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Regaining Muscular Strength,
Endurance and Power
Regaining Strength, Endurance & Power
Critical to maintain and improve in each area in order to
achieve competitive fitness levels and return athlete to
functional level following injury
Muscular Strength
Ability to generate force against some resistance
Important to maintain normal levels for normal healthy living
Imbalance or weakness can impair normal function
Muscular Endurance
Ability to perform repetitive muscular contractions against some
resistance
Power
Ability to generate force quickly
Combination of strength & speed
Performance is limited without power
Types of Skeletal Muscle Contraction
• Isometric Contraction
– Contraction that produces m. tension but no change in m. length
• Concentric Contraction
– Contraction that causes m. shortening while tension increases to overcome
some resistance
• Eccentric Contraction
– Resistance is greater than the muscular force being produced & muscle
lengthens while producing tension
• Econcentric contraction
– Controlled concentric & eccentric contraction of same muscle over 2
separate joints
– Hamstring and rectus femoris of quadriceps
• Strength training must focus on functioning of muscle
– Multi-planar
– Various contractions - functionally
Factors That Determine Levels of
Strength, Endurance & Power
• Size of Muscle
– Proportional to cross-sectional diameter of muscle
fibers
– Increased cross-sectional area = increased strength
and force production
• Number of Muscle Fibers
– Strength is a function of the number and diameter
of muscle fibers
– Number of fibers is inherited characteristic
• Neuromuscular Efficiency
– Strength is directly related to efficiency of the
neuromuscular system
– Initial increases in strength during first 8-10
weeks are attributed to neuromuscular efficiency
– Efficiency enhanced strength in 3 ways
• Increase # of motor unit recruitment
• Increase in firing rate of each motor unit
• Enhance synchronization of motor unit firing
• Biomechanical Considerations
– Position of tendon attachment
• Relative position of tendon attachment to
fulcrum of the joint
– The closer the tendon is to resistance, the
greater the force produced
• Change in attachment will alter force
generating capabilities
• The position of attachment of the muscle tendon on
the lever arm can affect the ability of that muscle to
generate force.
• B should be able to generate greater force than A
because the tendon attachment on the lever arm is
closer to resistance.
• Biomechanical Considerations
– Length-Tension Relationship
• Length of muscle determines tension that can be
created
• Varying lengths will produce varying tensions
• Determined by overlap of actin-myosin filaments
• Age
– Men & women increase strength throughout
puberty & adolescence
– Peaks at age 20-25
– After age 25, max strength declines 1%
annually
– Decline is related to physical activity
– Able to retard decline in performance
through activity
• Overtraining
– Imbalance between exercise and recovery
• Training exceeds physiological and psychological
capacity of individual
– Can have negative effect on strength training
– May result in psychological or physiological
breakdown
• Injury, illness, and fatigue can be indicators
Fast-Twitch vs. Slow Twitch
• Slow Twitch Fibers
–
–
–
–
Type I or slow oxidative (SO)
More resistant to fatigue
Time required to generate force is greater in slow twitch fibers
Primarily associated with long duration, AEROBIC activities
• Fast Twitch Fibers
– Type IIa (fast oxidative glycolytic- FOG)
• Moderately resistant to fatigue
– Type IIb (fast glycolytic - FG)
• Fatigues rapidly – true fast twitch
– Type IIx – fatigue resistant with force capacity (a<x<b)
– Produce quick, forceful contractions
– Short-term, high intensity activities, ANAEROBIC activities
• Ratio in Muscle
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–
–
–
Both fiber types exist in individual muscles
Ratio varies by muscle and by individual
Postural muscles = ↑ % primarily type I fibers
Power, explosive strength muscles = ↑ % type II
fibers
– Genetically determined
• Large role in determining ability for a given sport
activity
– Fiber changes due to training
• Enhanced metabolic capabilities through specific
training
Physiology of Strength Development
• Muscle Hypertrophy – 3 theories
– Hyperplasia – ↑ in number of muscle fibers
• Genetically determined & does not seem to increase with training
• Evidence exists of fibers splitting – conducted in animals
– Hypothesized increased number of capillaries – partially correct
• No new capillaries
• Increase in dormant capillary activity to meet needs of muscle
– **Increased size and number of myofilaments
• Actin (thin) and Myosin (thick)
• When muscle is stimulated to contract, cross-bridges pull myofilaments
closer which shortens the muscle, & produces movement at joint that muscle
crosses
– Reversibility – adaptations of muscle due to training can begin to
reverse within 48 hours of removing training
Other Physiological Adaptations to
Resistance Exercise
• Strength of non-contractile structures
– Tendons and ligament increase
– Increased bone-mineral content
• Improved oxygen uptake
– If resistance training is high enough to elicit a
cardiovascular response/adaptation
• Increased metabolic enzymes
Elements of a Resistance Exercise Program
• Alignment of segments of the body during
exercise
• Stabilization of proximal or distal joints to
prevent substitution
• Intensity: the exercise load (level of resistance)
• Volume: number of repetitions and sets; number
of exercises per session
• Frequency: the number of exercise sessions per
day or per week
• Rest interval: time allotted for recuperation
between sets and sessions of exercise
• Duration: total time frame of a resistance
training program
Elements of a Resistance Exercise Program
• Mode of exercise: type of muscle contraction,
position of the patient, application of
resistance, arc of movement, or the primary
energy system utilized
• Speed of exercise
• Periodization: variation of intensity and
volume during specific periods of resistance
training
• Integration of function: use of resistance
exercises that replicate functional demands
Substitute motions
Compensatory movement patterns
caused by muscle action of a
stronger adjacent agonist or of a
muscle group that normally serves as
a stabilizer (fixator).
