Principles and techniques of strengthening exercise

Principles and techniques of muscle strengthening

1. PRINCIPLES AND TECHNIQUES OF STRENGTHENING EXERCISES BY: Dr. Sachin (PT) MPT 1 st year(Orthopedics) Saket College of Physiotherapy

2. What are strengthening exercises? Strengthening exercises are physical activities aimed at increasing the current level of muscle strength by using various forms of resistance, such as weights, resistance bands, body weight, or specialized equipment. These exercises help to enhance muscle mass, improve muscle function, and boost overall physical performance. Strengthening exercises are essential for improving athletic performance, preventing injuries, and facilitating rehabilitation and recovery from various conditions.

3. Benefits of strengthening exercise Muscle strengthening exercises increases skeletal muscle mass/strength. Greater Bone mineral density or less bone demineralization.. Ability to perform activities of daily living. Improves cardiometabolic health. Reduce symptoms of depression/anxiety. Maintaining physical function reduce. Reduce the risk of injury or re-injury. Strength ,power and endurance is enhanced my some form of strengthening exercises.

4. Principles of strengthening exercises Overload Principle SAID Principle Reversibility Principle

5. Overload Principle: Exercising at intensities greater than normal stimulates highly specific adaptations so the body functions more efficiently. Achieving the appropriate overload requires either manipulating training frequency, intensity, and duration or a combination of these factors. In a strength training program, the amount of resistance applied to the muscle is incrementally and progressively increased. If the demand remains constant after the muscle has adapted ,the level of muscle performance can be maintained but not increased. To ensure safety, the extent and progression of overload must always be applied in the context of the underlying pathology, age of the patient, stage of tissue healing, fatigue, and the overall abilities and goals of the patient. The muscle and related body systems must be given time to adapt to the demands of an increased load or repetitions before the load or number of repetitions is again increased.

6. Progressive Resisted Exercise (PRE) The progressive resistance exercise (PRE) training method provides a practical application of the overload principle and form the basis of most resistance training programs. 1RM The greatest amount of weight a subject can move through the available ROM just one time 10RM The amount of weight that could be lifted and lowered 10 times through the ROM. PRE Regimen Delorme regimen Oxford regimen DAPRE regimen

7. Delorme Regimen This technique builds a warm-up period into the protocol. Incorporates a rest interval b/w sets, and incrementally increase the resistance over time. Determination of a 10 RM 10 reps @50% OF 10RM 10 reps @75% OF 10RM 10 reps @100% OF 10RM 4 sessions weekly Progress to 10RM once weekly Oxford regimen This technique diminishes the resistance as muscle fatigues. Incorporates a rest interval b/w sets, and incrementally increase the resistance over time. Determination of a 10 RM 10 reps @100% OF 10RM 10 reps @75% OF 10RM 10 reps @50% OF 10RM 5 times weekly

8. Dapre Technique The Daily Adjustable Progressive Resistive Exercise(DAPRE) technique is more systematic and takes into account the different rates at which individual progress during rehabilitation or conditioning programs. The system is based on a 6RM working weight The adjusted working weight , which is based on maximum number of repetitions possible using the working weight in set #3 of the regimen, determines the working weight for the next exercise session.

9. 2. SAID(Specific adaptation to Imposed Demand) Or Specificity Principle “The SAID principle helps therapist determine the exercise prescription and which parameters of exercise should be selected to create specific training effects that best meet specific functional needs and goals.” Exercise training specificity refers to adaptations in metabolic and physiologic functions that depend on the intensity, duration, frequency, and mode of overload imposed. For example, if the desired functional activity requires greater muscular endurance than strength, the intensity and duration of exercises should be geared to improve muscular endurance. Task-specific training that involves practicing the actual motor skill of avoiding a fall after loss of balance may positively affect biomechanical variables that prove effective among older individuals in avoiding a fall. Simply stated, specific exercise elicits specific adaptations to promote specific training specific effects that produce specific performance improvements. Put in another easy-to-remember way: specificity refers to the specific adaptations to imposed demands (SAID) principle.

