:ge J . dymamc : s:hren,gdl. inc reased 1 (JO percent,

S ub jlOC lC w asin itiaJ]y stro ng@ [ n .v en ty d eg rees

f orw a rd fro m fu ll exte:ns.i!ol'l,an d during: ~n.efol[mv:mgtem.w~ his stten_g lh in tlmtposiHon iflcreasooby

22pe:roent.Bu~ In the flexed pos i t lon l i l i i . s t l "ea: lg t l " l

increased by OOperren~ ' W i t1 1 1 l a 33 percent ;g:a.ini:n

the .f~y ..exiendedposition, and ·Mtn an. increase of

60 p e r i o o n t in.1.full-:Ulll~1 dynall."lic 5~g:1:h. WithOOitll

sub jects , f he ii 'c hanges inpeaJ> . t o: rrquewere m J j s : ] ! L ; l S l d : i n g ; :

d id n ot .in dic a t e UleH ad '.u ru . Inc reases ill strength.

Subjec t A w as a physkal therapist &0111'1. Plillt1l-

del.phla1and wastested durlrl:g a. medical seminar

in F lorid a, so w as no:tavaU i!L bl€ fiQl' later e xe rc is e iI I'I d l

i~es:ting.AheaUhyma1e irrhisaud h\re :n . I i i ! 6S , about

six ~ eet with a leanbed yvveig ht of app.ro:x .in 'la~ eJ ly

2. { lOpounds, he had beenexerc is ingea a C}ibexrower-

back machine fur several ye.vs prior ito'~he·tes~shownab ov ,e ; ,e x~ cts@ [ha t obviously d l i d , linL e or nothing

to i nc re ase tIl l,€: str@ lg lll of h l l s low er-back m u sc les ..

G iven his wry low le v>e l'o f strength inth e exibended

part ,of iii full range of movement, it is a lm o st certain

that a few weeks of specific: exe~d sewould halve in-

creased his peak torque hyat lea;s~00 percen.tl while

inne.1S]n.g s t u ' l e : n g U : - ' in th e fully-ex fel'u:led.position by

m ore than I ~OOO p erre nt. H is fuU-rang.e dyrlan'tir:strength would prob~ bly have increasedmere than

30 0 percent,

8/4/2019 Spine Knee


L U M 8 ,A R 'E X 'T E :N S , I0 N600 ~~~----.----r-----"""I'------"""I---""""-----'-~

en1 0 1 I

'Z : ,5 010I--If-----F---t----~~~~~~~~:::l

'~

- ~I-

ooLL.

z-' 0 1 0

36 ASIN DEGR :E E ,S ,195 222455 483

72

2. .55

518

309f577

0 112 ,2 4

A,NGLE170.419

RI:s:e:AFH::lI l ' l l : DU'l! ' i rn,ga :shl:-Im,onUlls'tudy" th e :a,"J\I;l l l3,glencrease Ilil p eia k Klli 'ique P ' I i " o c : i u c e i [ i l . ,by our

f irst g l f \ f H I . l I P 'o f fiI'Dlfl1a~ n!I:amesl lJlb j:edswas ·8, i peln ce :n l • '.' • bulthe ir a:ve r,IQ le ' iili 'llc!reaS'B h i! a , [p,ostUa'li lDIIlun extensio ' l i1l o l ' f ' the I IL!I I ii I1D~l!rs.pi li l:e w a s l I i I 1 I u 1 ch Ig ,li€ Ullte r' ., • " w I i I I U e U 1 1 E ! laV,era,ge o,~e ra~1 'cl i l8nQle'( ,a~eal u l 'i I,c fer f il il ,e CU lN e)WBS B in , hil,cl!',easeof 1 1 4 2 ,e'rioe:l1It.

A , h lt.e r S IIL lld :'~l\iU IiI a . l l:argell 'grou p of s:ubJ;e,c ls :" ibo , lt iI niJ:l le :an d fe ma I 'e~ ,w ,as co1i1i 1~I11!IJ~dIiOir isIP 'E l 'r ii od ,o f 20 1 weeks • • • wiith t e s t J I l ' I I S ! ped,o rm,ed , a t th e s : t J a r i l " a H e r 112w'eelks

"Bnd l a.Her 2 0 w ie e l!:s .

H:IVh lg I P ' V 1 o o l k I : C i e d ial! ' :ge gah1,s in s,pimll'l s;tl: '\e:n~lh dU l r l 1 l i l S I tb eflirs :l: ~2 . week :s IfI:f the slud'l d iU r~rngtlile l last ,8 !w ee ks th ,e !s ,v ,e ra ge h l'le leaSi8 ~n pea lk I~ rqu'! 'was : 10nil, on e pe rce nt; t n - l i t duMi!n9 ' t : l i U 1 1 1 , t

same pell'~Qd~stli ' ie'Ii lQtli1i In t: l i l:e!,ex:leiJ'i lded: ,Pos,ilh:)'lIl l lf l lc.ll lea.sed an a.veirsge 01 :31 pernent •• , • 'very:s:lglnlflclBlilt ga. i ins i in s :t l11en .g ln ' th :a~ wouh::l l have bee'n 'fIivell 'loolkeo i f 19!al ins ,w,ere , iLn::lg,ed by me,c!han'Q,e' i ii 'l l peak ' to:rque.

BEFO'RE 50

AFllER 34a114392

A . F AU LT V A ·S ·S UMPT'I,O N

It has bee n assu,m ad !, u n~1I rece: l l t l iy J tha ,11es tedJ U ln ct:h Jn a l t orq ue is :8 l : 1 e . s l d ~ o f llile fo lie s o fmus 'c u ! ar co ntra eU o 1 1 1 • • • a:ndtihus iit was ;as sum ed tlh at: c h a I I i I G I , e s : i n ,f u nc t ii o na ls ; lr eng l thw e r:e I n proportl iQ1n 10 1 c lhang : es i n thes ; tr eng l t, h

o f th e ili1vo~ve d musci l ,es. IB ' u l b o th a s s :ll.f Im , p~ti.DIiIS a l l ' e ~nlvaUd~

MuzruJu strength isa result of only one iacto'r,

tl'l@ ~OJ'Ceof mu scnlar contraction.

B iut~ ested . torque is a resu]t of four £aCb) l 'S ;pad

of the torque may (Cir may flot}be a resu l t ofmuscwarforce, but it is , not th e oriy factor, Torque is also pm -d uc ed b y tI .'1 :e ,e ff ud :f gra :v i,ty o n th ema ss o f th ein vo l ved

bocly parts, bYSW:l 'ed ,energy.and by muscularfriettcn

if a dyruunictes~ is lrtvoh.l'oo. Un'!llall of these :mctars

are measured and considered in l"elaHon to

tested ~Qrq ue~ the :r,esU[biMlill be : : !], l isl leading al: best

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f~G I l J l I f i I E ! 3~ Prim.w:ily mtended. £ 0 1 : ' elinical re-

se arc h.fld s v ersio n o f th e ]um :b ar" "ex :t'f 'l1 lsio nm a ch in e

p.rovid€Sboth.~sting and ~er6sewhen.:!:otated. into

a l at :e ra1 .posiHomi1lS Illustrated alwve; ap05itioo which

removes tha usualletl~(:tsofgr,~vio/J so that~Qil:quefrom the subi~1t"s torsomass is not ll1.volved..Static

testa performed in tbis manaer arebiased a , m y bys lbm:ed - ene .rgy torque '; bu tm . tests of lumbar .streng~

s~oroo,-~]1e-rgytotql le is a. very slgnifican:t faetor,

Mov in g iv ut'l) the flexed posincn of the lum bar

spine sfuo:re s e m .e : r g y by OOIJ'lJ'res:siJ.'1gtissues inh e front

and s~e~dUngl : i iS8U.es.Wl the r& 1 .1 'O 'f the torso;:: [his stored.

etlel'gy w ID th en p r o d t m . o o J b : r r re m t f fi l e d l l i O C l t k m . o f , ~ -

l ' e l 1 s i i O r l , and the resllrlting t O n 1 J . U . e tW l be sho\V[' l . by ' the

m onib lt as a O ro ' graph, w hllelhe oo m pute!r will recordth e eJ@d ID eve1of ·to~qll 'e.If aseated positioo prod uces

so much 5 ! t( J te ci -e ne J'gy t or qu e, then why no t res tuprl ght

like the B 200 01 " Ute Cybe ..x? B ecause unw anted pelvi:c

movement cannot be prsventedin a standing positiou;

so l :ests in ~hat posHfQ:ll .iiIl'e mis.leading_.l1e!prd1ess of

how they am conducted.

If the fresh corpse of a large ...dead n :mn was rE"-

strained in OMsmachine in ~belateral position shown.

above, with th~bady pulled into aposii'iion of full

flexion of the lumbar spine.thenthe output ofro'rque

might exeeed 300 foot-pounds; torque til.atobviouslywould not be a r-esult ,ofmuscular cQntract ion.

T,ested in an upright posltiOll,,\'\r:itllout proper

cou:nte.rweight]n~. where. the effects, of torso-mass

~oirCJ.uewowd also be i1"IV'Qlv€d~he resultswould

be more :nUsleadmg.

Wiit1."la Uvmg 8tthj~c:t..t es lb e d in any dyna.mic f ash -

iOl!l, where the efieds of &h:t io 'r : I and impaJc'~~QICes.

would be added, the test results would heve no' re-

brdiomhip wirth true stren,gfh.

fhe!se :n OIiliDlILIIscilIIla,r faC~DIfS are n ot 1m1~IilOreOIil~·

sioemthl l i l lS; ' 1 1 n , a . t .can be s a f r e ' ~ y i .gl iu"mcl d U l r i n g t e s : t -

in!Q P I I " D ' C e dures . IFo r r m e , a n ln g if u I i t :e'st m S ' L ! l n s ~ t l i u e

n i J l I J I . s c u l l a r s ' tl l' ,e l il ig t h I ii Il I! J ! s l I i J e m e a s 'L I I I f e · d : H 1 e l011i'q u a

a.duaU, I p l l i ( l d u : c e d ' by 'm e 'f o l l1 c e : s , O ; f 'm u s c l i .l il a . r clon~t li 'acUo irn JNe l Musc ll l~a ,r r ' f J i l ' r q l l ! l B " NMT . ln order t e

dete ' l i111ine NM'f. all nOlnll1lU'scILIII!a!f-tOr'qIU.U! · f a . c t o l l ' s

m u s t I b e m e a s 'L ! I re d lind. C i o n s : l d e tle d in relation tot i'J e l e ve l ls '0 " tested. 'kIrque .

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LIJMIAR~r----P~~~~~~~~~~'~-~

~ &D~---r~~r---~--~~~;-~z~ 2&l11-----I----iI----+-~--I~

2~ ~ 1 i iO 1---+~;:-----'''=_-'!!'P.''Ij

e: 2 15 0

Z: 1001----:.rf'!L4-~----,I__--~::;..--I,.......-~~

1[ 1 12 2> '1 ~ 4 8 ,60 12

ANGU: liN D ' E : S R E & So F I I. IN :C nONM .$1 '5 ! I1NGl il iI 0'tin MUSC I ! I ! . . I t ! i ! TO~!QUE

€ I' N O N M l I S C I J l A !R f O lt Q U E • , 1 0 1 1 1 1 0 1 1

fiG lU IR . IE 3 -3 T h e results produced by a . re s t of

isolated Jumbar-extension strength r funettonal

stre'n,gth~ compared to a {@s'toftruemuscUlarstrength,

NMf. The highest curveshews functlonal strength,

the middle curve shows true streJ.lIgth,W•

and i f u !lowest curve shows the torque pmducoo by storedenergy. The red area between. the highest curve snd

the middlecurve shows the error' introduced if stored

,e ne rg y w a s n ot o on sid ere d; w hU e th e low er. b lu e areashows torqu e re su l t ing f r .(Hl l s~ored energy. A faHure

~o consider stored 'eJJ!ergyin 1blitisase would lead tO I

an overstatement of true strength in the flexed p0-

sition ofn,eall'ly 100 percent, v.nth . t I I 'sHght under-

statement of true strength in the extended position,

These reselts were pI'od uced by a member of 'Out

initial group of test subjects;: five months later, fol-~owing a program of spec i f ic exercise, he showed ag,airn]rt functional s,tIe:ngfu of 1 01 percen~ In th e flexed

position, tOg E!,U rtetwlith a gain of 4 5 0 pe rc en t in the

extendedposition, But his true gains in strength,

changes in NMT. were 196 percent in th e Ue:>.-OOpa-s it ion . a nd ·440percentin ' ~heex.tel1lded.p ositio n. W i thsymptomatic: wbjects:r th e e rr-or from nonmuscular

torque may be even worse; as demonstrated by thefollowing example,

~,c:2 : '

'~ . . ' .l 1( JQ~

z

~ i o o I"----"#=-t----I-----+-----t~~+_--_"'IIIc J :~0'~ O~--_L~~~ __~ __~b_ __ ~~~

(!) 24 . S Q . . 4 !e

ANGUi IN I I ! J EG iR IE ! I E S

'0 fUN j ; nONA l .S l I I i :NGf i o i I@NEf MIJi5CI!IWlOJlQUE

• fE RR lO Ii R lO M N O"lIM IJ15 CI!IW iO ilQ :lJE

-I

I F IGU! IRrE .3 -4 A patient· wit~la twelve-ysar lustory

of chronic lower-back pain; a big man. six feet, four

Inches, with a bodYl'Veight of 260 pounds, The highest

curve SI.liOWS th e '~ e¥ el,o f f r.- e:s,h. fw1 i c: ti o na l s t ren . g~h ;

while the lower' CUl"'Ve shows true muscularstrength,NMT. The red area between the '!:Ul'Ves represents

error in test resul IS preduced by sllo:reden.el'gy ..F o n -lowing eleven weeks of rehabllitation, hlsfunctional

strength inthe flexed pos i lRon was '75 percent higher

than the level Sh01Wl1 here, ... but his 'true u U : : a : " I e ! l is e

in that position wasmore tba.n 353 percent,

Evaluation during reh.abilitatior! must be based.

upon changes in . truestrength, NMi; changes infunc-

t iona'i s tn ;~~n,g 'fuan! g ro ssly m i sh ~a d_ in g.

I'll would probably be too much to expect mostpeople to perform calculations in an le f for t to measuretrue str,engi:h; so the measurements, of nenmu scuJar

torque must be performed by the' testingequi pment,

and the calcalations done by the 'computer, with th et·est results presented to the therapist as an accuratemeasurement of true strength, unbiased by any non-

muscular factor .•. strength produced only by theforces of muscular contraction.

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1 1 MP 'A C T ' F O R e E . · S

.r n addit .on to I 1 i I l s : l e · . a d i n g l e ·s l I l' eS ll Jl h , an y dy-naml l !c nU::lII l1eo f msUng I lJlnav'IDidabl~ exposes '~he

s ub j:e ct to h wg 'h leve ls o f im pac t I 'D,roe; a .sub ject .

may p 'K l c il l l lC i e '[ J !I I1 ~ Y11m p o u n d s l of ', olr oe but bee :xposed~o ' :SCU IJpDlunds 10I ff if llf 'C1B ,o r morE!'..

Wi lt lh s t at ic t e s, ti ng ,Ihefoll'oo a.ct l lJal l~,p'l ' IodIlfcld~s ,ah l ll os t , e x8 .c tl ly tl n .e , s am e ,a s, tih ef,o K:le 1M iP ,Q s e d

U I P O n th e·s 'Ub f~ct~ SIDm e I l c ·V i I ~ev e~o f im l pa c t · ta ro oi s unav,o ldab le· e ven in s ta !~c te s1s :: bu t .f stat l ic

rests a re I f I , r o P EH r i l y ' peIf10·.rm.edli~he impo 'sedfo l l ' oos ih ou ld l n ot b e m o re tlrJ ia ne n e o rtw o, percen t abi l ive· t he .f a r, ce , p rloduced Ib y th e s .u bj~ ,c t~ DUFiingl r eha~ ·bllitatlon.deaUng as you usua lIy' ,are w i r U l 1 a,ii' llall-·l ! I e , a d y g,amagelli jO~li'Ilt,- t h e last tlili'ngyou should

. be , d o. n ,g is , im po sin g Ih fg 'h le v,e l's of unrequ i redfo:r,ce' during e iithe r' test~ng IDr B )I)e ll1cise O lln ltheI con tra ry ~' f~o lrgeS h D U l I h i : i l be as . l o W ' as p'Ds,sibfe c o n ~

s(stenl with the' r equ i r eme !n t s i if ",ot~ y 0 1 1 l J m ay(lh!termliIl l9 t lhe 'imils IOrti 'tructural strength by PI iO-

tt l u:cill1QI I.n illljury.

I

II I

I

I-" . . .

- -

FrGiURIE 3 - 5 ; Us ing anisokinetie machlns (Cy-

hex); if a know n level of 1 00 foot-pound s 'of ~nrqule

was imposed, and U the machine m oved throug h a

range of 90 degrees; this is the exact curve of torque~batshould be recorded,

I I

I

II I

-

I I, I

U I - V .~

~

'F fG iU R E : 3 '-'6 B u t WhM a known tQnque w as im-

posed upon. a Cybex iso kin@ ti.c m ad rm e , an d permi t ted

to m ov e' throug h a m ]1 ~ oJ 90 deg rees . t im, is th @ act.ttru.result, nUs is not a measurement of lorque,insteadsh ow s th e re s1 1 .1 ts ofimpac t furceproduced by therapidl.y'changing speed o f t[remachme Th is mach ine doesnot,

.M is c la imed , provide a > O O M m n t speed of mOVeiuent ;

instead, th e speed varies by ~ra] hu: ud_ ll ed per oent . .from F a - 'below thsselected 5 : 1 ' 0 0 : 1 to fa r ab ov e th e s e l e c i t O O

speed ; w Ith the 1:iesu1tingirnpad f ames reco rded . here.

L II

I

II

II

I

_ LI

II

I

I

1 l r ' 1 ~ l'~

o l l o a

1 1 0 0

f i l G i l 1 . l iRE 3~l' Electronic damping of the force

n19surements distorts the' aerua l test result until it

lookslike the curve shewn her ; wi'tb 110 relationshlp

to e ith er what should have h a ppell!eG (F Ig1 .U 'e 3 -5 )

or w ha tdid happen (F ig ure 3 ... ), and 'the ' actual rang e

of 90 degrees was, changed to an m r u c a . t o o r ange of

1 83 d eg rees. T hese exam ples w ere prod uesd by tests

with a Cybe:x isokinetic JIlaChUle; an d severnl studies

have bee" published in. number (1,( s c ien ti fi c j ouma : ls

during the last few years showing similar results.

FoUowEng l e xamp l es c.'earty Hlustrate' s·ev-

er,al other prob!le,ms praCilIU,cedby dyna ,mh :~

t es t p l!'o 'c ,e d u re s . ..

Pag e 2 .9

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IEA IROR: F,AO 'M MIUSCU lA ,F iI FFUCT , ION

.Ano tl rl e r 5 :Q 1liIK:'e' ID~ , enOI i lin al i ll dyn;a l iT i l~ctestsis; prDduc!sd by nJllJIscl! . l l larf.r~ci i iQn;al l i l im;plortal l1lt

fae~or' t lha .1 iha ,sooe,1 iI ~glIilO ' IEn:!'e r O \I',e ,rWoo ked by:m:an, peopre i l l 1 l this 111310.I i J l f I ~ :~t~glnCll:lied"the er l forl ' n b " , o d , l J J , c e G , b"fri!ctton Ima'kies i~imposs i'b,re~D~D'~d ll!.l:c em :ea nln g 'fu I t es t: l l i e J S < l I ! 11ts"

10 il\[i ~Il ,4~ . ! : I i : ! ~711' ,B t l ~ ' 100 II i:l l:2lJ

A NGL E liN ! D IE :GIE ES

• N IEGA ]1\1i • fOS lI!T tiI\!E • S lIiA nC

F I IGUIRES . . a Results of a t h ree-par tprecedure

f or t es ti ng f re sh .func tional sb: reng ifhof the quadriceps

musc l e s ([eg ex~~F lS ion ) . The bar-graphs Tep'le5enit

st:aticfuo~que m severai.posit ionstfu:ougll i ln! l l t th e ra ng e

( ) I f movemen~w,hileH'il.e highest curve is theooexi:stirlg

level of ec cenrrte (neg aU ve) streng th. and.th~~ow.est

cun1e shows concentric (pos:iHv'e) .strength, TIUiIll~si-

multaneous]y coex ism1g butd:istmd levels ,ojstrongth

• , .p osi.tiv e s:tren_g~his low>es~~,egadve s b : , e l 1 \ g l t h .L S

hjgh.est,~Iitd ~ta;tk:srren.gn. is midway between the

levels of pos~tive 8I1.:d negative Sh'e'Hg!th.

ill ger:U,~[flIl~hen positive strength is 100, then.

negatl.v~ st:rength Mllbe 140 (40 pru:-ren~hi:ghe:l ' t and

s ta ti c: sb 'eng tTh1willb~ 120~nrldwayl i :Hl ! l1N·een posil:iv'e

and negative JeveJs .AssU4l1ing only that you are

testing .fresh., rested rauseles, at any level of strength,

and that the clynawc: test's are conducted at a reia-

t iv ,e ly s 'l low speed a f m e vem eru , fatigued muscles

showa far difter'illllt :ratioland tesT s

conducted a~fas~&

speeds dwing t h @ dynamicpcrtions show a d lf :f eren ~

ratio. Bu t regardless of the level of fatigue, and re-

gsrdless of the speed during the dymamk testing pro-Qed I . 1 r e S " static strength will be midway between the

pDsH ive and n .ega t l ve strength levels, Assl1l! l ' l . ing tnaJ[h~ same speed ~ US0d during both dynmtir'~ests,.

Stale pflD oed' l l !m,s p:rov : lde the IDll1Ili~mean ~ 1 1 I \ g , f ! l . l l 1

t e s t o f s U - : e !l I 1 J g 't n ~ • . . 'd iyn am J c t:e sm ~ re g ia rd le s:s g ,1

h,owth ,ey i i l lte' oon:¢i l l lJIaedl,pr·odl i lce onl;, iani i facts;teU nQth ing alb Q utth 8' true lle ve ~ o f stl1englli 'l i.

Tests o. fpo i5 i t iV 'es lTength are ~l~W$l'YSan. under-

state-men~ofl:n1e str"®gth,reduced. by .friction in themuscles, while negative te.st5 produeean ove,r.:,tate-'

m ent or true strength, increased by muscular friction,If th e level o f f rk tionw .! lls blU.lW[I/tr..et:iI. ped.1laps mean-ingfull results ·cmiJ!d be pmdu.ced by adding to a. test

o f p osU ive s~ etlg rh r 0 1 ''0 '1 subhacfing h o·m a n eg ativ e

test .. . . hut Ilne [eve] ,o f friction, as a p& c,entage of

mUScWa l'io ro erc hange s a s 21 result o f itw.O factors"

speed of m usc ular c o:n b':ac 'tio o. end m.oll'leJllhlJ'Y levelof fatigu.e.

-- - -- -~ ~

I. ~ -

1

-

~I " " ' " " I'

" "JI

-

~

1 I I I

'J'I I

I

I , r!I

F IG l!I f ilE 3 :-9 CompMe these testresults to thoseshown byRgu: re 3~3;this chart shows, 1 [ I M ~I~re~ levels

oftested strength, positive, staac and.negative, aIi~er

a.subjec~ was exerc]sM to t]:tepoint that hispositive

stn!I'Igt:hW'8S totaJly lost.while only t 4 percent of]lls,J1Legativestrength was gone:, andwhile his erue

]oss. of streng fh w as ShOVim by h is r ,em .w iw l'I g le ve l

of Sill tic stf tn gth F red uc ed by 50 per,oont frem I ts f le sh

l i e w - , e I .

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1() .20 UI 40 51l ,60 ill 00 90 100 11012(11

A N G L J E m iN I ) I E G I i I ' E E . S

li"O SJT JVE F /mGUE .. 11l1!l% LO SS

F iIGUR : E 9~ 1 11DTh e le ve l o f f re sh Slren,gth meas-

ured d'mbi tg: a ~ € ' . . S t o.f dyna rmc p os itiv e s l: re ng t1 ~ com-

pared to th e levello flJ 'e'm a .tru ng s~ -e ng th following a

very hard exercise, an. ,e; .: :ercise continued to a point

w here the subject couldno longer pr-oduce movement

even ' l ; I ! ; 1 t h no resistance aga1 ! ., st such movement. Hisloss of mesh positiv,e stre,l1giUl l was 100 percent. The

red area between the fresh and exhausted curves

sh ow s p ositiv e fatig u,e fro m th e ex erc ise. Comparethese results bJ f u, e ' tw 'o iol lo ,\ II ri .ng exampl€S .

e n lQIZ~ ISQ

~o~ 1 00 1--I-+--bi~"'-i-I-""""-+-+-+----lI

i~l --+-&'lr-------*-F-I--i-Jt--+I

-+-I

, -+--~

I"", 01 L..-..Ii..-...!!---!........,.,!..........li:--JI_..!I.~~b~~~ .l.i!:..-"j1

- 01 1 D :! O 31 ] 40 1 5 0 ,(j()1 7 0 , 8 0 9I"l H ID 110 120

AINSLIE WN D ' E G , R ' E E S

F lGIL IIRE 3 . .1 1 1 Tested for fre s h~ eg a'tiv e s tr-e n g th

prior to the exercise, the subject produced 'tbehlghestcurve ef torque; when rerested hIml.edia,~ely after the

exerdse,prod:uced the lower curve, The red area

betweenthe two curves s hows negative fatigue from

the exercise,

'In'C;2

:::; 11,0 I--+--+--+-+ I-+-+--I--+-I-~: 1 i 2 - -I

I....,01 1 2 . ' I 00 ~+---I--il-..,j

Z

HI 20 SO' 40 .50 60 7,0 , 6 1 . ) \f O 1 0 ! ) ' no 120

,ANGILE IN ID EG:rU:iES

: S T :A 1 I1 C F . A n G ,U I E • 5 0 % a o s s

'F EG IlJ IF II E, ,1 2 The acru,allo8SeS of fresh strength

W'eIle deru:"ly indicated ·bythe tests of .statiC' strength

ShOM1 here. Posllta :ve tests grossly overstate th e' ]0 85

of fresh strength from exercise, while negativetests

understate the true level of futigilu~from exercise, But

static te51

!; s will show' what actually eceurred. TIlere d a re a b etv l.re en the: tw o curves show s staric fa'tigue.

In 1 '9.85 a nd 1 986, 'w e cond ucted more than 200

medical se:min>iU"S; with total a.ttendance Q ,f several

thousand people fr,oM every 'branch of medicine, andthis provided. OU~cpporhmlty to test the ~~,e]s of

c oex isft:in :g po sitiv e, n eg ativ e an d stath : strength ..vi thmore than. 2,000 subjects.

Most (If ith.e-sepeople were not exelrised to the

pail'lt mvolved in the above example; instead w,ere

bes~edfor fresh levels of posltiVie.t negative and staticswength" were then. eX le rc i sed only 'to a point wher-efat igue beca .me ,obv ious , and . w.eI\'e~helll.il:mmediatel yretested fortheirre~g levels ,of sb:m:l.gth. Butat anyrem aining level o,f strength, fatig ue w as alw ays

overstated by the positive tests. undeesta ted by the'negative tes~" and accurately measured only by t h @ ,

static tests,

Even fresh levels of dynamic strength ,1Ue biased

bymus.cu:lar mchan"but ,[he initial level armetia n

found in fresh muscles changesas t 8 1 [email protected] worked toa point 'where all 0f the fresh level

of positive strength has been lostj,th e mcTion has

then reached such a high level th a t it is equal to the

force of maximal muscular contraction, Continued

positive movement then becomes momentarily im-possible; even though the actual l@\leloffreshstrength

(fol",ceof muscular contractien) has been. reduced by

only fifty percent.

8/4/2019 Spine Knee


T~Ui ' fOi~hllwhil .g: ,examll tde demonstrates both P'hYS:E'O~o,gio,alUlld lP,syoi1,ol log~loaJ

sou rees of ,eno r iV '[d vle d l in dynamic tasU f i llgproced il !. l ll l l'es .•

•. . . . . .ooLL.

1 0 1 0

~5 30 45 6,0 J5 910 lOE;, 120

ANIGLE IN D E G R E E SN EG,A 'J llVE IlPOs,1 Tl lVEI I I STA' l l C

z-5 0 1

co

FIIGU'A'E3;..13, Look frf,S~a'[~h~ :ri;gJiltsi.clJ,~f the

d'l1u:tnotice that the blue llne which Iepfe'SMts the

pOsi[c:i\ l"leshenglll cune ir idicaJ.h~!s a pos]i[dve s trEngHn.

Qif]ess th~'I1 .half of the static s lTe:ngth m fuatpo5i '~of! .

There is a d otin 'the static-strength baJ : l ..gra,ph which

represents posUivEl' stFength in that position. a dot

wHh an arrow pointing towards it, MIlaJITO'W num-

reri!d 1 insid e a rude. In that poBilion. the posJI.tiv,e

strength should be abou t 83 percent of the :s la liestrength.r 'but in factwas less tban 50 percent.

This low level of P ositive str,engt:h inth a t position

was produced by a fa . cWr which introduces errormto

al l dynarruc test:!l@ suHs, th e .b 'iL a bU ity o f th e sub je ct

te , recruit a]] of Ihe available muscle fibers iruJ;tru:dly . .

In a dynanuc '~est#the' movement starts iI'lstaliltly:,bu~

you cannot recruit al l of your availeble muscular (1~

bees instantly; will move well a vvay from the sta rting

]pOsition before t l l i l . e muscle is . capable of pmdudng

i ts rn a .x im . tm l l ev e l o f ~o rque in filial pos]t1on.

Nowlcok at the dot : i 1 ' 1 the nex t bar-grapb to th eleft. Harv~g moved toot far from the starting po~sitiorlfllie subject was still. l1[)t prodncfng an appro~

priate l~vel of positive torqll1e, was prod 'lUcing only

~bout 70 percent of his stati!c level of S'blMgth li n that

position, when he sh'ou.ld ha ve been producing. above83 percent.

By the t l.D1e he reeched ~he posi t[on represented

by the third bar-graph, he Wa5 fhilally producrng an

appropriate r~v iE! lo f positive torque; but during the

first 35 degrses ·o:fmovement hiS measured level [I f

pos it iv e s h" e .lI lg th wa sto o low, He c ou ld nO it r ec ru it

a ll o f h i s m l lJ .st; "1 .:iJ arib ers qWck l y ,en oug l1 to pro duc e

~ truetest .o f positive strengith in those POSitiOlI.1S"

8/4/2019 Spine Knee


' I1wougl"l .out t h t E ! rem eind er of fhepesiti \fe l :e~tl

his measured levels of sh'engl-h stayed h U : r l y dose

~ow'h" t f hey should be as a percent of his stalic

5tTeugU~in those positions. Eut at the end of the

teseed rang e of movement he w as starting to show, 8 1 . 1 1 e f fo c tr .r om . (U :lO lt J :' l. e rE r u :~o r.U5 was ; l O f > i n g Sl:rru"lglh

ss a resld t of fu.tig u!e.. The positlverep!!litiOl'lIlequ:iJ1e(i.i\'I!bout$o,tu seconds to perfo.un, moving at a s~ed

'o f 25 d eg re es-per sec (n 'ld thro~ ghol!llt a r,alng e of a.p-pro;dmately ~( )Odegrees; and beeauseof the CQnth." Iu-

'DVi5 nature of Ithe tmt procedure hew-as startingto

lose strength from the onset of fa.tigue.

In g e 1 M l : t a J . !illb~ f1 s M ,th ahig hp~ centag e ,of f ast~

tw"itdt . f i l O O r $ ¥till. recrui t mpidlybut lWill.mo £~. t igue

qWck ly ; where as sub je cts w :i:tlil. 'low "'h .v 'itd l f ib ers w.ill

recruit more ! E ' [ o w l y but will 1'ICI~ fatigue as quickly.

Most s.ubjec tsw ill suffe J" p r i : n ' l . :a r U y from one . t l1 l .CID[

orUle o th er :" but g ime ra Jlly not from both; 'V!lillpmducestn~]]:gth 00IV'e5 that a ro e t oo low on ore end {lit Ul...e

n 'lo vem e nt o rffiJ e c flrl,e t,.but nO i[~ o' a ma rk e d degreeon both . end s, T his subjec t recn:a:ied slow ly 'but d id

not fatigue very-rapidly; iJilmcating a high pel:irentl1llgeof SlClW..ootcll fibers In th ese mu sc le s,

Havin gm .o 'V i ed a cr oss th e c ha d .&om : rig h t ~ o ie f~funovving~he progressof [he positive strength I l e s : t r

loo k no,w at the point where we ended I th ep ositi v e

I~t, the dot numbered 4 bemg both the e'ndn1gpoint

for the posittve test and the starting peint for tile

ThElgat iw lest. Movingno:W' left to nglilt;.fo]low the

red Ul1ethat repl ' 'esents ID~ s: !J 'mg : !: h 1C:U1'V~during

th e neg~jl : i 've dynamic tat; no tiee first f u h a ~ 't he l ev e l()f negative sbengfu indicated i I ' I ! the sbn.t~ng positionwas far too low. Ag~ i n the l!ecrl1~n'lent factor was

responsible ~or a low ~esJre.sulit;moveri!1entstal'ted.

ellld p ro ceed ed lo ng befo re th e 5U:bjOCt could fl~cntri[

all o .f t h e € l J \ i ' r u 1 a . b ~ e l E i , O O ] ' 5 .

Follow file re d line up to the posihon marked

as num ber 5 ; h~vm,gm oved . 1 5 d eg rees fron t the start-

h.lg posido1"l~he was still producing far bJO li'tt1.e

torque. This subject did not start fo pred ucean ap-

prnpriate level 'of negative torque 1 I ; m 1 : i 1 he reached .

.~pos;ition about 0. thizd o.!llie wayllirough the entire

'l "a ng e o f t es b; ~ d mov emen t, marked .~J;. number 6 . His

tested results were too low dum'lg the first third of

the mOv.eme:J.lt. A,gain.aJ meaningless resul t . , . or

WOi"Se~ 8.mi.s.leadingresrut.

Then, du rll1 l'g a la .rg e pari: of the res t oltn e

'rested range ' 0 ,1 mQ'"ement~ his results were 'OD,m~

p:romis!ed by B I I II . O i t li 1 . e r f ' ij 'c 1 ! c u · ;but " ' D , I ill Iphysiol~oQI;i~c la~facto:r ~ 1 1 l th is ; c as e . S'eeJng · t lne ! r U g l h i I'evels; o,ft o rque ttla t . h e w!as p,roo ueing, t l i l :e s I 1 . I I D . l e . c l i b a c i k e d

off In hfs e n,o rts ..•• s toppe dl trying to produceas IIl'iIllJIchton:lueas IP 'GSsl lb~le. IH~sles~ed levelsof n.ega. l ive stlrelllgith thin;) u:g t i lOIUlt lne r e l i 1 i l a ~ l i 1 , d e ( i ' o f :

t l i l : e IPIiQeedu l~e wB , r ,e f a r to'OI lo w ..