Alignment
Proper alignment is determined by the
direction of muscle fibers and the line of
pull of the muscle to be strengthened.
For example, to strengthen the gluteus medius,
the hip must remain slightly extended, not
flexed, and the pelvis must be rotated slightly
forward as the patient abducts the lower
extremity against the applied resistance.
If the hip is flexed as the leg abducts, the
adjacent tensor fasciae latae becomes the
prime mover and is strengthened.
Stabilization
Stabilization refers to holding down a body
segment or holding the body steady. To
maintain appropriate alignment, ensure correct
muscle action and movement pattern, and avoid
unwanted substitute motions during resistance
exercise, effective stabilization is imperative.
External stabilization can be applied manually by
a therapist or sometimes by the patient, with
equipment, such as belts and straps, or by a firm
support surface, such as the back of a chair or
the surface of the treatment table.
Internal stabilization is achieved by an isometric
contraction of an adjacent muscle group that does
not enter into the movement pattern but holds the
body segment of the proximal attachment of the
muscle being strengthened firmly in place. For
example, when performing a bilateral straight leg
raise, the abdominals contract to stabilize the
pelvis and lumbar spine as the hip flexors raise
the legs.
Intensity
The intensity of exercise in a resistance training
program is the amount of resistance (weight)
imposed on the contracting muscle during each
repetition of an exercise. The amount of
resistance is also referred to as the exercise load
(training load), that is, the extent to which the
muscle is loaded. or how much weight is lifted,
lowered, or held.
Submaximal Versus
Maximal Exercise Loads
Submaximal loading (exercise at moderate to low intensities):
• At the beginning of an exercise program to evaluate the
patient's response to resistance exercise
• In the early stages of soft tissue healing when injured
tissues must be protected
• After periods of immobilization when the articular cartilage
is not able to withstand large compressive forces or when
bone demineralization may have occurred, increasing the risk
of pathologic fracture
• For most children or older adults
• When the goal of exercise is to improve muscle endurance
• To warm up and cool down prior to and after a session of
exercise; or
• During slow-velocity isokinetic training to minimize
compressive forces on joints
Near maximal or maximal loading (highintensity exercise):
• When the goal of exercise is to increase
muscle strength and power and possibly
increase muscle size
• For otherwise healthy adults in the last phase
of a rehabilitation program after a
musculoskeletal injury in preparation for
returning to high-demand occupational or
recreational activities
• In a conditioning program for individuals with
no known pathology
• For individuals training for competitive
weight lifting or body building
Repetition Maximum
One method of documenting the
effectiveness of a resistance exercise
program and calculating an appropriate
exercise load is to determine a repetition
maximum.
This method was developed by DeLorme.
A repetition maximum (RM) is the greatest
amount of weight (load) a muscle can
move through the available ROM a specific
number of times.
Repetition Maximum
A repetition maximum can be used in a
number of ways. DeLorme reported
determination of a 1RM (the greatest
amount of weight a subject could lift
through the full ROM just one time) as a
useful baseline measurement of a
subject's maximum effort. From the 1 RM
measurement a beginning load for
exercise can then be calculated.
1RM; problems
Is not safe for patients, for example, with joint
impairments, patients who are recovering from or
who are at risk for soft tissue injury, or patients
with known or who are at risk for osteoporosis or
cardiovascular pathology.
Critics suggest that determination of a 1 RM for
a particular muscle group involves a lot of trial
and error and, therefore, may not be accurate if
the patient fatigues before the 1 RM is identified.
Some patients may not understand or may be
apprehensive about exerting one maximum effort.
Two Practical Ways
1) The higher RM value can be used
as the baseline.
If the patient was able to lift the
selected weight 10 times, then the
baseline measurement for future
comparisons is a 10 RM.
Two Practical Ways
2) 1 RM can be calculated from a conversion
table.
If the therapist prefers to use a 1 RM as the
baseline measurement, the number of
repetitions and weight can be cross
referenced in a conversion table to
determine a calculated 1 RM. According to
one such conversion table, a 10 RM is
approximately 75% of a 1RM.
Some Conversion Methods
• nRM = (1- 0.025n) 1RM
• 1 RM = 5 RM x 1.15
• Calculate 1-RM Estimate using the Coefficient
Factors. Weight lifted x the coefficient factor
for the reps performed = 1 rep max
Factor 1.057
1.148
1.247
1.318
1.393
1.513
Reps: 2
5
8
10
12
15
Volume
In resistance training the volume of
exercise is the summation of the total
number of repetitions and sets of a
particular exercise during a single
exercise session
There is an inverse relationship between
the volume and intensity of resistance
exercise. The higher the intensity (load),
the lower the volume must be, and the
converse is true.