10. 3. Reversibility Principle Loss of physiologic and performance adaptations, termed detraining , occurs rapidly when a person terminates participation in regular physical activity. Only 1 or 2 week of detraining reduces both metabolic and exercise capacity, with many training improvements fully lost within several months. Increased strength or endurance in response to a resistance exercise program are transient unless training induced improvement are regularly used. Advisable for patients to participate in maintenance program of resistance exercise as an integral component of lifelong fitness program.

11. Muscle strengthening Initiation of Muscle contraction Denervated muscles are incapable of contraction except by direct stimulation of the muscle fibres by suitable electrical means. (From MMT Grade 0-1) Innervated muscles contract in in response to a demand for activity provided the demand is sufficient. Measures Used to Obtain Initiation of Contraction. 1 Warmth:- The area affected must be warm, as moderate warmth improves the quality of the contraction. Active exercise of unaffected muscles agzinat strong resistance is the method of choice 2. Stabilization:- Stabilization should be achieved by isometric contraction of strong synergic muscles working against maximal resistance as their effort re- inforces that of the muscles in question, eg. for initiating elbow flexors the shoulder and wrist are stabilized by their flexors working against resistance applied by the physiotherapist hands

12. 3. Grip or Manual Contact:- The physiotherapist's hands give pressure only is the direction of the movement, to direct the patient’s effort and give sensory stimulation. 4. Stretch:- Sharp but controlled stretching of the affected muscle at the limit of its extended range is followed immediately by the patient's maximum effort of contraction. 5.Irradiation:- The use of resistance to functional movements of the opposite limbs which normally produces fixator action on the other side can assist initiation of contraction in the affected muscle The use of resistance to strong groups which normally work with the affected muscle also encourages contraction of that muscle. For example, the eating pattern involves flexion of the shoulder, elbow, wrist and fingers.

13. Once the power of contraction has been regained, the muscles are strengthened progressively until maximum function is obtained. Passive movements, support, and artificial methods (From MMT Grade 1 to 2) of assisting the circulation are discontinued gradually and are replaced by active exercise. (From MMT Grade 2 to 3) Principles of Treatment to Increase Strength and Function The Affected Muscle must be Strengthened Progressively by Resisted Exercises, which are Specific for the Group to which the Muscles belongs. a.) Range. The range of movement is increased. b.) Type of Muscle Work. Concentric, eccentric and static muscle work are elicited. c.) Resistance. The resistance is increased by: increasing the poundage of the resistance. increasing the leverage of the resistance. d.) Speed. Increase or decrease in the speed of movement is a progression for concentric work. Decrease in speed is a progression for eccentric work. Lengthening of the contraction period is a progression for static holding e.) Duration. Increase in the number of times an exercise is performed or decrease in the rest period between each series of exercises.

14. Full Function of the Affected Muscles as Members of the Teams of Muscles which work to produce Skilled and Co-ordinated Movement, must be restored by Free Activities, Natural and Skilled Movements. TYPES OF EXERCISES USED TO STRENGTHEN MUSCLE AND RESTORE FUNCTION All active exercises maintain or increase muscle strength providing intra-muscular tension it increased sufficiently by the demands of the resisting forces. Assisted-Resisted Exercise:- These are rarely used to strengthen muscles except in cases of marked weakness when strength is insufficient to complete the range of movement. Free Exercise:-Free exercises are valuable as they can be practiced at regular and frequent intervals and at home. Careful selection of starting positions and accurate teaching ensure the use of muscles in grade the exercise to match of their capacity for work. Resisted Exercises:-These exercises create the tension in muscles essential for increase in power and hypertrophy. Emphasis on the activity of the affected group restores the balance of muscle strength rapidly and so prevents trick movement and strain elsewhere .(From MMT grade 3 to 4 or 4 to 5). Proprioceptive neuromuscular facilitation is most effective in this context. Repeated contractions, slow reversals and rhythmic stabilizations are all suitable technique

15. Equipments for Resistance training Dumbbells Weighted balls Cuff weighted vests Sandbags Water Free standing or wall mounted pulley Variable resistance weight systems Elastic resistance bands and tubing Stationary exercise cycles Stair stepping

