therapeutic exercise: strength, power, and endurancesflanagan/kin 467/strength power...
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Therapeutic Exercise:Strength, Power, and
Endurance
PART I: SCIENTIFIC FOUNDATIONS
ProduceForce
ReduceForce
Stabilization
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Concentric
Eccentric
Isometric
Training Stimulus
StructuralEffects
FunctionalEffects
MotorPerformance
IntermuscularCoordination
IntramuscularCoordination
ReflexiveChanges
HypertrophySiff & Verkhoshansky, 1999
ANATOMY
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3
Sand
ers
& S
ande
rs, 2
001
NEUROPHYSIOLOGY
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Wilk & Reinhold, 2001
Chi
u &
Bar
nes,
Str
engt
h &
Con
ditio
ning
, 200
3
MECHANICS
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Key Points
Difference between strength, power, enduranceDifferent types of enduranceTorque vs. forceIncreasing muscle forceFitness-Fatigue ModelImpulse - Momentum
PART II: TECHNIQUES
PART III: PROGRAM DESIGN
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Indications
?
Contraindications
Pain
Increased edema
Surgical / physician constraints
Acute Program Variables
Choice of exerciseIntensityTempoNumber of RepetitionsNumber of SetsVolumeRest IntervalsNumber of SessionsFrequency
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Choice of Exercise
Isometric vs. DynamicOpen vs. Closed ChainMachine vs. Free WeightType of Resistance
ManualElasticIsotonic – Body weight & Free weightIsokinetic
Open and Closed Chain Exercises:
Myth, Science, and Clinical Implications
Sean P. Flanagan, PhD, ATC, CSCSDepartment of Kinesiology
California State University, Northridge
Presented at the Combined Sections Meeting of the APTA, 2005
“Advantages” of Closed Chain Activities
Stimulation of proprioceptorsIncreased joint congruency & stabilityDecreased shear forcesEnhanced dynamic stabilityMore “functional”
Prentice, 1999
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Open Chain
Closed Chain
Definitions
Steindler , 1955
Open chain - a combination in which the terminal joint is free.
Closed chain - one in which the terminal joint meets with some “considerable external resistance” which prohibits or restrains free movement.
More definitions
Closed chain – distal end is fixed (Zatsiorsky, 1998).
Closed chain - motion of one [segment] at one joint will produce motion at all other joints in the system in a predictable manner (Levangie & Norkin, 2001).
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Gary Mitchell
Alternate Classifications?
MNLFNLNo Load
MELFELExternal LoadExternal
Load
MovableFixed
BoundaryDillman, Murray, &
Hintermeister, J Sport Rehab, 1994
What does EMG tell us about movement classification?
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EMG and Force
Alk
nere
t al,
MSS
E 2
000
No difference inintegrated
EMGbetween
similarly- loadedpush-ups
and bench-press
Blackard, Jensnen, & Ebben, MSSE, 1999
Esc
amill
a et
al,
MSS
E 1
998Biomechanical
similaritybetweensquat and
leg press
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Angular Resistance
Single JointNON-WEIGHT
BEARING
Linear Resistance
Multiple Joints
WEIGHT BEARING
No easy classification
Distal vs. Proximal End MovingSingle vs. Multiple JointsAngular vs. Linear ResistanceMachine vs. Free WeightSeated vs. Standing vs. Prone
Ed Z
erch
er
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Rationale: CC & Safety
Decreased Shear Force
Increased Co-contraction
CC movements are harder to control
Shear forces a function of…
Type of loading
Lutz et al, JBJS-A, 1993Wilk et al, Am J Sports Med, 1996Escamilla et al, MSSE, 1998Kvist et al, Am J Sports Med, 2001
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Placement of external resistance
Zavatsky et al., Am J Sports Med, 1994
Amount of compressive force
Fle
min
g et
al,
Am
J S
port
s Med
, 200
3
What about co-contraction?
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Esc
amill
a et
al,
MSS
E 1
998
Esc
amill
a et
al,
MSS
E 1
998
Co-Contraction
Function of free-weights vs. machines?
Does not affect anterior shear forces at knee
Over-rated?
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No epidemiological evidence…
Shear forces are pathologic
Free weights are more injurious than machines
Comparisons across studies difficult…
Subject PopulationIntervention DurationNumber of ExercisesAmount and Type of ResistanceOutcome Measures
Eight studies, no differences…
StrengthPainFunctional PerformanceProprioceptionJoint Laxity?
Combined OC/CC appears superior to either one separately!
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LE Kinetics Following ACL Surgery
0
50
100
150
200
250
PRE ANG PRE IMP POST ANG POST IMP
ULAL
Case Study: Bilateral Comparisons following ACL Surgery
2%
410%
5%
83%
Three Variations of the Step Exercise
Flanagan, Kessans, & Salem, J Sport Rehabil, 2006
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Forward Step Up
Lateral Step Up
Step Down
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Intensity
Dictates all other variables
RM Continuum
Tempo
Important to remember your biomechanics:
Force – velocity
Impulse – momentum
Tempo
Important to remember your biomechanics:Force – velocityImpulse – momentum
Bandy et al., Phys Ther, 1997
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Speed Repetitions
Remember, impulse must be zero…
Newton et al, 199640%Bench Press45%
Flanagan & Salem*35%Squat50%
Flanagan & Salem*45%Squat25%
SourceDecelerationMovement% RM
* Preliminary unpublished data
Number of Reps / SetsDeLorme (DeLorme & Watkins)
Oxford
Aggressive Resistance Training Program
DAPRE
Performance-Based Periodization
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DeLorme (DeLorme & Watkins, 1945)
10100% of 10 RM3
1075% of 10 RM2
1050% of 10 RM1
RepsLoadSet
Oxford (Zinovieff, 1951)
1050% of 10 RM3
1075% of 10 RM2
10100% of 10 RM1
RepsLoadSet
Aggressive Resistance Training Program (Stone and Kroll, 1982)
4100% of 4 RM5
495% of 4 RM4
690% of 4 RM3
880% of 4 RM2
850% of 4 RM1
RepsLoadSet
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DAPRE (Knight, 1985)
MaxAdjusted Working4
Max100% of Working3
675% of Working2
1050% of Working1
RepsLoadSet
DAPRE Adjustments
↑ 10-20 lbs↑ 10-15 lbs13+
↑ 5-15 lbs↑ 5-10 lbs8-12
↑ 5-10 lbsKeep same5-7
Keep same↓ 0-5 lbs3-4
↓ 5-10 lbs↓ 5-10 lbs0-2
Next Day4th Set
AdjustmentsNumber of Reps / Set
Performance-Based Periodization(Flanagan, 2001)
Planned variables: load and rest periods
Target: volume
Performance variables: reps and sets
Adjustments
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Rest Intervals
90 sec?
Frequency
2 – 3 times per week?
LE Kinetics Following ACL Surgery
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0
50
100
150
200
250
PRE ANG PRE IMP POST ANG POST IMP
ULAL
Case Study: Bilateral Comparisons following ACL Surgery
2%
410%
5%
83%