Repetitions and Sets
The number of repetitions in a dynamic
exercise program refers to the number of
times a specific movement is repeated.
More specifically, it is the number of
muscle contractions performed to move
the limb through a series of continuous
and complete excursions against a
specific exercise load.
The "average" untrained adult, when
exercising with a load that is equivalent to
75 % of the 1 RM, will be able to complete
approximately 10 repetitions before
needing to rest. At 60% intensity about 15
repetitions are possible and at 90%
intensity only 4 to 5 repetitions are usually
possible.
No optimal number for strength training or
endurance training has been identified.
Training effects (greater strength) have been
reported with the use of a 2 to 3 RM to 15 RM.
Sets are a predetermined number of repetitions
grouped together; sets are also known as bouts.
After each set of a specified number of repetitions
there is a brief interval of rest. As with repetitions,
there is no optimal number of sets per exercise
session. As few as one set and as many as six
sets have yielded positive training effects.
To Improve Muscle Strength
Current recommendations are to use an
exercise load that cause fatigue after 6 to 12
repetitions for two to three sets (6-12 RM).
When fatigue no longer occurs after the
target number of repetitions has been
completed, the level of resistance is
increased to once again overload the
muscle.
To Improve Muscle Endurance
Training to improve local endurance involves
performing many repetitions of an exercise
against a sub maximal load. For example, as
many as three to five sets of 40 to 50 or more
repetitions against a light grade of elastic
resistance might be used. Endurance training,
because it is performed against very low levels of
resistance, can and should be initiated very early
in a rehabilitation program without risk of injury
to healing tissues.
Frequency
Frequency in a resistance exercise
program refers to the number of exercise
sessions per day or per week. Frequency is
dependent on other determinants, such as
intensity and volume as well as the
patient's goals, general health status,
previous participation in a resistance
exercise program, and response to
training.
Duration
Exercise duration is the total number of weeks or
months during which a resistance exercise
program is carried out.
Strength gains, observed early in a resistance
training program (after 2 to 3 weeks) are the
result of neural adaptations. For significant
changes to occur in muscle, such as
hypertrophy or increased vascularization, at
least 6 to 12 weeks of resistance training is
required.
Rest Interval (Recovery Period)
Rest is necessary to allow time for the body to
recuperate from the acute effects of exercise,
associated with muscle fatigue or to offset adverse
responses, such as exercise-induced, delayed-onset
muscle soreness.
Rest intervals for each exercising muscle group are
dependent on the intensity and volume of exercise.
For example, between sets of moderate intensity
and volume exercise (at an 8- to 12-RM level), a 30to 60-second rest period is common. With higher
intensity, near-maximal loading (at a 3- to 5-RM
level), a longer rest period before performing
another set of the same exercise is necessary.
Mode of Exercise
The mode of exercise in a resistance
exercise program refers to the form or
type of exercise or the manner in which
the exercise is carried out. Mode of
exercise also encompasses the form of
resistance, that is, how the exercise load
is applied. For example, a patient may
perform an exercise dynamically or
statically or in a weight-bearing or non
weight bearing position.
Samples of Resistance Exercises
Techniques of Resistance Training
• Overload Principle
– To improve strength, muscle must be worked at a level higher
than it is accustomed to
– Muscle will maintain strength if it is trained against a
consistent resistance that it is accustomed to
• Existence of current strength & will result in increased
muscle endurance
– Effective training requires a consistently increasing effort
against progressively more resistant loads
– In rehabilitation, rate of progression is determined by athlete’s
response to specific exercise
• Be mindful of pain and swelling when dealing with
progression
Types of Skeletal Muscular
Contractions
• Isometric
• Concentric
• Eccentric
• Isometric Exercise
– Capable of increasing muscle strength at specific joint angles
• Exercise with no change in muscle length
– May produce spikes in systolic blood pressure
• Could cause life-threatening cardiovascular accident
• To reduce this event to occur - REMIND the person to
breath during the maximal contraction
– Widely used in rehabilitation
• Attempt to use positional or functional exercise – work at
multiple angles throughout the range if possible
– Contractions should be held for 10 seconds at frequency of
10 or more per hour
– Utilized to enhance lift or activity at “sticking point”
Sticking Point
• Sometimes, there is a particular angle in the
R.O.M at which smooth movement is difficult
because of insufficient strength. This joint
angle is referred to as a sticking point.
• If strength can be improved at this joint angle,
then a smooth, coordinated power lift can be
performed through a full R.O.M
Isometric Exercise and Strength
Gain
• An isometric contraction provides stabilization
strength that helps maintain normal length – tension
and force – couple relationships, which are critical for
normal joint arthrokinematics.
• Isometrics are capable of increasing muscular
strength. However, strength gains are relatively
specific to the joint angle at which training is
performed. At other angles, the strength curve drops
off dramatically because of a lack of motor activity at
that angle.