IUIni~Ihe adldlliclnai errers p r , o d l l l , c e d b, ~mpa,ctf,orces t Ibo d lY"I Ii I1 ,9SS t1on ' llue I, n d s t!o lr e d -e 'lil e lf "gytlOliq ue arefacm,rea linto the test r,esults, .allly

m e a.n ~1 r i I ' Q . fU I I I I i', e'la tio n :s h itp , b e tw e e n t es te d ton, l !JIea. l i' ld t rue ni l uscuEar s t reng l th is im pos .s ib le .. .B I I.U Ii Its a;so i l l l11 po a si b m e t o m . ea :s u r e f il il ll seH l! cl o, lr 's , du li'-

iilillgl ,any kI,rm ' l J I f dyna.m~c test.

Twenty y ,ears ago, then. providing no n@ gat iv ,e

w o rk " N 'ith th elr' m a ch in es, th e p ro mQ~f ii of i sok fun l3 t i c

exercise w m:t ~o great lengtllsm their aU€Ulpl::s to labeln .e ga tT ve w o rk a sb oth w ·~ )d ille ss. a nd d a Jlg eI ou J5 . As

a r esu lt C it this c amp a ig n a g iiin s: t: n eg ativ e w o rk ...r om eJ?eO pleslill .av ,o ~d it d uring rehab ili:tatlm .1 . A v oid i'~

to Itheir ,~t lcsabecause negative work is certainly

one of the' mest impmtantparts of exerdse ..

Dllr.in.g the p'~riod:of six teen y,es:rc s that N aulil'llls

Sports / Medical lnd usb"~esrInc., was owned and di-rected by me, several teams of hlghly~qlilRm~edpeo~ple worked for ten years in eentlnnou s effor ts to

pro duc e saJe ,liI1 l5 'o1 niJ lg fu]. i:so kinetic testing m a -

chmes bssed upon servo-p'ower; 8.11:d one Ma:Jl1,

headed by Lester Orga.n~M.D., ptoduced the first

servo-powered machine ever bruIt for thisp1l.ll1'pose:;but Bus machinewas never offered for sale, al-

though we used it fur research. purposes for several

years, with thousand s of subjects.

W a s not offeJ!ied for sale because it pr-ovedto

be unavoidably dangero1!ls; the h)l'l,ger we worked

'!Wifhit the better we understoodthe prcblems wi th

such technology. Several of the previously-used

illustrations were produced by this serve-powered,.lsomeUc tnachine, and we learned a. number of

thing s hom its use;. old pri!Tl(lrily h~',amedtha t therelated problemswould not permit us to phu::e i.'~

on [he I'nEl'rket

We setll'ed I i Jpons t aUc resting f,orUte goodand s l l 1 1 plerelBJSOn Ili'ila~1 1 1 : 0 1 other metltl lDd works;

sU llie t es 1:i!f iI l m : 1'af' me re than the ! best metho d0 ,1 tes ' l ing s t rength , it is q iL iIte U te ra I llylh e on 'lymeanln glfu I rn'IQ!t!1iId Q f tes,~irrn,gstmli l lgtt l i l .•

rage 33

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'CHAPTER 4

ABNORMALSTRENG~HCURVES

200

II

1-'

o01,001LL.

z

0 1

72

f~GI!JIfIE:4~11This chart !i'ep~eseIl!rts 1 I" hyp6,l;heticall ideal curve of the fWlclionai strength of the muscles

that extend the lumbar spine, If strength in the .flexed. position is 1:4JDfoot-·p0W.1dsof I~orque,thenfully-extended :s.trengith. should be 100; wUh pmpQl:ritiona~e levels ,of Sb1er:tgilithroughout afull rang:eof movement, and. thestrength curve should be a straiglilt Bne, hi. this ,example.. U:li.endica ted level ofstre.ngtl'l is . far te]ow an avera:geleve.l, -

I-----I-----I---il--I---------i-----~

-

12 24 36 48AN.GLE IN DEG,REESID E A L S T R E N G T H C U R V E

RE :S ,EARCH~ A lar,ge 'Q R U .lIP ' '0 " nlormal' . subJects j, male a nd · fie m ale ·~exer'cised once each wee 'kfo r .2DIwe e k.s j: were tesl:ed -al th e s'larill a'ff:er 1 2 : weeks~a!f ld afts:1I' 20 ' we,ek.s . . A t the' stanl tnea v,s r ag e ra t'io O'fstl l 'ength W'as 2.3, to one .. .. . sll l ',elrngth hl nile Me xe d pc,s l tJ ion w as 130 pe ll'c :e :n th.fglhe,1I'Ih.en r r t was , I11'IIhe , Ix te l i' u. il ed pos ii ti orn .

BU I~,af1l ie:r1.2 weeks, Ih e ratro !h ad e l i I,ange d Ie 1~6 t o one a,

A ln d a;fl.e r2 0 w ee lq , 'th e lI',a tio w ,as 1.4 · to on e; s .tre li1.g rthin th e t~e xe d. P Q sil~Q n t ihen be ing 'Q.n'y.pe rce nt h i.gh er th ian h i! 'lu1~e x f. en s lo ,n , .G!a~li'Is,n e a r th e ,e :x le lilld e d po ,s it:i o n , we'N f a . 1 i gr,eater; i l l ' l l d~ClaUlI'IIgf:tUit. 1he · EI i1I ; it ia~state lot' a .tr,o ,p.h ie d w ea.kn ess was worse In tiu ! ,e xte nd ed posUion.

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When. to performa first ;~~stof spinal strength. lVl'til B e patient is a,derision thatmust be based upon

clinical jlldgemen~; som e d in id run s perfcrm tests,dwi :ng : the pal::le.nt's rust vis[~ and some perform. notestmg

during the first several weeks, of rehabllitaJtion. Dr. Brian Nelson, o lf Milmeapolls~ has rehabilhated more

th an 4:tOOOchrome spil"ta1pa:tiei:1.ts~vith Med X 'eqw pn'lG :ltJw ltll outstand ing results, and he .nor,mally performs

strength tests d :urmg the patfetllf's first visit. Some , othe r c li 1 ri d al 1 !s wnQare experien,coo with, MedX eq_mplnent

per1\onnfrle first s:tn:~ngfh r n s t a f t @ r four wOO:ksof sp€dfi,c ,exeFOse.

Research performed at I~heUruv,er,sityof Plorida College of Med:k:ine~i3!nd~wh.e:r-e, has aJre-ady es-

t~blisbed nor~l st: re:ngth eurves '0£ spinal kmCijOlll~ and mymeanmgful chiviation . ITo;m a normal curveis an ind ic a tioo of s:pbilaJ ,pathology; but itmus:t be clearly understood that such testresulhl, are not di,a:gIIDsticr

d o not tel[ us t l1 l e .nah ll re ' (If pathology.

men~he BaJliI;€ abnmmal curve of spinal strength has been pmd uced byrepeated testing pmoedu:re61w e C i I - 1 1 b e su re fn at a problem exisfs~but th e nature of t11eproh]e:m carrnoi[b~ d~termi:nedlby thetests,

~. . . . . ,

of 2z:[W : 2 :5:::l

O J1 1 1 : : '

oI-

~oo

75:

72 '

[FIIGU [fiI'IE4..,2 Thischart shows the resWts OfMO ~ls of the full-ran~ strength of·the isolated muscles

Uw i : ex~Mdfrle l umbar sp.m~ th e lowe st cu rve sh ows t:U 'Iee su lts o f U 1!is ,paden r ' s i n lr Ii ru : test, whne~ he .highest

curve SnOll 'N 'S test resoltsthetwere measured three weeks li:l:ter.Soth of' . l : h e s e 'runes should have been a

s'll"aigh line" but instead both curves Si'lowed.dipsm strength intwo PQS~itiO!:lS; dipi in stJIengfu that wererepea:l'ed mtt.e sameposltilOriS ] , 1 ' 1 both tests, Such. repeatability removes ,any doubts aboutmalifllg.ering. In

r - espOOlSeo sped f i c ~ercise, during trusthree·-week pedod, thIs patient's stnm gth inth e fully.exrendoo po8itiOill

increased by 50 pereent. from an initial level of 26 . r o o : t - p : D ' 1 1 m d s of h:nque IDE!. later level of 39 K,Clt~pounds.

12 604 36 ,4 8

AN:Gl lE IN D E G R E E :SII 3 ,-WEE ,KS GA liN

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1:224 a6 .48 Q il

M ,G-IL l: I N1 DIE GR EE S

FIIGUR:E,4~ A meanin g fu l ~ e st p re su pp os es aceoperatlve .subjectl but St'Ji1.1e subjects de no'l coop-

e t i l O O : fiOf a.wide variety of reasons apart from me-

lingering; they may n ot und e rs ta nd the llii. :!sbucoons.fowtlleYmn y haMra.kl to producea m axim ru e£ fm t.

TI le top (If therw area shows th,'e·CUf t l ie · producedduring a test ,of &esh strength; \ ¥ i t ! : ' ! . an Ob\ri01ilSly

abnorm al shape. 'f :h .e bottem of the red area ~shQWS

t.h e O l w eo '£ remm r ili:lg sb ·e ng th .. ollo w .m g a n e xerc ise

r o: nti n: ue d . t o S I. point 'of ~ failu:re; ag ain show ing an

abncrmal sh6lpe,hula. IdHfexeI1I~abnormal . shape. So

neither '~estCal"! be considered vaJid; tb :eoI ' l1y mean-:[ngful result prod UClOO by these tests was the mag~'

nitud e of fatig ;n.re caused bya rela t i iV1ei y Hght 'e xe rc is e

that ' \ /VaS Fer fo : rmsdb~ween tU1e test's. E a t i g J J l t e l\'€-

S1i l1 l ing fmm t l i t@ r!".xe:rdse]sI'epr~ted by th e red

area ; a high level ·of ~1tipehom brief exerd :se# in -

d icating a high perceni~age,o f . fas t- tw:Hdlflbers inthelumbar mu sc le s ..

q)

10:z~~ ~--~----~--~~~~~4-----~2~o: 2 ~ ~":::"'+-----4-

z

~~OO

'i]! lI: i

e ~ _ _~ ~ _ _~ ~ ~ ~ ~ ~I ~

(I 12 2 . 4 . a l ! ! l i l l ! ! 60

A : N l G i I ! . E u \~ D I E G R I E I E S

IF rG lJ R E 4-4 T ested ..for a thirdtime several h o 1 . l I " S

L ~t:er~apJ1 ooedW "e mtelllded to d e i~ € rm i n.e h is r ecove ry

ahi ti,~y(some subjecrs fu]lyrecovet from faHgue

Withnla matter ofmlllutes~ while some do not li!3CQ·v,erfor as longas several days) ,the subject shown by

Figure 4-3 replicated theabnormal shape of thestrsngth CW'V'I ! produced awing h is seeendtest. TIlI .e

g r een .ateabetlwe8l. tl l-l.e"MO oru:'V~ sh .ows reoQvery

Hlat ocearred dmmgthe period Offiest A :raativ'@ yslow rate , o . f rec :ov,ery; il1dicatiug tha~ t his : s ru bjeC t

shculd not 'be exercised frequently. 1Butthe most

impor~n'~resul~was the fad that the second a:nd

i l i f u r d te sts1 b o~ 'fu . sh ow e d th e' sa m e abnormal .shape.:;

indicating Hwt both of [hes~ ~~S~ wm-€ valid.

IN 'OT ,E~ r I I iH'~ a l ! : i ! f I I , o r m a l f l e s t r esu ~t\S sh owna:bDiV"e~IIFlgures4s3, and ~!IIW'ere, plro du ce d O ili'llOctober: 8,1 '911;1;1IlilIlfe l1anthfi~e rand a hadf yeam

later, ' O i l i l l . , J I u]''1,e'1 i ' 1 ! 9 ! { l I 1 I , tlhis submec! was w t e s t e d1 'm ial i! i d e n 1 1 : i \ c a ' l m : i l i I l i 1 f i 1 e r . .

1 : 1 u r J n lg the per~odof:mDire tha n thiree ,&SIl'S

b e ,tw e e n Ih e s e te s ts l t ih ls s l L ! I b je c t . eX iD re l s ed reg u-I'all'ilyona C y ' I : : J i l s , x ~ o w e l l ' - b a c t k m , a l c t l i i n e : had be~leome v,ell',st'flong Itm UlIiBi t mach ina, .a.liuil WI.S, c , o , n l v i i n ce di th at I i I l i s ~ulmbar~lI ( t :e l l1s lon s t ! r 1 e l i l g t h

w ,a s ia ls if!! ,g l I ' , e a ~ i l y Improved '• I E l U ' 1 'w h ie n r ele :s :te c I

on a Med X machine~ he pn:l'vedlQ be l r Ii iIO l re t han22 p e r c e r r n . t weiBlk"erln t i h , e S ip i n a I I m us'cEes ·the fI I

h ie! was tll1re e y e a . r s earliier. A n C ! l t h e a ib r l l ( ; H f m . a l

shape' of the e i u r U e l i strength ' C I l l I I 1 V ewas fe'pe'stedatthe h:rW8'f lew~ I lJl fslren g lt h..Most 01 ·tlll.eex.-I fudses i Inow De·Jrn ll! ' ; )usedl·or· UU I h l iwer ba.ck haveno, , e f f , e c t 0 Iil '~hes,PI~lI1Ial 1 m l I Isic ' Ies; will il l Clrease

tihe str 'englt ih crr h~,pan d th~g,1iImll!lscles. but w ~ nnrO,l hel p I'll eS,P~rn,a~mlll lsch~ls;a,

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INe,srly iI J ' y e ; B i r ~ale'J Qln lMa', 18~n n l'21 I lhlissub'j,ect W8,S ' tes t led agail:n ,on a M,edX lum~bali ..exleul i ls i ion machine, and thestll'e'liiIgth of:h l i s : hlo~a'led IIU 1m Ib a I "aexlen S i o 1 1 1mlllJ,s,cles w a r S

i ldent i ieal l to th e ~,eve~measured albo,ut a yeal!"

l e ' a 1 1 ' 1 1e ' li ' • I N l o , c ll i l a n g ; e in ~ower'Bb,a,ck5,tliellilg;th!

e 'VE !n tho WIg i l h i he' ha 01 'con'~,~inll!u~~dl0 e X )9 l fC i is e

,on tbe Cybex Eowe l r,~back mlB . ch i ln l le and had! cc ,m tinue !d l ti o , i in , c r'e ,ase l ' i I i s s ; t r e , n g t h , , O ' 1 i ! t'lrnllt

Ima,ch: i ine.

UJ M i B , A J R EXTIEINSI IOIN-

~

~

-

I_ _ . . .

I

II

12' 24 a6 .:18 W

AW9t1 ~IN D E G R ' I H i : 5 ,

I F :[GURE 4 . .5 'resting pefiotlned iUID1edia.tely be-

fore and after a hard ~x~,Qse o : n aNa uW;uslower-back

machine pmduced the two s;t:ren,gthCUll 'VeS shown

above. The ~ercise bald 110 leifuct on the' muscles

t lmt extend th e Iumbar spine In six : of the' se'ven

positions 'tested, strength was sI D ig htly hig l\e I f< onow -ing the' exercise on the Nautilus machine.and in oneposition was sJi\ghtly [OWeT. Ove:ran strength (,m;ea

und er ru.e C 1.U 'V e)w as 2 .5 percent Mgher follow ing

the Nautilus exercise than itwas before the' exercise,Compare these resultsto the iolJowmg example;pr'Q~

dueed when 'the same subject was ex,erciSerlo:n a

MedX machine'.

1 2 24 S l6 as roA r : 'U 3 LJ e l iN C H i ' G R E E S :

ih

oz;#! 300 t,t:---+---1~-+-=

I I :~.

0 >

i 2 ' . 2 i T I I J

:1

~ ' n / J i I J F--+~-I!---i--+----jL------I, mlill

9 a b-_~_~_~~ __~__~_~-0

fiGURE 4..6 testing conducted Immediately be-f or ,e a nd a fte r e x,e rc ise on a M edX 1 tmibar~eldension

machine produced these results; the fresh level of

Sb\m.gih w as red ueed by an averag e of 1 8.4 percentthroughout it full rm,ge o, f movemen t , as an ,efied

from ,only six rlepetitions of the' e:x:erd~. ThE tedarea shows fa tig U El & CH n the MedX exercise, In con-

trast, eleven repetitions 00UteNautilus machine had

no effect on the' spinal muscles. TIle total Isolation

of the Iumbar-extension musc1esprov:idled by theMedXmachine prod UC@,5 s p e , c i J f i c exercise; the onlysource ,of producti v@ 'I D ( ,e :rc ise fo r sp in al m u sc le s.

When themuscles of the hipsandthighsaremvclvedin the exercise, ss they are in all other exercises, gainsin str,enpil that are pmduced will h@llinited to the

muscles D F th e hips and thighs; with little, or' no re-swtingbe:neflt for the muscles of th e I~Woerback.

ra.ge37

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700

36 48,

I I IN I D E G R E E S

6 0 1 7 ' 2 ,

:z-17 5

oo 12 24

A N G L E :

F IIGU R :E " '7 T hree tests o f fre sh stren g eh (on-ducted over a period of 7:6days. The curve above'llielowest blue area sbows I!:heinitial level of strength.

The two red areesImmsdiately above this lowest

c urv e re prese nt a pp iliJ re nJ rab no rm a lities; th e computer

added a , normalizing' curve, and t hen filled' in the

areas between the actual curve and the ideal curve

with red to call. attention to the large, led triangle'

01 the lower left, and the red, boet-shaped area on

the lower right

During a second tes:t}!oHowing six weeks of spe-

cific exercise, the :middle curve was produced; in themeantime. the level of fresh strength had been mark-

edl y increased, and the' size of the red triangle on

the retthad been reduced, while the red, boat-shapedarea remained unchanged. .

The highest of the three curves shows fresh

strength after 76 days of specific exercise; by whiehpoint H:l!L ~1@dtriangle OIl the le ft was gone . The in itic:1l1

red triangle did not represent an acl:ual abnonnati.ty;instead, indicatsd an advanced stat,e of ab:ophy inthat posi;tion; a,trophy tha't was quic1!dy COrtl~t:ed "by

specitlc exercise. But the roo~boa:~-s:hap!d.area was

still unchanged even at a much higheJr Ievelof

s be ng lli ; tlr ls wa s a n a c tu al a oo,Q l lll'la lil )'that was . no tcorrected by e>l"ef l ruedlll'ing that: period, But a yearlater, this ahnnrma! shape in ftte strength curve was

gone; and he then produced ~ normal shape durIng

his tests.

Th is pa tie n ls u fife re d e h r Qn ic f lower-back. pah'll

fo il' lw eh ,e ye ars p!!IloIi ' to '~ h e c ia !'!! ''o f h il s irs'l te 's t ;paln that was, removed I b , y the Uml! the seeendtest was co ndlIJ,ctedj 'p'Sin that: has net r~tlllirnedf:ol";iJj period cf Im OF ia than. s ix years ' , Q I U D w ' i n g thesecond test.

JPage38,

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wQ

Z:'i, am~' ....

.!.0,~ ~

:z

IiI

~

II . : . . .. . . . . . .

~

~_ _ .

VF"""I

,

12 24 36 ., a 60

A N :G U 1 1 M DIEGREIl :S

FtGIIJRE W Tested before and ..mun€dia~~]y an~an ,~x ,~ ( 1 ci se f Jma twas continued tela p o . i . m i u t o f £ a iJ iu :r erth.is sub ject showed. a gain in stflengfu foHowing~le'

exercise; and hep.[Od'l!1c~d fresh and exhausted

strength cW'ves with the S c "lm ea bnorm al s ha pe ,d ,e ar

pro of of validtest results.

For a p@ l iod of several years, this was the moste 'xm,e ' IDee X J a i , m p l e ofa slow -M itc h. JC iesponse that w e

saw araeng ma.ny '~c:msru1ds of tests; .sl.o'w-h'!/itch

museleflbers (',aJ.l18mg such $tmjects to show th e sSJme

level of str-eflgth before and ,a:fter exercise, and,ln.

some cases" causing a gam in su,ellgth followmgtll.e

I . !-)\Jer~e[se.nTis subjectwM 23 percent mo:ng~ after

the ex.erdse than, he: was be~Q[i~the exercise.

~u~since then we enc::olW1~eredal1 ,svenmOfieextreme example of , a J . slow-hvHch il)e5pOil1Se.; during

his Initlal three-part testing and exercise prceed we ...this sUbljec t W ,1 I.S25 percent stronger folilowing itl'l!f

l~ercisethaJ:l he was before the e X e l \ c .m f il . His,fJir-st

fouetest/exerc iseprccedures, performed at inter-

va ls o f a.pproximately e n e w le .e k, mcreasoo .w:s over -allfresl1 strength in excess of fortypeIi:Cient;m.lhgains of morethsn fifty percent in some posltlens,

G a.m s that w eJi\@ ,produced dudfilg a period when

h@ was ~ercis:jlilg :m no o~her way.

DuriNg the exercise performed 8 .S pert ,of hisfirst test!eixerds€ procedure, he failed alter t e l " !

repetitiens with resistance of 150 foot-pounds.Then, d urmg his third procedure, aboiU,[ I:\.voweeks

laJer" he perfoirmed eleven repeti tlons with 180 foot-

pounds o r resistance; an increase of more Ithan20

percent ~ndynamic. . fuA1~raJ ' lgesb:ength producedby orny two previous exercises,

E xperiencec l ind ivld uals have been u.w table to d u-

pUcate- a fa~ed abnormal sltrengbhtestu8'lng' M:edX

equipment; domg sownuld regu: im producing the sam€

submaxlmal ]evels oftorque in fl1e~,e positions

! :ftuougil!out afull;r~ ofmovement , w.hlch is probab,~y

imposs~ble. It.5 e a s : i 1 y possible 1 :0 p.Iloduce 0 1 zero level

O!fm.usrularl; ' to~'que, ,alJld easy to produce a maximumle've~.of t'Or-que; but repeaiting 00. e x.1 c t le ve l of rub-

maximal effort is 'very' · r u : f W . :u l ! t IfIlotimpossibIe.

-

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i~ I'_""

I v V-

~A

~ . . r

I"(I

(II leI 20 3(iI 4lJ . 1 i ( J I s o : 1 ' 1 ) ' 00 ~ 100 ] l 0 1 1 2 0

A ~G I!.E IliN ' D EG RE ES= R I 'G ~ IT U 'G l .1 L E F I' L EG ~JN!JUJiEO}

IF iIGUR IE .4 ..9 T h eWgher, . re d . CU!fVl3S o:ni: l lt ischarrrt

repr,ese:ntMO tests of the neshsmength of a normal

le g; : fu es bconductedtwe days apart T h e lower, blac.k

curves showthe ..results IQ f MO testswHh ,anmJured

legitests also conducted MO dal .YSapart,

- .

I

I <.~ - -

,J

I

, ,

':Il~ ~ '4 .$6 ~I ·60

tmSIJE IN .D~SRnS72

fiGURE ~1 01 Theee r e s t s of lumber-eztenslonstrength p&i'onned at intervals, of 24 hours, sho'Wing

a d liI£ erenc e of less Ulan one p@lt'iE1t. Coopera t i v . @ sub-

jectswill p ro d u oo re pe ate d I~t .resu1l:siliat U@50' close

to being identical l1'1latany difference is , insignificant;

a lack of such consis,tent results is ~TI indication of ill

l" l:ol" lCfioper:ali ' l le subject.

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~I~

:2~~ 1~--~--~~--4---~~~

2l~

10: f 2 . 400 ~'''I.::---"i''"

Z

g : . .20 0C ll~0 >. . . .~ - - ~ - - - - J ! . _ _ - - ~ - - ~ ~ - - ~ - - ~

o 1 2 .24. 11 6 ~a 0: 0

A J N G U IN D l l i ! G I R l E l S

F tl l I l J R :e , 4 - - 1 1 ; fhree '!est:s o f t L!l ill -:r ang ,e , I lu 1 i l J 1 ; -

bSIi '- e .x tens i: on s tE"en ,g t li l I P I I I i ! ! ) du oodby 8.fastoi\tw'iteh

.suble,et. !Oneof n ~ et v i o , h~g!he!stClIIwes Qn~his

Ich:all1 represents we Ii1 stre n gU iI; whl'i l le! 1:liIe!~owes t'CUfVie S ; lf U ) W ' S ; .s tm rn glil f,o 'II,D ,w ,ln g b rie f ,e 'x erc is 'B .

T he second ofthe bvo ·I. ' tighest C I I l ' ! . " \ ? e S i shows ~~est of l "OCOVel iOO sl!rengtl"l oonductedabcet . r o w hoursafter d :lie ID : imJ .~par t proeedare, Within. U 1 S i t relit

per lOOj fresh. ~trel'i.gthhad been largely reoo~; but ,

iwaroolli rods · of Ule m ov em ent m rng e, the rec overed

level ,o f fsJhlen#h was sltil l. slighl: l iytJe1ow' i : l ' l C ! &$hreve l

Recovery fro'nl: wtig:ue!llssell 'ectivemregafd to po6ilf ion..

! l t J 1

Q2~ 400 io-----I1---ji,--..J-----

~:t ! - ,C)

f 2 f l O O

z

1:2 ~4 $b <lB W

ANG LE IN DEGR EElS

F~GURE'~12 TIle same su.bjectshown infigure

4-11; '~~h::d in the saIne way at a Im\"'~T level o f

strel"lgth;and thel'! not pe:rtniUed e'nough time for

rest between Ute pos t-exerc ise- tes t and the recOV' !1 ' ) I

t~tfresh sue:t"llgthwa stotall y restored in th e mid-range of movem~TI~1white re'maining faUgue was stillevident neat both. ends (~;ftl..~movement range. The

[91e!1 iL area shows rocov,€Nd : 6m'Mgtl1 , wIllIe tile red

areas show remaining fatigue.

~c6 2 . 250 F~~~~~~~~--Ir---I

Z

12 24 ,36 4B 6Q 7(;

.ANGU: IN I I t :I E G I ! i: I i! I E S

. I A I R l S : t I ' 1 & S T .SiiCONIiJI lE S t p M E !C $ ! ! A 1 ! E I ! : )

PIIGURi! 4~1 l3 Hav in g previou~]y mcreasedthe

funcdenal .strength of his, lumbar muscles by morethan 1 ] 7 p.9C lL !nt in the flexed position and . by 300

pe rc en trnlUU ® (:te.m iJ o]\,as a result Iota re~aijv:~y

briefpe:docl of specific exercise, this subjectthen per-

fonnedno exercise or testing lEora period , o f sevenweeks ; this char~ lcompares l'lli:s.trength ,after U~eex -

ercise progrml to his slli11I:tema:W:il1.gs:b"ength.anow~

in g sevenweeks w ithout exerc ise, T here <'!:J i1 ewo

sl:rength curves shown 'Oil! this ch ~r,b ut 'f : l1 .l!e yre so

dose to being ideutic2Il l~ a,tthey appear to beorlly

one curve, his loss of sbength was effectiVielyzetoeven ,af~erseven weeks of inactivity.

Subse:qll:[erI l t research. wJiJhlarge nnmbera ·ofsub-

jects bas established that one specific exerc ise per-f o:rn le d f o'r th e h ; I 1 I ! 1 i h a J r " e x b e m i o : n . rI 'uusclesev@ ty f o u r

weeks 1 W i . l li l mamtain all ormost ofaprevio,us[y-~o-

duced level 'O f peak: strength,

P a g e iJ O

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EXERC~S ,E f'Dr P 'REVENTI IO ' IN0", I INJU IR~ES

T i m e , L I I l n ~ q i . l Ie ' I r e 5 ; p , O n , s E !, ,o f n i le , lu m b a r - e , } d ! e , lf i I s : io ' li iI

m u s c l ' e l s pilliovidies iJlIiI 0PFl i l l r i tU l i1 I it y ! O , I I g l t eS , tvaluef o, r i ndWls tr ii al appUcat i iQI i1S. R ' B S e ' a l r ' 1 c h ha .s :

c l e a r l , ) , l e s t : a b l l ~ s : d i l e d t i i l , a t Q ' l I 1 ebrfl~,fexerc~se!S!aelilw e , e i k . f 'Olr , 8 lperh ld o , f ten, o r tw ,e~ve w:ee l !c s :w : i I 1 1 I

incriE!la:setih:e s , t rength i 0 1 1mlo,s, t : S U D : j : e c t s 10 aleve~fa r a bo iva a V I e . l i ' a g , e ~ iJl l l i ldaddItional1 Ir:esearen hils: s !h ! O i W ' n 1t lm a , t o n , e , ei,xerc:is,e,leach ' F J ' i H m t h w i l i l l O il a l i l l i i l ~

t a l i I i 1 thaI Ihl~gh h~,velof! I ! o : w , e r - b a c · k s t r e l i 1 l g l t i i l 0'

P r o p e : r i l y used~tlhls kno iw f edg le l c[nJ~dIbeapp~1edh i ! ~ l i1 I d u , s t! ry to l I i e d u : c e the frequiem::, , o t ' 1:llwer~

back i n j , t r l l r : i e s : . And be c,alU se of' 'thl9 b:r)eift!lme

,reQll!.11id for such ,ex:el~ciise, ICO ulld be appliied

1 1 1 1a clDst-efifectlve manner. W lh ~ fe e x er c ~ :s e

is , n o lt h e SiO~I IJUCl ln rn aU IC ' 8 J ! i i ' l ' : l ! 8 ,I l e H : h e l i i l l ! 1 l m~hab: i I l ii ta. t icm n o r' a s : pWl.'Ie llil lom J I' iit I c o l l l l ! c : i I r , e a WlCS:

th e num be r 1 0 1 1~ o w e l i' - .b : a c k : . iuoblems:to ja n ex~ten t that: 'w o W lI :d mpJesen t ian :annWl[a~sa:utn.g i

'o f b iiU iio ns : o f ' 1 : 1 0 1 1 1 . , 9 , to , A m e : r u l c 8 1 1 1 i l l1dl! lstlry.

Ttl Ell 'CI!IIl i e J i l t . e e s t s re'~ated 1 0 s p , i l I ' l I a : t i n j lU Irybei:n:g 'w ha ttli le y are , ev,eIi1lU.laHy it w in be

, e I one. Wl~hinthe lias,lmly y,ears, p'liev'€U'iJUO n

has Ii,edWlced, , d ]e r lf ia l p li 'Qb ~e,msiby J ' I ! i I . i C l l rathans . i i x : : t y p ,e lrC,e! ii l! ; a 1 1 1 d f ' i n yye,all's f lrol m l n ow I

h : :lW 0 1 1 ' - b s , c :k plroblemlswiiU ble red'uced by 2 1 1

h~'a:stmtype Ii1c ien l • •• redWlced ,bypln~lventiioFII,by sp ,ec i lf i c :exerc ii se .

P .;Ig e 4 2 .

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'C :H A,P TER 5

R E H A .B , I I I L ~ ITATIO IN

An parts of the body which have ,aJtmction. if used .m moderaOOn .and exercised,

become thereby health:y and we,threve~Dped cU1d age slowl_y. but ifunused and

left id~ethey become liable to disease, defective and age qUiddy.

TIle value of exerc ise for rehabilitation has been.

recognizedin Europe fo e more than Mo-th,ousamd

y@m'S, blll~ was genernUy overlooked ll1l.I~his oountry

until abou t fifty years ago. During the last few years,

a wide variety of tr,eatment modalities have been in -

troduced, allintended Ill' reduce pam ; but proper ex-

ereise still remains the best, and probebly 'the onlytn:dy productive, protocol for rehabilitation, With

m u sc ulo sk ele ta l in jiuri·e s, th ere are only h vo c ho iee s;

surgery or exercise, or a. combination of the two,

Ol n. er t re atm e n t may r ,educe 01)" tem porarily rem ov epain.; but nothing else seems to enhance, f1epair andimprov,€ fundion; which is th e goal.

VVlu]e sometimesrequired, immobilization should

usuany be a vo id ed ." an d red uc ed to,the sho:r~t period

possible in allcases, tissuechanges from immobi-

lization occur very rapidly, ,ood long in:1IDObiliLli: ion

may produce changes that em [lever be corrected,

Cu rre nr im a g ir n: g te ch no lo gie s, X-raYSI CT scans

and lVJRI SCMlS, provide ,2 1 cleardtagnesls i I ' l l mill" a

small percentage of spina] pathologies; inmost casesidiopathksitua tions are lnvol ved, some ofwhich will

iI n:p ro ve a lm o st r eg ard le ss of t h'e t re a tmen t appl:.ied.

Spontaneous improvement tha t has been Iarge]y re-

sponsible for a wide 'ilariety Q if C l . U 1 " e I : ' I t trea tnle.nt pro-

bJCOls of no preven vaJl;.ue;whatever was tded 'P'Iost

recently usually gets, the credit in such caS€S.

E x e J cis e 'o r re b ab ili1 atio ln l j 'nv:o' ivu o nly ' a fews fm p,le pO in ts : ,one, k in d of eX ie ro is fl!' .. _ • 'MOl fre..

Iqusne l { o lf exe irc ise • • . 'th re e f l 'e'WJIIOf r es i s t ance

••• f'O Uf, lI1Ium lber ,of repeUloRs 0' •• live, style ofperformall'loe~ Apart m D . m l things te avo·d, lhasafiiVe po,in. are , a n fhat. need to be con.s idered.

Hippocrates

KIND IO F EXERCISE

Dynauuc exercise wl'fu variable resistance; vari-able resistance because strengthvaries throughout

any fUll-range movement, sometimes varies by _v-e ra l hundred percent from onepositi:on to another

within the same range ofmovement, If the level O F

resistance remained constant throughout the move-

ment, you would be limited by str,erigth in the weak-

est:pesititm, and the resistenee would be toolow jn

stro ng er pe e itio ns.

The exercise should also provid e both positii 'ioremd

n eg ativ e' :re sista no e; w il:h ou { n eg ativ e re sista nc e, f ull-

mng,e ex,erdse is impossible;wilhout ~gIl l l ive resis-

tance, ~her~'ron be 00 resistance on. eitherend of a.fW].-ratngemm,re.men.t ;andlbenefit fr om th e ex erd sew ill

be prooUced primarily i n. t he midr-ang,e of movement.

Range of movement should be capable o f pro t-'

v iiU ug f uU _; r- an ge e xe rc ise .. o r any d esired part of a

lim i te d . : r: a,! I.g eo f movement,

W1: IUe resistance can be pr-ovid ed by weigbts,

sp-r-ings. hydraul.lc cylinders, a servo m otor .. o r by anumber of other p os sib le s ou rc e s, the best choke sliU

requires the use of weights, All other resistancesources have unav,o]daible limitatians, and in some

cases produce dangerous levels of impact forces..

f ,R 'E Q U ENCY IO F EXERC ISE

Exercise for the purpose of increasing function,

strength and muscular end urance, should never be

perfnrmed more than three times WEekly I and betterresultswillsometimes be produced byonl.y Mil weeklyexerc ises, or even one.