16. Techniques of strengthening exercise Isometric Exercise Isokinetic Exercise Isotonic Exercise Plyometric Training

17. Isometric Exercise Isometric exercise is a static form of exercise in which a muscle contracts and produces force without an appreciable change in the length of the muscle and without visible joint motion. Sources of resistance for isometric exercise include holding against a force applied manually, holding a weight in a particular position, maintaining a position against the resistance of body weight, or pushing or pulling an immovable object. The need for static strength and endurance is apparent in almost all aspects of control of the body during functional activities.Loss of static muscle strength occurs rapidly with immobilization and disuse,with estimatesfrom8% per week to as much as 5% per day. Types of Isometric Exercises: Muscle setting Exercises Stabilization Exercises Multiple-angle Isometric

18. Characteristics and effects of Isometric Training 1. Intensity of muscle contraction: It is sufficient to use an exercise intensity (load) of 60% to 80% of a muscle’s force-developing capacity to improve strength. 2. Duration of Muscle Activation: To achieve adaptive changes in muscle performance, an isometric contraction should be held for 6 seconds and no more than 10 seconds. 3. Repetitive Contractions: Use of repetitive contractions, held for 6 to 10 seconds each , decreases muscle cramping and increases the effectiveness of the isometric regimen. 4. Joint angle and mode specificity: When Performing multiple-angle isometrics, resistance at four to six points in the ROM is usually Recommended

19. Isotonic exercise Concentric exercise :- refers to a form of dynamic muscle loading where tension in a muscle develops and physical shortening of the muscle occurs as an external force (resistance) is overcome, as when lifting a weight. Eccentric exercise :- involves dynamic loading of a muscle beyond its force-producing capacity, causing physical lengthening of the muscle as it attempts to control the load, as when lowering a weight. During concentric and eccentric exercise, resistance can be applied in several ways: (1) constant resistance, such as body weight, a free weight, or a simple weight pulley system. (2) a weight machine that provides variable resistance. (3) an isokinetic device that controls the velocity of limb movement. Although the term isotonic (meaning equal tension) has been used for many years to describe a resisted, dynamic muscle contraction, application of this terminology is incorrect. In fact, when a body segment moves through its available range, the tension that the muscle is capable of generating varies through the range as the muscle shortens or lengthens. This is due to the changing length-tension relationship of the muscle and the changing torque of the load.

20. Isokinetic exercise Isokinetic exercise is a form of dynamic exercise in which the velocity of muscle shortening or lengthening and the angular limb velocity is predetermined and held constant by a rate-limiting device known as an isokinetic dynamometer The term isokinetic refers to movement that occurs at an equal (constant) velocity.

21. 4. Plyometrics training Plyometric movement involves rapid stretching followed by shortening of a muscle group during a dynamic movement. Think of plyometrics when you stretch a rubber band, the stretch creates stored energy within the band that releases when the band returns to its "resting" position. Stretching in a muscle produces a stretch reflex and elastic recoil within the muscle. When combined with a vigorous muscle contraction, plyometric actions greatly increase the force that overloads the muscles, thereby augmenting increases in absolute strength and power. The basic principle for all jumping and plyometric exercises is to absorb the shock with the arms or legs and then immediately contract the muscles. For example, when doing a series of squat jumps, jump again as quickly into the air as possible after you land, while at the same time thrusting both heels up toward the buttocks. Quicker jumps provide greater overload to the muscles. In essence, "fast" dynamic plyometric movement "trains" the nervous system to respond quickly to rapidly activate muscles

22. REFRENCES Kisner C. Colby L.A. Theraputic Exercises Foundation and Techniques. Fifth Edition . Margaret Biblis ISBN -13: 978-0-8036-1584-7 Chapter 6,150-212. Mckardle W.D. Katch F.I. Katch V.L. Exercise Physiology Nutrition ,Energy and Human Performance Eighth Edition. Chapter 22 Gardiner M. D. The principle of Exercise Therapy Fourth edition. Chapter 15

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