Aims
To prevent or minimize muscle atrophy when
joint movement is not possible due to external
immobilization (casts. splints, skeletal traction)
To activate muscles (facilitate muscle firing) to
begin to reestablish neuromuscular control but
protect healing tissues when joint movement is
not advisable after soft tissue injury or surgery
To develop postural or joint stability
To improve muscle strength when use of
dynamic resistance exercise could compromise
joint integrity or cause joint pain
To develop static muscle strength at particular
points in the ROM consistent with specific taskrelated needs
• Progressive Resistive Exercise (PRE)
– Exercises that work through a full range of motion
– Isotonic or isodynamic contractions
• Most popular & commonly used technique
– Concentric (positive) vs. Eccentric (negative)
• Greater force can be generated with eccentric due to lower
number of motor units recruited allowing other motor units to
be recruited to generate increased force
• Oxygen use is much lower with eccentrics
• Efficiency of eccentric exercise is higher than concentric
exercise. Thus, it is more resistant to fatigue
• Needs of the body – acceleration and deceleration
• Must be able to control body movements – deceleration and
eccentrics allows for this control
Note:
Although the term isotonic (meaning equal tension)
has been used for many years to describe a dynamic
muscle contraction against resistance that causes
joint movement, application of this terminology is
incorrect.
In fact, when a body segment moves through a
R.O.M, the tension that the muscle is capable of
generating varies through the range as the muscle
shortens or lengthens due to the changing lengthtension relationship of the muscle and the changing
torque of the load; thus, force output does not
remain constant. Therefore, "isotonic“ is not used to
describe dynamic resistance exercise.
Research has clearly demonstrated that the muscle
should be overloaded and fatigued both
concentrically and eccentrically for the greatest
strength improvement to occur.
When training specifically for the development of
muscular strength, the concentric portion of the
exercise should require 1-2 S, while the eccentric
portion of the lift should require 2-4 S.
Concentric/eccentric ratio should be approximately
½.
– Free Weights vs. Exercise Machines
• Advantages & disadvantages for both
• Machines
– Safety & easy to use
– Constraints on motion & generally single plane of
motion
• Free weights
– Do not restrict motion
– Incorporates certain level of neuromuscular control
– Stabilization decrease the amount of weight that can be
lifted.
– Surgical Tubing (Theraband) or Exercise Band
• Allow for motion in multiple planes
• Ability to perform more functional movement
• Can be utilized with PNF & plyometrics
– Variable Resistance
• Change in force required at different angles to
move a particular resistance
• Greatest when joint is at 90 degrees
• Accommodating resistance or variable resistance
equipment changes resistance at different points in
range
• A number of exercise machine
manufacturers have attempted to
alleviate this problem of changing
force capabilities by using a cam in its
pulley system.
• The cam is intended to alter resistance
so that the muscle can handle a greater
load, but at the points where the joint
angle or muscle length is mechanically
disadvantageous, it reduces the
resistance to muscle movement.
Whether this design does what it
claims is debatable.
• Progressive Resistive Exercise Techniques (PRE)
– Terminology
• Repetitions
• Repetition maximum (RM)
• Set
• Intensity
• Recovery period
• Frequency
• Recommended Techniques of Resistance Training
– Must consider 4 areas
• Amount of weight to be used
• Number of repetitions
• Number of sets
• Frequency of training
– The healing process must dictate the program!
– Intensity is key
– Multiple potential routines
• Single set – 1 set 8-12 reps at a slow speed
• Tri-sets – 3 exercises for 1 muscle group, 2-4 sets with no rest
• Multiple sets – 2-3 warm-up sets with progressively increasing
resistance followed by several sets at the same resistance
• Superset – multiple exercises, 1 set of 8-10 repetitions or 1 or 2
exercises, with multiple sets of 8-10 repetitions
• Pyramid – One set of 8-12 reps with light resistance, then an increase
in resistance over 4-6 sets until only 1-2 reps can be performed. The
pyramid can also be reserved going from heavy to light resistance.