N OT E: Th e opin ion s Bxpllessedlln th is , ch aple r (,an d e ls eW he re [n th js bock) on U le ·sUi~lect of rehabi l i tat ive

lexerdse me based upon p ers on al e Je lpe rie nc e in Ute 'HeTdof,ex:amkse 'for iii: lperiodl of l1iI,ore than 'fifty years, and

upon personall ~searotl I n ' th i s ; ' f ie l d th:at has now been ongoing ( 'Dr mom th an M'e 'l1ty ,e a rs . U ke ' -any aU1e :1 'lre a 1m e n t in 'th e f le 1ld o f medlci 'rte, th'e appUcmiona f r,ehabilUalive, l e ·x e r cl s e mus t be giw'dedl by elin:tcaJl Judgemen t .

M Ilch m ean s th at it is lfI,pos Slb le to re eorn m en d a bre a'lD 1e nt IP ro1ooo1.h at w ill b e su itlh le 'fo r a ll pa tie nts .

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R'es.is'~anc,ehould 'be ]ow enough to permit atleast eight full-range mevements, but lugh enougb

to prevent more than. twelve, Wlum twelve repe-

titions can be performed the' resistance should be

increased by fi'!le' percent,

N IUM,B ,E R O F REPETIT IOINS,

Fast- tw itch s'U bjerts sh ould use a. lo ,w e :r ran geo f r ep etiti,o n: s th an indicated above, from six tonine

repetitions. Some slow-t:liilikh subjects will pro-duce-greater gains in strength ,mth a.range of fif-

teen to twen.ty repetitions ..

STYLE OF IPE, 'RIFOIRMAINCIE

Perhaps the moslt' tmpor~aJlt co.nsidera nor.!: aproper style of performance reqtti:res a relatively

slow speed of movement. Too slow provides , 8 I I ]

of theblID~t:s and produces none' of 'the potentia]problems, while too fas,tavoids rome benefits and

doesproduce problems, g'ene:relllyprobleme result-.ing from h ig h l,e v,e ls o f im p ac t force.

At Ule starl of ' the first repetition, muscular eon-

traction should. be'produced u-adualiy, and should hes :I ow ly tnc rea sednnd l li:u~~ta rt o ,f lI i.o 'V ,em e nt i s p ro -

duced. Once movement at a. sl,ow speed h a s . stMted,

the level of effort should remain just h i g l 1 _ ,eno'~h tocontinue slow movement Do 1101t ID~~e the speed.

as m o vem e nt c ontinues. men approad W 1 g the end

o f '! he p os:s~ brn eran ge o f m o v'em e nt, sp~ shou ld be

smoolhly reduced to zero. VVhk :h does not mean that

you sh ou ld re la x in I lt ha tpo .s it io n ; bu t you should pause

briefly in that position, Aftera pause of one or '0''11'0

seconds in th .e fu lly:. .c :ontrac~ed POS l i : I : : i C H " l : r mov,e:nlle.I l t

should be struted in t he o ppo .s lte d i re c ti on ; gradually

and smoothly ..and continued at a.slow spee d .

But you should no t pause, nor reliX upon re-

turning to the s~rting position; instead, a smooth

change of direction 'should be produced without

pause, and with 1\0 sudden or jerky movement, The

exercise should be' continued In that fashion until l't

'becomes momentarily impossible to perio'ml. anotherfu ll-ra ng e m O V oIID 'le TL 'tg ain st th e resistance

How many S@~Sof the exercise?' One. Additional

sets usually oorv@no purpose and may prod uee a

state of overlrairnllLgmth some' subjects.

Cont ra ry to a somewhat c ommon m i sc o nc ep tio n ,the $circe involved in the i1legative pad of the ex -ercise is actually lower than the force durtug th,e

posldve part, During the positive work you must

prod l1C@ force equal to th e f i€ !S I ista nc e..p lu s a d d i-

tional f,01' 'Ce equal to the fr,[c lion in the machine,

hut dUl'ing; negat ive 'Work . the' mach ine friction re-duces the frorce sHghtly'below the selected h!ve:t of

resistance, If machine frktion was one percent ofthe' Ievel of resistance, the force would be 101 dur-

n l , g thepositive work, 'I.¥Hl!1resistance of 1 00, but

n ,eg ,aU ve fom e wQu]d 'b e only 99 l 'V i th H e l , e same level

of resistance.

As f:angue from tile 'exercise makes U more d:if-D . oo lt to , c o n , t m 1 1 J e , sO :~ I 'I e,s ub je c ts may start jerking

mste; ; ld ,of continuing with smooth. .movement;by

jerking they are trying to invoke the stretch .r-efl.ex

ill order to continue; bue i I : l 1 i s is not required and

may produee high levels of impact force, so should

n.ot be permitted. The €l~etc ise shonld be stoppedwhen the subject is,no Ionger capable of completing

at full-range movementwithout jerking; at "thatpomt

you have done everything necessary, and have

avoided any potential problems.

Workmg to f.a:il 'w:e does not mean exercise con-

tinued to a poin,t where all of 'the fresh. strengthis lost, and does not mean w()l'lHng until any move-

ment is momentarily impossible; but does meanthat th~ exercise should be ccntintred un'til,;1Ifull-

range movement is momen taruy impossible with-

out j:etlci:ng. At that point your strength is not zero,instead has been momentarily reduced by fatigueto a poin t where yO lu r re m a ini:ng sl l ' "€1.18dl lis . slightly

belnw UU~ level of resistance: if tile resistance is

1'00'pounds, you willbe forced to stop when yourremaining gltfengil:h. drops to a level of only 99

pounds, With most subjects, when tbey fed], the

fresh level of stte:ngth has been :mOl l lent l : ' l rilyre-duced by only about 20 perc,ent; but 'lliat level 01

fa,tigueis all that is required Itos'timulate followingstrength increases,

Properly performed exercise-is both sate and pro-ductive; moot SLlb)N:ts will respond with rclatively

fast and steady increases instrength untiJ readdng a

level dictated by their individual potential makes,

additional gain impossible. Wbm, sleady IllCf'eaSles:in

sb"ffi8"lhare not being produced, the first fhing to

suspect-is that you are performing too much exercise;try doing less before tryIng anything else,

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HIUD

Modem military airplanes use a : fligh'tama rege-

ment sys '~em called HUD, heads-up display; ABol1the absolutely essential lil:lfomudion, and nothing ex-

tra, is projected on 'the llli'indshie]d so that the pilotcan fly while look]ng Oibltside the airplane', In ex~r-cises where the range' ,o fmovement makes itpoesible

fo,t the subject to C,otlstantly watch the romputermonitor, MedX machines provide a similar ,eapabH-

ity; the subject call dearly see his. position within a

range of movement, can see the exact level of '~h,e

resistan ce f ol'c .e, an d c an 'tell if his speed of mo,vemen'tis,proper; is. constantly prol\1ided all of the informa ~

tinn required for a properstyle of performance of

the exercise.

As the level . o f fatiguemC(@ases/, the c:oo.xistin,glevel of fiiction inthe muscles also increases; but i t ,

t s impossib le to~eU \¥,hld, is cause and wl ;d ,c h i s e ff ec t

(do s fati:gu,e increase friction, or does friction in-

Cf1eas~fa.tigue?) since they go up and down t,ogetller,

.Friction is also increased by a faster speed of'movement, and reduced by a slower speed, which

is why you areforced bl' red~ce speed ( D i f move:m@i'lt

E ' I S you near the end of a,hard exercise; when QOn~

tinued movement at the same speed becomes, mo-

men~arll.y impoI3s~ble,you cart centinU~ to move if

you reduce the speed; slowing reduces thefrietienand m~.y permit the performance of one or two

additional repetitions after eentimred movement at

the initial speed has become impossible, Whlchmeans that -the initial. speed should be slow '" , ,

],ai~erspeed should be slower . , . and tha t the ex-erclse is proped y completed 0111ywhen momentaryspeed becomes zero.

More than fifty years ago, attempts to test

streuglh were performed using barbells 0 ' 1 1 ' weight

machines. by trying to dstermine just how much

W',e:igMthe subject could lift for only one repeti-tion; later calledllRM testing, one repetition maxi-

mum, this system has been used in ill number ofresearch programs,

Another system of testing involves the perform-

ance of ten repetitions mlh as much weight as pos-sible; this, being both til sa f e r system of strength

testing, because the weiSht must be lower, and a bet-ter' system for several reasons, En t both sys tenlSha'ile

pm b lem s; po ri-m an ly resultlng fromthe fad tlha , yo u

must guess, right each time inorder to produce mean-

ingful resuhs, If you 'testwithtoo much Wej;ght1 then

you will fail to 'complete Ith.€ 1 i f I t ; but ~fyou guesstoo [ow, t hen YOll cannot teU just how much more

weight you nught have lifted.

But an awareness of this system does provide

the ability Ito judge your progress from workoutto workoutmlholl t performing ,5weng th tests eachtime; ~f you rail a f te r ten repetitlons with 1.00

pounds, and 'then fail art,er eleven repetitions dur-

ing tli'H~:nex t war kou t, ~hisdoes no t meal'! that youate ten percent stronger, hut it does mean that yourstrength has increased. A ~en pE!f1l:'ent s'trength in-crease would be indicated only if you failed aite.r

the same number of repetitions, but 'With tenper-cent n101e weight.

The' above being true only if both. style of per-

form anee and speed o f mQoV ' j~men ,tema in constant;if you move faster you will be able to perform more

r - ep~Ht1onSI while iii. s [Qwa: speed 'MU reduce thenumber of repedtions, Tune under load bemgtheimportaut factor here, the higher the level ,of mus-

eular force" the shorter t:he,ltime it can.be maintained,

and vice versa;ilIss1lllllirlg that the-level of resistance'

is high enough '~(lpmhJJbitaerobic work.

The last paragraph abovemay appear to ccmh 'a -diet 8statement inan earlier paragraph; but no'actualcontrad~.c:ti.on exists. Eal'Uer, we mentioned that

s l O o \ l I r .i l1 g theullli't'ia:[speed of movement may permityou 't'Q perform 'one or two more repetitia,ns by re-

dueing muscular friction . , , later, we said lhat less

mpefitions are possiblewith a slow speed of move-ment; an apparent contradiction.

"Butin fact 'both statements are correct; current

knowledge and technology do not permit meaning-

ful measurement of metabolic work, and Lry ing to

do so with measurements of mechanical work ismeaningless; a machine must produce movement to

p€!:rio rm w ork, but a m usc le can work without move-

ment, sta~fjcwork, muscular force of con traction \vi'~h

no resulting movement, For more than fifteen Y@M S ,

we m o o , but failed, to measure metabolic work basedUPOll force x time. the am ount of force muUi,pHErl

by 't!ie time theforce was maintained; but we even-

tually realized that such measurements earmot be

provided in ameaningful fasbio'll,

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But the higherthe it~\v@lf force', provided onlythat it is above the threshold of anaerobic work, the'

shorter the length of tim e I:ihaltnJ,ran be m ain ra med.

Ifmaximum-possible forcewas 00"you: might main-lain that ~ev,e~for only ten seconds, but if force was

reduced 1 :0 S lO r then you m i g h t malnrain the force

for twen.ty seconds, eventually, having reduced the

force to ,i:!ve:ry Jaw level, you might maintain it for

several hours.

During an exercsse, a highernumber of repeti-

tions 'l,-'II'ill be produced at a , faJster speed. because each

repetiti.on :r-eq ukes less tim e, forc e x tim e { tim e und er

Ioadl for each repe' t i ' t ion is reduced. And a greater

number IO J repetitionswill be produced even, though

'[he f ! l ls,ter speedincreases the level of muscularfrie-

I~iol'l. But in the ~ater stag@s of fatigue, as you t'1'P-

preach ,9 point o f fail u re , s lo '\ 'I li I' Ig the speed 111.ay

permit one or two additionilil repetitions by r:educing

muscular Iriction.

MUSCULAR SORENESS

AI~we really know about muscular soreness is ,

tl" !!atjtis '[m isn am ed ; th e c on tra ctile 'tissue in muscle

does not have the type of nerves required to indicate

p~ so :i t is not the actual working pad of the muscle

th~t eels pain. Itmay be connective tissue', but what-

ever it is can become painful as aresult of exercise,

BI : i [ such p.ain ismgh]y i nC (n15 ] s ,t ,e ' l1~ some hard ex-e rc lse s c au se J :e .S u1 th ,g pa in } a nd some d o not A first

hard exercise : m a y cause pain that occurs a day orm ore later; but a second M Jd ex erc ise d 1eI'1serves to

reduce the paID,f50 it is obvious that exercise can both

cause pain an d reduce or remove pilI]n.

But if e~er1::ise' is pe t fO lmed on a regular basis

t hen any iniliaJ pain will usually be gone withtn a

fe w da ysat m ost, and wiUnot return as long as no" 'gU-

J a r exer -c is e is continued . E ven in) tiaI muscular SOt@-

ness caa be avoided by starting a pr,ogrnm ( I · f ~er-cisegradually: the firstexerd se session shoU ]d not 'be c on-

tinned to failure, stop while still capFlbl~ of rather

easy movement. . . and 't hem , workou t by war i < :C l ' 1 . 1 t/

,gradual ly in crea se th e 1 t~ 'v e:lo f effu,rt until you are

working to failure. When this is done properly there

will be little or no resulting muscular soreness.

F iAT I 'O of S TR E,NGTHto ENDUIRANCIE

With. a majority of a random group of subjects,

strength and anaerobic endurance go up and down

while maintaining th initial ratio, Mos't subjects .. if

they c an p erfo rm t en . l'JspetitiOJlS with 1 m pounds, of

re sists n ee, c an p erfo rm only one : r ,epet i t ion m~h l:r opounds, and tltis ratio of streng,th to endurance will

ch_;; 'U'Igevery mtle a s smeng this

increased by exercise,

Butsome subjects, have far different ra tios of

shengUl to enduranee, and some S iU bjects do

chauge their ratio as strength is increased. The fol-

lowing U l us L T aU o n s d@ f i'lO l 1Sm ! ll. 'ie d iff e re n tra tlto s o f

strength to endurance.

'-. -

120I I

I

'\~I::

"60~ 2 3 1 1 1

IU!'1; l1l ' l i lOHS

F i lG U I R l1 i : 5 -1 1 Maximum-possfble[evels oftoI\que

produced on a serve-powered, isoldnedc, leg-exten-

sion machine during four eonsecutive repetitions.Having measured torque during the f irs .t liepetiti!on.

the computer then eompared the three ~oU(Jwil1l.g

repetitions as a . percentsge of U'll~.first :reperition; the

purpose being to measure the loss. of fresh strength

produced by each maximum repetition.

This \ \ 'VaS a fast-twitch subject" and his fresh

strength dropped rapidly from repetition to repe1i-

lion; ftrse repetition was 1 0 0 1 . • . second was a bit

above 89, showing a loss of more than ten percent of

fresh strength as a result of the first repetition , ..

third was between B2 and 83, a loss of abou t sevenpercent D , f fresh strength nom th e second repetition

+ •• fourth was 73, a loss 'of more than nine percent of

fresh strength fr0111 the third repetition . .A total loss

of fresh strength of 27 percent from the first three

ma xim um T ,e pe ti'ti.o flS . A very high level o f f atig ue

from brief exerdse; a typical last- twitch response.

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120

~' I ~I!,

I1

I

···'JfC)llir l ' R l i j ;! 'E T P I H f' l1 ,O M . . 1 1 8 " 1 0

~ • ~ 1 iM U R :D R ,E F lE lIn O iN = 1 1 11 4%

, . ,• • : SI E CONO R lE P i1 l1 i1 l0 N l" !I )\ 6' %

~ • , ·n l l ' , s r R'E~T~)ONcl 00'"

,s @ 1 2 3 ..

I R E :P i E l1 T J )O ~ 5 ,

fl>CiUlRIe5~ Conducted bl. the same manner,

this tes~ Mth a slow-twitch subject showed far

different results; the level of l~orqUJEl [ :nc: r '0aseddur-

ing the first four repeti ti.ons, was 18percent higher

du:rmg ithe foudh repetition than i was d urhlg

the first repetition.

Co ru sjd l er t he implicatiOl1'S of sum md1.v1dua'[ dif~

~e're:l 'IJ:.1esor ,a'H'IJ!ebc competitliol ' l ; l l ie normal warm ...

h:rlg~upprocedures prior to compe' t iUoVl would

,imprOIV@ thlll t:oUowlng performance of [he slow-

l[witch, .s~bject but would gmaNy reduce strength of

a.mst:-twitch sub ject for the ; !: o]lowingpe r.formance.

1 , : : : i } 0

I,g

u

~2. . . ~~D0

iii

~ e o_: : 0 :I,g

U!)o!

~,~Il

~I

I

I

r Il__

I ~

\2,J,~ 5611'1.l

I ! I E P E i 1 i l 1 1 0 i N S

FIIGURE 5-3 Tests with a subject having a usual

mixture of fiber types in the quadriceps muscles; CCH1~

tinued fl)f nine mamlll1UfI.'1 repetitions and eornparing

his r i ,gh t leg-to IUs left leg. Fresh strength. was re-

duced by 3 '7 pE !~ oe nt d urin g repetition nUmb!Bl T'Line,

indicating an aV'etag:e [OS8 of four and one-half per-

eat of fresh str1eItgthperrepetitien during the .fu'.s~

Eig~.t repetitions.

But all of these were masrmnm-posstble repeti-

t i C H 1 ! . S ; during exercise.if faUwre occurs after ten repe-

' l : : i :t i O I l S . " Ul! e'n th e f ir st n in e r e pe t lt io !l1 J iWe r lf :;l!.aIbmaxi~

mal. With most subjects, exercised inthe' usual man-

Tiler, fresh s~rellgth wm be reduced by about 20

percent" an average loss of ~eslli strength (lif 2 : percentper repetition,

Such . i r : u : l i i i v : l d u l l , 1 d~f i ferel l1oe's a i l ie IClriitica~ dur~rr tg lr le l tJ . a b l i ln : a , t ~ Q I i1 ; :u i lj e c lt s m u s t be , e lO e : r c li s e d wfrlh e a r e -

t 1 ! J l ~ c o : n si

loEl 'ra!t i . f l l I i1 iDf b e r t h thei i . rnbel i Iy,pe 8 i 1 1 1 d t i l 1 l e , j ' f~eco,.eryabUli ty.

Durnng exercise, mostpeople seem to have aninstinctive des[re~o grip with UleIrhalllds; ,eve:tl in

exercises where I~he ha nds and arms ere not in--valved, and fhis is a practice that should be

avoided. Muscu],EI]" contractkm Increases blood

pressure; bul therels no relationship 'be tw 'ee l1 themass of muscle in valved intilie COll l . tnu::t i ,Ql ' I and the

re su lt in g e 1e viI.tio l1 l.m b [o oo p.re ss u:re ..

Maximal eontraetion of one ef the ql ! lad,noeps

muscles ' W ' ii ll usually raise the blood p r : e s s l l l 1 e about50 poml:s; bM[ maxima l oO lilib :a ct i. on of both legs si-

mruronootl ls ly wi l l p:rod .uc e thesam e ]jesuIt, a 50 Fom~elevation in bloodpressure, So it ]s na~' the mass

,o f imvD lved ,uiluscle tha~ mat~ersl '

Maxinlal contraction of thearm ...le;xor musdes

'O f the' 1JJpperanl1l wmus,ua.l1y Increase blood presSru:fiby aJbcltlll80 PQ~n:ts;a .fu smaller muscle-mass but a

greater ele'v~ltion in blcodpressure.

But ~h.emoiSt dramatic effect on blood presiS'lwe'

is caused by maximalcontractlcn of the muscles that

produce gripping\¥i'th ~he hands; blood pressW" l e in

this case is so high it is diff icudt ~o measure. ForQ ! bv J:o us 5 are ty rle as oltE i~ s uc h le le va tio n o f the blood

presswe should be ,8iv,oided~.8100em be aV'oldM; don ot g rip durmg ex:e .wcise ;ins~eadjm a in ta in '~ he ha nd s

In. a loose, semi-relaxed po5ition.

In jhe lumbar-extension tnachine~ handles are

provided; but sh,(}uXd not be used for gripping; these

handles a re provided f O If , 9J n o th e rp urp os e . s e rv e only

, S i S ill known pasi t ion fo.rmaintairr il rLg the haJudz:;during

test and exercise procedures, Moving the hands dur-

ing the procedures would change the body-part

terqus and mltroduce lerror into test results; so. t : h@

p o sU :: io n o f the hands sh ou ld no t change ..

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An ao cur1 .,D e Jy measured , s m m g : r h curve phlQvides

a d e a r p iCM@ o f s tr-e ng th tltro ug ih ou t a . fu]ll~Mgeo f mQ 'li,/,em e:n t; btl[ d cu!!s nof alwa ys teU you what it

can be, 'or should be, StreI'lgth curves chal\g~; changein [ lesponse ~oeX !e]1c . iser asaresul t of ~trophy

Once the shape of ii, normal str,ength, curve ~s

knOWl'lf then a testthaltprod uresan. aibno.nn.a1 sl" l:1 1Iipe

can be easily f\ero,~ed; if the same abnom.wsl~peis prod.twed.dlWing[a.~rtfts~, then you have dear pmof

o f an ec tua l prob le m, but t l1 :er l l il l :u f f l o f t : h e pmh l !2mis n or alw a ys esta,blishedlby the sJ~ape,o r ~hecurve.

W l i1 I te n alfllappalfelflll a bn ,o ,rma~ it y Ws~ 1 f I, c ll i' c a W d byan f i n i ~ i a l l ~ e s t ~ Blflla , c o l fI J l 1 in n :e d l b , t lne:sarme s h t a p e

be:]I fI IS Imp l: ii ca .tOOi tCi l! lr ing ~ il Jt er te 's t$J bu t t hem r a p i d l l : y

c l :1an~g:esdur ln~g, 1IlEl'li1'lirl:)niitatllon~you ,pre pr,g'bIBbl)!,

dle91~rngWl t1 il ,a f! in it Ia l' s ta " te ! , o fa t rr o i p J iJ i le d w r e a li t l i l , e s s ,; .

a tr , o ;p !i1 Iy ~ h a t w m u S 'L ila ll ~ , be ( i l 1 u h : : I ! ! l J l yCItl l I l ' f \E!( l ted byfE!gl!Jll'ali'exercise. Itut: II in s te a d, 'I he ill1 itiia :la l b : r n o f l i i f 1 i a l l

sbapels l i i f 1 i a ~ F l l t a i n e d es stml'l[gtill l in:clreaseS1Utel'l l

ylOiU are d ea ,n ng w ith idlc,paithie f ac tf ll i' S ; oB ' l! It io n

S!h!fU.IIh: i be COlf1l~~II1IUeds hm g as an ; a D I i 1 ; D i r m l a ' l: shape

I I I i I ' 1 I 1 1 e s l : r e : r n g ~ 1 i 1 'CIL l INe l p e ' l ! S i l s l s .

A l i I :r i i ted Jiangeof movement . i l s ·moo~alshape.;th e s tr en g tl" l. c u rv e should 'be longer on oneend, orr

Olil. both ends. limited .mngEl' of mO'v,M"I:~~can beca~by~1lh~ i l ' or both oft:w'ofactors~m~w~1tk-

ness or some ~O:m: i I . . of mocihanical l:imilltatiO]l that pre-

venlt:s"ddiHllF1ltl movementbeyond a"certain positiioo,

MOVeED.len~ < f the body produces m ~ e n wresjsm'lt'ea g a :i r m : O O l 1 l : t i n U e d D 1 Q v e m . e r a t ; when the eXist ing level

of nmscuJarsbrength has producedmovemeat to a pointw h ere , th e e : o e x i s ! i 1 1 l , g [eve] of intemilli resi.stmoo. stored

energy/has been mereased to an e q U I D ~~e]r then ron-

tm u'o omov e:m e:rn t is impossible. At 'tn atpom t ylCiUhave

e q u a [ . and o p p o . s i h e fe,roes.But wnMMini.tiaillinUlted

mngeo.fmovenl61. t is produced onlybymuscuil iuweak:-

ness,llie :nrnge'ofmove:men~will be in crea sed , as,smg~1is in cre ase d in :resp on se to exercise,

movemen~then a mechanical .limitation of some' sort

i s prev,enl in ,g additional] movement. S uc h m e eh an i-

callimitatienscan seldom be [ d.e rn ti lie d" a nd shoulda]w,~y.'ii be h:earedcautl.ous]y; do 1 " 1 . 0 tatremp~ to .m~

crease the rang€ of mO'llem~l1Lt by stretchlng·.

~

,ez:;:1' 52'S iF----t---i'----;------!I---l!--' .....""

'~

I. L0 0: 1 2 300

:~

1 : 2 . 2 0 4 36 > 4 : 1 1 W

A !N So lE U 4 , DlEGREES

flGU fiE 5~ When rirsttes~ed" this subject couldnot produce ; : u n : y meaS<'Wab],e~rquein a.pasUion , o rfull f 'xtensiml. In t h a 1 l . t : position, im; existing revel 0'£

WuscWaI:" t o r q u e w a s ' e q u . a J : to : = i> b : : J ] : e d ~ m e r g y torqueaee-

mgin. t h e o p p o s i :b 9 0 c ll i 'e c t io , n . ,; : s e , 1 1 1 . 1 .u c t lo m [ s i l: :r e n g t b w a s

.ZIDiO. Sb : d e ,gwee s fo rwa r d from ..ul l eden.flsiol 'f h e e eu ld

produce amy 4, £ooirr -po~ndsof fuIlctiQ'E!!~to:rq1!e. Fivemonths !a iber,h js. sb"e_n,gflllIDlliatpomtioolFtad increased

1:0 296 f oo t-']J ound is , of .fui'l:ctio'llIaI ,torque.

I V o i i I

~.2~ ~~.==~~~~-t~~~~-t_'--T-12 -I

.,!.

0'~200~+-~~~~+-~-+~r-+-~~~

2.

o I

a 1D :ll!l lS jJ l .10 &'l MI 7 ll a a 9\'l 100 1 HJ 1 : 1 1 . 0

ANGLE IN DE' !3REES

Lrnuted lange of movement produced o1'lJy by _b-- ...I

muscular weakness can UEuruIy be Idelltified; insuch

cases, lhelestoo ]ev·el o .f fu ne tio nal tn rq ue "Wi]] a lw8IYS

be zero at tile end e,fItheposmble range of movement,

Zero, because the t:rtJ:emuseular torquel l\lJvlll',. is then

berng oppos~d by an equa~ level of ncnmuscular

~o:r'q'l..1!eom ing Jrem an opposite d lreetion. B ut w hen

the tested level of fu:t.1diol'1.,,1 torque iSfinything in

excess of zem, at the end of the possible' rang,e of

F IG L IF ilE 5 ,,5 T he s lJ r.~n gth c u rve pro du ()o o byquadriceps testing is USUS! lIy rel~~]velyro w in ~he

f le x ed pO !5 iit :io n, highest as you. near the midrange of

movement, and lowest nearfull extension of the]egia bell-shaped ru:rve; but there [sa widemnge of pos-

sIble shapes even with. normal soojecls; differencesin shape resultin g primarily from previous ,ex~ci:s@

experience, Untrained, but normatindjviduals usu -

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ally have a very [ow level of strength DeM full 'ex-

tension of the leg. 50 lheyhave the potential for largeincreases in str,ength in . lha~position.

But some untrained s u b j i e C t s have , 1 ' 1 m uch fia.H er

stl'ie~1g.t:hIJ.t ' \ I 'e;. may no t be stnnl,ger in tI~e strongest

posili-'oflrbut a re s lr ro n g ;e f tl'lilill average near , ex~ens iQ,n.

'W h i c h . u s u .a 1 1 y means tha.t they are what we call a.type

G (general) su bje ct; : p ro du ct? stre ng th ia ere ase s fromexe rc i se even. in un worked ra ng es o f m o vem en t, Peo -

ple with an initial very low tevel of s1J ."engthnear e > < : -

tension are usually Itype S (specific) subjects; do not

produce strength increases outside the worked range

of movement . . • ' l 1 " l : a y even lose Streng:lil in the un-

worked ~ of m ovem e:rlt w hile' gaining st:n!ng 'lli in

tlte \ > V O i : k e d range of the same movement,

Both type G a.nd .~ S . sub je c tsp roduce fu ll -r anges tr eng th . in c re as es when workedwith ful l~range 'exer-dse; sothere win be l es s d iif fe nBno@ in, the shapes of

the strength curves when properly-trained individualsare com pared . but: there W ill still be s ome d i ff er ,e nc e ..

WH .h: the q uad rtc ep s m u sc les, y o u U _ 5 "u E lU yhave

another leg for comparison pu.rposes. ~Vhen ~hestrength in both legs is 'the'same to-within three orfour percent, and whenthe shapes of the strength

curves produced. by bothlegs are nearly identical,

then you have probably done ~verythlil"lgthat is po&'sible as a rmult of' exercise' Regardless of the shapeof the final curves,

Te5t~ng of spinal nmct i :o l1s ~ J1 .eX;!rension, or in ro-tation. produess , : 1 1 normal strength curve that is astra.ight line.;:Sf) in these' cases you have anermal

sha pe ~or comparison purposes; any meaningful de-viaticn from ill straight nne is a n in d ic atio n. .o f ab-

norm aHty. And you ha vea know II, 'target for

evaluating rehabilitation; the shape of th e curvewill

t ,el] VOll when normal runco,on has been restored ..With torso-retetion and cervieal-rotafion t,es-lingyouhave the additional advantage of being able to com-

pare the 'nghlt side to the left side. Abnormal .stTe:ng~h

curves produced during spinal-rota tlon testing are

seld om d uplicated in both Cl l i! ec lions o f movement,

A comparison of a fresh strength. curveto an ex-

hausted curve (following exercise) provides two im-

portant SOUfCe.s of information; if the shapes of bothcurves are <consistent, tneJ.'l you are dealing with a

coopera tive subject; if not, then you shculd suspect

malingering. Secondly. the loss of fresh strength

f ro m . th e exercise tells you th e f a tig ue c ha ra cte ristic s

on an individu<llbOlslS.

P a g e 49

H!~ 2.4 36 48 60

A i r : . . ! S L !E ~N C 'E eR E ES

12

FIGI l JR iii .5 ~ 6 F r-esh and exhausted levels of

strengfh showing the same abnormal shape; dear

proof of abnormality, The level of fatigue producedby brief and f ie ]a ti ve 1y light exercise ind icates a rn.gh

percentag e o f fast- tw ifch fibers in [he lum bar m usc les,

The red area shows fatigue prod.u.ced by only fivel iI epe ti ti ,o n so f an exe rc i se with a low l@veIof resi stance .

Controversy' 0 nthe subject 101 muscular f~bel l ''type h as lbe;en o ng lo in g l 'fO il' th e 'Iasltwenty '~Irs~

and no ,end ! l i s , in ,s ig ht; b 'L ll1 ' f ,O I i I lh e , ' p, uf 1 ! I o s e s of

r ;e ln :abl ll lh . tl lon , ,a l'm,cls l aU s u l b ~ e c ' t " S , can be 'p:laced

into one 'fI'l Qnly'thllr'ee ca~egorjes,' fasi t~twir ich!, sl,o,w-t w i r t c 'h . 0 1 1 ' Iml i iXedl t ibe l ! ' t ype. .lFasM wi tc I i19 I ! .1 i :1 jec ts ,

a re u su sn , s1 :r o: nge r t han ex , pe ' ct e d . b a sed on SB : X "

,H ioe , s iz e i an~dl IP il le ,v ious , e x B ' r ; c r s e e xpe lM ie ncs ; Ib ut

hav,e ve .ry UH I'e e nd u'ra nc e; us ua lly have a m ow 1 011

,e ra nc ie fo r ,e x ,e r,c ijs e ~s h o l l J l f r d l not be ex ,e ro ise dl 'fre-, q u enUy 'Ol i 'wli lh hlQh~repel l i t jo l i1l exe r c i se .

8/4/2019 Spine Knee


Mixed f iber- type subjects usuruJy show an average

le ve l oJ sl:rengt:i ; l ; will genern l lyprodluc:€ i 00s~results

from exercise' if workeci two or three times each w , e e k "usU" !g a schedule of from eight 1,0 'h.velve repetit ions,

Butatrophy is , s el ec ti ve t fast-twi tc h f ib ers ,atrophy

m : 8 i O e r and to a ,~eate:r degree than other types; soan m itial appearan .c e ,of fib er 'type m illy 'b e m isJ ead in g.

WhC=D.first i tes~oo.lmany patients will show a normallevel of fatigu~ fOUOMl1g exercise, But as strength

increases, fiber ' t y p e m . a y appear 1 :0 ,change; h 6 1 V i a : : l g

increased strength to a bi,gh lfi!veL I they milly show

the Iati\gue characteristics of fas't-hvitch fibers. Butthis is not, an. a C < 1 1 1 a ] cl1 t" lng@in fiber type; instead, 'in-

dicates the reactivation of a trophied fast:-t'w:itch fibers,

Since fiber type 'is usually re1a~ed to tolerance .for

ex 'e i l' ,c i se ,such apparent ehanges in f ib er type are criti-

cal during: Jleh~bilita,'tiol1; 'when this OCClll'S, the num-

her of repetitions used in the el) (erc.s~ should be

reduced, and the frequencyofexereise should alsobe reduced, With lumbar-extenslcr, ,ex :,e rc ise , fas t-

hvi.tch subjects may produce the bes,t results when

exercised only once every twa weeks, and sho-uld

never be exercisedmore frequently Ith.M once each

'Week. Do 1to:~reqmr'e mere-frequent exereise.•an d

sometim es C ilU \fio t~~ole:r,81temo re -f re qu en t e xe r- ci:se . A

few subjects produce better results when exercised

only onee every three weeks.

One of tnemem'bers ef our research sta ff losesstrength if exercised once each w\eek, maintains an

existing level of streogth (but does not gain) if e% -ercised once @very two weeks, and grons, strength

Drily w hen exerc ised once every three weeks, A ve.ry

low tolerance for exercise.

Slrength increases are not .al.ways proportionate

throughout the full range of movement; so the-shape

of the strength curve maychange by becoming flatter,th e in itia l ratio of sm engU, from i l11e s!:ronges'~ to the

weakest position may be reduced, In lumbar exten-

sion, an initial ratio of 15 to one is not rare, strength

in . I:l 'lefiexed posi non nm y be 15 tim es as high as it is

in full extensien. But hav Lnginc:na!l@dstrength asmuch as possible throughout the ful1 ran~ of move"

ment, the final ratio wiil usually be 1.4 to one, strength

in the flexed position then be ing only 40 per cen t higher

than strength in fu] extension. A n ideal ratio.

These ratios being applicable only to functional

strength of the hmib.a. r- et :t enoor mu sc le s; tru e muscular

strength, NMT. v r i J I l I usually show a flat curve with aproperly trained sub je c t; s tr eng l: h will be the sam e in

every positioothrouglnouta full l1' I_l ' l jg 'e of movement,

Utlid~that ratio has been prodlllc:edl by exercise, ¥ C I a

h~ .ve a. c l€ 'M i: nd im ' ij,o :n I ~h at , il Idd i t iona l s treng th i in-

crease-s are possible, and this usually means -H-mt

strength near fu n extension has not yet reached ,a ,

possible level, D uril:\g t 1 1 . , ~ W tal '@ ]ght w eeks, of iI

hnf'! l ' l ty-week study a t th ~' U niv ersity af Plaride, fh es ub je c ls in c re as ed - t l . 1 e i r str '€%'>ih in f he f l. exe d po .s ;i ti 'c n

by an average of only one percent, while 'increasingsttength in full extension by 31 percent The' addi-

tiona] weeks ofl:tairiiqg changed the shape of their

s t r e n g t ] 1 L ~/proouced. much. f 1 a : t : b e r 'CW-Vli!S.

