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Joe's Therap. Exercise Notes

Interesting fact. for ya:
During wrk outs...
to gain muscle mass or bulk...weights being lifted must be heavy with low reps.
To gain muscle endurance...weights must be light with alot of reps or hold weights up for a longer period... To gain strength...weights vary and different muscle groups are used interchangeably to do lifting, lowering or controlling heavy loads for a low number of reps..

Therapeutic Exercise Lab. Notes (taken from Colby, Lynn and Kisner, Carolyn. Therapeutic Exercise: Foundations and Techniques. 4th Edition. Philadelphia: FA Davis Company. 2002.)

Resistance Exercise
Dynamic Exercise: Concentric and Eccentric Contractions.
Concentric - muscles shortens; Exercise in resistance training refers to a form of dynamic muscle loading where tension in a muscle develops, physical shortening of the muscle occurs and an external force (resistance) is overcome as in lifting a weigth.
Eccentric - involves dynamic loading of a muscle beyond its force-producing capacity causing physical lengthening of muscle as it attempts to control the load (negative work, lowering a weight) muscles lengthen during tension

EXERCISE LAB PROGRAM for PATIENT
(with weak Lower Traps, Bilateral Rhomboids, L hamstring, Adductors)

Muscle Testing:
Stretching

4 Week Exercise Program Resistance-Strength Training

Equipment: 3-4 ft. Resistance Band
Exercise Program Summary:
Beginning with a 3 foot resistance band and a distance of 2 ft between you and the origin of the band. Gradually (or weekly) decrease the length of the band by 0.5 inch (limit up to 1 ft), but keeping a consistency of 2 ft distance in between.

1st Week � 2 sets of 20 (3 ft.)
2nd Week � 2 sets of 20 (2.5 ft)
3rd Week � 2 sets of 15 (2 ft)
4th Week � 2 sets of 10 (1.5 ft)

EXERCISE 1
To do this exercise, start with your arms straight out front of your body. Then, pull your arms back, bend the elbows and squeeze the shoulder blades together. This exercise works the upper/midback trunk, shoulder extensor muscles and the rhomboid muscles.
EXERCISE 2
Part 2: Chest Press
To do this exercise, stand facing away from the door, arms up and elbows back. Push your arms/hands forward to straighten your elbow. This exercise works your anterior shoulder muscles, chest pectoralis muscles, and tricep muscles.
EXERCISE 3
Part 3: The Bicep Curl
Notice that the tubing is placed low on the doorway strap. Begin this exercise with your arms straight. The hands are down but the palms face upward. Bend the elbow and move hand upward as if to touch your shoulder. This exercise works the bicep muscles of the upper arm. This exercise is good for those who want a bit of "Popeye" the sailor demeanor or need better strength to lift and carry items like groceries.

Sources (intergration) from: http://physicaltherapy.about.com/library/weekly/aa120201d.htm and Yours truly.

Therapeutic Exercise (T.E.) Notes:
1. There is a difference between ROM and stretching.
ROM means that the joint is put through what ever ROM is available.
If the joint is very painful or the patient has no active ROM then the motions are performed passively by the PT or PTA.
Painful joints may become more painful if the muscles around the joint are contracting to perform the movements. The tightening muscle may put the joint in close packed position. Patients with no active movement tend to have either hypermobile as in patients with flaccid strokes or hypomobile as in patients with a spastic stroke condition. Hypermobile patients definitely do not want to be stretched.ROM may be done passively, active assisted or active. STRETCHING however is motion performed at end range, on a joint that has some type of limitation in the Subacute or chronic stages of the condition.
Joint should not be acutely painful or inflamed if stretching exercises are being carried out.Stretching may be passive, as applied by the PT or PTA or using gravity, weights or theraband. Active assisted, as using a wand. Neuromuscular inhibition as using hold relax techniques. Stretching should not cause a lot of pain and should never be done in the acute phase of a patient�s condition.

2. The action of gravity. Gravity or the lack of gravity can make the difference between a patient being able to move or not. Positioning your patient to eliminate gravity is a good place to start if they are weak. i.e. Quads done in side lying with a powder board for friction free surface will often allow patients to move independently before they are able to move against gravity.Gravity can assist you in your passive and active assisted ROM exercises. i.e. Shoulder external rotation in supine 90/90 position is assisted by gravity once the hand passes the position where the hand is straight up to the ceiling. Gravity will now provide the passive stretch without any assistance from you. The same motion done in standing means you are working against gravity through the whole range.
Working your quad muscle with gravity i.e. prone and straightening the knee is actually eccentric for the hamstrings and nothing for the quads.

3. PROM is only performed on patients with flaccid conditions, joints that are acutely painful or on joints that have conditions contraindicating active ROM such as tendon repairs.

4. AAROM is performed with patients who have some muscle control but may not be able to complete full joint ROM. Make the patient do what ever they can. Pick the position that makes the motion the easiest for them. Can be PT/ PTA assisted or mechanically assisted

5. AROM is performed as soon as the patient has any active movement and seeks to strengthen whatever movement is there by unresisted repetitions. Again positioning may allow patient to perform movements earlier. The goal is to perform actively against gravity. PRE is performed when the muscle is able to perform actively against gravity for a reasonable number of repetitions. Standing weight bearing exercises definitely come into this category.