• Split routine – Workouts exercise different groups of muscles on
different days
– Circuit Training
• Group of exercise (flexibility, callisthenic, strength, brief aerobic)
• Used to increase strength or endurance
• Move from one station to the next, performing exercise for a given time period
or number of repetitions
Progressive Resistance Exercises
Progressive Resistive Exercise
• Resistance training techniques for rehab
– DeLorme’s program
• Based on 10 RM
– Set 1: 10 reps of 50% 10 RM
– Set 2: 10 reps of 75% 10 RM
– Set 3: 10 reps of 100% 10 RM
Progressive Resistive Exercise
• Resistance training techniques for rehab
– Oxford technique
• Set 1: 10 reps at 100% 10 RM
• Set 2: 10 reps of 75% 10 RM
• Set 3: 10 reps of 50% 10 RM
– McQueen’s technique
• Beginning/ intermediate: 3 sets x 10reps, 100% of
10 RM
• Advanced: 4-5sets x 2-3reps, 100% of 2-3 RM
Sander’s program
• Was designed to be used in the advanced stages of
rehabilitation and was based on a formula that used a
percentage of body weight to determine starting
weights. For example:
• Barbell squat – 45% of body weight
• Barbell bench press – 30% of body weight
• Leg extension – 20% of body weight
• Universal bench press – 30% of body weight
• Universal leg extension – 20% of body weight
• Universal leg curl – 10-15% of body weight
• Universal leg press – 50% of body weight
• Upright rowing – 20% of body weight
Progressive Resistive Exercise
• Resistance training techniques for rehab
– Sander’s program- advanced
•
•
•
•
Different % of body weight for different exercises
Day 1: 4x5 100% 5 RM
Day 2: 4 x5 100% 3 RM
Day 3: 1x5 100% 5 RM
2x5 100% 3 RM
2x5 100% 2 RM
Progressive Resistive Exercise
• Resistance training techniques for rehab
– Knight’s DAPRE program
• Individual differences in rates at which patients
progress
• Set 1: 10 reps 50% RM
• Set 2: 6 reps 75% RM
• Set 3: max reps 100% RM
• Set 4: max reps adjusted working weight
DAPRE Adjusted Working Weight
Number of
Repetitions
Performed
During Third
Set
Adjusted
Working
Weight During
Fourth Set
Next Exercise
Session
0-2
-5-10 Ib
-5-10Ib
3-4
-0-5 Ib
Same weight
5-6
Same weight
+5-10 Ib
7-10
+5-10 Ib
+5-15 Ib
11
+10-15 Ib
+10-20 Ib
Progressive Resistive Exercise
• Resistance training techniques for rehab
– Berger
• Adjustable within individual limitations
• Weight selected should allow 6-8 RM in
each of three sets
– Trial and error
– 60-90 second recovery period
– Progress up about 10% of current weight
For rehabilitation Purposes
– Base program on pain and healing process
– Should be performed on a daily basis
initially
– Reduce workout to every other day as
progress in healing process is made and
pain and swelling is no longer an issue (at
least 3 times but no more than 4 times per
week).
• Isokinetics as a Conditioning Tool
– Maximal effort for maximal strength gains
– Dynamometer will move at a set speed whether maximal or
half of maximal effort is put forth
• Athlete can cheat with machine and not put forth the
effort
– Not cost effective
• Isokinetics in Rehabilitation
–
–
–
–
Gained popularity in rehabilitation during the 1980’s
Provide objective means of athlete/patient evaluation
Training at fast vs. slow speeds
Functional speeds
Isokinetic Exercise
• Involves muscle contractions where length change
of muscle is set at a constant velocity.
• Maximal resistance throughout the range of motion.
• The key is not the resistance but the speed at which
resistance can be moved.
• Variety of machines/manufacturers are available
• Can be used with eccentric & concentric exercise
Isokinetic Training Principles
• Disadvantages:
1)Cost
2) Although isokinetic training affords
a spectrum of velocities for training,
the speed of limb movement during
many functional and sports-related
activities far exceeds the maximum
speed settings available on isokinetic
equipment.
3) Isokinetic exercise usually isolates a
single muscle or opposite muscle groups,
involves movement of a single joint, is
uniplanar, occurs in an open-chain (non
weight bearing) and constant velocity. (not
so functional).
Plyometric Exercise
• Encompass a rapid stretch of muscle eccentrically
followed by a rapid concentric contraction to facilitate
the development of explosive power
• Greater stretch relative to resting length = greater
resistance muscle can overcome
– Speed of stretch is emphasized over magnitude
• Used to develop eccentric control of dynamic
movements
• Exercises should be performed technically correct
Core Stabilization Strengthening
• Fundamental component of rehabilitation
• Strengthening of core (lumbo-pelvic complex)
• Used to
– Improve dynamic postural control
– Ensure appropriate muscular balance & joint
movement about the core
– Improve neuromuscular efficiency and expression
of dynamic functional movement
• Provide optimal stabilization of kinetic chain and
balanced muscular functioning throughout the chain
Training for Muscular Strength vs.
Muscular Endurance
• Strength and endurance are closely related
– As one improves, the tendency is for the other to do the
same
• For strength development
– Heavier weight and low repetitions should be used
• Endurance training
– Lighter weight and high repetitions (10-15) are suggested
Resistance Training Differences
Between Males & Females
• Females tend not to develop significant muscle
bulk due to reduced levels of testosterone
• While bulk generally does not increase, muscle
tone will increase through training in females
• Gains are primarily neuromuscularly related &
tend to plateau for females
• Males tend to continue developing strength through
increased bulk following the neuromuscular strength
gains
• Strength/Body Weight Ratio
– Females tend to have a lower ratio due to higher levels of
body fat
• Absolute strength differences
– Reduced when body size & composition are compared
– Leg strength can actually be stronger in females with upper
extremity strength greater in males
Resistance Training in Young
Athletes
• Same principles can be applied to young athletes
• Much debate sociologically & physiologically
• If properly supervised, young athletes can make
improvements in all areas of fitness
– Pre-pubescent child will experience gains in muscle strength
without muscle hypertrophy
• Resistive exercise should be integrated into a young
athlete’s rehabilitation
• Close instruction & supervision is necessary
– Base on extent of maturation – critical to effectiveness
Specific Resistive Exercises Used in
Rehabilitation
• Goal of program
– To regain and possibly increase specific muscle strength
– Increase efficiency of movement
• Variety of exercise modes can be utilized to achieve
goals
Progression of a Resistance Training Program
Factors
Progression
Intensity (exercise load)
Submaximal ~ maximal (or nearmaximal) intensity
Low load ~ high load
Body position (non weight – or weightbearing)
Variable: depending on pathology and
impairments, weight-bearing restrictions
(pain, swelling, instability) and goals of
the rehabilitation program
Repetitions and sets
Low volume~ high volume
Frequency
Variable: depends on intensity and
volume of exercise
Type of muscle contraction
Static ~ dynamic
Concentric and eccentric: variable
progression
Progression of a Resistance Training Program
Factors
Progression
Range of motion
Short arc~ full arc
Stable portion of range~ unstable
portion of range
Plane of movement
Uniplanar ~ multiplanar
Speed of movement
Slow ~ fast velocities
Neuromuscular control
Proximal~ distal control
Functional movement patterns
Simple~ complex
Single joint~ multi joint
Proximal control~ distal control
ACSM Strength Guidelines
• Frequency = 2-3 days/week
• Intensity
– 85% of max for strength
– 75% of max for muscular power + (method)
– 50% - 65% of max for muscular endurance
• Time =
– 30 - 90 sec. per set / 8 - 12 reps per set
– work to rest ratio 1:4
• Type = resistance type
Closed & Open Kinetic
Chain Exercises
• To a large extent the term CKC exercise
has come to mean "weight-bearing
exercise." However, although all weightbearing exercises involve some elements
of CKC activities, not all CKC activities
are weight-bearing.