12 24 $6 41 6D

A l:\I 'G U : IN f ) ' E : S I l ! E E S ;

IAGURE ~7 Peak level or fuuetional sb'englli to}..

! o,wmg seve ra lmon th s Of1s0la.~ed e xe rc is e; e xe rc is e th at

mO'ei1Isal strength: in the f l.exed pos i 'NJ l ' l1 :by 11'1 percentand strength in full t!Xtensionby 300 peIlcent The

g re e.n a re a MO\ -VS in ere ase s in f un ctio na l sl. l ."ength.,

12 24 36 48

ANGLE IN I D E G R E i E S

.INIMJ GAIINS

fiG UiiiE 5-8 Corrected ror the errors producedby nonmuscular torquef these curves show true levels

of streng th of the 5aI1 "1 eubjec t, F igure 5 -7. The g reen

area showing changes in true strength, NMT. Truestrength in the flexed position increased by 251 per-

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Cf'ut , -compared ~Q lth ec .h an ge o f 117 perc ent III func-tio na ] stre :l.1 g tJ ." I~h ile tr ue str en gth . in .Ml extensionincreased by 2SD percent; mmpwm to the change

of 300 percent in. functional strength. JudgLng

s b 1 e l 1 J ; g ! : h b u : r - e a s e s by c h a n g e s in fu:m::t ic'Rii l l sb"ength

in [his case would prorl uee !;'[JO!['S varytng from iI.

low of 2.7peroent in one pnsitlen to a high of 53.4percent inanotber position.

A t his f iJ la lle :v el o f true stt:'e~gtl,~this subj~ t pro-

duced an .almostperfectly-Ilat c 1 l i I w v e of torque;

~M-o ugho u[ H1 !@ -a ng e$ his a~r-(l~ tm etorqne w as

.3018 foot -po!! l l ld:s, \"itlth a~ow o f 309 and a high of

327 foot-pounds; fla~ to within a,margin of ermr of

QI-,Jy 2.83peroen:t. An ideal ra~fo of torque,

O b s e N i ll 1 l g U ,e , c h a n g e s : t i l i l a t . 'D e C U l li " ilill sitrelJi lgth

c u rv e s f J I l1 1 l r ~ l i ' I : gl I s li l 'a b l l l i m t m o l i l l n o t on[ly tel ls: y O ! J J e . K - -

act;, w hat. I'ie sIJ JIllsh ave [be en p I I D d . L u m d . , bUl t : a l : s : o l

provides h i l i f o r m s U o : n J 'FE!ga:rd~li1:g:afldllt! lQlIla~ ~ m l p m W ' e -

me :n t; s ho ,ws you ,a reas t l il a~: s t il ll r il eed h 1 ! l p l r i Q , v e m e n t ,an d ' m ~ I : S :y,ou I i i I , D , W ' Dil li e h ~ n i lp r ( ) \ I I ' ie l 1 i le l l i it , c a n be rea-

sO I i l' ab!y ' e xpec led .

1:;!' :;:;~. 36i1iB 60

AiN:GU IN I D I G , R I E 1 E S

; .2;

IFI[GUfilE 5-'9 Five tes ts of heshfuncUonal

sbength. conducted. Q ' V 1 e : J " a period of five months.

While fue general bend was a slowerrate of strength

gains near the end of ~at period .. a comparison of

these curves m akes ita.pp:a:re:nt ~ h a f rs ff i 'tl ! i l1.gf:hU:10E! \ l .SESw ere m ot a l w E i l y s . consistent throughout the fullralllge

of movement, From t : l ' H ~ 'first~esf to tbe second tes t,

strength increases weregreates t neat full extension,

001 hom the sooondtest t- o '~he rifthtest~ 11:1Cre"1le5

were gre:at~st]lear the flexed post'lion. And evenat

this relatively high level of strength, the ratio of

st re1.1gth fmrn~he flexed position to th e extended po-

sition was, still notpmportiona~e; 3 . clea.]'indica't:lcln

tha~ he still h a d the paten 1 t:iajJora d di t i o : n l l 1 . illU@IlI$e5.

near the extended position.

'U"I '

ez~ 1.50_ .m .-

c~ 100 ~I--!-~ .. ;__-:I---+--il---I

z.. . . .

m : i ! 1 4 I 1 1 6 - ' lE I 0 0

A .N 'G L IE I N D IE @ R E E lS72

F IG I I . l I F ilE 5 ~ 1 1 ) ] 1 Tw o tests of .&esh strength con-

dneted abeu t ,e ig ht m lln utes ,i;lP ru t; n o I~e~dse w as

pedorm.ed betweeaIhesetests, The .f.Lrstest pro-

dueed ti'IJ.e'owest CUI'V'e; during the second r~est~he

WH stronger in ,every po sitio n te -sred i a s [c ~ 'w , ,~ .tCh

fiber f6pOfise·. Havi~~g :a i ll im i l ed range of movement,tm :s sub jec t w as tested in oruyfi.Viepositio'l1Is; the rust

positiontested was 54 degrees forward ho.m normal

Ml exlalSion~ an d tn Uilat .first restedpom~.Oint]lL.e

subject did not produce a true level of rnaxhnal

torque.was p.mbably ah'aid to produce iii. maximum

'eflor t in rtlil!flt first tes ,~@dposilion..

A !W 1 iJ ! U ' : I(l ~ooper.-(! te fh."lt w as c l e a r l y eStablished

by his resuhsinell other pos i t ions daring oothfuesit5"

sn d by th e J 1 Ic trf ua t h is se co nd te st in r~ha: tposit i .ol ' l

w as; m uc h hig her. Give'll a m axim al effort iinthat first

pctsition, h is ,~ curveswould have been. pa:uilld in

e v:e .ty prud ti.o 1 1. S ome su 'b jo cffis will. s1\ow s u m h€Sitil!-

Iiol~.m the . f irst oae or htvoposi.tions during ;m.lni~l.l

tes~.rbut will ~ruly produce l l l 'ue curees during latertests. TI ' I i ismbject"s .movement ]s ]lhlli~~Ionroth ends

of the mnge as .~.result of a il l<ylos ing spo:ndy1 it ic ; .

PageS1

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E VA lU AT llN G STR EN GTH IN IC :IR EA SE ,S

Gains in. :s~ngil:haIi~ USllitaUy evaluated by com-pafingt.h,e' increase in strength to th e i n _ i l L i a I level of

stre ftg th ~ an d then. exp:~!essingfl1!;e i m . p r Q V l a n 1 e n : t as

a .p61ce :! ]t age o f th e s,tm-t ing sh 'mlgUt; if the iuitial1evel

was 100 , and th e :s'~ength~ollowing rehabill:talion

was 1-'0, that would be a gain of 5Opercel'lt" But

usmg .tl1lissy.s~m ofe:raluatlo~ em be ~8Ie~djng;

sometimes g;lvmg the rmpll~B:Sl00 that gaJilli$ menean~iIwere ,farb~tte:r[han gaIns in ar: to~; ' Ie:rarea, when

the iU::ru.a[ gah"hB wm'eoons is l@:n~~ 'ffitrollghou~ a full' ''".. &~ ,....£ : m·... .. ' , " " '" , · , _ c ~r_ LI;;l 'O;;. OJ . . .. 1.." <; :JU-" , ,£l l .

Six : yea rs agp lt a s tudy group ' ( I , f normal men .. " ! J =

creased ' f f i l . e ~ : rs ta J :r tfung l ev 'e l o f s t 1 ' l e n g t i 1 l , in, '~he flexOO

pos i t ion by an 2IV1erage o f 87 pe.,me_nt~w,hile m,cr lea :s l l iLg

s t r engU l in, full If'xtenshJfhto a much gr ,oo l :e : r ex~@ nl ; ;

wluch gave the impression t t :: l :M J t their .smm g t"h .. in-

creases in hill ,ro;::tensio'Il!WeTero.lUm greater than in

the fle:-ool positi.on. And, as a perc-ent~se of U"ms~arling level o f s b E l l l l _ g f h . . , ga ins. i n f u n . estenslon were

ID !l l. ch grea~er .

B ut w hen th e a c t ua l increases . n l l fi\l ' leryposltionthroughout, a fun range of movement were com-

pared, 1 t [ 1 I E : g ;a .i ns we re 'very ccmsls' [e t 'i !t ; 1 l I .€ aver-a .ge

mOl€ i l ISe in t he s e v€ f1 I.. po s lt io fils I~ -es~@das 2 68 foot-,

pounds, wUh a lc)w of .249 and a hig;h of 297' . . .so th!2 p,elltest Increasewas less than. 1 ]petcenJ

ab ov e l:1 '1 .ev e : r , 8 J i g e . , w h l l : e the low est w as 7 percentbelow av erag e.

Us[ng the' percentage method" U would appeal'that strle l1L,gd i lmcreases in full e:>;;t~lOl1l . wei'emorethanfive 1Jm~ as lugh as, inthe flex ed positio n, w h.ile

th e true dif~er~fl.cew as ]ess,fh~ n 20pe_rcenJt. '5 0 it

mny bebetter b:l ev:al t tabl~'SbEmg[h g a m s by compar-ing th ea .dm r u in cr ea se s m eadlposiiIJon~VfiH1;gut re -

g ard for file perc enltag e o f initial strength.

PROB , l E IMS 'WiITH NOR 'MAT1VE DA.TA

With knee pallu :d .olgy ~ the usoal itvaUabifHy of if!

norm al leg for com parison purposes prov id es an ad-

vart~ge du r : img r eha_b il il at io : rJ , g ive s you a stand a mfor judging '~e progr,ess ,ofthe injured ~eg.WIth torsoro ta n on . B I n d o~cal Tlot2 lHOJ: l r the right side ca 1 " ! . be

compared t- o the~:eft . B ut you have fUlfl1ing to t:QU'I-

paai,el no standard fur jud gement, when cleali1"lg Mth.

the most crHica,[ funcncns in spinal pathology,strength. and r a n g e of movementinIlexion Ie x i t e r h S i : o : n .

T l lm , e : m.O IS t . p : r , a ! c U c a l SDl l lY I~ i ( l1>n ~nYQlve · s ;l [ ls; lng

eiU: '~1pa.11ienl as a s : t S t r l ci;Sfclfo,r j udg i in~g t i i f u ! i t l i

own improvemetF i l t du,r i ing reha lb l lU laUon. Ifthey are i im ,prov~ng l~ ithen you ! i!UJiem,C)ving' I~ nIh e rllg 111d~"eef ion.

Nc rr:r:ll[l:l: iv e d a ta h as b e e n , established in m an y a r-

eas of medicine, butb'ying to compare , a ;S1 lJ b je c 't l>V it h

spina] pathology to i!¥erages is hequently mislead-

iI'l.g"tleca.we an indi vid ual is diffe.reut"oo.lll"l.p:aJroo

toaverage, does ll~~'mean tt[la~ they areabnormal,

and e v e n i f a J O i l O i r m r u J. this is not always proof o f

pathology. 'I'M slow-twitch subject m.enHo:ned~na]l

earner d" l~p~@Ft~OUowi:nghVentY-seven w~b ·O i£ex -erdse was still. . . . . . . , l y . . . lz~-h.t_:tc i1I:1~_V~a "- .~..,-IJr,""" :.fb,"""~ . __ . vubJUlg _ y _JY'V _ '" __ ~ age:s " " , . , g , - i ' . ~

which wQuldindic-aJe a relatively poor resuU.lif com-

pared ~Ol aIvera,g,e. But wheuccmpaeed bJhinwf,hisresults were very good , an m c rease olfS 77 percentin strength in the ~t.ended position. His very low

level of initial strength, and I u srelalt:i i_v~y

low levelo,f later streng th. w ere both. res-ruts of M s fiber type;

comparlng such . 8 1 . s1l1bjecti!:Q, avemge is mls[eilding.

DWlng research ronductedi to d!!tennmBllie h~st

freqlmjel'u:~y ur € 'J ll er ri se of~ lhe lumba r -ex tenslonmus -

d es~ six ; ].a :rg e g ro u.p s o f :su bje cts w e re compared ...

one group, th e eontrel group~ performed no exercise,butwa_s tested b ef ore a nd n ftie .r t he tw e lv e- w ee k pe-

riod; sh .owmg no change in .s tr e: ng th , the expected

result. . . a . S€ :Co o d g r oup '~~8I 'd:8ed.oiI11y once e a I . c h

MO weeks , .. a. 'fuildgrOllp ~erciBoo Ol1JCieaJch

week ., . ..a ..~ounh po,up lexe~ 'c ised twice w e ekly .., .a fifth. ~oup tilltee' times week ly ; these ~oupsusihl.gd yntil1 'l:1 lJ :cex erc ise ... a nd a six lli greupwasexereisedonce each . w e e } o : : , ' V i t h a staticm.ooa]ity.

A eempanson of ~ h .e fi v e g ro up s. tha. t exercised

indicated no apparent di:ff.eli'EI1LCi€,all exercised

gmups g,amed; <IDd, as groups, they pined to the

same degree, If did not appeat to matter whetherthey worked onlysix umes withm a ped od of t\.v,e1 veweeb or w orked as m uch a s ~hiirty:. .si:x: i : m t 1 e 5 during

tILe same p~Q(L

But looked at inruvldua11y $Uleammmt of workdid matter. One of the subjects inthe three-times-

week ly group lost s'tr€ngth f rom . overwork. Thissu bje ct, a v 'e :ry ' a th le tic woman, w as placed .in hergroup on a random basis, which was amizlhle; €);:-

erdsed less frequel1Ltly sh e w.ouldptoba2blyhave pro-

d lillcW la rg e g ain s instre:J.1g;th instead of th e l os s ac tua ll yprodured. During her imt1aJ] t es ts she displayed a r n s t -

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twitch .1I~ to ~ a l'iigh level of f t t i f iguefrom brief exerrise; but atthe end o f thetwclve-;·w~period, she showed a sl():w~;h¥ik:hK S J ? O l i I i s e ; . v 'Wj ' [ ;i ,t tl e

fati~e .frolD.1 exercise. AIl . appanm t !c:ham ge ill ijlber

type '&a:~. res·w ood from ov,~ abJophy.

Like most athletic St1bjects~ she was, determiaedenough to continue wUh. t.he programInsplte of

steady lo ~ ill strength; losses thait were 'oibvious.fromthe fa:c~tli!atshe W8.S J !epea~edly foreedtereduce

't he l ev el o f ~ r es i! sta n ce in ord er to p erfc rm the desir-ed

number O I f l'epetitio.ns.By Uil;~end of the pr-ogramshe had lost a large part of her Si~:a:riling~eve~of

strength, and appeared to ha v €: chan~ed · [h e f ib er

type in her lum bar-ex .te.l: 'Islon m usd es, 'T lym g to

jud ge this sub jec t by a c omp a riso n to ai~re[ 'agewould

b ea m llis tn ke .

Sevl;!$ill years ag o. to ' d erernnn.e true rang e 'o f 1 00-

la! 'hul[um ba.r-spin" l m ovem ent, w e X - 'lI'fI.y;ed . largei lUI'!! 'WeT o rsub j; eC1S f rJ :l . f le xkm , in. Im. .dos~s " Md . in

eX'le'l ' l lSio'J.'!.Ave.ra,ge range P!l 'O' l l ' 'OO to be 7 2 degl1ee s~

w ifh som e varle tlon 00. ani nd : iv id ~ , !l ilb a Js is ; D u t one

sub.froct wU~ a rm ~1 !: of : ; ; rI Q i degrees~which would

appeal' to be normal ifcom,ued bJ average~ prcvedI~ Obe gross]ya bnermal, Three lo f h is lumbw joints

had spontaneously heed and showed no relative

m u v a n e I 1 l ~ ~ wnUe thetwo unfused j o i J : ' I I ' l \ ! S ,eadaprc-

d u c oomo ,r e tilam t lN ' ic e a n o rma l :r al'lg ~o.fmoven:Th€nLEvaluatedona basis of rusruJl-mIlge mo,vemenl,.

he-would appear norma]; whHe ~he'true s'~a.teof . 1 d -

fairsdmdymdlc:a~ed

i i l I .g:rossnOIllO.m:1il l l i ty,

A . .forniIru: ll n e bad~l! !]' 'W i th Uw Ch i c~gQ Bearsvis-itedus recent]y, hr. ing j : l I lgh is oldest .SOIl , a ,ooUeg'€:

footba]1p],aye.r; whl~e here~ we tested th e strength

of their qta,aclirkeps m1!!t5cles~ w ith sliU pristn g re sults.

His football career was ended. bya kne.einju:rJ flrtat

s~U gives 11lhl ' lpWI"! landgreat ly-reduced f;wlctioFl.

B 1!1 the strength of trois in.jw'oo, ,olbwo'UslyalJi;op1tied,

L eg W,~5 still m u eh IU g l:u~ r th ftl1 .l:h .e . S i r - ® g ; t h 'of his

SQUJS n orm .a Jlle g. A d if fe re filJ e' in strengtllJ produced ,

by different fiber I types in their quad rtceps muscles,

E v@ :OaJroplried , he still show ed iii hlgh pru-ceJltage'of fast-hvitd! fibers in these muscles, w.hil€ 1m scm

has a nighpercenta,ge o f slow-tw'itd1 :fibers.

~ , - ~ ~ - - - - - - - - - - - - - - - - - - - - - - - - - - ,

30l

~I~~~-+~~~~~~----*---~~.200

,fiG L ! I F iI 'E5 -11 TI ': J.e 'fad tM .t th e ] .eve:] Grfr~]stM:ce

in anexereise ])em~ns constant does, nOi tm ean thatt . l f l .e level of iCIJ:oe·bnposed.upo:n ~h~~ j@ct remains

constant. Ibis figure illustrates t he~.evr® ts o if ioroe:lllvolv O O . during jog,gmg iaplaee T he [Q iw e st h ori-

z:on~allw€ shows a zero level of w e ig ht ( f:o rc e)f ' the'h ig blM .h oln zo nta l lin e :[ibQWSth,e·bodfW',t l ight 0 .£ th e

su)bj~d" 260pouFld6~1!>\Tlillethe peaks and valleys

shown by ~hecurnn,g lin e sh ow th ec haI 'f l;@S in.forcere su Jti:n g f r- om m(r'!{leill '1i.el:Ji~w.hlle joggi .ng.

5ta:ndmg ,stil[r thre subject is exposed ;~CI a foree

equa l to bodytNeig,ht" , 2c60pounds, ~30 pounds of

f o r c e on €ach.~eg.BuJ while j a g g l _ _ 1 1 ! i S r the level of

farce :is :mcre-ased~o more 'l~haJ!i.

600pOlUl'lds, an d .iiIIIlof that : [ 5 0 imposedl,lpon o l 1 1 y one leg; t i l i l t e · force ismcreasedbymo t l€ U\a l1 I30Dpercen tHighlevE!]s offorce caused by mrpa.ct , even In alle!atively 1 0\> \1 '-

spe ed a ct iv i: ty .

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800:f-I--------------~

CClI.1I----~-----------_I

r"" TO T AI " FORCE400~-----...,ff---------I

~~------~--~--------~~ ~ - - - - ~ ~ ~ - - - - - - - - - - - - - - ~ ~~------~~.---------~<BOtl'~IGHT FORCE I

,f:~RO~~I,~I:~ ~ ~ - 1

f ilGU IR E 5 :-12 T he ' lowest ho,r i2lQf l tal l l i l 'L2 showsa zero ~ev,elo . r , f Q l ! ' o o l ' a higher :horizontal . t i n e shows

bodyv;,eight, Mal po un ds o f v ertic a" [ fo :rc e~ ,i3 1:n d.1 ~ e

highest horizontal nne shows the :resuUiIilg fOf ioe

when tllJ~'sU bje ct is .hohimg &60 p ou n.d b aa rb eU , w h ile

standing mcdonless, 320 pounds o .f force,

F IIG UR 'E s"lS , B ut 'W hen the suojed hfm th e b ar-

bell with sudden InoV em entf 'the resW~ng forces av e

changed to analarming degree; changes in forceshewn by the red Lme ,of ron:~ on ~h.i.schart,

Prior to the start o f 1 T IGV leme 'l 1I ~, ill tl1 e plac e id en-

ti f j,ed as A OIIL Uus C M : r ~f force remains proportionateto we.lght , but just prior tO t the upwards movementof the baibeU, the line of force drops below the actual

level of force, marked as B on t:hls eharb this initialre d.u ctio n. o f f m c,e being-produced by so-called p~

.S'I1lm'CH, wh en 'f:llleb arb el! is pe:rmiUro bJ drop a

shod distance i rml(1Jl l&Hafely prior tothe star t of th.~upwards movement, Th: is p J le - st fe tch is an Instinc-

thl'e Slcrio'nprior to a mrudmrnn effu':rt fl~atproduces

a higher level of fnrce in the fol1owing C(ln~acijon.

Then~Mi"!i?ing~ad1l~d th is hig;h~.evelof f O l ' C e : , tl:u~downwards for-ceon the subject is sudd.enlyreduc~to ' le ss, th an . ze ro s le ss, th an ze ro b ec au se , at Ul!atpointin the movement" marked as D, the barbell is lifting.the su.bjed m~othe arras a result ()If ki:ne'~cenergy,

and no $orce' is 'bein,gimposed downwards on 'thesubject. But th is upwards mevement of both barbel].

and subjec t d oes :not continue 've:ry ]o.ng, a.l'Id when

tlI1ey c O ' : P ' U ~ back" dOMl th e ~esWt is th e 'wildly and

suddenl yvarying ~evelsof force shown by the curv-hili line in the pooHiOl1SmaiJ ikedas (:i, F, Ga.ud. H.

But i~lmsdj,,:~ely foUo~n,g this imllal drop inforce.. thelevel of fc re e in c re a se s s u dd e n ly , and '~C

a v<ery high ]eveJ; in t h i : 5 case, to a maximum level

of 860 poMds,.wludl means tllat the force produced

by th e btubell ~ s te n tim e s, a s Mg[' I , a8its w - cig hl" la dd ~

mg 600 poJUMS to the fo rc e o f bod~llight,a. position

m arked as C O n this force curve .

S1 ! lc h g re at v ar ia tio n in force is a re su lt 'O f in lp ac tforces p r c d n e e d by suddenmevemenc d J ; , j ! J . " !g ~ O l .l l

]e~ls, 01~OIce that are not: reqaired fur aJ:~ywad~h

while pmpose; £0l100~1.El[ canbe avoided by slow,

smo o th mov eme nt,

~'I~------------------------------~I

r:" TCl T. AL FORCEAOO1--------1-----------1m~ t__

~ I ~ - - - - - - - - - - - - ~ - - - - - - - - ~ ~ ~ -~11F_------------~~"~--------------_

" "- -. I B .o :OV I NEIGl Hl :i r I FOF, !C iEr-ZE~O FO~;E_ __

FIGlilRE 5..14 This chart shows the varla:lionm

force produced when the same' nn was performedwith slow, smoctlrmovemenx ins'read of suddenm ovem en], W ruJe there is still so m e s.lig h!t '!/,rui.61tiOIll

in force, indicated by the curving linemovingsligrnt]yebove and bclow I& e highest honzo!l'lb;ill ]ne of fam e .

it Is obvious tha t such force changes are or no realimportanoe. Compare foree changes shown here tothose shown by A:gure 5-13.

In spite of tne[le5uJ ta of sudden movement

again st resistance, some people have been recom-

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l 'nendillg sudd en movement dur[rtg exercise for the

past twenty years; to no good purpose. When indoubt about the proper speed cf movement duringexercise, move slow@'; it is impossible to ' move too

slow~y durrn,g exercise; but U is easy to move toofast, with results like those shown above.

AUyou are tryingto do dmiing exercise is to ex-

pose the muscles to known resistance for al1e]ative'A Y:bdef period, in order to produce the desired ~ev,e!

of ,fatigue vriUun a n~asonable length of lime. Anyforce above the miniimum requlred to . producethe

desired level of rnti,gue adds nothing of value, but

does reduce the safety of the exercise,

I l n j u I ! ' J dUl f li ll1lg eXI i 'Clise C O n i e s 1ro:m e m Iy one

:S l f lU l rcu" , I I fo rce th at ,e xc ee ds t he l c o ex is tin g I leve l '

0 : 1 1 ' S:"Ulctu rail sWengtli1 ;60 km ;P I ~h e "o :llc e a s; I~o w'as p O l s s i lb l ' e , ,consis~ent wUhth,e exii s ; 1 i n g l fev,e~of

stf'engtlh; work W 'I,U ililf il nilS I l imU:s ID,ffllJllfllcth:l'liUIII

s t reng thl do no t, tr y to d e te n nlin e 'th e U m l i l l s , o f s tme -'~Ura l s tre n g d 1.

RegardJESS 'o f U'lepote-ntia] value, of ili,e equipment,

t he sub jec l s usLng itwill n ot p ro du ce g oo d re sults with-QUit motivation, compensation payments, litigation,

and other factors can remove the required motivation,

Tile subjects involved in our .first study group

(mendoned illan earlier chapter) were' allmemberso,tour research team; all of Ulefii! were mgl\ly moti-

vated" and they worked very hard ... and theil- re-sults were oUb;tandwng. . 0group of random

subjects used in , ]a~~ studies did as well on ,the'av-erage. Some individual increases in strength have

1been even betterthan those shown by ~mymember

of our ms:t group. but the ave ra ge s lh i'e n gt I'l in c re as es

were not as high. Motivation,.or a lack of motivatiol\,

being respensible f or th .!s d if f@ I 'e: nc e.

T:Ills is an Important subject that needs to be

clearly understood. But given a little experience. it

becomes ei1l ls i lypossib1e to recognize patients tMlt are

not motivated.

Another impertan! faClt.Qtduring relm,bilitation is

recovery abiJity; some subjects recover from fatiWle

caused by exercise: ln a matter of minutes, while some

do not even start borecover fur a.period of several

d~ys. Recovery ~ests mvolve only 1 1 1 , 'test of static

strength fhwougI10Ut a. fullrang~ of movement ; a test

that should be conducted about fivt'!: hours after a

rest of fatigue rna:racteris.'!ics.. The wbjects,to look

fer here are those that do not sl10'W full recovery

after five 'hours of rest. B y thaI: point, their strengthshould be back to the fresh level shown, atthe start

of the earlier procedure ..

If full recovery is not indicated ,af ter five hours of

rest, then a, fO:]]OMng recovery t es t : shou1d be conducted

two days later; if full recovery is , stilln..ot complete,

this indicates a low toleranee for exercise and the Bub -

j ec t s il iO ,u Jdno t be ~erdSedI m are often ' than o nc e eac h

week, and' then onlymth areJja~vely low number of

re petitio ns, f rom ei:ght to teJ :lirepetitions. S om e few

~bjects ' \ ' l I iU no'~ m ake gains 1 1 : 1 s t rengOl if exercised

mo re f re qu en tly th~llonce every third w eek. A nd sub-

joc15 'tha t do best on at sc hed ule of one e.x,ef1 cise every

second week are common; are usually subjects with ahig hp& 'C en ~ag e of fast- 'rw itc b :liben ;.

T he potential for m uscular size, and thepO 't:en hal]

for bothmuscelar strength and funcl:[ona] strength,and these are dif fe re nt' £ ac to ,r :s, vanes widie[y on an

'individual basis, on the 'basis of age, 0'1'\ a basis O 'f

sex and O,D a racial basis, The resultbeing that some'

people have f a ' ! : ' more potential than others;

Poital:tial ~OJ'muscular size is determined by ge-netic fa,etors; is w:rgeJy d€ternunoo. by th e tela live

l,ength of the muscle-belly compared to the distance

from insertion Oil one end to th e msertion 01'1 th.e

ofher end. Long muscle-bellies and short tendons

previde the potential fur 1 l I J 1W5Ua J degrees of mus-

cular sizei while short muscle-bell ies and 1 00ng t en -

dons mean a lower than average potential for

muscular mass Some people can build very g r - e 8 l t

muscular mass, and some cannot; they Jack the po-b;~]\tia'i , r o l l ' grea t m uscular size.

The functional strength of an indi vidu al is de-

termined by several !actors; the size of the muscles,

the lype of fibers the m uscles have, there~61ifive length

of thl! lin'lbs and thus th e leverage adv.n1 ' lages or dis-advan t~ges. short limbs being a great adv,nntage f O ' T a

weightlif~erbut a disadvantage for a basketball player.

But given (ill advantage of le\lerage.and with1a t.rg e m u sc le s, som e people are still not v,ery s f ; ton,g :

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'but not because there is som eH llng 'W :r:o.ngw ith theirmuscles, this problem is usually a r-esult o,f the f,act

that such an individual does, not have the type of

muscle fibers required for great strength,Ms f l ih!rsintended for endwance. So the fad that somebody,else reached a certain lev,eJ of strength or size does

no~ rnea.t'Ithat you can ~oo"flO[' does irmean tha.t

'the style or amount of training that ~ey used win

be' right for you.

B ut there arethings that you can expect; yo u can,e xp ec t to in cre ase your sw eng tll, from its starting I@ ~ e : li f you have l~everpedormoo exercise for this pur-pose; you can ,expec t to increase yourmuscular siz~;you can, expec t to Lncreas@ yom f[,exibility to' , amarked

degr,ee in some movements: and if you. eontinuewi thexercise for several years, you can expectto increase

the size ,ofyOUl' bones; and you ean 'expect to produce

all of ' these very wo rth w h ll'e .resultswit1hout hurting

yourself In ,a ny wa y', if yo u exercise in accordance

'''lith th e instructions offered in this book,

C H Y , I. T V IP 'E e 'F R :E S U L TSI, Expect your mus-

cular size and strength to increase steadil y and

rather quickly; six months of t@ ,gular exercise may

increase the stren.gth of y 'Ou r mus cle s to twice' thestarting le e l for a. previously-untrained Individ-

ual. Musc les that you. 'have never used to a.mean-ingmJ degree· win respond faster ~whUe those that

you have used will respond slower, but I they willall become stronger, some by as much as severalhll.mdred percent,

Of parncular ilib~r,es,tfor I;hepIimMy subject of

this book, the ],umbax spine, most people have 'thepo~efitiall~oincrease the sbength oftheir himbar-ex-

tension muscles to an enormous degree; primarily

because most exerci~,B do not work tbese muscles

lin a meaningful wayi ' and because normal activitiesdo not provide much work fur these muscles. Manypeople can expect to increase the strength of these

muscles by twn-hurtdred percent within iii few

months, making t hem three times as strong as they

were at the start, and. some people can expecttwice

th at d eg re e o f resu lts, Th e neck of the aver tl lge person

usually has the poten1tial f or la rg e and r ap id str en gth

tncreases, an area of great importance for p r1E!vent ing

injuries, and also of importance or the rehabilitationof neck i1 1 juries. .

TWO . D URA nON Of RESUL 1 S " , Som e o,f th eb en ef its, o f e xe rc ise la st for vears, w hile som e Me t em-

porary and are lost if tihe exercise is stopped entirely;

in general" the longer you msmtain a hi:gh level of

strength, themoreyou will retainafter you. ,quit the

exercise that increased yOW ' strength in the fuB~ place.

H your StaT~fi ,g ]ev@] of strength is 10Dr and if

you q uic .k ly Increase it to 200" and then quit exer-

dsing entirely and return to your normal act!vities

that We:i:'€i performed before starting 'the exercise!y,our strength will. not remain at a . level of 200, but

it: l;vill not drop back to 100; part of your strengthincrease waspermanerrt, Increasing ~he strength O Ii

your lumbar muscles to a high Level lwill red uce the

chance of a later back problem to at lea sit som e d e gre e

for the rest .o f y,our I m r e , ev,en if you stop the ~ercis€after reaching a highlevel of strength.

B ut :i f you :I.llabltain 'fha thigh level o f : str en g thfo r se ve ra l y ea rs by ccnttnued exercise, then you will

not Lose as much when you quit the eXlelrise; you

rnaylose 8 0 1 peroent of a, strength increase that was

maintained only bri!efly~while yO'll would: probably

lose only 5 0 1 or 60 percent of a strength increase thatwas man" ! !t il inec l. fo t seve ra l years. S ec 'ond ly ... hav-

ing increased the SITetiLgth. of a muscle to a significantdegree" and hav.ing then ,quit exercising and havmglost a large part of the increase, i I i I . " I . , ~ next time you

start ~erdsing th e previous level of peak strengthwill be prod uced more rapidly; tile body seems to

rela_m a memory of where it ha s been, aad w i.1 1 .r,e ad t

a pr ,evio·us.1y-eXi .s ting level. Q ,f s'~eng~ m U C ' . h faster

than H did the' first time.

rHFU: : :c" 11!11~LATE IRA l IE fIFE ,CT :S , AN 'D '1INDi-

R . ECT EF :I FECTS ,. In spite of the fac t that m ost poo-pI'I!! are Type 5 , meaning that the results of theire~etdse are hugely confined 'b) 6l.e part of a muscle

'thillt]s ,exerd .sed .; it is still true that hard exercise ' for

a normal right leg win h@ rp Itoreduce the atrophy

or an injnr·ed, left leg that is immobilized in a Ci1tSt;

w i.th ou t su ch bUa.tera J effect, you migh t Iose70 pet:-cent of 'the strength of the injured leg, while Willi:such effect you may lose only 50 percent of the

sb(ID,g: l :hof the in ju red leg. A us efu l bi t of kl10W ledge'

for peopleworkirng 'wi.thinjuries of the limbs.

A lso . . . ' heavy ex erc ises for the' ]ilIrg e m u sc les

of the body produce atleast some degree of size and

strength mcreases in other, smaller muscles even

INhen no exercise is performed for these smaller mus -cles, The value in rehabilitation should be obvious;work allof the muscles of all injured individual that

you can;t :h. i !s '\vill no t ori ly inc r ease ' the' strength of

the exercised muscles but w iU help toprevent some

of the aIrophy that would otherwise r-esult inU'l'ei n j n . u · ' e d body part,

Pag e 5 6

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Soft tissue' i r Y 1 . l 1 Y ' results from failure of collage.n.Jibers.. In-

juriesjaU tnio one of twO' categories; microtrauma, resulting

from overuse and,mac~o~auma resul.,ting from the impost-

tton of a jorce that exceeds the structurall strength oJ'the tis-sues, FoU,owing injury, heaU;ng occurs in three staqes;

inflammation, repair and remodeling.

Soft tissues respond to recent use, are changing constantly,

growing stronger or becoming w'e,aker,.Even two weeks of

disus,ewiU ,resu,ltin a mean" 'b ' l . Jg fu l loss ofsoft-tissue s r rue-

tura,l stvength" together with metabolic changes,. Full recov-

ery from two weeks of immobilization may require as much,as six months ,o f rehabiUtative exercise. Perkins {Journal oj

Bone ,and Join: Swg,eryJ' 35B,:521~539t, 195,3} noted: Ifnot.

immobiUze1d, ,an trgu~ed shoulder will regain afull range oj

:motionwithin 18 daus; but ifimmobilizedjor 7 daus, reeoe-ery requires ,5 ;2 daus; immobiltzed,jor 14 days, recovery re-

quires 12'1 days;' immobilizedJor ,21 days. recovery

requires 300 ,days~

Immo,bilfziatlon produces losses 'in bone mass, ,and even a

Jew 'weeks of immobilization m~y produce losses in bone

mass that require a pertod .o f several ,years for fU U recooetu.