Muscle Actions in the Kinetic
Chain
• Muscle actions that occur during OKC
activities are usually reversed during
CKC activities. In OKC exercise, the
origin is fixed and muscle contraction
produces movement at the insertion. In
CKC exercise, the insertion is fixed and
the muscle acts to move the origin.
Kinetic chain
Steindler:
In mechanics, it describes a series of
sequentially activated segments.
In human body, it is the combination
of several successively arranged
joints constituting a complex motor
unit.
These series, or chains, can occur as
either of two primary types: open or
closed.
Open kinetic chain
An exercise or movement pattern where the distal
aspect of the extremity is not fixed to an object
and terminates free in space.
Examples: waving the hand, movement of the
foot during the swing phase of gait, the seating
knee-extension exercise, straight leg raises
Closed kinetic chain
An exercise or movement pattern where the
distal aspect of the extremity is fixed to an
object that is either stationary or moving. In
other words, the distal segment remains in
constant contact with the surface, usually the
ground or the base of a machine.
A condition or environment in which the distal
segment meets “considerably” external resistance
that restrains free motion.
True closed kinetic chain movement patterns do
not technically exist in the human body, except in
isometric exercises where no movement of
proximal or distal segments occur.
In clinical situations, an exercise in which
resistance is placed through the distal aspect of
the extremity and remains fixed to the extremity.
Example: standing squat (both front and back),
Leg Press, Lunge
Bilateral closed-chain resisted hip
and knee extension
OKCE concentrates on a strong quadriceps
contraction, which will strengthen the
quadriceps and restore quadriceps power
output.
CKCE concentrates on a co-contraction of the
quadriceps, hamstrings, hip flexors, soleus,
and gastrocnemius muscles. Also this is a
multi-joint movement, which focuses on the
knee, hip, and ankle. CKCE are labeled as
being "sport specific movements" .
One exercise whose classification as open or closed
kinetic chain exercise is uncertain involves stairclimbing machines, where the distal aspect of the
lower extremity remains fixed to an object (the
pedal) that is constantly moving during exercise.
Similarly, riding a bicycle involves a closed system,
but many clinicians and researchers argue that the
movement of the pedal and the trivial resistance
level occasionally encountered while pedaling do
not clearly qualify that exercise as a closed kinetic
chain exercise.
Characteristic
Open kinetic chain
Closed kinetic chain
Stress pattern
Rotary
Linear
Number of joint axes One primary
Multiple
Nature of joint
segments
Number of moving
joints
Planes of movement
One stationary, the Both segments move
other mobile
simultaneously
Isolated joint motion Multiple joint
movement
One (single)
Multiple (triplanar)
Muscular
involvement
Isolation of muscle
or muscle groups,
minimal muscular
co-contraction
Often nonfunctional
Movement pattern
Significant muscular
co-contraction
Significant
functionally oriented
movement patterns
Other Commonly Used Terms
Single-joint Versus Multiplejoint Exercise (Joint multiplicity)
Boundary Condition and Load
The term single joint versus multiple joint have
been used to describe exercises based on the
number of joints being exercised.
Single-joint exercises correspond closely with
traditional open kinetic chain exercise movements
such as the biceps curl and seated knee extension.
Single-joint exercises are also commonly referred
to as joint-isolation exercises because these types of
exercises isolate activity at one particular joint and
often isolate particular muscles or groups of
muscles.
Multiple-joint exercises correspond
closely with exercises that are commonly
classified as closed kinetic chain.
Movement occurs at multiple levels with
muscular co-contraction during these
exercises, and the ability to exercise
numerous segments and muscle groups
simultaneously is their primary benefit.
Dillman et al. (1994) proposed an alternative
method of classifying exercises based on
mechanics. They used the boundary
condition and the presence or lack of an
external load as the two criteria in the
classification scheme. The boundary
condition is termed either fixed or movable,
rather than closed or open. An external load
may or may not exist with the exercise.
Therefore Dillman et al. proposed three
categories of exercise:
Fixed with external load (FEL). which most closely
corresponds with the classic definition of a CKC
exercise.
Examples: push-up or squat.
Movable boundary with no external load (MNL). This
condition corresponds closely with a true OKC exercise.
Examples: raising the arm or extending the lower leg
with no resistance applied.
Movable boundary with external load (MEL). This
condition attempts to classify the gray area in the
open/closed chain classification and the single-/multiplejoint classification system.
Examples: bench-press exercise for the upper extremity
and a stair-climbing or leg-press exercise for the lower
extremity.
Characteristics of OKC Exercises
Distal end of the extremity is free in space.
Distal end of the extremity is not in contact with a fixed
object.
Movement pattern is characterized by rotary stress in
the joint.
Joint movements occur in isolation.
Muscle recruitment and movements are isolated.
Joint axis is stable during movement patterns.
The proximal segment that forms the joint is stable, and
the distal segment is mobile.
Motion occurs distal to the instantaneous axis of
rotation.
Movement pattern is often nonfunctional.
Movement causes shear forces in the joint.
Artificial loading of the muscles and joints
occurs.
Velocity is predetermined by exercise
equipment if isokinetiks is used.
There is artificial means of stabilization.
Testing is not typically functional.
Characteristics of CKC Exercises
Distal end of the extremity is fixed to something.
Movement pattern is characterized by linear
stress in the joint.
Multiple joint movements occur simultaneously.
Multiple muscles are recruited.
The primary joint axis is transverse.
Both segments that form the joint move
simultaneously.
Movement patterns are functional.
Movement causes compressive forces in the joint.
There is co-contraction of the muscles
surrounding the joint.
Movement often occurs in multiple planes
simultaneously.
Muscles and joints are physiologically loaded.
Velocity is variable through a movement pattern.
There is no artificial stabilization.
Loading is physiological and provides normal
proprioceptive or kinesthetic feedback.
Performance of movement is not inhibited by design
of equipment.
Movement causes compression of the joint surfaces,
thereby increasing joint stability.
Testing and exercises are more functional.
Summary of Benefits for CKC
Increased joint compression forces
Increased joint congruency and thus stability
Decreased shear forces
Decreased acceleration forces
Large resistance forces
Stimulation of proprioceptors
Enhanced dynamic stabilization (co-activation)
Protect healing soft tissue
Characteristics of OKC exercises
Increased acceleration forces
Decreased resistance forces
Increased distraction and rotational
forces
Increased deformation of joint and
muscle mechanoreceptors
Concentric acceleration and eccentric
deceleration forces
Promotion of functional activity
These are typical of non-weight-bearing
activities.
External forces
During Kinetic Exercises there are typically two
kinds of external forces: shear and compression.
Shear force, is the force which causes a disruption
of the ACL by shifting the tibia anteriorly and the
femur posteriorly. This is caused from the strong
contraction of the quadriceps, which is typical of the
Open Chain Exercise. This force, which is placed on
the front of the knee, places a large amount of stress
on the ACL.
Compression force is caused from a strong external
force placed on the knee, which pushes the head of
the femur together with the head of the tibia. This
external force causes stability in the knee and a
decrease in shear force. Compression forces are
common in Closed Chain Exercises.
Closed kinetic chain exercises serve to
minimize the tibiofemoral shear forces
through both axial loading and
hamstring coactivation.
Several authors and clinicians have offered additional
or alternative categories for classification of
resistance activities to eliminate the ambiguity. One
suggestion is to add a category dubbed partial
kinetic chain to describe exercises in which the
distal segment (hand or foot) meets resistance but is
not absolutely stationary, such as using a stepping
machine or slide board. The term closed kinetic chain
is then reserved for instances when the terminal
segment does not move. To date, this additional term
has not been widely used in the literature or in the
clinical setting.
Comparison
Closed kinetic
Vs.
Open kinetic
chain exercises
Isolation of Muscle Groups
Open-chain testing and training identifies
strength deficits and improves muscle
performance of individual muscles or muscle
groups more effectively than closed-chain
exercises. The possible occurrence of substitute
motions that compensate for and mask
strength deficits of individual muscles is greater
with closed-chain exercise than open-chain
exercise.
Control of Movements
During open-chain resisted exercises a greater level
of control is possible with a single moving joint than
with multiple moving joints as occurs during closedchain training. In open-chain exercises stabilization
is usually applied externally by a therapist's
manual contacts or with belts or 'straps. In contrast,
during closed-chain exercises the patient most often
uses muscular stabilization to control joints or
structures proximal and distal to the targeted joint.
Greater levels of control afforded by open-chain
training are often advantageous in the early phases
of rehabilitation.
Joint Approximation
Almost all muscle contractions have a compressive
component, which approximates the joint surfaces
and provides stability to the joint whether in open or
closed-chain situations. Joint approximation also
occurs during weight bearing and is associated with
lower levels of shear forces. This has been
demonstrated in the knee (decreased anterior or
posterior tibiofemoral translation) and possibly the
glenohumeral joint. The joint approximation that
occurs with the axial loading during weight bearing
is thought to cause an increase in joint congruency
which, in turn, contributes to stability.