In 1859J in The Origin. oj Species. Charles Darunn noted:' In

the' domestic duck the bones .o f the w,tng w,etgh less and

the bones oj the leg weigh more inprop!orlion to the whole

skeleton: than. do the same bones in tbe unld. duck., He ai-

trfbuted these variations to the domestic duck s reductum- - - - - - - -

inflying time and increased usalkinq time compared to their

wild dude ancestotu.

.PageS!

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CH :A PTE IR 6

MIIE .AN I !NGFU IL , T .EST ' I'NG Q IF S PilN AL FU NICT IO IN

c..:EAD REST

L U I I M B A . R

RES ISTANCEP ' A J D

I P E L V I CI R ! E S T R A I N T

llHlGH . ~

RESTRA INT _ _ _ )

FIGURE 1 6 , · · ' If the pelvis is , free to move, it isimpossib[e to produce meaningful b. .~sts of hlullbax

sh:e:ngtll (lit..mnge of :motion, H ·the p e l v m s can move

dnrmg sbJ)~ng;th~ests" the measured tor~ue , Y i U be

a result of the [011008 produced by three muscular~stems, I the hips, the thighs, and the lower back;

and it is then impossible to determine what pill_It of

~h.~ measured torque was ,acruaUy produced by lIhemuscles t:ha~extend the lumbar spine,

PeIvicmovement durhlg measurement of spi:n.:ll

range o f U lo ti o'n ( fl ex i on ! extension) prod uc es an over-

sllit:e:mJmt of th e h ie I t . lng~ two r l f C e l l t 1 y published 5 1 t u d _ .le s in SPINE l : : i o t ! te d I tha t t he r&'1ge of movement varied

[TO m a low of 91 degrees, wl1en measuredwith tw o

indlnometers, to a high of 9 6 d e gre es when measured

witl"!. a. 6200 (lsoleclmoklg:ies). Which is an lennr of at

[east 1 9 degrees, mas, mach as 24 degrees. True Ium-

bMo-Spinal . f l e > t i o n / e > c l i e n s i o n is normal ly 72 degrees.

The same sh:ldies quolled torso-rotaticaal range of

rn ov em2 l1 it t ha tv nrl:e d f rom a low , m e asure d w it; h aCOID-

~lss/gQll11ometerr of 54 degrees, to iii hig)l of 71 de-grees measured with a BWD. VVl1icl1is an error on

th e low side in beth eases. True wrro~rola.·tionin

'this planeis flonnaUy 120 ~ Addtlirn.,a] error

was involved in the ta lmo-rotat ion ~lirIg by an un-

known deg:ree of pelvic rotatio,n; which. was unavoid-

ably inc-h tded In the published ranges of movement,

Fen' Jl'l.eaningful test results, thepel vi s must-not

move; and when restrained in the manner illustrated

above, unwanted pelvic movement is prevented, or

redneed to such a small degree that it ~simpossible

to se e a ny movement, and all but impossible to meas-UTeany movement, During a recent tesl: to , de tennine

the degree of pelvic movement that actually occurred

during a test of torso-rotation strength, utilizing vlery

sophlsticated CADCAM equipmeru that can measure

movements far teo small to be' seen, the pelvis movedJJM of one degree under load imposed bya very

large man durin.g a test of maximalstatic torque inthe subject"5str-ongest position. Pour-thousandths of

one degree of unwanted pel'r lC rotation.

Page 5 8

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Such all-but-total isolation. Q i . f the spine can be

provided in only orne manner; bone-to-hone re-

s t ra ll 1! t: o f t l \ 1 i ~ pel vrus, UtiliZ~llg t h @ fem urn as an im-

pe'rtant part ,o f the:restraini:ng proc ed ure, T lft,etrue'strength of the spi nal muscles, 'OT the trLte ranges

of movement of the spine. can be mearrilligfully

measured In no othe'r manner,

In MedXequipm.ent~ .foJioe'mposed againstthebottom of the feet (the iUustra~ed footboard) is trans-

mitted by th e lo w er legs t- o the fm 1utS . N or:mal tight-

ness, ( ) / f the hamstr'llIg muscles w r n t h most subjects

requires that the legs be flexed about 45 degrees atth e knees, :50' th e f or ce a ,o m [h e .teet p ro du ee s r esul ti ng,fu~cesan the iemuxs int'wo directions; if a, force of100 pounds is ,imposed onthe feet, then. a. ku"ce ofapproxiLmab~.l :y ,:0 pounds will be d irec ted to w ard s

th e pelvic sockel~salong the' midline of t h _ £anura;,

wh ile , anoth er c f ue clioo of fol'iM wil l atl'e:mp't 00 push

the knee ends of fhe femurs upwards" but the knee-restraint pads limit upwardsmovemeru of I t b e . knees.

The thi.gh-resttamt beltthesbeecmes a fulcrum;

an upwards force of 1 , pound On i the knees becomes.a downwards fm:-('eof apprO~1ately 2 pounds on

,the pelv ic end s of fhe fam urs, T he resuU being force

,an the pd~s f:rOUl two clll~ctioIl:s;force pushlng thepelvic /hlp so ck eb iro,w iU 'd s th e rear, and 6 orc ~ push -

ing the pelvis dQWRWtU'ds,.

Located!behind the pel~s~ tne'pelvic-restra.imngpad is m ounted on ]tli;, own rucis o f r o: fr at iO l 1r :i s , free

to spin M iu.m d this ax is; but in , us e it sh oulld n ot sp in .

B 'ut I t m ust 00 free to m o ve, b ec ause any movemen t

O f this pad d uringte.s[ing o;n:' xercise p.rovf,d ,es a d ear

i . r t l l i c a 1 t i o n thatunwm:ted p e l v i c movement i is o O ' C U : r-

' r ing; which means 'that th e S Ub jec t is riot propertyrestram ed , or if ptiJpedy msrei l ined, means tha~ th e

subject is producing a ra ng@ of mO'vemen~ ~' :hate 'xceOOs

their actual range of iscdaled spinal movement.

When a subject is properly restrained in I t h e ma-

chine, the re la .r to nsh lp o f the pelvis to the pclvi:c-II'-e-straint pad bec om es, .id .entic al to the rela 'tionsbip of

!:wogears locked ~ogether by their teeth; when eitherone of such a. pair I O f gears rotates, then the other

gear must also rotate, Exac t ly the same thing IOCcurS

in th lB ma.chme ; if th e pelvis moves, then toe pel-

vic-resl: l 'ainl t pad m us t ro ta te around its own .1:005 ,

movement of t:he pad that can be dearly seen. Butif the pad does nut move during t.estin,gor exercise

procedures, then you can be assured that no.move-

ment of the petvls is occurring.

As Illustrated above, the pelvis r u s restrained

against countercioekwtse rotation, but no' attempe

is made to prevent clockwise rotadon of the pelvis;dQh1 .g so would be a .m ista ke. If restrain in g .fo r,c e

was imposedagainst the top l&o,nt s~des of tl'l.e pel-

vis, then cloekwise rotation of the pelvis would a]8:0

be preventedsbut prO\rklin,g such ~ o t 1 l l W immobi-

lization of lili~elvis, preventing movemen t 'in any

dir'eJCti.on,wo~d then make H impossible to deter-mine fhe true range at isolated spinal movement.

\IV1ten a s~bjed is 6 : _ j ' S i t ' ,res'trained in th e madooe ,

the resistance pad is moved to the reanncst (fully-extended) posU:ion and locked m plaice; 50 that n o~ orc e from any SOU1'cel a pa rt f rO om itlle re stra i:n in g ,

fO:foes.is Imposed upon ' the subjec t ;: thenthe subject

is requestedto slow ly' m ove' { onw ard in the cll i--e(:t iO!l1!

o~full flexion, of the lumbar spine . , ..and while the'subject moves, tit,e ~hempist should watch. the pel-

vic-restraint pad.

If I the stibjed can move forwru-diu'! ' to a positionof full f l, ex io l'l . o f d l eIDumba r spine, wilth no rot at le n

o f th e pel vi c- ·r es tim in~ pad/then '~he 'Yhave a t II ii ll rang€!

,of normal movement m , the direction of flexion; but

if the pelvlc pad starts, to rotate at any point dtu'ingtl" l!esu bjec rs m o vem e nt, [h is indicates that the pelvis

has started to rotate" which 'meanstha tthe subjec~does not have a. ,full range of norma] movement in

the. d irec tion of flexion.

But if move.men~ in. that direction was pre-

vented, if the top/fmnt of the pelvis could not move

forward, then a patient might move into a posi I:i!onthat exoeeded their ,existing range 'of spinal move-menr, So the freedom ,o. f the subj:ed's pelvis to rota b e

clockwise' (clockwise in the illustration used abovelis an important ,e-onsb:i:,eration, a requir-ement for

safe and meMlingful pmreclures.

During I:es,tso f spinal extension in this machine,

there is no, t-endel'l.cy for the top of the pelvis to

mov@ forward, so such restraint is not required;

during testing and exercise procedures, themuscles

of the hips and thighs wilJal:ltempt to rotate thepelvis towards thereat, H " 1 I I : } u e direction of extension,

which provides an advantage rather than itprob]em,;

because". by trying to ' rotate tile pelvis towards ex-

tension, the muscles of tl1,ehips and thighs, hold

ehe pelvis tightly against the pelvic-restraint pad;and Oms prevent pelvic movement.

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The ms tr am t l ea ttr ne s, o f t he 'to rs o- ro ta tion ma ch ine(n~)t illustrated here) are WIY s m U 1 a r to the system

ab ov e; utilize fo rc e Im p osed upo n a le feetand redi-

rected d l r o u , g 1 1 t h . ! ! ! Femur s to the pelv ic /h ip soc kets,

B ut in t ins c as e tl he pwpose i s s a'n : tewha t dH ' fe ren t in-stead of preventing pelv ic m ovem ent tow ard s ex len-

sien, the to~mtalion SYStffi1 prevents Iongituduw.

:rotation O f the pelvis, Bu~ in both cases 'the results

Me·ident ical : UiI1.WMted pelvic lllo,ranent ts pf,evented"so that true' tests ,o f both spinal s:n-ength and range ' ofm otion can be conducted w ith ou.t th e b ias 'llia t is o th -

erwise introduced by i nvolvement 'o f th e hlp and itl1ighmuscles, (II' by movement of the ~vis.

IF ! IGUFI:E6 . . : 2 'T , e s ;i : : i n g p O S i J It iO l n s , f e r ~ 1 .e a s u r- @ m e . I l L t

'O f lumbae-e tension strength, Haring: mtabliishedt a

norm al, full r-ang e of movement, static tests, o f to rq ueare then 'conducted in each .o f se"llen positions} atIn-~ervals of 12 degrees '~-vithin72 devees ,of isolatedlumbar-spinal movement. While th e number of testpooiiiollsand the exact positionsf(lll"tests,lrearbitrary~

we'norma l ly test in th e sev' !1"lpOS~jtiOl"!iSshown . above.

However/tests can be performed in, any or an 'of

MJ€nty . .Bve p o si ti cn s, with three-degree incliemen'ti

b etw e en a dja:c en lr test positions; UlUS it IS possib le to

b~s~within one and one-half degrees of any desired

position. WUh lirnited-sange subjee ts, as many as

possible of the above-shown test positions shouJd

be 'Used within the possible range of movement rOnan individual basis,

I- -- -

i II

I

Fl.E·XllbN _ . . , . I ,IE ) fElN·Slor

,~'.

F--

- ~ - ~ - p--'""""

-]2 2A S6 4(1 ,60

AN 'GIJE MIl D,EGR E E S,12

IlFlGUF !: E . 1 6 . . : 3 A bar '- -g ; rap~1 .o f te ste d . torque is d is-

played by t h e ' computer mnnitors as a test is be ingcenducted 11\ leach position; this visual ~oodbac_k of

their e ff orts te nd s I t o , encourag e subjec ts ~ o'prod uce

good results, and also shows the therapist enct1y1 : . .. ._ ~ . 1~ • •'WUd~' L S , ~Iappenrng as 1. ~ cccurs,

II.I lJ N lIA R E X 1 EN fU O N

wQ,: : 2 :

~3?'5'

,1 1 0 -,0,

,I t : i 5 C I

2:

I

- " ' r " " ' " !I

I II _

REXI?N'~

. . 5 -I"

I

I

I

I

12 2 - 4 , 36 48 00

.A NG IlL £ I til i l i ) , EG !R E : I S

F IGUR IE 64 W hen all of the d esir-ed positions

have been test,ed~ the computer will il'lterpo,late in-te rm e d ia te p om ti.o ns throughout a fullrange ,o f tested

movement and display I the results on the mDmlo , r

as a curve efstrength. Simulhl_neously, thecompererprinh~r will producea hard . copy o f th e strengfh curve ' ;

together w t th the actual raw da ta shO'VI/lllig tes'~edto rque c orrelated . V llith t he' test positions. A n d all of

the results are stored by the computer for later use.

8/4/2019 Spine Knee


' i I ' . I I l

,0:z

: :: ) 1 !( !1 1 ) ~11;;~~~t---r-=:.2 ~~o~ , iIIO O l . . , _. , - - -- - ~

~~ . : z o oC Ja ::

~ Q I~~"""' __ '___"""" _ _J",",-_"""_~~

(II l::i! 24 Sb 46 ~

A NG.LE IN 10E G.Iu!:E S

I F l I G ] l U l I RE 16-$ When aprcceduee is conducted for

derermh; ru~tio.n of£atig ilJ 'e" &ara.c1eristllics (~usoi1i1l1r fi-

ber;..type)'llill.te monitor will disp.la.yaJ."Id. the prwter

will. print both pre-exerclseand post,.ex1e.x,dse strength

OW"V'ffi1rorgetih.e.r w:ithallolfthe ra.w

dam.pi l 'odulCfdl,

d u r i n g bofh tests. lB i ised upon the ]ev,el of [ f \e 5 u l l im _ g

: ' , ' I i ' , - u ' --m , ., .. ..".;:J.~ ... ., the ameunt of exercise ~[-a Ig_e~ CO__ p.u~ '-' .. - - . _. -- --- :t'"~

fo rmed d .uring 'u'e p~ooedurej the rompLd&"N ' iU . p ri n t

a hardcopy of Ute :significant resul ts prcduced by

tllie~lilsts;to,g€'lh~rwith suggestions ill regard ~othefreq1lleney aad ,extent of ,j3Xi@c]lci;se ,oo.nBid,e.ood best for

a sttbjectwitll ~ chMacteris,l~cs.

Bdore a subject is seated in the madWe., the ~.sistarnce arm s h . o 1 L : i l l dbe moved to the . f u l l y " , e x r e n d e d ,

position and . 100000.. Once seated in ~hl~m.ad1i:M, . ,

andpreperlytestrained, fue $ubjed" shotddbe In-

s lt 'nu: :t ed to re lax in an uprigbt position.; and fh en th e1:iesistanooa:r.m shQuld be l il Il iI .locked aad rotated .mr-

WMdstmlfil.th~ pad touches the :subjeclt's back. Bin.ce

the resistancearm i s C ( n u i l it e :r w e : i : gh J b e d , it wiU impo.se

no fo rce on th e sub je ct dur ing , this p ro :OOU ID ! '. T h e

s~b1ect shauldthen ] li gh t ly g r ip the handles Umt funna. pant of the reslst,uiloe arm and remainrelaxed in

an uprightpoail!i.on. This part of t'he procedure is

plilepamtionfor roUD.1iemre]ght ing of "the torsc-mass

rorq'nle; fimt wemus't esmbli:sl"l a pesittenof top~ead-

,oen re ..· on an lndividu.al basis/Uu:' ba la nc ed ; tllp rirgM

position in w m c h the's~bjed has I'!O ~ende'f! :cy tomoveei ther forward or backwards when. relaxed,

CENTER Q ,F

T O IR 'S O M AS S

CENTER O !F

TORSO MA SS

FEGI I JRE:1 6 . .6 f lecetuse of mdiv idM:a l .~®~

inbuUd1 thebalancedr .rehlixed position of top-dead-

eenter varl.es as, mueh as 18 degrees; so we must es-

tablish STRAIGIIT UP~ . I i n . nrder It o assure thatthe

o oun .teI 1\V e.lg ht is lo ck ed . in to apos:itiolil tha.t istl'lenSTRA ]G rITOOVVN , UID degrees outof ph1il8e with

the .subjecr s midnneof torso mass.VVhiJeUl@ subject

rem a im st:ra.ig ;Mup:rig ht, th e coun~e,n.veight is ron-neeted ~oth.e resnstm1Looatm bya~odking lever, To

assure !~hat he c:rnmtenveightis :5 ltralght downwhlle

b ein g ro rm e -tlD € d , it is provided mth a bubbl~]evel

devtos s~m[]u to ehossused by {'~nb.\l:rcS,

AJl of themoving components o.f the ms..chinerapart bm:lJ:"t:heres~5,t:allae source, are counter-

w@ighlfrl on an mdlvidua~ b a s r u s in . orderto prevent

the introduetion of unwanted random torq:ll l.e byf - - - . ",1,parts ., •ij'Lemacru:l1Ie~ andlliis cou.nterwei&llUng is

0 0 carreful l .y pt'Ovld.ed tna .l [ even au~ H g 1 1 1 t w~ght of

fhe rooW l~&Weig ht-I(lc kililg [ever vvilllt:hr·o'w it 01.11 Of

bMi!ll'lQewhen the le'\lel' . : i s II I I~he un loesed po !S itio'n .

TIllIS the need fOil" the bubble level,

Me:rlhe O O r n l t e f '! l! \ if " e : i g ; h t is lod.o08d.inrop~r p o -

sifuiol1l,ile su bjK t sh cu ldm c ve to the mQst-e:dend.oo.

po,sition and relax; wher'eupo11thenlomfor 'Will. dis-

play a namber ~hat indicates the e~tmg error in

fl'l!e'oount eI 1 \Ve ight t orque ; I bb ism ay b e' a posHive num -

ber" if the CQWl~h.t is roo ligbt, or a negativenamber if tile 'OO11ll1lb~e[ghi!:" is too heavy.

Lo~ted o n ~o,p f t h e ' C 0 1 ! m i : e n - v e ig h r t: , a .l a J r g e . wheel

provides the ability to ad ju st t he coun te lV! il e'i gh t; while

tl"i:e'ad'UaJ.wefgh't oithe cO'Ul ' I i tenveight remeias C0i1'l~

stant" .its~np'Ultof torque can be adjusted hem zero'torque to as much as 15 [J ' fO l )i t- poun r ll s .o f ItQ::rque~ad-

justed by moving lite weigh t up or downin f8at[on

to t.he axis of themachine,

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Rega J li d le ss o f th e num ber shO '~ on the m onitor I

the them p~st should turn the crank ..tum it in. either

d i r: ee li .o n , d o c b<vis e o r c oun te rc lo c kw i se ; the origi_nal

ditecn,on of c ran k m ovem ent does not matl'elj moved

in ,eil.h~ direction it ' w h l l , c b a J l l ' g e 'bh,emunber C'tl 'tIl.'e

monitor. But the.number S110uld change bybecommg

smaller; and if the number does become smaller as,

you tum ttH~crank, then you are tunlmg: H. in the

P!r~lF d i rec lion' but if the number becomes larger-r- ,_-I I '- - ~ - . - .,. ,

then stop and tum the crank in the opposite direction.

Continue to turolli,e crank il l fuepfoper direction

un til the ' number on tl'le m orular bec om es e£ fec liv cly

z er o, e ff ec ti ve ly zero because it w ill never ]i@ m ain

exactly zero, the torquereadlings, in this machine are

so e xa ct tb at d l,EQ Jn g:e -slno rq ue p ro d uc ed by th e sub -

jeers breath ing and . heartbeat wil l be' shown. When

the number ts fluc:rnel'nng between about .'1 (seven-

tenths) ' 0 . £ a pound of negative torque and the same

magnitude of positive' torque'r you are as d ose to a

perfectly belanced position as itis ,p os sib le 't opr,oducewithal Hvling s.ubjed.

The goniome tel" (angle detector) on th e right

side of the D'I.a.chlnewill tell the the.r,apist the po-

sition of top-d ead -center.and a d ig i:ttal positioo-

indica tor on the cou It,erwei,gb.t will show th e

position of the counten t!/e1 ght in w hich propel' 'COUI'I-

'~,erwrughlti~gw as provided. Both of these read ingsshowd be entered into [he computer record for fu-

ture use with the sam e subjec t,

Ba rrin .g :m e anm ,g :f ul d lilln ga s in b o d . Y ' N , e i g ' h ' t ~ thetop-dead-anter setting and co'mlm"l1'~ght position donot have bJ ' be r e m & 1 S U l ! o o prior ' t o , follolli.'Ving tests Mfh

th e sa m e subject . T he abo ve p r , o c o o l i l I 1 1 ? S a re b oth v e r y

sim ple and easy to perform ; can be poer fo®oo proper lyin less fum} one m inute , and will pro bab !y never have

to be repeated ,Niththe same subject.

Fallowing these ,eo'unierwreightlng precedures,

the resistance arm should again be Iocked into the

rear posilion; and the subject should. 'b e instructedto s low lymo\re forward in tile dir ,ect iOI ' l of full flexion

of the lumbar spine; and while the subject movesforward, the ther-apist should watch the pelvic-re-

straint pad. This pad is free to rotate about jts O\\'l1I

axis, but should. not rotate'; any movement of t'he

PCIJ: Iindicates that the subjec t has m oved forw ard

beyond the true range ( I f isolated spinal movement,

The subject's forward movement should be stopped

at the point w here' th e' pelVic-r-esh:ainl pad starts to

move, if itmoves.

The subject should then return to tlile position

reached j us t prior t o ' pelvicmovement, and the thera-

pist should unlock the ' resistance srm and rotate it

forward until its pad touches the subject's back, andthen re-loek it in that position. The goniometer l m . nthen indicate the subject's exact range Of movementin th e d .ire d:iio :n o f f le xio n, a nd .th]s information. should

also be r-ecorded by I the computer for future use.

A ssum ing a iulIr,M 1ge of movement, the subjectshould move fo,:rwaro into a position of fullflexicl'l,

and the resistance arm should be locked inthat po-si tlon: 'then the subject should relax, produce no forcef r, om mu scu la r contraction.

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tI

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~, 2 24 , S l i , 4£ 1 O € l

ANG:LE IN I D E ! S ' R I ! ! I ! : : S ,

UNO~"'lISC'LJlIAR fORQUE

P'.gure 6..' Nonmuscnlar torqueprod uced. b Y ' a

pathological sub~ 298 foot-pounds in the flexedposilltion. A large man, evml ,wtallYl:1eiro:ed in . that

p os itio n ,. :m f'ly s .h e ,w mo 1li~ than 300 f ,oDt-pounds of

t orq u e o n i th e 1 Il 10 1U tO i ri:o rq u e produced by' nonmns -

cular factors. ' oom: ing pr luu l] ily .hom st .oved-energy.

Whi le 'the su bj,e ct rem ain s lie ]a xe d in th e first test

position/the therapist hould move a switch on the

m a ch in e ~ o rec ord n.onm,lL~fll' to rq ue ; f oD o v rin g tileres t of maxim.um. strength in. that pnsition, the com-

plllt1'!t'will subtract nOllm1.JSC1i lM torque. The ranain=

dec ig,ameasuranentoftru·e muscular-strengt.h, NMT.

torque aetna U y produced by the force of muscularcontraction. The subject should then be tested in six

cther positicns at 1 2 de~ Increments, Ineach tested

p ositi,o n, th e o om p ub !r will m easure and record bothmaximum torque, and ! : r u @ muscular slTength, NMT.

During the test II'Leach position .. the subject

should be instructed to watch the monitor (a second

monitor is provided Jor the the'rapist). and as the

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subjeetstarts to prcducemuscular foree, 'themonitor

shows a :risin_gbat-gl'aph.ind.ictltill"g th e level ofwrque

being produced.

Efiort druing the bests should be increased gradu~

,~nyand s]:owiy~ sudden changes in force shoU[d not

be prod 1 !loed ;~ora of m1l1:scttlar eontraetlen sho1:1l !d

begradually increased until a maximum level of

torque' is produced, having produced 8maximumle..re~of torque, the subject shouldt:he:nm~intajn this

maximum lev,e:lfor one or two S«'onds, and then.

gr,a:dually reduce :ale force 'Uldil a sbde ,of to,taJimus-

eular relaXiation is regained. Do not increase forcesuddenly, and do not reduce forc:e suddenly,

f t J h J l Y j r n , g l S U g , c ! ; e : n I~~e ' l I ' l l I : i l n g l d l u fl 1 n ! Q 1 : e ,s t in Q I p r t l ~

ce 'du r es , seN es; IrU :lIw(I,rnli lwh i ih!PILII r p ' O r E l i a ' ; wll'li'e 'PIl'io,ch.•,ciFIl l h m S ! l I i l ~eve'ls of lin paet f , o l I " C ' e ' t:lfl.at 'ma,y

be dlan 'Q,en!lU'8"

In itia tio n o f m o vem en t, at a ny sp ee d! while totaUyavoidmg th.e production of any ]evel of hnpaet force

is impossible., but :i t is po ible to reduce the impact

fam es to such a low level that th,ef are safe; bymoving

S h : l l > \ r } } r , and by .inoeasing dIe foree iQ f muscular con-

t raclioI!!_gradU!d~y. mhef 'o : rces of~_;roon;tm_c::bio,n

are increased slo,wly, then any resulting pall' l l mU be

obvious to the subject ~ongbefO'Jie a. maximum level

of force has been reached: hut with sudden effort" h igh.

levels of Mrre are produced so rapidly t l f t a t damage

m ay result to o quickly f ol' th e s ub jo ot ~orespond prop-

erly. Su_bj~ shoUld be instructed to slowly relax at

the first sign of pain.

S om e d oc to rs an d llte:rapists e::<~ 01' tat patients

e v , e n when pain is produced by t he eUof it s. ;:bu t that

decision iJ s a matter of indivi_.du.al clinical ]udg~e.nt.

GeneraIllyf V o 1 : i l ' h a new subject . . having completed

the test of f resh streItglh, they Me then exerdsed wjlfrj

a n appropna 't e level of resistance, B ut just how muchr esisb lu c@ is,a pp ro priate ? This, too, is amatler of cli.nical

j ; u d . g e I D E : 1 1 t but W~ usually exerc ise a flew subjed : for

tile first l ime ~t re sista nc e th at is f if typereent

of

the peak torque prod uced d u.ring the in.Hia] test o f f re sh

strength. If peak 'barque w as 300 foot-pound s, then w e

~ \o IJ dd use ] 30 f co t -pouads of f ' E ' S i s t a n O E : tOI th e exercise.

But with a 11~"II subject, this represents an educated

guess ~I'tbest. Given what appealS to be ifheright level

of resistance, some subjocl:s then cannot perfonn even:one full-range movement, while another subject might

have perform ed too nlallY flepetitL ons.. T hese d:ifrer-

enc es are E ! result o f ro usc :u 1arH be r- ty pe ; a f as,Hw itc h

subje:t ~giht be so w~ened by the test procedure

that they then cannot move agains-t the : s e l . O C ' ~ e d level

of resistance. while a s low- twi tch subject migh t con-tiaue for more than a hundred :repetitions if 'not

stopped by i l i J 2 ifuerapist.

~dea:UYrth e s ub je ct should be ablejo perform at

lei;l5t'eigl~tfull-rangemovements, but not more than~leIve. if they cannot perform e~ght Fep€: l i t ions~ th e

resistance is too h(g-b, and if they can perform more

than L w elve then. the 'res:isW "lc e is too low.

During th e e xe ro .se , m o vem en t in f he d i ir ed f i'on (If

exteruion ,should be started slowly and smoo'thly, and

the speedl·ofmovenl~lt sboukl . i 1 i l i w a y s 00 quite ~dQ iw;

upon reaching the most extended pesitionpossible,the sub,jectshould stopand hold that position against

the resistanee for oneor two seconds, and. fo.mowing

that brief pausein the extended. position; movement

back towards flexion should be started ..

Dur ing the exerc ise, 'the I@ v e1of resistance Is d is-

played by th e m c nlto r, 'to geth er with th e position of

'lh,e subject; sothe Sl-lbject should ¥ra.kh the monitor

th rQ iu ghou t f he ~m'd$~. an d will se e tlJ e IllOving level

of JOKe as it m oves to,waros e xt .e ns i: on o r flexion. ru ,the force itpproaches the' llex:ed position, the subject

should reduce the speed of movement smoothly and

startto m ove back, I t m v , a r C i : s extension ' ! . - v i i l : h o u t aJl]owing

th e fo rc e to d:r~p inIthe f lexed p o s i ti o l l: : , , , " fi b e ronly oneO f two repetil:: ioIllS during a first exercise session,most

subjects {em produce very smooth curves of force~ 'hr :oughout :movenla l. t in beth directions.

Positive force Is displayed as a grren line, while

n e g a 1 D .l r e : l 1 m - rn is shown a s a red line; 00 til lines of

fo'J'ooshould be almost perfect ly straight llile5,ilnd ran,

be. A ny variation above 'or below a straight line of

force is an l l lrucanon of jerky movement on 'the part

of 'the subject; an error thaI':will be obvious It o both

th e su bje ct and th e d 'le r- ap is t,

391 level s o f resistance are provided by th e lum-bar-extension machine, in increments of one foot-

P 0 1 1 . m d , from a minimum of to foot-pounds to a

maximum of 400 foot-pounds.

For both testing and exercise, the tang@ of move-

mentcan be adjusted toconform 'toany possible range

on all.indi vidual basis, in increments of three degrees

of movement; and the machine will no t provide 're-

sistance outside the selected l'anse.

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r200'

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~ 1 1 > 1 i ! ! \ ! i i , R n i STANC ,~ i~ . . . . . . . . .

I. 'I . .. .. . NEGA ' I 1 il !C I iE I S limCE

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!

Ff:Gi 'UiRiE,8"":Lev,e ls oJ res is tanee in ve lve d d urin g

eight :repetitions, performed on a Med_X lumbar-ex-

tension machine. Both mcllon and kinetic energyita v e b een , redured b ; : ; , the lo w est" p ossib le lev els in

Me dX m a c ltiu es, , a n d ! th e r esu l,t is , i l l s ou re a o f r es is ta nc e

that is almost pakct1y smooth. Me-oX machinesmeasure tl'Lf'level of ,effort durin,g resting and provide

the selected ]'eve~ of resistance . fc r f exe rd se , but do,

not impose force on Ithe subject during eithertesting

or exercise.

Dw:ing t es ti ng .. 't he r ,e si st ance' pad fuslocbd in

the selected position, and cannot move; the subje,ct

produooseffort ,andtbe machine records l the level

o f eUort. During 'exercise, prlor to the-start of move-

ment; {he machine providesno resistance, V\7he.n

moiVing. resistance is provided that is exacdy equal

to flt~~evelof , ef for t prod UQed by ' the sub jec t. A iev ,c lof ,eHOd and matching resistance that is selected bythetherapist; high leooit ;Ightoprovldemea:rringM ex-

ercise b1 l . l i ~ low enough to' permit the desired number

of repetitions, and always in propOdJiOI i i to th e sub..

jeet"s momentary level of strengtli

Pro'per l ly,e ,xerc iseci oncea 'W,eek 'f'o r a Ipe"~IDd,o lf IEHi l iDr~we lve ' wee J il:s , m 'D s t s u b,jects w ' n l l i r ~

ore,a,se tl ': le'irstlrisn'glh in a IP ,o siIEQ '1iliof fun e xlle n ..

si:oJlliby at .e a st .1 0D p ,e rc e n t, ane ll f hany s l lJ lb iects' w E n p'fodue,e much beUer rr,esult.s. With the ,mIUS"

,o les tha. t extend th e ' E umb ali spIne, rn 'O lFe ,exe l l ' -c is e is : s e l'd lo lm the s ollu 'llo 'n •.• antll's ,sa ,met imls,s;

t h e ' pFlolblem.

TE .ST ING 'TO 'R ,SO . .R 'IOTAT I ION ISTR 'EN 'GTHI. -

F,IGUiRE 6~1 The pelvic~festtamt system usedfor'

terso-rotat ional testiing is sim ilar 'to ' th e sysl iem used

m the~unibaf~ex:~ension machine;: but is designed. 'to

PWi;'\'en:tpelvic r-otation ,MOUlld a longitudinal axis,

rather than inthe d ir-ed icm of ex.te l\S io 'l l. \ IV1 : 1Mthe

rorro is rotated, the pelvis wID l10tate together witll l. the

sp IDe if 5 ud l m ovem ent is pcssible1and this pelvic

mov·emen: t D~' it.im:possible '~Omeasu re true sp in alr o ta t li ion , ; 00 the pelvis musl be res t ra ined, and can be.

In order tl O :mtate,U.~pclv:is must push nne of'the femurs Iorward while pruJ:mg the o~~ femur

ba,ck; so preventing au:y movement of the femurs will

stop unw anted m ovem ent ' O : { t he pe$v .i ls .When pr0p-

erly re:stramedil any movement of the pelvis Is im-possible to O see . i 1 I u . d elmose imposs ibl le to measure,

wrth no .mo,vem.e.nt oft-he pelvis, a nd ,e x: clu ;d lngcervical mta t iOI1 ,a i Ii li j' r.mal. full range (If spfnal ro-

tlitiOl'll, is 120 degrees, 60 de..grees to either sideef a

neutral, straight-forward positien. Nearly all ofwhkhspinal.ro'talion occers above T 11; longitudinal

rotation of the spine from T ni:hroug,h the sacrum

l S ' I i ."Ery slight, ,~dl impossible to measure with current

t!echno~ogy. ~aningful rota Don belowT -11 is pre-

vented by the interlocking relationship, c.f the ver-

tebral facets below TIL A si'tualion tl,at can ereate

problems i f not considered; no attempt to' slJletc.hshould! be made. in this plane of movement. If Ute

range of movement is be]ow normal, you cannot al-

ways teUwhy the rlmge is limUed; trying 'to increase

the range by stretching could[ thus, lea·d to damage

in the face:ti' S o the true rang e of pain-free m ovem ent

nliUst :be established prior to testing or exercise in.

this plane. Whlch involves a 'rery simple procedure,

Pa: ge 64

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Oneereseramed in the machine~ the subJec t shouldrotare the torso as far as possible towards ~heir.right"

[I.,ov[ng slowly ...and mevingagainst no external

s o urc e o :f I1 e si st a:n om l no .EXTERNAl resistance; but

f l u a m " e m _ 1 i 1 besome resistance to sueh movemenrpro-

duced by:s,tored energy. As yo u mO'V,E! durmgtceso

mltaUo~ i: t is necessary to store enc; lT 'g ) ' inO:Fde.r~o,

move; you a re stretching tissue 'on one side of the

bod y wMe ,aompmssingtissue on the opposite side,whlCh\ !ViU produce Intemalresistance against 'QQn~

tinued movement.

At the end of the' ra:nge o f movement .. c e ' J . l i . t i n . u e n .

movement in that direction may beimpossi:bie ~Vf;c'tl

though.~he .spine itself '~ capable o r a gte3!ierrange'' of ~no"VemelI t; continued movement then being pr.e-vented becausethe exi :S l t lng IeV'~ Q lf strength Is iden-

tical to the ooe:xisting Ievelof stored ,en€rgy. thus

produdng equal and opposite forces that make CDn~

tiaued mOVemLm t impossible,

Whicl, explains why R.'1any pa1~e:rrls using this

maehine mereasethelr range ofn1cPite:ment even Mlth-

out B;tretching; as they'beClQ'lfie stronger, t11ey can.

move .£adher against th~ internal resistance from.

stored energy.

Siuce this movement is performed in. a horizontal

planet the usual effects of gr~vity are not lfivd.ved ..

50 no cQ 1lm ~ e:n ve1 ghtm g is, required ; which ma 'k@s

both , · te siI :T I: ngn d e xe rc lse p rm : ed ur,e s easier te per-

form , Billt ,one add iHo.m.aJI s tep is required it~ tms

macMl'le,; having determined ~h€:mdividual range

of movement in both. directians, [heml!J:h:m~ 'must

then 'be lcckedto p:rev,ent any nwvemerut beyondth at ra J:~ g :e ,

lFi 'gUll '\e '6..101 A locking system located. above the subject linul:s movement hJ ' any desired rfln~ in :

increments of 6 degrees. Thus locked, i 't is t'hen impossible toT t;ne Siubiec~. 'klroo'll€! pas t lhe' en d of the

selected range,

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Durmga strengtb-test proced ure,tl:i.,e .subject

shoeld rota~e to either end o.f~herange of movement

and the machine should be locked in Umt position.

With the subjed ~ofa l1yre] i ; I_X 'ed in ~ha t :posilio!n.~he

monitor , , \ ! ' i J ] show ~and th e COmp:J;lb3t' tri]J~~eoord,

the torqueproduced by stored energy, nonmuscelar

torque tbillI must be measured and 8ubtta.cred fromfhe foUowingleve] oftested torque Inorder I t o . de-

t emdne true stre ng th in th at p os~ :lio nrN l V IT .mlethe level of :stOireCl-eue:rgy torque in this movemen tis far less than sueh torqu:eproo1!l.Qed during tests

of lumbar ex~e1'!1s[OUt i~still remainsan important

fnctorfal' mel1lningfultes~ reselts •.

@ ll~ : i l i t !

A ! N ~ G U U\ll £ ) i ! l G I I l 1 i I l ! : I E : SI I f~NCnO,t\ l I .AiJ l . S T R E , N G o 1 'H

fU l U IR ; 1 6~ ·~ 1In m s sll"ong~t posi:tio.n1th is su b-

jec t prod uced 2 /i2 4 .mc.h,~p() lunds offuru : :t io i1aJ ~o ' rque ;

ill!hls weakest posUdon" torque was, a ' l ' l i l y ens Inch-

pound . S tm eJ:lgtth in . in:tenn.edia~e pO~l 'Honsvaried

throu,gllout t h e f fi o\! fe rnmH range , andthe sWengt f : l

CUlVe was :nead~ra stra~ght line, asi:t should be.

In his s~l'Ong;e8t posinon" this subject's true

, i5 t n :m g t h w a s ·O·V\fU 's rntOO. by only 2'16D() i t~pO'Und.s (324

~nch . -pQUnds)GfS ; l o red~ i " ! ne rgy ' i : o : r - q l i 1 t ; and in th eweakest po.sil:ian, LT U.e 5 h'eng:rh was underSffib!!d hy.25 foot~pound:s (,300inch-pounds) .0 £ stored-energy~oll 'qu,e;whicl"ll.~ re la tiv ely .lo w e oz rr pa re d bo th e le ve l

produced In a test I O f lumbar-extensien strength,w l~ l[ mary exceed 300 iO D t-potm d s. B ut even 'With

filis relatively ]ow level ofnennmscular ~o,rque.the

~e5t results were biased to an eno rmous degree;'\Ivithone error exoeedIDg 2 4 0 ~ a O O Ipercent and "nother errorof 30,000 percent .

W

01~: : : l I ' 2[1001 f:--I--I--+-il---+-+--IF-~2 ' - - - -. .3:'( JI .~sao I!---+----lf---il----+--li-~Z

:!lOOO I---+-~--+~

00 ~ • M • 0 ~ • ~ ~ ~

A ! t I , u s u : 1 ~ 1 t 4 1 l c ~ R E : E ~ STRU IEM~ISO l i l I AR S ' T R I E N ( j i m i l (IN M~) i

fIIGUIR! 6,~12~Corrected for the error from

:stoJled.-energy tor'que" th e c t1 i1 'V ,e f tru.e stfen gth . w as

tOWGf'iil:1 U'lie ~ W O I T hg ~ t posilio,n,and higlleil ' in th e w i5 a k-

,est position. Pea.k ~o rq1 )],ewas ID educed .f r- o:m 202 foot-

powuis to 1'75 fQot" 'polJJndsl ar,e~ativelys~H change;

but strengtl1l In the weakestpositlon was rncreasednoma tested level of emly one mcl:l-poUI'ldtoa true

~ ev ,c lof3m inc ll-pom 1 d s~ an . m c r~ ~ O If3(J i" O O Oercent,

V V'1 litean eveng reater d eg ree e,f errorw as cor-rected in ~he tested . ratio of strength, In tbetest

,o'.ffu~lCtionilil strength. the higJlles'[ level w~2i!2.-4

tim es as hi:gh as the low est t€'Vebal1mcrease~n.s rr en :gU ll o f 242.,300' pereent from his weakest po-

siticn tohis strangest pos~Ho,n. A Chtllll:g€! inftmc-

hona1s,tllen,g:th fhat exceeded 2,000 percent perdegree 'of movement, om the ave·,a.ge."tmr.ougfiout

thetested range of 120 degrees,

B ut w hen. U U : 8 tesit@ d S ' I T ~ : n g : t i 1 1 w as QQJ ]" ,€ cted for

t . l " J i ~ error f rom. s tO~M- e :n er gy to r- qu e, ~ e tr ue ria l! :loproved eobe seven lo one; an. in01 1B iu,;~n sl l1mg1:h

f rom [( ,,'w ,e st :k l highest ofoir!!ly 600 percent SO ' @ le

actual increase ill s t r ' e ' l " J : g H 1 J ! r per degree of movement.wa s ,o J:iJ y5 pe[ce~t, rath.ef than theind icated 21 O a

percent But ~ven wHilil[ru@ c ha ng e in stren gH1 !. .f

5 pernmt per degree of movemenltr~e ffilpartamoeof ,oo"~aling meastll'ern:nentsof posH: ion with t~8ted

levels of sbe.ngHI should 'b e , B 1 p p a r e n t ; an error in

posi Hen of .only tw o d eg ree'S m ight p : ' ! " , ( d u c e am 'eF]\OIr'

in tested torque of ten percent" or more.

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f lU l II J IIFlE 16~ '13: In fhte torse-roeation marhine,

~'t :renglthm,U:5t be tested, in h-vo direcdons, rotation

to the :nght and to the left; wrucll, wouldpllodJucet€Stres,u]ts lft.€ the abov,~',exampleu notoon. ' lOCtOO.,

WhJen streng~h In , o ne drr,ecti.On Is conlpared Ib o

sh :en gth in th e op po site d be di:o J:\. w ith olllt cerrecdcn,the C! l : 'O~I1\g o£rhetw'o strength [curves md.esi.t dil-fic!!JJtro' [o om p are the stre ra gU n. .o f one sid .e to thaJ~ oft n @ ().lli€1' side,

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F~GURE 6 ..11,4 ,So th e ,r omp t l~M ' CO rNe ts f o'J ' [ his

problem byl\O lat:i:ng O rt@ 'o f th e ewvesby 1SOdegrees ;sD,tha , t both, cu rves slopem thesame dwection, w htch

makes ccmparison U 1 u c l 1 , easier . This, abllit)' e o eom-

pare :streng th and rang e of m ov'em ent inone d i re c 't io n

ro fhe opposite directiem protVJ:desMhnpOrt: .arn t ca-

p.ability for ju d g in g s pin al p ath olo g y; normal subjectsshow little or Il!od iffe.rence 'Iic '!;" henhe rig ht side i s ,

Compillred to tile Left,but spinal patients freq uentlyshow marked differen.ces.

E@:searchconducted with ~heIumbar-estensien

ma,chine established the enormous po'tenH;~[ forstr'eIIIg'thincreases, in that movement, and we then

expeceed to prcduce s im i la r : n: nc c re ase si n terso-ro-ta tion; but UUs did. not occue. Wh:il[es tn lmg' l "h in-

creases in torso-rotatiee.have been. very good, [.heya :I'@ rU J it a s g o ad as these produced by the]u:oo-

bar-extensien machine.

Whicl~r initially, wasa dlsappoin,ti.ng resW:'~;but

in ret:rospect it Il l l iay have been an. actUidadvm~ge ...

became i~provides one moreindicatton of the uniqu€!

nature of the lumbar-extension muscles. It is ouropi :n i .Q ,n [~ha t theusnal weskness o f thehJ!IlI1~bar-ex-

~e I llS ionmusdes j even. in healthy, no,~Jsubjeclsr ~ sthe weak. link in Ule musculoskeletal system. of the

spine; weakness that Is probably resporuslbre for a .

l ~ l' l.peT , 'r Je l1Lmg ie o f spmalpmhlems. It is also OUI'

opinion. thatth~ muscles 11 :00 '1 :ota~ t b . € ! torso are veryimpo'rtaIlt , . ,.second in importance mdy to the ex-

tensi,01l. musc les .

TesJtlngtorso--rotatioo strength. irrvclves tests, in

a 'J:eb~iv'E!ly la~g,ellumb€r of positions, d]1.e to th egreater range o :f mov~enl;and sm~e tests mustbe

I conducted in l U J i f u directions: of movement, we do

nOJt recommend su ch ~ silI '! 1g mOTe' often th aW !.oncee'vsry four weeks, B~ t . b e st reswtsin strength i I I L ~

erea sesmaybe produced b)r ,e~eroc is iJ ; l Ighese mu scles

OOO€, each week. or even. three times woo.kly.

In gene ra], . exe:rc isefu l :' [i l l'u~'h::m. ' Ilbar.. . ., IDttenmQ n mus-

cles should no t be cOI l l d .uded i [ 0 1 1 1 the same day thatexercise fu.rrorso~rotatio![:lisperiormed; the level of

fa'~guep!ioduced by some subjectswh..en boHl exer-cises areperform ed on the sam e day ]Jil;aJYerve to

inhibit strength mcrcea~. Exercise does l lLO't fRO-

num stmng~hin.cr€IiI~~t :i f STMULA'fES sljl~ngth

increases; but hav]ng been pro1PS[Y stimulated ~byexe rc is e , f cH .oV ll in g strength. mcreases eanno tbe pro-duced without 'the required period o f rest be tween

exerc ise sessions.

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CERV IC : A LROTAT~Q1N

M easurem ents of both strength S ind rang e o,f m o -

~on inthe cervieal spine are (:onduc:ted us]ng pm-

to co ls sh l'L ! ilM ~o ID r so =ro ta tio n; sim : ila r b ut w i th som e

im ponant d ::lfferences. T he level of: s tl1engUl is m~lIlcll

lower; SO'E\1easureIDel'lt of srrenglli ~[spedo'rmed in

in cw em en ts of inch-pounds oHol'lCj]]Je,rather foonfoot-

pound s. R ange of :o."lotion 'i s grea~e:r: ; normal : range

b ein g 1 6 8 d eg ;t:e e8 , .rath er than 120 degrees, Thepos-sibili.ty of exceedlagetree nmge of movement being

mo~e critical in . f llie ne ck ~Mn in I tAle~o:rso~range of

movement is]im1~ed 'Withan infinite nember of po-si tio uscw ith ln a f in ll:e ra :n ge '.

Sw.OCJ ! t h ne s5o f r e s is t an ce : W I ' exe rc i se being im-

portant, the kineli.c energy in fhls machine has been.reducedby more than 95 per()€.nt below a.usual t~v,el.F r i . c l i O I l . also behlg impor;~I1!ti' because of i~he!J!lela"-

ti'l!e]y~ow levelof s~eIllgth of tllesemu;sdes~~t has:

been reduced to i~helowest possible level. Red uc-

tions of both kinetic ~n er ,8Y and . f ric ti on al 'i € p l'o vj ]d e d

by theunique capfl 'b:i lHy o lf . ~~ . compound-cem sys;-·

temused inthis ma.chine fur automatic vanati.on of

resistance as movement o cc urs fro m a :s'tlol1 g :e :rp a~

sitionbowaros a weaker position. Or vice versa,

Resb:amt rorpreven.tiJQflof 1ll1liw'antedmovement

0 '£ body partsis pmvided. bya .sys~~mthat isolates(he e.e:rvical spin.e hy a nc ho rin g th e sh ou ld ers, rather

Ithan :restrain ing the pelvis, Because mQv,eme:nt oc -curs in a tSltem plane, the effec~5ofgravityere not

mvdved; so Q(n.lm~enveightWg is not req~anderror nom body-part torque isavoided, Restrainlt

involves o:nly two ad jti:sm:ten~~s;'e~tical adjusllnent

of '[he seat.. and ~drus l ;men t of :6h.epadsys;temtlllatrestrains the s],!ou]ders. 1'heQnly nenmuseuler

sourc e of torqueiis a l 'e su l'l 1 'of a low level of storedenergy; wm ch is measured by themachh1:e arid m e-tored m~o·~es~esults by the computer.

i F i l , G U l R E &o l . 51&Mus~ o .f I frhe gt'€aler ram ge of

mOV€1m~lil["with nar1l"llallsubj,ects, lestsa.re conducted

inatotal

of eleven posirieas, in . Incremeats of 12 de-g rees; but w ith a. L im i:ted !=rang e su bje ct1 t: ests c an be

eonducted hi increments of 6 degrees if desired.

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AI\ ! GIJ ! m :N I D I E G I U : : E i S

flGIllIRE 1 6 - 1 6 Re se areh h as d em o nstrated . fuif l l t

tll:lem.~:sclest.hatlcotate th e c erv ic al spine are usually

slow""'lwitch in theirfiber type. This test comparesthe p:r.~ercise w€ft of &~h .s:trength ~D the post-

ex~('i5e 'level of remajnirlg sitrengtl1.shc~g almost

no c hiID tigem s.tre:ng l:h as a result of fatigue. Research

hasalso esta blished the need for exercise in these

muscles; best results in streng~ increases areusually

produced by three we~y sessions of exercise; in this

easel more exercise does seem to b€more proouctive}

up ~D iI. reasonable point.

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FIIG UR :E II"~ 1 V e[ltical ad justm ent o:fllie soot is

r o q u i l l : r e d 'i:()ipo~ ~rHoo~ hembject's head in relaticn to

the ,hei3ld"",resrr,adntpads~ p.d.muUy~o avoid pr;essuli"~

on the ears, V erdcal adju:stmen~ of the seat is pro~vMOObyH-us iaI'ge whetd; and once th.€' proper po-

sition m established, the e<mctelevalion .]smaicntOOby a digHaJposioOIll-mdicator. InfonI'laliofll~hat

should bes~or~din t11€lCOIlJJlputer fo a v oid la ter re pe -! ilio n o f U ris ste p w h e : l . i l d e a ll i'l gw i tl 'l l.t he s ame s ub je c t.

IPlOUR! 16~~: Add'iLionru v er d c al a d ju str rn .e nt is

provided by the bead-restraint sys~em. ifrequiredon. an individ ual basis,

f~G I J J I F i l l ! 6 ;.,1 9 U nwantedmovement of th e e orso

is prevented by restraining the shoulders; adjuBl:men.tof t i l € ! shou1d& p.ads bein:gp~ovided by tile iar:ge

wheel shown. ,~bove.

FIGURE 6-201 Turnatg l"hls cr,ilIn lightens the

head-reshaintp~d5.

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FIGURE 6-211 Seated and properly restrained,

in aneutral (straight-fo[1fl{Md) position" movement

of '~hehead is prevented by t l l@ range-HIRith1lgsystem,

Initial prevention of movement is required as a first

step in, the measurement of cervical-rotation range

ofmovement on an iudi vidual basis.

F lO i U A IE . 6 m '2 2 The subject & 5 instructed to rotate

their head, first inone direction and. tater in the op-

posi te direction ....prod udng a very low level of effort;

a n d . w h i 1 1 : ! !he subject t r ies to turn the head, the fila-a-

pist hJ.ms one of the' two large wheelstha t permit

such movement. - o for:oois imposed upon the subject

in . an attempt to increase t i 1 . e range of head movement;

when the subject can flolonge:r produce movementill that directiolJ'l.l::he therapis] stops turning the \"IIoeet

and T an g'e o f possible movemen t is thus limited to

t I " I . e subject's exact range. Range llmita lion should then

be provid ed ~n the opposite rurection.

fiG uR E 1 6 . .23 , A ] ar :g~ 'g ,(m .i ome te r'( a.n g le i nd ic a to r)

is Iocated above thL2:subjocl's head, and · @ : l i s l ! l i. . : r iI l show

th e a ctu al'ra ng e o f mo v en 1 'e nt; while th e c omp u te r 'Will.

record . the r-ang e in increments of one degree. Having'

established nm ge of m ovem ertt on an i nd i v idua ll b a si s,

staHc te sts o f s:tr en gth . sh ou ld be cond uc ted in several

positiOll5 H:rrooghout 'the l'imge; tests be'IDgIieqwoo

in both din ' l l : t i .ons , 1 1 0 1 1 1 lion to both lefiand right.

Ex@tCise is provided with aiRY o f 2 91 . lev els .o f r-e-

sistance ... . from a low of 201inch-pounds (one and.

tw'Crthlnls foot-pounds) to a high of 600 1 i i l . 1 c n - p O ' l L m . d . s

( f i1ty : foot~pounds) i ' in increments 0'12 inch-pounds, A p-pr,opria.teresis·~ £ 0 : , any level of strength.

Exercise should be performed inboth direetions,

a nd sh o,L I ld be 'c o l 1 t im l O O until the subject i s u nabl e to

c o m p le te t h e h 1 i' t . i . a J lU i l t I l . g e ofmaV~m@Ifl[ agamst r ,es i&I tan lJe; when lIemrurung r ang ,! ! o f IOOVeIllent .fulls 1 2 d e-

g rees be]ow the' inU iat range, the ex erc ise should bed iscontinued W l" i.@ I\it subject is c ap ab le o f p erf um t in g

12 movements ' 1 1 ; - 1 ' ] ill the same range involvedin th e

first IISpetit icm, theJevel of resistance shoWd 'b e in-

creased by 5 peoc ent for follolc v.i.ng exerdse Sli!!'SSillns.

Speed of movement should be slow, with a brief

pause in the position of full contrac tion of the muscles ,sud den or jeD :'kymovemen t should 'be av,oid ed , bu t

will be displayed by thecompub&f monitor if itOCCUfS,

thereby providing the therapist ' \o.. .riili a dear picture

of the actual style of performance of the exer-cise.

Proper style of performance b ein g irm p orta nt b ec au se

it provides ilppropria.te levels of resistance through-

out a full range 0 . . 1 : possible movement, and because

it a vo id s U !1 Iw a nte d levels of excess fam e resulting

from impactif tI l e rky style of movement Is in volved,

P ag e 7 0

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C ER V llC A l e X T IE N S ,IO :N

fIGUR,E 6-24 Normal range of movement is,126

degrees, and iteslin,gcan be conducted m allY of 43

pos~:tionS.rm i nc reme :tl 'b ; o f :3 degrees, Given a subject

wU:h full-range movlemenltstesliflg i s , normallycon-dueled in . eight posi'tians,iill increments O F 18 degrees

throughout the full range.

Stnce vertical Ul0vement is involved, coun'~e'r~

weighting of the head must beprovided, together

'With adjustment fur ind:i vidual dlfferencee in the up-right pesition of the head.

Ieolatiou of the eervical spine is provided byre-SIT iI: ll l llJlgthe torso in a m anner id entical to th e systeJlii

used inthe cervteal-rotstion machine,

Resistance for exercise is provided at any of 291levcls; from a miJ:t:i:mum of 30 inch-pounds [0a.maxi-

murn of 900indl-pound:s,m Ineremen ts of threeinch-

pounds (one-fourth of a pound).

Tests of strength are 'focoTded in inch-pounds

o f torque, eorrela red. ",riUl th e positiO!llS inw Men rests

were conducted,

Vertieal adjustmsntof the sea t is provided Itobring

the effective axss of llie neck into coaxial alignmentwith the axis of the machine, Sineeextenslcn of the

neck involves, movement of several joints..this com-

pound movement produces an effective axis of 110-

tation that 'is lliJ,t incoaxial alignment with anyone

of the individua1 joints; and sinoe the machine hasonly one axis of rotation, and. because theeffective

axis of the neck changes as movement occurs, thismeans that the axis of the machine will never remain

p erf ecUy a lig n ed w i th the effective axis 0f the neck.

Compensation Ior this change in the location

of the efJ«tive axis ,of the neck h;.provided by theresistance pad .. This pad is ft1ee to rotate around

~ts ownaxis: and movement of tile 'pad automet-

kaUy compensa tes fur a:nymisalignment of the neck.axis with the machine axis. But movement of Ul@

pad should be very slight; marked movement ofthe pad as a subject moves born the flexedposition

to the extended pcsificnmeans that tl"le vertical

position of the subject is wrong . . Movement , Q , f th epad will clearly indicate therequired direction of

seat adjustment.

V iew ed . f rom I~,ek left side by the tlre:rapist, if a.marked degreeofclockwiserotationof the pad o{:CJ]rs

as a subject moves towards extension, this, means the

s~at is 'too high, and if movement occurs in a coun-terdoekwise directton, this means the seat is too low,

ln either ease the seat sllowd be'adjusted up or downuntll very Iittle rotation of the pad is produced by

f u1 I "" ra n,g emov emen t 'o f th e h ea d .

Having ad jllst,ed the seat for p]'Qper positioning

of th e T hl.ead ..m ,~e .l at i[ li l1 it o t h e r es is t an ce pad. the ce n-

terline of the head should beesta bllshed and thecoun-

te .lWeigh: t engaged in t ha t pos it io n. Theil the massof the head should be balanced by adjJusting the levelof torque' provided by '~heooun.terweight.

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F IG UR I E !6-25 , A part .from the resistance SOUJ' ;oe..

,~very part of the machine 'Iti'l.atmoves is COW'Iter-

weighted to prevent the Introduction of random

torque from perts .o f lh machine, Then, halmg been

cowl'~erweightedl i l1dividuru[y, all o f the'moving partsa re mu nte r~w e i,gMed cOUec tlv ,e ]ywith rh e coun~er-weight sho,wn here.

And then the eounterweighe itself is CO'UrI ter-

weighted inorde.r to compensate for any slightest

vari a tion from one machine to another; counter-

weighted intwo w a y s # to adjust the counterweighttorque on an individual-machine basis, and to , correct

any difference in the centerline of co,u.nterw,eight~orque. The two small, round \ I \pe~gptg,mounJ ed on

threaded rods provide these adjusl:rnents. Balancing

procedures fuartMe perfo ' I 'U led at the' factory.

FIGUR'E 6-2'6 the wheel located on top of the

ooWl te r \r 'l le : igh t fo r head mass, is used foradfustment

, o f cou nterweight torq ue, and the w eig hi: of the blackhandle used for adjustments ~5 individuaUy eoun-

terweighted by the smallweight located directlyop-

posite the handle positiom providing a perfect d@~ee

of countenveighltmg even rorparts with a \.-~reightof

only a fe w ounces.

IFIGUR'I! 16-2~1 WIh'en a sulbje!ct 's h,ead Is:

STRA~G:HT UP1 the !(Hlunte' lrweigl i1l l must be

S TR AIG HiT E J OWN; SiD t l l i l e C , D ! Ulille'rwelg lni l mustD B ! :ad jU is tabre ' ~1 I i I o , r r d e , ! : ' to c : c n 1 l i l penlsi l l t ,e' m i l ' ~l'iIdi~vJd u,a l d ilfferen,ces in th e t !o!p-d:ead~,cefnte r p,osi-

t iDn ! D , ' f t h e ' he , ad . Whii'ch adjustmen~ ~s provi idedl .But the exact ba an,ce af es,ch part of th.e mackln 'e 'is , s e care fu illy ' IprD vfd ie d tha,tt.he 10e l k . m ' g ' I I 'ev' ,efof th e ' D o u l i l i t e l l " w , s i g ' h t ,assemlbl ly w~nI lnlr!o,w Iii CI'utof ballance wh,snthiS I~eve ' r liS in th e I U n l ! o , c k e d

pos.t~,on;, S iO a le v e :1 d ' B v i:c e , :i s prov ided 'to' ,e'nabl 'e'the ther:ap,j!st to! plf'O dU lce , a n exaet p os,~thJ,noif

b ! C I I I tD D i I: ~ d e a d , .. a e l l1 t :e 1 l '( s t r a i 'Q lh t d ' D ! w n ) (i f th e ! C O ' I L I -te rwe:i :g l l1 't d Urln Q I ttle Ilo !c 'd IilS p :ro c ed u,fe .

Such exact counterweighting, together withproper alignment of all related parts, .o f the machineand body p a m of the subj:ect , i ; ! 3 required to remove

randomtorque that wnuld bias t J E $ ~ results. A scale

must bebalanced before U can provide an accurate

weight; and any testing machine must be balanced

ina similar manner for- the same reason,

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IC :HA P TER 7 '

SPINA.L FUNCTIO'N

Spi nill fu, I1J,cth)n ls rn ota lw a.ys ; 'w h atit a.IPiJilIlI!IU.sto !be ; '1ru e ' s piin .al fu m :l:iiiQ lnCian be , , d le t e 'f 'm iii,n,e"dl0 n,ly un der eer-

1,ailA ccnndi l t i ,o lns: .

f IGU lRE1-2 : During th e ' type ' o fmoYen1eJ l t i ; mll,l&-'

tra~& l1 1 ~ the pelvis m oves as a result ,of t he hlp andf r b l l i g h n 1 Iu sd e s .•wh ile I ~h e'Awn b at sp in e I t !OV'e5· as a resultof f t iespmal mu sd es, l'e sfu lg 'lf liso om p ou nd :funcilLion

tells nQl~ hin g o f v alu e a bo ut the sb.'engUl of ~h€Lrumlbar

Fr tGUFUi i i : 7 : "1. Back ,ex teM.TQn CMl! bepe:r1o,nnoclmtlrsc]esl an d e xe rcis e pezfcmsed in this manner has

in flUe€: d i: st: in ct f as :h io :n s; llijjs fip e illlu slT a~ e.s ba ck . . l l i . t t l e or no ,eiffect upon the . s p i J J l . a [ . m usc les. S 1I:t!:hex -

extension that involves ,only h ip func tion . T he pelvis e rc l.sewU l in cr ea se til1 .~~ itr fm g l h o f th e hip and th ig h

moves as a result of ~heli:ripand thighmuscles, b1ll!t mnsdes, whilie leaving the s p m a i l l ; muscles ina roo-the hnnbar sph1:e' does not cha:nge Us p O S i J t l Q I [ ' ! ]1'I.:r'~~ t i n u m g :st:a,teof ! looph:fued weaikness.

la ti.o n~ o itT hl.ee lv ts, T estin gm tlu s {a,smon tells l:'lotb.~

L n g : about the s,b_lcm g lfl.o f th€ ' spinal miU8C~~; and

exe:rciS€l pedcllrm.ed.ln this fashionloV:W n ot in cre ase

I :hes: trength !ofspmal mnsdes. Both te s:oog.and ex-erc ise pro~edur :esper fo rm ed i rnlthis mZIJM8 alle dan-

gerQus; because the spine has reachedIts l imit of

Ilwvem.el1L'[ l l ' 1 l t h e diredio(J;ll o f I 1.ex io u ...any force im -

pored in . th at po sture will ~liI.dto mOV'1€ the spine

beyond its limUof mov 'emen t .

f ,IG U A IE 7 ..3 M €'an 'm g ful testing or prod uc tive

exercise must beperformeda s shownhererthe pelviis

must not move_and i fpJ l-o~dy restrained will notmove, Isolated IURlbar fu:nclion.

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F U1U iIil:E 7 -4 W he n th e tesso lsrotated, the pruvis

'W i ll a lso ro ta .te if not restrained ; and :il .~ th en . im -

possible to d etem .tine [he '!rue rang e of spina] motion.

In order to rota~e. the pelvis must push one femur

forward while pulling the other femur back, whld1,

produces the ' type o .f knee movemenl~il lus :b"ated here.

But pelvic 'rotation can be prevented by lIlaking itimpossible f u i l " the , kneesto mo\-re;and then the huerange of spinal rotation can be measured,

The average I 'a_n,ge of lumbar-spinal movement

in flexJ.on IexteTlswon is 72 degrees, whi le fhe aver-age range of spinal rutation, excluding the cervical

spine, is, 120 degrees, almost all of which rotation,occurs above T 11" The inter],od:ing ~elati.ouship'

'of the spinal facets below T 11 limits il:'O'tad.on to

such a small degree of mcvemen t that it carurotbe measured aecurately.

All O o f the muscles in the torsoare important! buts om e a re mO [ 1j! 'im p 01 ,"ta .:n t th a n others; a ra th e r com -

mon opinien suggests that t he ,a lo c: {. om in a ] muscles

are critI.cal.for prevention OIf rehabUitalionof lower-

back problems, and. these muscles should not' be tg-

nored: but the abdommaImuocles are s-e1dom ~he'cause of lower-back problems or the sOlution to such

problems, To the degree that muscular weaknessis

a factor 'ill spinal pa~holo,gy~the most 'important mUS!-des are the ex.tensor muscles ,of the lumbar spine,

and the second most important musdes are thosethat I io ta te [h e to 'I"S O .

Attempts have beenmade to determine the ratio

0 '£ sb re ng tl'1 lb etw e en to rso e xtsn sio n an d f le xio n; andc la ims have been made that this ratio is important.

But dynamic attempts to measure this ratio. were

n"jjsle1lldling; biased by terse-mess mrq-u'e, by stored

energy torque, and by muscular friction. Moving

towards flexion, the weight of th e subject's uppe:r

body Increasesthe torque, while s~omd-e:n.ergy and

fric tion tend to reduce the level of torque; any testedresnlt being meaningless.

But when nmving towards extension, the "vcl,gh,t

of ale subject's torso, head, and aIUlS reduces torque,

wit l" l an ad di tiona.[.tOO.1LU:tlO:rrl. c omm g from .m uscW a!l".&icti'Ofl:/.while s~ored_,en'e:rgy tends ~o increase the

level of torque; again producing meaningless ~estre-

sults, Add i lE i i ona i en'o'r is produced by impsct forcethat i s una'V ' o id ab ly induded .lin any d yn 6!!ID j. c test.

So even ilf the ratio of extension strength to the (0=

e'xi:sting level of flexion strength is important, this

ratio cannot be establiShed by tests like those nowbeing conducted.

IF~GURE1..5, Eve.u'lwith ~be'use oJ the mDst 50-

phisncatedima,gi~ teehnology available, itis diffi~cul't to measure the true range cfisolated spinal

movement; problems :r,esulting from perspective

make it impossib~e ~,odetermine the top or bottom of

(he individual v,el1ebl'al bodies, and the megul !ar

shapesmake it difficult b),determine thelocatioa of

th e ,front surfac es, B ufbyusing '~ a.ter:alX - r ay pichlLi'eS

in the flexed and extended positions, i't~s possible to

measure th is , r ange ·o rfmovem ent wi tha h ig h d eg reeof ,acrura,cy. S cribing a Itltin. .s tr aig h 't li ne o n. tbe X~:raypicture inthe 'manner illustrated here. a different line

on the front of each ofthe fivie'lumbar vertebrae, Will.

provid e a reference for esbii blishing the ang u1 a.r rela-

tionship in any position Jrom the flexed position to

the extended postilion.

P ag e 7 'J

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fIGUR.E1~ X-'raypictures ,offue sacrum are

seldom as, clear as the v '~ l 't i. 'l :b r ae . b1 ! .l lthe f ront face '

'of i~hesacrum usual]y has rather distinctpeiuts that

can 'be dearly seen on aIateral X-ray picture; S lO a

thin line' scribed on the piclWIe iiiS illustsated here

wHI es tablish a reference pointfor measu ringmcvement from the sacrum throllgholll't the entire

r,f,lngeof lumbar-splnal movement,

STROING IS A P IELATIVETIEIRM

Tile first person ever aceu:ril'J'~ely~ les tedfor the ' L S O -

lated strength of th e muscles t ha t extend !thelumbarspine was (I, very muscular m an in his n:Ud-thrrties;

a mall with ilil!tvilenty year hlstory of bard exercise,• 'I .J ~,.. ~ ~ t .,."~_ . l'_~.~ . ;I'JilJl;CtUWi.18 s e ve n y ea r'S o ~ r eg il: :! hl.. I ex 1? rc .IS €~HjHii~.JI.

wlrh a Nautilus lower-back machine. S O WI! ex-

pected him 'to be strong.

For a. p eriod of severa l ye:rurs prlo'r ' to,his, first test

o f ioo ,] a'l 'e d l umba r strength, we had been testing the

stre.ngtb of bis quadricspsmusdes (leg-extension),

and he was farabove an. ,at¥er',21ge levelof strength in

0I_at movement, will, fresh muscles could prod uce

m ore than 400 £oot-po'UIiLil 's ,of~m:que inhis str-ongest

position". l ' I l i tb. lboth leg s w o rk in g together. I<I1o,wing

hislevel of quadriceps strength, we Wen! surprised

when he produced a peak, torque of 340 foot-pounds

with ltih,em uch smaller m uscles of the spme; consid-

e rin g th e r e[a :tiv ,e shes of the quad riceps m uscles andhunlnrr muscles, it appeared to be im:possible for th:e

lumbar muscles to produce that much tcrr,que.

B ut w hen known le ve ls , o f to rq ue W8J1e unposed

00 themachine, H'Ieerrorwas less than one-tenth ofone percent, the machine was accura te. So we then

justified his apparently high level of [umbar strength

on 'tne grounds of his lo ng 11 i.sto ry of ha rd . exercise;at the time did I ' I i IJ.t expect In find many other subjectsthat would be @ q u a li y strong,

During' the next five months, he mcreased the

strength ofhis.Iumbar-estenslon ranscles to an enor-

mous degree; ga lns in strength that made it obviousthat his, u u t i a l strc en gtih , r ath er t.h an being unusually

high, was actually a low level of spinal strength, A v . .

,erage stre.ngth for untrained subjects had Lbeu not

b ee n e 3ta b[is.h ed ;: b U l l t when it was est" abllshed , ~t

turned (lut fha this ini tial strength was below average

tor an untrained subject of his sex, age. and size,

CI,I,

oz~'~,F---~--~--~~---r--_,~~I' 2 ',t!.o:~ 300 t---+-~=t----"""""~~---Ir---:iII

~

~ 175

Q 1I~

~ '0 ,1l...- __ ....&...__ __ .~~dL ._~_ ._ b......__ ..!

Q I l2 24 1 , l i 6 48 60

A N G U 5 I, N D 'E :G R E E S ,

'7 2

! rEGillR E - P ' In i tial s~glli ot the su~ bjed m en-

tioned above, compared to average s b o e n , g i t h for anuntrained subject. The red area between the h'll'o

curves shows strength below average.