Coactivation and Dynamic Stabilization
Since most closed-chain exercises are performed in
weight- bearing positions, they stimulate joint and
muscle mechanoreceptors, facilitate coactivation of
agonists and antagonists (cocontraction) and
subsequently promote dynamic stability. During a
standing squat, for example, the quadriceps and
hamstrings are thought to contract concurrently to
control the knee and hip respectively.
In the upper extremity, closed-chain exercises in
weight-bearing positions are thought to cause
coactivation of the scapular and glenohumeral
stabilizers and, therefore, to improve dynamic
stability of the shoulder complex.
Proprioception, Neuromuscular Control,
and Balance
After soft tissue or joint injury, proprioception are
disrupted and alter neuromuscular control.
Reestablishing the effective and efficient use of
sensory information to initiate and control
movement is a high priority in rehabilitation.
Closed-chain training provides greater
proprioceptive and kinesthetic feedback than openchain training. Theoretically, because multiple
muscle groups that cross multiple joints are
activated during closed-chain exercise, to control
motion more sensory receptors in more muscles
and intra-articular and extra-articular structures
are activated than during open-chain exercises. The
weight-bearing element (axial loading) of closed
chain exercises, which causes joint approximation,
is believed to stimulate mechanoreceptors in
muscles and in and around joints to enhance
sensory input for the control of movement.
Carry-Over to Function
Consistent with the principle of task-specific
training, exercises should be incorporated into a
rehabilitation program that simulates the desired
functions and prepares the patient for the functional
tasks. For example, squatting exercises in standing
have been shown to enhance performance of a
jumping task more effectively than open-chain
isokinetic knee extension exercises.
Parameters and Progression of ClosedChain Exercises
1) % Body weight
Partial
full weight-bearing
(UE:wall push-up
modified
prone push-up
prone push-up)
Full weight-bearing + additional weight
(Weighted vest or belt, handheld or cuff weights,
elastic resistance)
2) Base of support
Wide
narrow
Bilateral
unilateral
Fixed on support surface
surface
sliding on support
3) Support surface
Stable
unstable/moving
(LE: Floor
rocker board, wobble board,
sideboard, treadmill)
(UE: Floor, table or wall
rocker or side board,
ball)
Tight
soft
(Floor, table
carpet, foam)
Height: ground level
increasing height
(Low step
high step)
4) Balance
With external support
no external support
Eyes open
eyes closed
5) Exclusion of limb movement
Small
Short-arc
large ranges
full-arc (if appropriate)
6) Plane or direction of movement
Uniplanar
multi planar
Anterior
posterior
diagonal
(Forward walking
retrowalking;
forward step-up
backward step-up)
Sagittal
frontal or transverse
(forward-backward sliding
side to side
sliding; forward or backward step-up
lateral
step-up)
7) Speed of movement or
directional changes
Slow
fast
Closed Kinetic Chain
Exercises for lower
extremity
Minisquat
performed in 0- to
40-degree range.
Standing Squat
Standing wall slide
Wall Slide
Leg-press exercise
Leg press
Lunges are done to strengthen
quadriceps eccentrically
Stair master stepping machine
Lateral step-ups
Terminal knee extensions using
surgical tubing resistance
Tubing resistance
exercise
Stationary bicycle
BAPS board exercise
Balance board
Mini-Trampoline
Fitter
Lunge with medicine ball
Wall slide with medicine ball
Slide board training
Slide board
Rehabilitation program
Acute phase:
Aims: motion, dynamic joint stability,
decreased muscle atrophy (VMO)
Standing mini squats (0-30 degree)
step-ups (low steps to high steps)
Forward lunges (length & depth)
Mini squats (progressed)
wall slides
lateral
Sub-acute phase
Squat 0-60,70, step-ups &lunge include
lateral movement and exercise tubing
resistance (forward, backward and either side)
Initiation of cone drills
Uneven surfaces (trampoline, fitter, balance
board)
Dumbbells of different weights
Advanced phase:
Squats and lunges on uneven surfaces.
Cone drills with high speed and duration.
Also with medicinal balls
Slide boards
Closed Kinetic Chain
Exercises for upper extremity
Weight shifting. A, Standing
B, Quadruped
C, Tripod
D, Opposite knee and arm
Weight shifting. A, On a BAPS
board
B. On a wobble board
C. On a Plyoball
Push-ups done on a Plyoball
Push-ups done on a stair climber
Press-ups
Weight shifting
Wall push-up
Modified push-up
Using elastic tubing
Tripod using dumbbells
Modified push-up
Push-up
with balls
Push-up with fitter
Versa climber
Push-up (tripod position)
Upper body isokinetics
Rehabilitation program
Acute phase:
Punching machine
Isometric retraction (middle trapezius,
rhomboid)
Isometric press-ups
Subacute phase:
Resisted quadraped exercises (roller, fitter,
thera-band)
Tripod (simple, elastic tubing, dumbbells,
balls)
Opposite knee and arm
Advanced phase:
Push-ups with hands on the balls
Balance board, balance system, movable
platform, lateral step-ups
Lateral walking on hands on treadmill or stair
stepper
Thank You