12 2 , 4 , 3lI 48 W

ANGILE IN I DESR'I;] ! !S

72

F~GURE 7~B The lowest curve shows initi.al

strengthl th e h ig hest c urv e is str en gth af te :r f iv e m o nth s,

o J s pe cif ic e xe rc ise " a nd the dotted c urv e s how s, a ve ra ge

s!rreng.til for 'untrained m ale sUbjec ts. 1 :0 the best of our

know]edge at lila t time" those gains .in strength were

im possible. m ,any leng th of tim e; no other m usc lein the

body shows anything even approaching this potentia]forstrength increases. No normal muscle ... but an

atropltied muscle c an produce sucl-t gains.

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But even 'the Increases .in strength shown above

turned O'llt to be an understatement, his 'true gain'Sin muscular s,trength were even highM"; w,e\yere

,then unawsre of the effect!)of stored-energy torque,

assurnedthat changes :in functiona] s'tr,ength were

in proportion to changes in muscular strength.,which they arenot, Later, when we became awareof and measured 'Hll! results of stored-energy

torque, it turned out 't:ha~hilll' true increases, were'19,6,percent in the flexed p()sitio:n~d 440 percent

in full exbe:nsiOl'l. Much higher in the flexedposi-tion than inHially believed, and slightly lower in

full extension, At fil,t1tlevel ' 0 ' £ strengtlll he was pro-

clueing fLfty percent more torque from the s.maj;]

mnscles of Ute lumbar spine ~haJnhe was bomthe

much larger muscle'S 0 '£ the Ithlghs. A relationship

'that caused us initial surprise,

But the lev,erag:e provided by Hte jointsystemmust also be considered, The knee join'~ havea gross

mechanical disadvantage; if the quadric~psmusclesproducea force 0 '£ lOt) p 0 ' 1 I . U 1 d s , . . the measured oU, tput

of torque will be about seven ~oo't~pooli.ds. 'Which

iswhy th e q ua d rio ep 5 , mu sc le s H ie s o la .rg e; they m u stbe large in 01"0.1&o loompensa te for very poor Iev-

erage in the knee joints, But in the joints of the~um-bar S ' P ' l n t ' " ! ' , in the o,e.xed p O s W o H / i th e muscles aile

provided llrith iiimechanical advantage of at leasttwo~o O I l1 .e ;if the 'm1ll lsde~prodUrClil: lOOpoood$, of fOJlcel,

'lliemmsmed output will be a:fleast 200 f ,oot -powlds

of '~Drque.

V E l m C A J ! .

MOMEM

~~-_S f

fUlUFIJE 1-91 TIUs dra'Wing illustrates the m e-

chanieal advantage [email protected] ~umba.lr!ipilu;!; the inpu.t ,of fo rce £ Jam the muscles

wil l be ineeeased by tile leve:mge of the joint syst~.

1 f 'I ,G U R E , 7 ~101 Themechan i: cal ad vantas,e in th e.flexed posilion is reduced in a position. ,of f u n ex-t~iO'n of the lumbar spine; changes as a result 0 '£

ate.locadon of the axis of rotation. In th e fl.exed po-

sition, Uteaxis of rotation is , located between 'the ver-tebral bodies; but in full extensjo~. H I I , e a;ds haschang,ed to ' a posi t: im l we ll ~'Olthe rear ef the posteriorface of Ute lumbar vmebme; in. full extension, Ithe

axis tis located in the facet's Relocati 'on ,of the axlstha1 t r educes the mechanical advantage found infl' '1e

flex,eclposition.

P : ]'I ev iously-un tr amed s -ub je c ts a re usually muChweaker in:full eXT!!1'1sion than fuey are inthe flexed

positiml, and the loss of leve.mge as yo u move fromthe flexoo pas-iti,on to full extension might appeal" to

be :r 'espo11SilJI~or the [OWe1"' le ve l o f stre ng th inthe'extended position. But trained subj,eds, after theiri.nitial level ofSb:e l ' l .g th haa been gr~ t lymcrloo:sedby s.peciik exereise, usually prod uce 'the same levelof (rue mustu1M strength, NMTI inevery positionthroughout a full range of m ovem ent. -

If th e in put ,o f fm c ,€ !fromthemusdeswasccretareinevery position, then the output ofmeasured t-orqiLl€

would drop m d~ec~ proportion ~oallY los'Sm lever-agel'bu't this,does not happen, 'W'hlchmeans lila t the. f a r o e , e iromlli,emu:sclesis in.creasinga.s you move from

!:h e f lex ed po sitio n to ' [till extension. Gr e al te r f -o rc efrom the muscles compensating for a loss in leverage.

Which also means that some of l !:hemuscles that I~

tend the lumbar spine are not involved thr,oughoutth e fuUnlllg.-e, ,o,fnUl,v.ement; become i \1'01 ved only as

you I II U J ' V \ @ ' close to the fuUy-ex' tended position. A p-pare:nHy these m uscles cannot be used inother posi-Dons;which helps to explain why they are' usually soweak when a pl'eVimlsly-untrnilled indi: vidual is :first

tested; never having been exposed to meaningful ex -

ereise, they remain in a stab~ of atrophied weakness.

Pagei6

mailto:[email protected]

mailto:[email protected]

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flGIiJRE 7~11 A test ·offresh strength cempared

to a tes'~ of exhausted strength. On the left side ,of

the dtad there is, a meaningful differenoe in the I I

strength levels .. fatigue from the exercise; but on t h i e i! IIX! F"""~""-----r~~.,.....--"T'"- __F " " " " ' . ~right side of the chart there was no change in.

stren gth " n o, fa:iig ue fro m the e xe rc ise . f :i! ltigU Jein h isstro n ge st p ositio n , b ut no f atig u e h li h i s , weakes t ]lo-,m'non; and ' U t i s occurred. even tl:'lloug"h~:hemachine

provided variable resistance, heavler resistance inhisweakest positien, and Hgih:ter .r'esistance in his strong-

est pas] tlon, Bards workeaused no fatigtl~, wh~ie@a~er work did produce la n gue . -

'Iheabovetests were produced duril1gthissub~r s

sec on d m st/ex e:r,d sep ,ro ced ure; he was t es te d , f or fresh

stretl lg' th ..was t h en exercised with what 'Are consideredan app1 1 Jprlate lev'@ l 'of I 1 e s i . s t a n o o . , and w as Ithen re - ,L ........__ ~~_~_~~~ ~~_~--II

tested fo'l' ren1ah1ing strel1gflJl,inn:nooiately , a t f t e r th e e x , -@ re ise. Ow in g his first proc ed ttre, approx hn ate:ny tw o

wOOks ear li er . .he fai led during I the ew:.en::isea t f t e r fi~een

repelitions ' ~ l ! I ! i i h 175 f o o t - p O W 1 ld s of resistance, and

since lIis fresh strength had increased by ~e fulle of

Uu s second test, VIle·mcre as ed t he r es is lt an re to 2 00 foo t -

pounds, B ut thatwas not ~oog):t of an. il'lic:rea.se;he

should have been given heavier r es i s tance .

. ~ 3 6 0 1 1 9

AN SI.!E eN D E , G R ' E : E S ,

7 .2

The ~light li!¥d of resistmCle became obvious

when he perIo:r.med 'Menty-" . f i v;e'Mpetitirn1S 'willi no

s ign O rf fatigue; so we stopped him at that point and

immediabily conducted the pest-exercise ees t 0 · £s l'. re Il gt h. F a ti g; u: e f rom l ig n t: re si st anc e in h is stml!'lgest

posUion; but no fatigue from hea\!l.er resistance in hisweakest position. Itappeared that he bad s lo ,w- twUdl

muscle .fibers in part o f th e f u_ ll~ ra n,g emovemeru, an d

a mixture of muscular fiber types in another part ofthe mwement range, Which was , 0 ; 1 true indication of

theaetual B~tuation;in th efirs't h all o f a full-n m ge m o ve-

ment, J U s , msHv.tib:h f ibers wer-e atrophied; but in the

last hili of themovement, his .f:ast-~kh .fibers had

been lieactivated by heavy work in that limited part

o f tll le movement r ru;ge. The J e ' o ;1 1 . o f re s is ta n ce used

in tile exercise is shovm by the Mue line; W g h la " re -sstanoe' m tl1e flexed position and loy,rer r e s i S ' t , a I 1 C ' e

in t1~ee:dended pos l t ion : autoIDal'lic variation 1 1 1 I,e-

sis,ta1'l:t'e provided by tile cam,

Many years of water-ski activity had exposed hisspinel m uscles Ito a . ' ! : t e a r y w oild oad near l ! T I e ex:tend.ed.

part of the range" and hadl mcrelsedhis strength to a~eve].fM a bove aver age in those posili~; whi le doingnothing to increase his sblengt:h above ,avemge for an

untrained man. in the flexed PO$i,tiOrl~wlidl is usually!:he position of highest str-el'lgtl1.

t: i ! 24 36, 48,

A N i G I L E I N DE G : R i I i I I l ! S

IF lG, I I JRE7~12 In a pe riod o f tell wee k s f ollow in glUs,6:rst test, as a result of om y Bve previous sessions,he Increased his su-ength i l l the flexed P ' O S ~ t i O J : ' l l , ] ! U s i l l m l -

lli.aIy-weakest positiO'11/.by 60 ' peroenJ, with an increase

: i n full ext ei :'l ai on o f 33 percentl an d with an inerease

about tw 'en ty degrees ~ o . n v a r r d l frem r u n ex tension , h isini ' tW]!y~b'oi1rgest posi t i l ion~ of 21peocent. His dynamic

strength .increased by 00 percent, from 15 repe tl l: ionswith 175 to 15 w:i th 2BOloot~pounds of resistance.

B ' ut ,f oDowmg ' l l 1 i s ~ast test his fiber ~ appeared

to have chil.l lged. in the first half of a full-ran~ move-

went; ,at ilL mtll ch higher level of Smengd.l near f lexkm,he started to show fa t igue l'f'l that area. But fuese

changes d i d . not indkate an actual change in fiber type ;

.insteild~ demonstrated the selective nature of atrophy.Fast-hvitch fibers atropby i a J ; t e : r and 1 : 0 i l l . greal~erextentthan slow"rnr i jeh f l ~1S. W:hen first ,~ted. his fast-

I l : w i ' ~ ' r n fibers inthe first part of the m(wement range

were nonfunctional from atrophy; but as strength was

increased, these fibers starred to function again.

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A r,esponse that dearly supports a point mentioned

@ u U . e : r ; son1e t O f ' t h e u1iuscles that 'extend t h e h~!,]:[ibar

sp in e are involved om , m . ill posi ti on n ea r M lJ extension.

STRUC:TURA l INTE .GR : i I T ·V O F T H E:SPINE,

WhlLe It'heUppel part ,of the spjine,. from T 1L

through f 1 1 is provided f i . r . r .D . l s.u:ppo:rt by th e c lo se drI bc ag e, 'th e' lower spine is supperted pr!.nli lr i l iy by

themnscles, the tendonsand t he :Ug.i lXI ' le l" I tsn fha:t

area; a nd w e·alc rte ss m any of ~heseSUppOl't strueturescan lead ~o injury. 1 1 ' 1 1 1 3 ' n ~d f or : 8( )if ~ -tlssu ~sb 'lm 1 g th

if ! that pad of t f t ' H ! ' !spiIn!~is beyond q U e ! l l l l t i o n .

F u n ctio n . s s a ~ e rro .with a double m e am n g; fu nc -tion implies producing sOlne~bjj"lgrbut it: alsemeans

proevent in ,g some t lr lng ,. The spine is designed toper-

mit certain types of movement, but isalso reqidred

t o p feV ' i: !n t oHt ter types o .f m,QVE1 ne n t Bu tith e sp ine

itself ]sincapabl~ofprodud:ng force in allli}i' diJec~]onJand has only alli:mlted ability to resist forca from

ii1illY direction, ID some way$the sp.h lle IS § imU 8Ir eo

a tall, l~h'il:1lower thathas very limited abiUty i~O , ' I I i th-s tand hori z( ) lI :'l ~a1 fo rce s, yet ]5 required to resist lrlgll

le ve ls o f f orc e f rom . th e w i nd ; :r ,e slsm n c ea ga jn sth o: ri-

zontal force fromthe wind is provided by cablesattached to ~e tower and ,al1cil l:oroo : [ [ " 1 the ground.

S ' U 1 m . cables provide ne resiseance ag.wliEt c:omple!g..

sioa forces, 'but do pr,eventllie tower from bending

because t hey resist pum n g: forces,

The mlUSdesll"he tendons and t he l ig ame :n 1 ts sup-port the splne in. a similar w"y; but unlike tile cables

• . .';!.. 1suppornng 3. tOWefl tn e SPUMl! SuppOd-St :rl ! lc turesre-

sistboth pulling and. compr€SS:iofll forces. The banes

and discs of the spme are prim..ll"ily m~~nded to resist

compress ion f01 'OO9, . provid € very UH:l!einthe 'way

of resi stancea ;ga ins l[ foroes from any ' O H l e r . direction.

n~e functions oithe spicJtle cannot be understoodif th e ~ts a re vie w ed irr'lciividuBllly, become meruting- '

ful oruy when th € functions af allofthe parts are OQn.-

sidued. Mttsd.esi tendons and ]:~ent51 collectively

the O O f tt is S U : @ 6 " o n th e left s:l:d .e .f the s pin e r es is t stretch-. ing fumes,. and thus l im i t b en d in g of th e spine l owm__s

the right; bending tewards the ]dl: is imi'bedby the

so ft t is sues on the ript s id e o f !;];'Ies pin@ '. And th e

e to ss- see do na l a re a of the so ft : t i. s5u~ is l~rge leno~h

tn provide meaningful resistance to comp res si on a lforoe.WUhoul~ t h u s . support from 'the oo·ftu_ss.Ue5" the

:spi:ne couldnot remain in an upright pos]oona_gairut

t I . 1 :@ form produoedby the weight of the torso. So

the strength of these soft tissues i s . critieal,

The spine is designed to pamH bending. but is

a lso intend ed to preveat be~ding beyond : 6 1 . de:greethat would becomedangereus, ]n th e e arly d a ys of,amatiOllrwings were very r~gid structures, andwere

not very strong as a cons eque: r: tC i e . Mode rn alrplane

w in gs < iIIl)e .e$lf¥l£ld ~o ·bmd l t atndbmldmg gve~ tlyin-

aei51ises 1 I 1 1 e t t struc tural :S beT lg ~h . 'Io bend a wing lUfP-

wards, f'O'll must strekh~h.e W]ng;Si skhl on the

boUO~1.5 ;yr face while oom pressing 'llie skin. on [hetop of :~he :w in:g ;~M ~e~ tertT h:l.e ang le of bending.

the h i g l 1 J : e r th e Ievels of Ic 'Om.p! l : 'e: ls ioII ' land si;r.e,khing

forces. Whldb. desf f ignpem.u ts be.n~g up~o apeint,

but stops addjt iDrl i lJbe1.1tdi :ng;and the saft tissues

support the spine in th.e same' w , a : , ) " . . B ut like Itlil.ewing.

if exposed tom . f oreetbat exceed s the cooxlsiti ng level

of g!frriljctur-al BtlimT hgt:h$som sthing will break.

Most of the bones, are hollow fur a good r~ason;

because the center (, f a. solid bar providesres:isl'anoo

pr lwar i lY i l igMl1s t (lonlpression~QrQes~does ve:ry~ime

: U 1 J the w ay of resi sting beI iL d ing w !I ":c es, ' \N'he:~eweigh '[is no c:ons( tderat i i0J i1~you can. use a .soUd . bar or a,pipe;

but when. weight mus~be considered, and wheJ:~ Y0U!I

prima.ry conoern : is to resist henrul'lg fo,rces:, then .iliebest choice is a pipe.

The honwrn:taJ distal.lee· from the center of [he

: s p m e to th e aUadlmen t points of 'ilie soft I t ] ; S S U e s is

a:Il:Qtfte.r,eriti.cal C:Qnsiderar~io1'll; the shcrter th is (L is-

tMlC@1 fhehlgherth .eh~,r€Th of required f uf ;o e. I nth e

[( )W.eTpru- t o f the sp in e, tl'l€ 'S e·d]sOOQes are short;

which means '~hat a. very high level of flJ·rce is re-

qmred I~Op rov1 id . e t he support [h a t th e sp ln e canne r

provide fO'l" itself.

Sb.:udural integrity 'is prilnari~y cll@~sm]nedby

cro!;SdSectiOIll; a two byfou:r~b:tch ' t imber lsweakerthan ill four by four beca use the eross-secdonls

smeller, Given the same chemical composit[Ol1. and

~h€same densUy · o.fm a.te ria .l, stru ctu ra l str ef lg fh n or -

mall y clUmgesillp,~oportion to changes incross-sec-ti.onru area, Changes . in shape also produce chimges

in s truc :tura] :5 t1 : 'e J ll ig th .,evenwhen~cress -sec t ioaa larea

remains eons tan t; but this is not a significant factor

when d.ealing with th e structural streng th of hl,m 1 a:tl

body parts, because changes if! cross-seetional area

usually do no t produce a change in the shape of the

bod y P ru 'Ittii.

Almost any design is,a compromise, snd thesplnei s .no 'e'iiiiCieption; bu.t w hen all of tIle tequiremeJ'Its are

consideredl,llie actual design of ~e spine and its

!JU pporHng: s·of~tissueswould b e d iff ic ult to i.m p ro v~ "

represen ti s a masterpiece of struc tural engiIlLeering.

8/4/2019 Spine Knee


But having built it right, you still have to main-

t , M r I . it; and all 'O f the tissues in th e body are con-

stantly changing,lbecollUng strongeror becomingweaker, Futurerequirements am based upon recent

demands; when you stop usi1~ something you senda signal to the body th a t it is nil longer requir,ed; IIlack of force in cuter space leads, ~Q' sigrdflcant loss

o r bone mass; rotal im.mobilizatlion of a Joint pro-

duces both ,a,trophy of ,therelat,ed musdes and tissuech.anges, inth e ' tendons an d l igaments ,

'But when you use these tiSSU~5,ata level that is

dose to the momentary limit of functimtal abili'fy,

this sends, a clear sigmu t- o ' t fh:l bod y;tells the booythat the existing level of function is not higll enoughto m eet th e f ,equin~.meI1 ' ts i and if im pm V em e1 1t is pos-

sible. ' 1 ] ; ' 1 j ~ 'body wiU pr-ovide It . Proper exe~ pro-vides this signal; does not produce followingincreases instrength, but 8Umu1ab~ 'S t hem.

P r rope '!r e ,x e n ::lis 'e ii· s , lmpo rta n t f lair

eve ry 'vo llun ta1ry m usch e in the bDd 'y•• ,0 but for the musclles '0" U i i l e lumbar, 5p~ne it i i ,scri i t icat

RESEAR IC:H : S ,P IN IA L ST .AB 11lrrv and l IN -TERSEGM I !NTAL 'MUSCIL ,E rO 'R C E$ ..

A B Ilol1leclhlrilnilca.11 'Mode d 1 b 'y 'Ma.nlolhsli iIPanjabi.•PInID, e,lat Val !e, Uni,v ,ers i ty SchooII1 0 i f IM :e d lc iln e a nd IH o:k ka id o M e d~ ca l SChDO, l "J a ; p ' I I 1 I . . , Pu bUshled 1111SP INE I vorlu r n a 14 ,num be r 2 , 1989 ".

~"h e ' h l u m l s ll iI ls p 1 r u 3 i 1 co,l l l I Imn IId~ev,orh: i ,1m u a -cu' l ,ature, Is E INCAP 'AB , l E ,o f ,carry ing Utephysior)QrQiircal l ~ .oad :s 1mposed o:n ' j,t" ' 1 1 ' 1 ha~sbeen s ,h ,Qwn expe l l 'mm enta l ll iY ' I i1 ,a l an iso latedfl i ' ,e~Ui\cadav,e ri c spi lniam cQ l lumn ' t r Q l m T '11oIh e ,sa,crum placed in ia n u p, rr ig h t: ne'u,l l i 'al lp,o sU i:o rn w~fh :s ac 1ruml .,ix -e d 10 , thele~st ta, t"e 'can ear l IY I,I load o f net m ore t'h ,an 2 0 N'bet:cure lit : b uc kle !s a nd becomres uns tab l le .Therrefolre~ m u l s 'c m e . s a ' l'e n e ce s sa lry '1 0 s ,ta bE ~U ze! 'the spii n :e &,0 th at : ilt: Clan carry OlL!l t rmno , l lma ' l p 'hys iohJ 'Q l ic f iund l i ,ons : . , 1 ih is , s t ab li -,

n z~ n !g t u n e tl on ij:s in , a dd liU a n 10 'th e u sua Im u s 'c~e " u r n e U C l l I 'I 1 ,o f I P , r o d u ' c i l R ' Q m ot i ,ons Q,I

tbe Ibody parts " -

'; 'M u se lie s : p la y a n imp ,o r ta ll lt : f o li e ~1iI ~h,e ,eU -0 1 1 0 ' 9 1 ' pres 'en ta t ion; and ' t l re,stment 11) ,1 .OW~

back d is o rd e rs , " • " M,uslclle st l l tengt i t i l ' eni inge :x ,e rc ls es fo rllile 'tll'ie atm e n t o f lio n-b ac k pa in,air'! gelil lenill l l l!y ,Idviocated. Fur therm,ore I' ii iIn IS, been s,h,own t h at sl! Jb j;e c t:s a re r I leas, l i ikie·ly' 1 , 0 1 have Eow-bac'k d i so r de r s . Th,erefore

"it

,ap'p ea r s Ulla~ ;adequ,a le J n 1 I JJs!cu iar tu n otion i;sl'e 'q uilJ le d to s lab iiU Z ie th e s IP ,i'n e w U ln in itsno , rma1 plhyslro,lo.allc mot t ons , "

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MedX Knee machines provide specific testmg fo,rboth quadriceps and ,hanr lSbi r lgmusclesl and specmcexercise for the quadriceps. Testingand exercise pmcf!dures can beconducted with both legs workingtogethet or w~tll'eilhe:r leg w,orkil1galone, Range of movemere $orboUl testin:gand e X e : l i C ' i s e can be limited

on ei:l:herOil" both ends of i1 I hill-range' movement, Support :is provided fur an injur-ed leg enclosed [I' ll a

ea too 'that the other leg can be tested or exercised. Both ,functional ,sl:1mgt11.and Net Musrul.ar Torqueare measured by the machine snd recorded by the' computer and the levels of strength are correlated

\Vitb,I the ' p o s i ti m ; 1 L S in whi,eh 'lliey were measured. The levels of nonmuscular 'torque produced by gavityand s ' O C I r e d energy are measured by 'the maciri : l le ' and £acbor:ed[n'ta re8tr~\JJts in order to provide' a mess-urement 0, 1 true muscular strength.

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'CHA P TER 8 ,

' T IESTI INIG KNIEE F 'UNCT~ON

fUll!JRE a . .1 Initial research to develop aecu-rate 'testing tools for the muscles of the knee was

started ill January ,of 1972. more than tw'enty'-olle

yeiilfs ago" but we were not satisfied with. this,equipmant un 1 t i J 1991 f fea tures and .functions of thism achine w ere first subm itted bJ ' fh 'f ' F D :.A .illil April

of 199 '1 . But research was , conducted atthe MilitaryAcademy IWest Point, in 1975, nearly s ix ,~ee:o ,years

earli e'f; followed by several years of research a t fheUntverstty Q ' r Florida College of Medicine, in

Gai.n.es-vine;in both cases using prototypes of omcurrent equipment. -

FIGURE 8..2 R'an~geg ,l movem enll(RO'M) iis0 is-played b ,· a l large 'g :o rn Ieme t s r ( ang le d:ete,cto,r) ane l l

F S recorded b y the computer .. ! R O M I can be plro-v id 'e d fo r a full ran ge o f m ,o ,v ,e m en t or an y d es ire d

pa rIo f a llm ite d ra n g:e .

24 48 72%

.ANGilE IN I D ' E G ' R i E I E S

IFIGURIE 8"13 Curves of 'torque produced by a.la rge male subject d uringa tes t ofqlilad1t']:ceps

strength~ 0 '£ oneleg: comparing nmc: ' li o l"ml s treng th

to tile true level of strength. NMT. The colored areas

between the curves show the degree of error mot-ro-

d uced :u the effects of l1IQI'IJll~ torq,ue are [g-

nored, O n . the right side of the chart, in the position

showing strength in the flexed position of the leg,

nonmuscular .(adors (mass of Ule leg and stored en-ergy) overstated true strength by 63 ~oo't-pounds of

torque, w hile 't1 i:1 ;eam e faetors prod uced an und er-

statement o,f hue suength nearfull extension of 22

foot-pounds.

More than 20 years agp~,our proto io / :pes of leg-

extension machines could measure torque,the only

remaining problem then being our inabili'ty to p,re-

venit. unwanted movement of the involved bodyparts; without which it was impossible to correlate

measured torque withposittonel measu remente.

Seven distinct problems r t i l i ' l t o o to ac curate c orrela-

ti.on of strengthwith position have now been iden-

tified; eolleettvely producing largs magnitudes oferror in. po:sitioniil measure rnents of the invo,Ived

bod y parts.

Six of t nES@ problems were eventually removed

or red ueed ' I tO such low levels that aI'ly "JI ' iemaining

d eg ree of e;oC l'rw as insignifican t; but d then req uit',@ d

several more yean ofwork to solve the Kno l l1problem;

unwanted rise of the pelvis under load, which

changed the relative positiunsof the involved bodyparts in a manner ilia t cculd not be meas ured,

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This correlation is essential because changes in

t el a l iv e' pas] tions of ~he'body parts produce changes

in streugth; an apparent ,g a In in strength may a ., cru aHy

represent a change til a stronger position, rather Hlan

a true increase instrength, Such COilisideralio:ns 'be-

mg critical during bests of ' i]:uadriceps strength, where

the Jevelef strength n C H : n w J l l y rises aa movement oo-curs and then drops as movement continues. A

somewhat b@]l-shaped strength curve.

In contrast, the strength curve produced in all

( l l th,ex' M e d X m a c . b i i 1 1 l r e s [S 1 F t strai,ght l i n e , descending

from the highest levelin fue starting position ~othe

lowest level in the finishing position, A coincidental

drcumstance ti."Iatproduced a valuable' result, Since

strength testing~s usually concluded with atteulptedi.

movement in the drrec non of a weaker range of

movemen t, and given a str,aight-]inej descend]ng

,rurve,~ny error in positional measurement leads to

understatement of results rather than overstatemen t.

H, for example, a subject was tested in , E l l position

'of lO a degrees, with a result of 100 foot-pounds of

tor-que, if later r,etested in the sa..nle position, then

showing a strerIgth cf .200foot-pounds} this wouldindicate an increase of Ul(]p er,c eltt} h 1om , 100 to Zi(lO.

But the actual gain would be somewhat higher; be-

caU S@ , a~the lfligher level of strength in the second

test, allY unwanted D:lov,ement' would be produced

in the d im ",ec tian o f a w eaker posH:ion; so , d uring the

second test, the actual p o s i ' i: iO I 'l r under the highertoad f might be 99 degro~ rather than t h . e selected

position. of 100 d@gtI"~es.1fe.aning that rorque hadbeen Increased lOOpercetlt, even though the' second

test was cond ucted ina s l i g l l l i t l y weaker pooi'tion; thus

me an in g f ua '~ E llie'Uue in cr ea :se in strength w as som e-

wha't more than the indIcated gain of 100 percent,

B ut "\"rith a bell-shaped strength curve like Ute one

produced ill leg-extension testili1g~this means tha t

errors 'in both directions, can be Introduced by such

'UTIwanted changes in pOSlition.

B ut for m any yealrs prior to H 1.e' om pletion of OUf

knee machme, we conducted research with thou-

san ds o f ~ "1 I.lb iec ts;and discovered several importantbut previously unsuspected factors that are critical

for rehabilitation. We discovered, among other

things, theonly meaningful protocol for determining

fatigue dl1:Macteristks,~he Typ~ 51,specific,re:sponse

to limited-range work an d '! :- heT yp e G1 general, re -

sponse to limited-range work.

FIG lU I RIES~, A Type S~selective ..response Ito ex-

erose.. Provided larg-cly,but r11lot e : n t i r e l c y . W~U'J.Iim-

i re d -r ang e e ."< ,en: i: se ,wo rk primarily in th e first half

of full-range movementJ,this, subject mcreased his

quadr1C!!!Jpstrength to an enormous degree in the

worked Ji'irngeof m()ve·m.eI~t; as a . result of on1:y sev-enteen ~)teF-dses d~.ltinga period of man! than cight-

een w @ E ! k s " less fhan one exercise each week. In therange of movemen t that we called the unworkedarea, his g a l I 1 I 5 , in strength were much lower, an av-

e ra ge o :f 0 0 1 1 1 ] 1 ].3 pefOffit In th ellID wox 'k ed a tea, C O J ! , 1 1 1 -

pared to an average of mona [han 60 percent in the

worked area, with gains (Ifmor,e than .sOpercent ill

some 'pOiS~tiOllS wit:hJinthe worked area,

'But some work was perfonned in the unworked

area d uring . itl'lat p eriod ; o f tJ . le to ta i l of seventeen ex er-

cise sessions, on e involved work only illhe posit io l: ' ISwe are calling unworked, one was ody inthe'midrange

Q o . f possible m . O i 1 J ' e I D . o o t " and one invoIv,oo a full rang e 'ool

movement, and, addUionally,i1epea;ted 5 , t : ~ ! ' I : i C ~ , e s ' f r f f i _ ; _ l ' I g

was pe z fo rm ed th roug h ou t a .full R i n ge o f :rf IO ' V e n1 e lllt ,

which provided some exerose infhe unworked area,

Nevertheless, [he results were largely llmi ted to the

w orked area, a very,wstil'lc~TypeS.response roliIni.tM-

r-ang,e exerOse., g~in:s inUte w orked . area vvith little or no

gains in the unworked area.

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Following the results shown abo'-ve,s,ev'eraI

week s of continued exercise performed once each

'Week failed to produce any additional gain In

strength; whereupon, W@ started exercising' him n N 1 c e

each week to see if more frequent exercise was re-quited.But several months of twice weekly exercise'produoed~ J 1 I ; Ochange t l 1 l . s.trength. Ha:vmg d i s c o V l e l j i ~ ! d

tha t mo,re :frequent exereise was not the sol ution, we

then ehanged I tOi nmUed-l1l l " ' Ige exerci~ only in. th elast hal f Q 1 f the fu l l - range of movement, l Iv,o,i ,d, d any

exercise in the preVlQUS]Y worked area. R ve weeksQ 1 f ~e:1"CiLse in.fhe 'previously unwo rk ed r ,a n,g :e'P ro -duced the ~ollowrn.gresults.

~oZ

237 5

- ". . . 'e~ 2Sfll--il-+-" '#:...j--I'~~+--I--+-----1f-----+-""

Z. . . .

OL-~~~~~~~_'~~~~~~

0110 2!1l &l 401 50 ,&01 70 &I 9Q UiIIlH® 1'2ti

AN GL IE liN I ) O E G , R U S- G}JN I . I .OS$,

FIGUlRIE,B~5 Exer c i sed once 'each week for five

weeks in rhepreviCDoUslyunwo,rked, last 'half of a.

full-range mov,eJue:~,t/he inunediately started to In-

crease his strength in the last half of the movementrange, while losing strength inthe firBT h 1 1 U of t h e

ra ng e; g ain s in (H1epad of the movement r , 2 1 n g e ' with

simultaneous losses of strength i ll ,E I I l"1ol :herp ti ttof the

range, The red area shows Jesses in.stren,gtl\'. while

the green area shows gains.

UP 21 :1 3(11 ~I:I &I ~I '70 00 90

,ANGlE IN IDEGRIEIES

!~:2001 II--"'f"'--I---+-f---H--+---i------lf-----+--+--lt------t

(]6::

e OL_~-b~~~~~_.~~._~~~III

fll,GI.IIR:Ea:~ In. contrast wiil'l. Type SresuHsshown byF~es & -4am d 8-1 5 ,his chart showsstrengtljl .

increases produced. by a Type I G ; , genera l , subj~ct as aresult of ((my 2] .lim ite d -r nl,g e e x er cis e s es sio ns dll.tring

! \ ' I I period of 13 weeks. \'V 1 : il leis SbJ~'l gains were

b e U e r in '~hewo[ked area.he prOOM~.Very s i g : r w i c a . : . n ; t ,if not proportiot1l,a'te, ga in s e v~enin . the u nwo rk ed J :a ng eo f movemen t. TIiis ,soubjoctw as ,exerdsed oll l iy in 'the

a / _ I \O Ocal led worked, and was tested f O f 'f u l l - ra .t l g e . s tE l t i c

strength only t[ ue e " lime sdu rin g th at p erio d .

A n other im portant poi.nt :l" eia ted to fuis subjoct 's

resu.Hs \~ S ~he m_agni.tLlde of gains produced ina f : i d a -liv e1 )' s ho rt p erio d by in fl'eq -uen t ex erc ise. F bI" fifte61rt

years i t lU l '1 l e W a t c l . y p.riarto this l ' i@ S e . a i I lc l f L , this subJecthad been performing heavy, fUU-r-ange exercise for

th ese m u sc les three t imes weekly, wi th tll. l" t~ es ets , o f

the exerdse du r ing , 'eachsession, atmal of nine weeklyexercises; wifh nothing: ill the way of additional

strength g am s ih.m in g the last several years D f such

training. A fatigue-characteristics 'rest of his quadri-c eps m u sc les in dic ated a very h ig h perc en tag e o f fast-' rW l b c l l fibers; and given this fiber type h could not

p ro du cead d itio nal stm rl:g l:lilin crease s w h en ex erc ised

f requent ly ~had remained in a sta te o f c on tin uo us o ver-t r a U U l 1 g for several years,. An l . l n a . v . o i d . 6 1 b 1 e condmion

dearly established by the increases in s tre ng d'l H .-ta t

were produced when his exercise WM r educed to a

small pernmlage ' of his earlier exercise program.

His dynemic mengfh ga ins "eff! in dimd propor-lion to increases in .static strength; an d at the end ,ofthe thirteen-week programhe W~ '!:]aetrongest man

we ha ve e v e r tested fur l l i e s : t r - e n , g f : h of I i l l e ' quadriceps

muscles, prod ud:ng more than 791 foot-pounds of

torque 'in his strongest positiol1!;lilith fresh muscles.

The strongest among many thousands of subjects,

some of whom were far above Rverag ,e strength,

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'M,0

:~

2~~,0

:~ 400

2:

-- - - -- --- -

I ,/'""""""

r\I

~V ,r I

I,

~// 1/ "" " ' -

V ,/~ . . ,

VI ~ -I

I , ~ ~

il.JII

fll!(U Il A e ,B ~:7 A comparison efquadriceps

stt-engithofthree subj€cts~the Mghes t curve was the

fresh strength of the Type G~fast~t!!",~Ltch.ubjectmen-tioned abo,v,e ., . .~emiddle C1J1V,€! ' w as the hash,

strengHl. ofthe Type S subjectmentioned earlier, a

man ~th a random D l l : x m J " , e D r fibe1'sin his qtsad-:rkeps muscles, ., while the lowest wrve shows fresh

sitre ng itf l o f: a wodd--class power lifter, :ill m an who

set a record in the squat lift only a fe,w l¥eeks after

this test.

He W~ssbJl1lned by U\eresmts, and demandedtoberetestedthe folllo,iwng day; but if tvv'e1rty y~MS

o f cont inJ l1J;ous! :: :ra in i l lg had nor produced a high ]eve]

of quad riceps strength, then twen.ty~Olllrhour,li,would not change]'~ when retested the next d.ay hlsresults werealmest : J J d e n t i J C r u . He was weal<,as it Ie-

: 8 1 1 l 1 t of a very high perre:l'liltage of s ]ow- i 'w ' :i tch f ibe rs:rn.llie' quadri~ps muscles, showed. ill high level ofenduranoe,du.ring the exercise part oJ the testing pro-

'cOOUJIe, btht:tI ve:ry 10w level of Sb"e:ngth fo r a m a:nofhis sl~e.

TIleI'! how eoeld hesqua twith more tl'!all 1,OQ(]

pounds of weight? Because sq_uattimgstrellgth is

J : a 1 ' g e 1 y a.reswt ofthe s t r e 1 n g t J . " I l of the hip musdes1t I : re

hamstring muscles, and the lower-back muscles. He

would not permit 1[[8 to . tes~the strength olms muscles

inother parts ef the body; but even V1tithOllt these tests

i'~ is, obvlou:s,llia tile l i l , B 1 d a d~.ffe] 'ent fiber-type in ~he

oth er m usc les; givenslow-twitdl ..A .bers in (1 11of his

muscles, he would not besettingreeords in the squat.

TEST IN I : ( l l

Stil'll 'lgJth tesm1gin. ~[leM O O X .bee Il'!a.mme can. be

conducted. Witll bofll ]egs sinl,wtmleo~sly, or witheither J e g working al~wMch. provides tl1.empoE tan l r

ablJ~ ty to !c om pare o ne l.eg w ith, the ' other leg ; An ap ~

pa..renltly neanal l~ may prove to be abnormal whencom pared tc the o:U 'I .i€ :r]eg ;andJ Q1l .u ingrehab i l l . ta ; t io ' [ l

of an :injured leg ; testing of the nom.1GlllegpIDVldes a

la:rget o f p os sib le ~tl:"ength. $01' themju:red. leg.

T Ile m a c hin e also p rov id e s f l" te~pe !i bi li ty 'O J 'testingo r ex~ ti s i: ngano ITnal leg while the eifr} leXle g isinacast,~I'td provides snpport for a ~egin ,2 1 cast. Rangeof m ovem ent fo:!:'o o t : h , testIDg an d ex erc ise is i2 .0 d e-

grees of moVenle ' : l l t f l b u : t range 'canbe .I:mllred on eitherorbo:th ends of a fu:illrnnge mOV€nlei,1t if desired.

.Z41~€~IDs of rl~,ist.am:oeer ex~i~ are provlded;

from aminimam oif20foot-poullds to a n~mum of

.500' foot-pounds, inl:naem&lts .o f 2. foot..;pouru:l!s.

T esting c anlle cond ucted in allIyot all of hventy" 'Ol \e·bIl· ., .'... ..... F - 6 ~ . b - . . , , ] . . l'

POSll i l iOW, ~ n n l ! c re m e n ! .O : :! ·o ~ . - I ; I~grees ; ~.UtMl:lrtanCn\ ' lm~

fu[l~ra: l" Ige rt'UWemerut of ]20 degrees, teSfulg is usually

ool1Lduded in , e ac l'l o f e le ven positions" [ 1 ' 1 mcremm1:~ o : f'1 2 c .:ll '. ' , , if'd-"::-~· .. .. .~ ."~L • .."~" Ul~:art . "~'~lmSIXposiuons,V\fJiu~m,crem.eJlL~,

of 2 4 d eg rees, N onm nscular t6r-q tm : is ;m e asu red b y·th e

mamme and factorred into illietest f\BSuis by f in~ mm-

purer , p rov idmga .l :i l'ne test oJ Srn&lgjh, ~NMI'.

Positio'n oftheback pad is a c i j U ! S , t a b n e L' O compensate

fa 'T va ria tio ill in fe ili lU T length 01 "1all, u1:wyidluai bi\l!sis;andthe relative angle of the back pad to the searts

des:i:guect to r t" II .1OV ete l 'l lS ioo in the ' l ' lml lBmng muscles

that 'Would f u f l l ' u b i t li.m.dion of' the qua d ri.c .e ps mu s d es

Jf ' tlL ,eslrubject was seatedin an . up:liglttpQ5~[ion oo~ a.tive

to the seat. If a subjec t leans fonva.m : d uring le:g -ex :-

tenslontesting 01' ,exerc ise; ,~nemOVeNl.eIIt towards torso

f le x ion sb !eh1 :r es ll ie hal1lStrmg m usc les over the hip

jo i :l !' lt , whl Ie extension. of the le g p ro duc es s i:f .e tc l:r in g

of ,t:ll'u:harostrin,g muscles over the knee jomlt; theham-

slT ffig m usc les are str:ekhoom'l. b O l t b ends , and th!1 !Teo'

suIting tension in these muscles i:nhioots functkm of

th e quadnceps musc le s l leMa .p08 lt lon ofhtll extension.

Even si~g uf'TigM, with a relative angle of 9()

d e& ,e es l: :u ~tw9@: 1 l!he seat and the ba.ck pad , \W l. inhibit

quadriceps nme'mon from ham s:tm 'lg ~ &tsion with most

subjects. Tests conducted in that posture arebiesed onthe lew side near a position of full extension. But the

solution to this problem is maple; 'the torso should

remain at a relative ang le of aoout 1 ZO d eg rees to the

surface of the seat; which posidcnremoves the un-

wanted tension in the hamstring muscles.

P ag e 84

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A s. 1LIs~dearlier, the b~RESULTmeans aJong -

te:lnl change [0. streng th prod uc ed (or stim rilateQ ) bye xe rc ise ; w h ero ea s,l:h ia te nn E P FECT m .e an sllie irnme-

dia'fuechangep.oouoed by exercise. E ff io c~ a nd re su lts

, i E I _ j \ e b o U . . c oaseq ueeees, h 1ld ic a:~ ec h a n , s e s ] ] ' 1 . StreIilgd\;

but an ,effect is an immeWa'te' Clonsequenoe j , whilea

result isa consequence fhat occurs days or 'W~ks later,

Fa !: :i g1U€rom ~ . se ' is , i l I I 1 i L effect~an immediate 00[1-

seqUl ! l ' lOe, iwlit:ilea gamm s tre ng th from on ete sl" I~Oa

]ater I tet l is aresult, a rong -OOm: i t r on sequmoe . n t i sbeing a . d is ti nC 'ticm i n . :~C!ffi"ISthat lS im:port f lI 'l ti rn l 'e . laHon

eo the f o]]owll1 !g ex am p ie.

,~,

,0

:3 :~ 31 ·5 ,"-+--+--+---+f-: 2 .t; £o~ . 2~1 1--+-~-..I~Hf-+--+--!-~~+

:2

~ l~Ei I--F-+--+-+;-~~--+-----!f--+--+--+---I

G . ' I~S

HI :21 1 1 . 1 ! 1 : I 4~ 5 I ! . ' I · 6 ( j 1 nl 60 90 1 00 1 1 1 1 : 1 12 ( 1

A NlGlI.E I NI tl1)E GR I E : E S

IF l lGUREB" ,B T I t i . s , iS l1 l11 . e ffe cts ~~tM lb .a T~ S

(spoci f tc) subjelct, an individual thatshows m n h - o o - ,rangerespcnse to limited-range exerdss, T e B t : e d . for

f u J I ] ,. r 2 in g e s m a n g t h o f th a , q u a d r i c e p s muscles, t h e h ig h -

est C'li:mte sho~.o!ll this dl_t" than WOl'~ lo a.pomJ

of fa il,u reW'illi 'e xe Ji~ ·'nti~ed !~O t ll te a fi e. 3L s h o \¥ n . o n

~Jherlght side ,of the ehart, R Om . f 1 1 H ' ! .f lexed. pooiHon of

th e leg to themidrarnge .ofposswre movement; wn .en

retested following the i ex :er~s l t i rengt l1 was red ueed

Vliithm. th e w o rk ed 'range f rom f a.ti .g ue ,,¥ 'Uh no cl"l.:a:n~

in 8tl1m1g~1 inthe unworked rnnge" showing 00fatigtm'in!tile last pm o f a fullran g:e OfmOVelllerlt A T}'p@

S- . t=_:~_.J' .'re spo ~ ID uu .lJ .U _ "t!L -m n ge e xe rru .@ _

Such specific effects from l imited-range work canbe produced OIl ,either end of ~1emovement range.. or

'Within ' t l " J . e D " l t i r u a n g e of poMib le movement; fatlg'UJe wil l

be sho'llVn O ] ; ' I 1 y in th e w orked area. In contrast a TypeG (gerleral) !ru.bject Mil s h ow .f a'~ gu ethroughou t th e fullnm g e ofm overt!ent as an effec t.of llinited - range: exerdse,

Type S S l[1 bjec tsshOWOOlll1llinitro-rmlge · e i I o c t s and re-Sl t111 : s ;h ile T ype G sub jec ts show bo th ful l- ra ng e e f fec ts ,

and r esulls ev en f:romUn:ited-'fam:)g~ ,exe"Cise.

S'wcemany o,f I~heexE:rcises in widespread useacmaUy provide ]jmlbed~raJ:'Jigeresistance~ Type Ssu b je et s will sh ow litH e ar .l:'Io ~ln .in gin . theway of

st.rength gains from these exercises insome positi.ol\S;

examples for the legs are Ieg-pressesand squass, beth

of which. mi!,y[\\ppe1ili1'~O pl!iovirle' full-range ~ercis~,becaUBe~Jheyil'lvo~ve fun-tilnge IThCl"'~meIIIJl; around

the-knee axis; but neither of lvhkh Reman ) , l'rDv~de'

m eanlng fu:[~ es:i:sta.nc e near a posilio].1 0if fw U ,ex ten-sion of the l~g, and no resistance i~ a position of

fu n extension, The soh . l1 t i.o .n be fu I" I.gthe use .o f th e leg-

extension exercise; which does provideresistance forproper ,ex:erdse~o1lltghout afullrenge ofmevement,

Proper exercise sifunula~e;mcreases in. 'bo~1t nlUSr

rum sl!z:eand strengfl1l; bu~ we still do not know ex ac tly

why tms h:appoos, !or l l i l . o ,w . i l l t 00C1U:'S. B ' u : t Itappears

th~tMO factors aremvoTItvro: t[he I~ d of :fatiguepro-duced.by the~e:rosef an d th e timerequired to produceth a,t le ve l o f fatigue. W i!:hm reasonable lim its, a hig ha

level ,offa~gu"eis betl5~ but only if it can be pmdueed

l i i V U h f u ashort per iod af time.

In 1972 1 then havilllg no OpmD:OIl1.regarding th e

relativemerits of':posJtiveand negative work during'@ :l<.e r,c ise ,e c on du cte d a .research prog ram . to d eter-

mU.'1l3' th ere su lts o f n e.,g aU ve -D n~yexerciser a .s ty h~ of

'@ j r ( )@ . i t c r i s ehat i l 1 \1 'o ,lw d n o posi l : i v e ' wod..:oif a.nykmd, .

Usingwlib ells ~nd Naul;ilus :Jl1achin.es, the]iftiIllg pal'it

of the exerc ise w as perfeemed by several assis;tanl:s;

:5 0 that the subject being wor~ed eonld t h e ll l pe rfo rm, ' " ' I 'L' . ···f] .". L .,'

' Q l' Il :I .Y ~. .1 1 1 ; .~owenJ1gplIrt or t : n . . e exercise, !~,Ite negan vepart ef Ute work. For example, ln a bench-press ex-erclse with it barbell, tw)helpers lifted thebsrbsll

into positlon above th.e subject's Mfst, "Wi th no he:lp

f rom th e su b~ oc t; :1 ll1 L dwh en the helpers released the

barbelljn the top position ..the sub~&truow]y lowered

it tmtllmacl:ting tIle l o w e ! : i : l t position! 'Withfue barbell

t he n t ()lu .c h b"lg m s ehest Whereupol '1.r thehe~pel"5

lifted it agam, and the subject lowered i.tagainl and

00on; the helpers doing all ofthe positive work w hilerh e SI.lbJ,'6Ctdid all of the l1!.ega~:hr,e work .

N OTE : Wm th ,a fe w ,ex,oeptr D'Ii IS,th r :s Is : I l Isl! I iaUy

nota p~alct~calfcJil'mof exe li cisE !1 sh lo e ' ill feql l lJi l l 'es

Ii le l'p ; a n d lt ls un avo h :la blya d a l 1 l Q ' e l l ' o ' U s s ,ty I e' o il,exisrcTs e, s.l" ee t'h ,e ,as:sist:ants m,ay lfie~ease thle

we~gtu bel,o,re Iii!e subject j;s:expeeli ng themffl

.., • In wili l ien ease , t i n B' wisig I i I l t will i fall andthlli

.subject may De ~nj:ured.

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B ut we were 'v,ery ca refu l , lm: l , n'o, i,i U r ' les,wer,e

p :l'l o'd lu ced ; a nd DIUI:' w n t : e ! I ! ' , e s ' ~w,as I H m i it a d t o 'U ' I : f i I '

v'Slue D f pure n eg aU ve w'CI'lI'k~

Each exercise was stopped when the subject

started to lose control of 'the weight . . . when the

speed of downwards movement started. t- o increase,and when the subject could notprevent this increase

in speed, men ,e igh t or more repetltions O D I . d d beperI :or .med w h i l @ still controlling the speed of d ow n-

w ard s m oeem ent, U te resistance w ,as increased, A nd

wequickly learned ' that Oli[y oneset of each ,exerc ise

w as req uired ]" an d only tw o week l y h am i ng ,s es sio -ru ;

more than Ol1(~set , of each exercise.•or mor-e thantwo

week ly workouts, prod uced so.much {a t igu,e that th eS'ubj~ CQu]dno~ fully recover between workouts,.

The subjects in this study Included high-schooltQ(l,tball players, tw o p eo fe ss io na l football players,

and several advaneed bodybuilders.; a u .subjects be-

ing fa]"abovean average level of sblength r O , t the startof the' program, Conti.nued £or a. period of three

months, this styJ,e'of training produc:ed be1f.erresults

than any form of exercise we had tried p~evi,ausly.

'We d" idnO '1 t:~henunderstandwhy the results were

so outstandmg;but we do, now, Because of the il'l>-

crease in muscu.lar friction Ii'l:at comes, ..v:ith fatigue,

friction that increases m~gati:vestrength while reduc-

i :n ,g posBiv ,e strength, w e w ere prod ucm ;g levels of

f.atigue that w ould be ' im possfb le to reach 'W~u[eper-

forming any usual style of exercise, Impossible t e l '

reac h w ithin a eeasonable l el lg !t h o ,f time,

If yourr fresh level of strenglth is 1 0 D ' r and if youexerdsewithresistanoe oi80, then youwill be farced.

to stop w hen ymJlI ' re m ain in g stren gth drops OO1 ow

80; yOW' fresh s'tren,gthwill be reduced by about 21

perCent. Bu~:if you immediately continued the ex-

e : r t i S I E ! with resistance of 60 1 ' then you would fail 'whenremaining strength was about 59, and if you then.reduced the resistance ~Q 40 in order to continue ..

you would fail when remaining strength was only

39. If stopped . at that point, you would have pro-

dueed a high level of fatigu@,but doing so would

require approximately thirty repetitions of the exer-

rue. The' level D , f resulting fatigue would be good

.for the purpose of stimulating strength increases; but

the amount of work required to produce that level

D , f fa'tigue' would not be good for the same purpose.

With the negative-only exercises outlined above,

we' were r'eciucing the level of fresh strength by at

least 80 percent, and Wet-e r~adili1,g Ulat high level

of fatigue \I\filhin a relatively brief period of time.B ut Ith~sstill l,ef t u s \!irlth th e unav{lidab~e problems

assocla ted VIo ril h n e ga ti ve-only sty le o f e xe rc ise ; re-

gardless of potential value, an. exercise must be both

practical and safe.

Problems that were eventually solved in the fol-.~CI\...ng manner: Negatli.ve-a.coentuaJ:ed exercise pro-

vides the benefits of negative-unly exercise, butwitlu::lU,tllie pmblems.

Negative-eeeentua ted exercise cannot be per~

formed with a barbell, and cannot be performed dur-

in,g s om e e xe rc is es using , ""eight mach ines , 0itdoes

not solve the problems in all cases, but itcan be used

in any e x er cis e 't ha ,t 'in v olv e s both I im bs " I 'O rld ng to-

gether. In a leg-press exercise; for example', theweight w,ow.dbe lifted by bothlegs, but would then

be lowered by only o ne l,eg ; both ]egs would share

the p05" idve part of the exercise , but .amy one leg

wo uld p erf orm 'th e ~ iu!g ati,v e pa rt. Up 'with both, ]egs,d ow nw ith the rig ht legonly, u p' w i1 l1 ;\o th leg s ag ain ,

down wlfh Ihe left leg O W d y , and so on.

If your .&esh strength using both legs was 100;you\" / 'I iI1oui ld .ormal ly exerc ise "Ni,t;h resistance oJ 8 0 ; ,

and would fail when yo u could no longer IUt tM

weight with hot:h~egs; would fail 'With a remainingsb:en,g; fu ,ot about 79. But with a.'negativ,e,.,accenwaied

styl,e of tra inn" lg youw oruld use a m ow e.r level of re-

sistanJ :!e; in stead o f 8 0 percent of &eh. s t: re ng ,[ h you

would use OIl,]y 50percetlt Wi'th ausual exercise,

using resistance of 80, e ar n, le g, w o uld llift! and lower,40,.but with negative-aecennrated exercise, llsing re-

sistance of 50. eatCh~egwowd lift onJy 25r but would

lo,wer 50. Resistancewouldbe lower during the posi-Ltve work. but r ughe r during th e negative work .

Performed properly fat a slow speed, you willfail during the positive part of ~he exercise; ' \ I v i l i l failw hen. both ley; c an no long er lift the 'W eight Having

reduced your fresh positive strength by more- than50 percent; a level of fatigue far higher Ithen the 21

percent lo ss o ,f f re sh strength produced in most ex-

ercises. But having failed to,lift the weigh twi th bothlegs, if somebody will lift it for you, then you can

still lower the \'\'eight under full control with only

one leg. Before the exercise your l'U'!~thre strength

was 4{l percent rugher than your positive shi~ngth"but that ratio ,0 f 11 . ega ti vet Q P O ' S : T tTve strength

changes as a result of fatigue, changes, because'(If attinerease inmuscular friction; Friction that

reduces positive strength 'while shnultaneously

increasing nega tive- strength.

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This negatlve-accenruated styh~oif exercise can00 used with ItheMedX knoomaChine, and may wen

provide the most productive form of exerdsefor the

quadriceps mlllscles; but should not 'be performed

more than 'o oc e ea ch week with any subjectl becauseof the' high level of resulting fatigue.

Apart f ro u) . H l'e description above, ,the only ad-

ditional information required for proper perform-anee of l1I:i.sstyle of exercise is related ~o the posi tion

in the exercise where the weight is shifted from both

legs to one leg; this hand-off of the weight to one

leg should be performed smoothly and 8 . 1 0 ' l > - ' I l Jy. Liftthe weight to tbe top position. with both legs, and

pause in[hat position. ,,' ! l ith 'both legs fully extended,,the'l'Islowly move one leg awa y from. theresistancepad, so tha'[ iU1!e,,,,,reight is then being held 'in the

fully-extended posi:t:i.onby only one leg; if you can-

no t hold the' weight 'With ol[lly one leg, then the re-sistance is too heavy. . .

Having carefully shifted th e load to one leg, ~he~'l

slowly start to lower 'the weight using only one ]eg;[he downwards speed of 'movement should be slowand st~ady; iUl.dif you. cannot prevent an increase

in th e downwavds speed. of movement then the' re-sistance is too heavy. But with at proper level of re-sistance, together with the correct styli@: of

per,fum1ance;,fa:ilure will.1beproduced when you csn

no]onger lift f fbe weight withbolh legs.

Negative-accentuatedexercise is one: of the saf-

est styles of exercise, does not expose th e subjectto high levels of force hom impact; but does pro-duos the high level of fatigue reqllired to stimulate

increeses in strength, and p r o ( I D u . e , e s ' f lus level of

fatigue 'Mthln a brief period of time.

NOTI!~ H,a.vhllg observed tlile' l I ' ,esull ts we p,ro-duced wtth a neg,aUvs ' -on ly style of ' 'E !xe l l c is 'B dur-

in g tl~J .I!'e s ea re h ,Ill 'l lUri?! , COBe h I BU I IBra,ofo,rd 'Gf'

th e IDeLandl F I :o 'r~da, h ' ig l i1 -sc 'hoo I J t hen started awe ,lghU lfting team ••• and wa iloed l hS s a th le tes :

withi n e g , a t I V i E l - O nlly 'exel'cjse·.

Star1 ing oompet i t lon In 1 9,7 3 ,with no p lI 'ev l'D 'u s ,

w,e ig hll l ~fiUIiI9 ex J I e ri'e nce , B ra.d f'o ll'd th en ,e 51:ab-Ilish ed a I r e , c Q l r d 1h a t r s ; p r "io ,b a'b ~ u np r eced , en ted

in spo l1s ..: . h 1 l s te am s w ere ' un tfe d ,an ,d un de fe ate d

f ' O l I " a pe 'l 'i h )d ,of' seven years, , o f com ,peU t lo l ll , wonm Dre th ,s n a . hiu ndredl we i 'glht l iling , com pet l 't l.o ,ns .

T IHE , RATI IO OF Q'UADIR: I 'CEPS,

STRENIGTHI TO I HAMST IR ING

S,TR'EN'GTH

During the last twentyyears, hund red s of published

articles have me I 'lt ii onoo ~he r e r n t i O J i lS h i r p o f quadriceps

strength to hamstring strength; and it h~ generally been

acaept:ed that th is ra tio lS , imporiant fo r both functionalability and the prevention o:finjury,. And it probablyis hnporla .nt; ; but al lear l ier attelnpts to measure this ratio

were n1 islead ID g at best Isokmetic tests performed in

attemp~ to dcle : rmine this raHa Wl@1 lE l ' biased to such a

degree tMttlley we re me alU rtg Ie ss. Biased by ilnpadf or ce s tb at are U l.'U lv ok ia bJ e many dynamic testing pro=

eedure, by tO~'qUeproduced by fueweight of the in,-volved . body pads , by friction and by torque produced

by stored .energy.

~. • 1~

AN,SLE IN I DE GR EE S

IFtG I I J R E e . .g l A c-om parisol1 of tested ,nmcrnor l t l l

stre ng th to th e 'b 'u e .1 ev ,e lo fm u sc uh rr strength." . f \ T h o I T ,

dwing leg extension tqlllad:r:iceps). On the right side

o f this, c hart, ShOM.Jlg :strength in i h i 1 ! ' flexed po,silio.r'l

of the l eg , the true lev,e]of str-ength was overstatedby 65 foot-pounds of nonmuscular ~or'que {weight

(I" the lower leg and. stored energy). On the left sideof this chairt, showing str<~:r!.gth near full ,ex~nsion

o f llie leg, 110 l1 IDuocuJaT torque understated the true

level e,f s tTer!Lgthby 31 foot-pounds of 'torqu e. The

curve of testoo fundionru strength is black.

The gooen curve shows the true level of muscularstrength. NMT. The tested level of Functional

strength in the flexed position was reduced hom 1102

to only 37 foot-pounds; a very significant difference.

N ea r full ex tension of the leg, tested hmcl:io·nalstrength was increased from 17 foot-pounds of

torque Itoa true level 0 48 ; an increase of nearly 200

peTCeII t indlar P05~ion,

FageS7

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L E .G E X tE IN S IO N

~ iii1-----I!---+~~......:r---__iF

, 0 1 1Iii:

~ f 212 0

F IG U IF i I E I~ ~ i I l l Whe'r l b e s t ~ 1 1 : g s'f .refn;gl l i of thee ham-

51::r:li.ngmuscles, nenmuseular torque produces bias

in the opposite direction; overstates true strengthwhen th@leg is straight and understates true strength

when the leg is Ilexed.

The ,green curve shows th,e tested lev€! . ,o f func-

tional. strength IQ f 'tile hamstring muscles throughou!

a range of 12:0degrees. The black curve shows the

tnl:e leve1 of strengthi lower than indica led. by t n . e ofunc t :l iQna[tes t when the leg w as straight and higher

when the' leg was flexed, Again showing ' ! I e . ! : y sjg-

ni ficant differences bstween functional strength andtrue strength,

In th e f le xe d p os itio n, functicmal sl:mngth w,;as zsro;

whie true str-ength was 89 foot-pounds of torque. In

tha.t posilion,nonmtlSrular to.rque and 'true musenlarskength, NMI'r were , e q n . : l a 1 and opposite.

PageSB

1 Q i ' J

C

:2~ 150 !---~--+---I---=

~o1 2 l O O

Z

24 48. 72 ~6

ANGLE IN 'CE 'GREE!

FU3URii 8:&11'A ccmparlson of functienal

strenglli of the quadrice:PS to functional strength ofthe hamsteings. If the ratio of strength is based UPOI'!

acornparison of these two tests ' 1 ) £ functional strength.

the results will be mlsleading, The true ratio is

shown by th e f ollm> i ,'in g e xample ,

~,0 1:z;;! 1 , 5 0 ~--I---4~

~I . , ! . ,> 0;~ 100

:~

.~ 00 1-----il----r---I--~9---_I

,jJat

1 2 : ID 6'

__ ~ __ ........._ Ib......_ ___il__ __11

(I 24 U ~2 96

, A N I G U : IN 1 0 I i ! ' G : R : I E I E S

fUJiUFIE a~12 The' true' ratio of strength of thequadriceps, muscles to strength of the hamstring

muscles is shown by this chart; I : l - . . e curve of quad-riceps strength is black, while the curve of hamstring

strength: is g t @ E m . A comparison of ' this true ratio

to' Ult! results shown by Figure 8-1] (functional best

resul is) shows significant cllfferenoe.s.

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CH,A IP 'T IE R 9

eU : ; ' t U :U : l 1 0 1 Me d !ie :h l'e iU niiverrsi ly 1 0 1 : Fho [ri idla~ G , a l ~ lIiI'esv UIe

M,edX: Research

IP U lIB I llS H ED RESEAR :C :H

1, "E Hiec t o f red uced tram ing frequency on muscularstrength" (Intemationel Journal of Spor~s Medicine,1988}.

2 ., MEcf f iec to f v is ua l feedback on re pe ae ed tri,!1 Im o f fu U r an g,e -o f-m o~ iQn isom etric stre n,gU l" (M erlk 1 ne and

Sd.encein S p Q i f l t . : ! i a l'! fd E x er cis e, 1 9 88 ).

3. "Comp,lrison of two versus three days per week ,o f 'V a ria ble r es is ta nc e training d uring 1 0 and 18 w eekprograms" (International j ,oUTnM o,f Sports medioCine, 1989),.

4. "Specificity ot liimib:d ff'llIge-of-motion variable resistance training" (Medidne and 5dence' in Sports andBx erd se', 1 98 9).

5. "Effect .o f resistance trainmg on lumbar extension strength" (American Journal of Sports, Medicine, ]989),

6. " Qu a:n titatlv e a sse ssm e nt o f fu] raJlge-,or:"'motion isometrIc lumberexteasion s.trengtb,"(Spine~1990).

7. "Ef~t . o r training . f requEmey and sped:fidty on isometric lumbar ext'e.nsion sb"ength" ~Spiner ,[99~]).

8. "COl1lstan!t versus variable resistanesknae extension f(,ailnng" (]vIedidne and Science in Sports and Exer-cise .. 1990).

9. " Reliability and 'variability of isom etric torso rotiil'D:on strength measurement" (Medicine and Sc~Mae inSpOli ' ts and Exier-cise, ]990).

1 0 . ".Effect of order of multiple jom't angle testing for [the quantif ic ation of isom etric 1um bar ex tensionstrength" (Medicine and Sdena~ in Sports and Exercise, 1990).

11 " "No.ru-spedf id l ty 0 '£ l imitedra1:1ge~of -motion~uDlbar ,ex te :ns : i Ion : ! llT 'eng th ' lr o o l 1 ! m : g " (Medidne and :Scie' l1Lcein S ports and Ex ,e rd s e', 1 990) .

1 2. "E ffec t of 1 2 m d 2 {J\lI i'eeksio : f re sista nc e tra in i.n g on lumbar extensien strength'; (Physii:aL Therapy, 1991) ' .

13. "]njuries and adherence ' t o . lu~:robkand srrengtb training exercise programs for the eM.erly' (.Medicinean d Science in Sports, , and Ex@ rri se~ 1991) .

1 4. "Aeeuraey o,f eeunterw elghang toaccouot lor upper body nUISS in testing lw:ncar ext@ illllon strength"(Medicine and Science in Sports and Exercise" 1991).

15. "Quantitative assessment , o f i somet ri c lumbar edemion net muscular torque" (Med idn li il : and Science mSports and EX ' e r dBe~ 1991).

16. "Effed of l : r :a in1ng fr1equeucy on cervical rotation sh~ngtb"(Medh:ine and Science in Spo:r~sand :Exer-dse, ]991)

17. "Quantitative assessmeut Q ,f Isometric torso rotation net muscular torque" (Aochiw~s of Physical Medi-

elne and R eha bilitatiofl, 1 991 ).

18. "Effect o f testm g order ,OIl i so l11emc torso rotation strength" (lntezrratiunal Journal 'of Sports Medicine.199:0.

19.. "A pllysiological evaluation of elite' professional water-skiers" (N<lt.ionai Stlrengli:1and Condi ' t [oningAssociation J ournal)

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20. "QUiIl'IltihlUve assessment and 'training of i$on lLemec~nr : i1C8l1 e:xb~]lsion sJrength" (Therune:r:i~n Journal

oJ S ports M ed ic ine, 1 992L

. 2 , ] . "C om parison of tw o rfsh\a:i i!1t systems fo r pelvic : stahi l: iza tio f! . on iseme I h ' r c .1ILlmbareJ>:'~ensioI 'l strength"(Journal of Orthopaedic and Sports Physlcal Therapy, 1992).

22 . "E llec t ofred ueed h"Jb.'ling .frequency~nd d.e~am]Ilg, ,on lnnr\ha: r ~ltensionstreli1gth" ( S p : U : i U ~ , 1992} .

.23. "QltitnH~ifI,[iveaSS~Sm€l l l t otisomemc cervical 'rol~ationne~ : ll 1uscul ar torque" (Medicine and &.i!e:ncehil.

Sport's atlid Exercise, 1992). -

24. "Sing]e versusmul ~]e set dynll1!rnlcand Isometric hurib~T e:x:bel'll5~on5b"engltb" (Spine Rehotbilila : lion,1993),

25 . "L um bar stret.i1Slhenm;g in , cl ' t l"O'wC'ow bad . pain pn ti e'n ts : Psyd to log ica l and physjo log ia 'l !lbe[J je f .i J~s"(S pm e, 1 993).

2~i ' ' E . f f i e c t (If tira~~.wi:.th p.e]v :ic stab ilizalio n o n lum b ar ex ~ensio 'l'i!.skeng~ll"(An; :hives, offhysiG'll MOOI] '~erne and ReJ."labdlation)

2 '1 . "E nect o f heq ;~ :u~ :nCY i l! l' iI . dV10h , l l neo.f r ,e~~It :aJ. l ( \e 011 ce rv ic al e xte n sio n s !b rie :rn gth "A re blv es o f PhysiCiliIMedicine and J:~.b.ab~lit~ijonJ.

2 8" " A l~ g Je sp ec if ic I so m etric k ne e .f 1e xio n/e xb ~n s~ of l b orq u.e ra tio s," (ToumaJ of O riItI.o pae ru ca nd S po rtsPhysicnl 'fherapy, 19913).

UN:P U B L1SH;ED RESEAR"C :H

1 . "E ffect of .~oWlg-[~tm.e .s:i.sta no o tta imn g o n th e d ev elo pn .'I .e l:1 't and m aintenance of isometric ]uID,ibar exJte.n- 's : i o : n st.r,engtlt

2. ' 'S f f -. ;c t o . f i'501~ted Imriba:r ex tJms]onms: is t i lu ' Ioe training' on !3ympkrm..~.tology and s t r eng~ l l i1en ing 'o f'Patie'!!ttsV!.>i'~h tciLci d i l l < O O O C lowbacs pain."

3. ".Effed of jow";b~ck ~mmi.rligon]umbal' extemon strel1lgtl.'I!in female ca]]egiate tennis players"

4. ''E ffec t otcancurrent v j]su ~lf ee d baC k am .d knolf,vledge o f p ll E !\ ti cm :s restillbi on ioowliltt.k l umbm; ,eXl~erI:5'ion

s r r e n g ; l l i . "

,5 , " i sometr ic ]1 i, Imba :: rextE1 lLshul strength in fema1c: mU flg ill.~ e~ oo isp .~ ay ersi: A ,c omp a:r.i;so n among ,adlletic

pOpuWilJ~Q.ns"

6.Ad~ptaijgns in lumbar ~~e.ru;OT muscle swength and cross-seetional area of the lumberextensormuscles fulloV!lh'lgresistance ixa_imng

li

' J ' , ; 'E f f ,e d t o f subm2lximEl~.e ff od ~ lJ td . 'k n ow le d g e of previous results o:n th~ reU;)Ibll iJty o f lW l iL b ar ex~e'! ' ' ' ! .S ioin:strength';

8, t'E:ffiec[o .f b " 1 i I m m g frequency on th e d . ev elo pmen t of isometrlc torso rotation :strength (one andtwod~ys per week)'t

9., ''Effe.d of lIilinmg .freqUll!ncy Oil"! ItOfOO rotarlen s:tfeng:th (one, hovo, am dl three d ays, pel week)"

10. "Qun:ntaUve a5SesSllJient of full riill8e-of-m.otiotll. oerullcru rotation strength."

[1. "Qu].an ti rn ti .v l! a s se ssmen t o f full fiilng~cf~moti,cnisom e tric k nee ' f le xio n and extension strength"

12. "The udli1l:billty of repeated isometric strength measura~l~n:tS!!t d i f f e r e l ' ' 1 1 ' joint angles"

13. '1oometrk: evaJu~Hml of dynamic muscular strength: Acute changes and t r a i l 1 i l 1 L g responses"

]4\. " l5 i O , m e 'm c IL lD ' I . o a 1 ' ,extemon strength ot male collegiate swimmers"

IS. 'lsolrnemC' lumbar muscle strength in 60a92 year old male: track athletes"

16. "The e.fIeo~of trruning volume on the deve]opment of isCl'me:trk knee .flexion and e:de:n .s ion torrque"

17. "The evaluation and rellabilitia,'Hon of the lumbar exte:rIiSG:rr muscles in patle]]:ts\'Vii~n1Oder,ate low back

pain and work-r.e'laloomjuries"

8/4/2019 Spine Knee


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